Socioeconomic inequalities in low birth weight risk before and during the COVID-19 pandemic in Argentina: A cross-sectional study

Background: The coronavirus disease 2019 (COVID-19) pandemic may have exacerbated existing socioe- conomic inequalities in health. In Argentina, public hospitals serve the poorest uninsured segment of the population, while private hospitals serve patients with health insurance. This study aimed to assess whether socioeconomic inequalities in low birth weight (LBW) risk changed during the first wave of the COVID-19 pandemic. Methods: This multicenter cross-sectional study included 15929 infants. A difference-in-difference (DID) analysis of socioeconomic inequalities between public and private hospitals in LBW risk in a pandemic cohort (March 20 to July 19, 2020) was compared with a prepandemic cohort (March 20 to July 19, 2019) by using medical records obtained from ten hospitals. Infants were categorized by weight as LBW < 2500 g, very low birth weight (VLBW) < 1500 g and extremely low birth weight (ELBW) < 1000 g. Log binomial regression was performed to estimate risk differences with an interaction term representing the DID estimator. Covariate-adjusted models included potential perinatal confounders. Findings: Of the 8437 infants in the prepandemic cohort, 4887 (57 ? 9%) were born in public hospitals. The pandemic cohort comprised 7492 infants, 4402 (58 ? 7%) of whom were born in public hospitals. The DID estimators indicated no differences between public versus private hospitals for LBW risk ( −1 ? 8% [95% CI −3 ? 6, 0 ? 0]) and for ELBW risk ( −0 ? 1% [95% CI −0 ? 6, 0 ? 3]). Significant differences were found between public versus private hospitals in the DID estimators ( −1 ? 2% [95% CI, −2 ? 1, −0 ? 3]) for VLBW risk. The results were comparable in covariate-adjusted models. Interpretation: In this study, we found evidence of decreased disparities between public and private hos- pitals in VLBW risk. Our findings suggest that measures that prioritize social spending to protect the most vulnerable pregnant women during the pandemic contributed to better birth outcomes. Funding: No funding was secured for this study.Fil: Cuestas, Eduardo. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Córdoba. Instituto de Investigaciones en Ciencias de la Salud. Universidad Nacional de Córdoba. Instituto de Investigaciones en Ciencias de la Salud; ArgentinaFil: Gómez Flores, Martha E.. Gobierno de la Provincia de Buenos Aires. Hospital Doctor Ramón Carrillo; ArgentinaFil: Charras, María D.. Gobierno de la Provincia de Buenos Aires. Hospital Doctor Ramón Carrillo; ArgentinaFil: Peyrano, Alberto J.. Hospital Materno Provincial Dr. Raúl Felipe Lucini; ArgentinaFil: Montenegro, Clara. Hospital Materno Provincial Dr. Raúl Felipe Lucini; ArgentinaFil: Sosa Boye, Ignacio. No especifíca;Fil: Burgos, Verónica. Universidad Católica de Córdoba. Facultad de Medicina. Clínica Universitaria Reina Fabiola; ArgentinaFil: Giusti, Graciela. Clínica y Maternidad del Sol; ArgentinaFil: Espósito, Mario. Clínica y Maternidad del Sol; ArgentinaFil: Blanco Pool, Silvyana S.. Hospital Misericordia Nuevo Siglo ; Gobierno de la Provincia de Cordoba; ArgentinaFil: Gurevich, Debora P.. Hospital Misericordia Nuevo Siglo ; Gobierno de la Provincia de Cordoba; ArgentinaFil: Ahumada, Luis A.. Hospital Misericordia Nuevo Siglo ; Gobierno de la Provincia de Cordoba; ArgentinaFil: Pontoriero, Ricardo D.. Hospital Misericordia Nuevo Siglo ; Gobierno de la Provincia de Cordoba; ArgentinaFil: Rizzotti, Alina. Hospital Privado Universitario de Córdoba; ArgentinaFil: Bas, José I.. Hospital Privado Universitario de Córdoba; ArgentinaFil: Vaca, María B.. Hospital Universitario de Maternidad y Neonatología; ArgentinaFil: Miranda, María J.. Hospital Universitario de Maternidad y Neonatología; ArgentinaFil: Ferreyra, Mirta E.. Hospital Misericordia Nuevo Siglo ; Gobierno de la Provincia de Cordoba; ArgentinaFil: Moreno, Gabriela C.. Gobierno de la Provincia de Buenos Aires. Hospital Doctor Ramón Carrillo; ArgentinaFil: Pedicino, Héctor. Hospital Italiano; ArgentinaFil: Rojas Rios, Melvy. Hospital Italiano; Argentin

