Trends to keep an eye on - Pregnancies in Scotland

And neo-natal births

Image: sciencefriday.com

Has Covid, lockdowns and/or vaccines had any impact on fertility and pregnancies? This was always a key concern and probably why so many women decided not to get vaccinated whilst they were pregnant. There is no definitive answer to this question but we can see some trends occurring in data from Scotland that needs keeping a close eye on.

The mRNA vaccine were never specifically trialled on pregnant women and their own documentation said that available data was insufficient to allow assessment of vaccine-associated risks in pregnancy. Subsequently, in the UK anyway, it was advised that pregnant women should have the vaccine as “it had been given to over 140,000 pregnant women in the US and the data has not raised any safety concerns. At least 62,000 pregnant women in the UK have had at least one dose of the vaccine, also without any immediate safety concerns”.

The UKHSA have said that “while overall the risk remains low, pregnant women with COVID-19 have a higher risk of intensive care admission than women of the same age who are not pregnant. Women with COVID-19 disease are also 2 to 3 time more likely to have their babies early than women without COVID-19. Pregnant women with underlying conditions are at even higher risk of suffering serious complication from COVID-19”. We are regularly reminded that pregnant women should have the vaccine and that the majority of pregnant women in ICU are unvaccinated. On 16 December 2021, the JCVI identified pregnant women as a priority group for vaccination.

There is a worrying upward trend for pregnant women to be hospitalised and in critical care with COVID-19 and predominantly in unvaccinated women. Setting vaccination statuses aside, why is there this increase? Is it due to an increase in testing, more incidental cases or COVID-19 affecting pregnant women more this year.

The first thing I wanted to look at was whether the last few years have impacted fertility. All the data I look at in this article comes from Public Health Scotland. Whether for biological or psychological reasons, there has been a noticeable change. Looking at the number of women booking in for antenatal care gives us a pretty good idea about the number of women getting pregnant.

Between the end of April and October 2020, there were clearly fewer women getting pregnant when compared with the average over previous years. Was this caused by lockdowns or COVID-19? In terms of raw numbers the total number in this period in 2020 was 26,574 versus 25,522 over the same period in 2019. A drop of 1,052 women or a 3.96% reduction. Fortunately, after October 2020, the trend returned to normal until the end of April 2021.

Whilst in 2020 the trend returned to normal by October, the data in 2021, up until November, is still trending downwards. Again in terms of numbers, when looking at the period above, the reduction is similar, 25,375 in 2021 versus 26,574 in 2019, a 4.5% reduction. If we compare the period up until the end of the data set (1 Nov 2021) there are 27,362 women booking antenatal care versus 28,596 in 2019, still a 4.3% reduction. Why is there a bigger reduction in women booking antenatal care in 2021 and why is the trend continuing?

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Looking at terminations, fortunately the trend has remained relatively stable. However, it is clear that lockdown in 2020 caused a spike.

Since March 2020, then has been a noticeable change in the average gestation at termination. Whilst previously, the average was around 7.6 weeks, this has dropped to around 6.7 weeks and remained like that until August 2021 when the data set ends. This is an 11.8% reduction in the average age of gestation at termination, why did this change happen and why is it continuing?

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Next on to births. There has been an increase, since August 2020, in percentages of births delivered by caesarean section, both in elective and emergency. This has risen from approximately 34% to 38%, a 10.5% increase.

There has been a decreasing percentage of extremely preterm deliveries resulting in a live born baby and as of June last year, this had reached the warning limit. The drop was from an average of 85% to 71%, a 16.5% decrease.

Finally, there has also been a spike in neonatal deaths per 1,000 live births (deaths in the first four weeks of life). This spike went well over the control limits in September and was still relatively high in October 2021. There was also a smaller spike in March 2020, when the first lockdown occurred, but a similar level spike also happened in 2018.

Fortunately, in terms of numbers, neonatal deaths are relatively uncommon. However, the September peak consisted of 21 deaths versus an average of 8.25 (for that month), a 155% increase. The latest data from October included 14 deaths versus an average of 8.75, a 60% increase.

There have clearly been short term shifts in trends in women getting pregnant, age of gestation at termination, percentage of caesarean sections, extreme preterm deliveries being born alive and neonatal deaths. There is no definitive cause for any of these, however the recent spike in neonatal deaths is alarming. All data sets that need keeping an eye on over the next few months.