Pregnancy outcomes during the COVID-19 pandemic in Canada, March to August 2020

OBJECTIVE: Several studies have documented changes in the rates preterm birth and stillbirth during the COVID-19 pandemic. We carried out a study to examine obstetric intervention, preterm birth, and stillbirth rates in Canada from March to August 2020. METHODS: The study included all singleton hospital deliveries in Canada (excluding Québec) from March to August 2020 (and March to August for the years 2015-2019) with information obtained from the Canadian Institute for Health Information. Data for Ontario were examined separately because this province had the highest rates of COVID-19 in the study population. Rates and odds ratios with 95% confidence intervals (CIs) were used to quantify pregnancy-related outcomes. RESULTS: There were 136,445 and 717,905 singleton hospital deliveries in Canada (excluding Quebéc) in from March to August 2020 and between March and August 2015-2019, respectively. Rates of obstetric intervention declined in early gestation in 2020. Odds ratios for labour induction and cesarean delivery at 32 weeks gestation for March-August 2020 versus March-August in 2015 to 2019 were 0.84 (95% CI 0.74-0.95) and 0.92 (95% CI 0.85-1.00), respectively. Preterm birth rates increased in Canada (excluding Québec) from 6.42% in March-August 2015 to 6.74% in March-August 2019 but were unchanged in March-August 2020 (6.74%). Stillbirth rates were stable between March-August 2015 and March-August 2020. However, stillbirth rates peaked in Ontario in April 2020 due to higher rates of stillbirths at 20-27 and 37-41 weeks gestation. CONCLUSION: Changes in labour induction and cesarean delivery at early gestation and other perinatal outcomes during the period of March to August 2020 highlight the need to reconsider the use and impact of obstetric services in pandemics as well as the need for timely perinatal surveillance.