Association between COVID-19 mandatory lockdown and decreased incidence of preterm births and neonatal mortality

Previous studies suggest a decrease in preterm births (PTB) during de coronavirus disease 2019 (COVID-19), possibly due to the effect of the mandatory lockdown. Nevertheless, other reports have been unable to confirm this finding. Most of these studies originated in high-income countries and evaluated a limited number of potential confounders, and all of them assessed a short lockdown period. In addition, an important question remains unanswered: How can we be sure that the observed changes are due to lockdown, when most of the pregnancies delivered in the lockdown period were conceived prior to it?To date there is insufficient evidence to support the notion that public health interventions during the lockdown prevent PTB . The aim of this study was to compare the incidence of PTB, neonatal mortality (NM) and stillbirths adjusted by potential confounders during the lockdown period assessing a time window of nine and a half months during which all the pregnancies analyzed in the exposed group were conceived after the lockdown, with the corresponding incidence in the previous year where all the unexposed pregnancies analyzed were conceived before the lockdown.publishedVersionFil: Cuestas, Eduardo. Universidad Nacional de Córdoba. Facultad de Ciencias Médicas; Argentina.Fil: Cuestas, Eduardo. Consejo Nacional de Investigaciones Científicas y Técnicas. Instituto de Investigaciones en Ciencias de la Salud; Argentina.Fil: Gómez Flores, Martha E. Gobierno de la Provincia de Buenos Aires. Hospital Doctor Ramon Carrillo; Argentina.Fil: Charras, María D. Gobierno de la Provincia de Buenos Aires. Hospital Doctor Ramon Carrillo; Argentina.Fil: Peyrano, Alberto J. Hospital Materno Provincial Dr. Raúl Felipe Lucini; Argentina.Fil: Montenegro, Clara. Hospital Materno Provincial Dr. Raúl Felipe Lucini; Argentina.Fil: Sosa-Boye, Ignacio. Clínica Universitaria Reina Fabiola; Argentina.Fil: Burgos, Verónica. Clínica Universitaria Reina Fabiola; Argentina.Fil: Giusti, Graciela. Clínica y Maternidad del Sol; Argentina.Fil: Espósito, Mario. Clínica y Maternidad del Sol; Argentina.Fil: Blanco Pool, Silvyana S. Hospital Misericordia Nuevo Siglo; Argentina.Fil: Blanco Pool, Silvyana S. Sanatorio Allende; Argentina.Fil: Gurevich, Debora P. Sanatorio Allende; Argentina.Fil: Gurevich, Debora P. Hospital Misericordia Nuevo Siglo; Argentina.Fil: Ahumada, Luis A. Sanatorio Allende; Argentina.Fil: Ahumada, Luis A. Hospital Misericordia Nuevo Siglo; Argentina.Fil: Pontoriero, Ricardo D. Hospital Misericordia Nuevo Siglo; Argentina.Fil: Rizzotti, Alina. Hospital Privado Universitario de Córdoba; Argentina.Fil: Bas, José I. Hospital Privado Universitario de Córdoba; Argentina.Fil: Vaca, María B. Hospital Universitario de Maternidad y Neonatología; Argentina.Fil: Miranda, María J. Hospital Universitario de Maternidad y Neonatología; Argentina.Fil: Ferreyra, Mirta E. Sanatorio del Salvador; Argentina.Fil: Ferreyra, Mirta E. Hospital Misericordia Nuevo Siglo; Argentina.Fil: Moreno, Gabriela C. Sanatorio del Salvador; Argentina.Fil: Pedicino, Héctor. Instituto Universidad Escuela de Medicina del Hospital Italiano; Argentina.Fil: Rojas-Rios, Melvy. Instituto Universidad Escuela de Medicina del Hospital Italiano; Argentina