Professor Asma Khalil, lead author of the study, of St George’s University of London, said: “It is clear from our study and others that the disruption caused by the pandemic has led to the avoidable deaths of both mothers and babies, especially in low- and middle-income countries.”
The review was not intended to explore the impact of a Covid-19 infection during a pregnancy, so only included studies on mothers who were not infected with the virus. Instead, it aimed to measure how Covid and lockdowns limited access to life-saving medical care during the pandemic, and what that has meant for pregnant women and their babies.
Of the studies in the review, covering data on six million pregnancies, 12 reported on stillbirth. Analysis of the pooled data found that the chances of having a stillbirth increased by 28 per cent compared to before the pandemic across the countries studied, including Botswana, India, Nepal and the USA.
During the Covid-19 crisis the rate of stillbirths was 1,099 of 168,295 pregnancies included in the studies, compared to 1,325 out of 198,993 before the outbreak. From the outset, rates were far higher in lower and middle income countries, and these regions also saw the most dramatic changes during the pandemic.
The calculations are more complex than just adding up the numbers, however, researchers said – for example, studies with more cases included were given more weight in the analysis because they are more likely to provide robust data.
Maternal deaths also increased, the review found, although only two of the studies covered the impact in depth, from India and Mexico. Most of the data came from Mexico, but pooled analysis found that the risk of mothers dying during pregnancy or childbirth had also gone up by more than a third during the period. Before the pandemic, maternal death rates were 698 in 2.2 million, compared to 530 in 1.2 million studied during the coronavirus crisis.
Mental health outcomes were also affected, according to the review. Six of the ten studies on maternal mental health reported an increase in postnatal depression and maternal anxiety.
The researchers said the outcomes were worse in poorer countries and immediate action was needed to preserve safe maternity care worldwide.
Dr Jogender Kumar of the Postgraduate Institute of Medical Education and Research in India, who was not involved in the study, said: “In resource-poor countries, even under normal circumstances, it is a challenge to provide adequate coverage for antenatal checkups, obstetric emergencies, universal institutional deliveries, and respectful maternity care. The Covid-19 pandemic has widened this gap.”
Researchers said their work – taking in studies from January 2020 to the same month this year – was limited by the fact that the studies studied outcomes differently, making them hard to compare.
But they said it was still an urgent call to prevent more mother and baby deaths.
“We urge policymakers and health care leaders to prioritise safe, accessible, and equitable maternity care within the strategic response to the pandemic and aftermath, to reduce adverse pregnancy outcomes worldwide.” said Professor Khalil.