The aim of this study was to evaluate sociodemographic factors associated with perinatal health outcomes before and during the COVID-19 pandemic among US maternal-infant dyads. Using the 2016-2022 Centers for Disease Control and Prevention (CDC) Pregnancy Risk Assessment Monitoring System (PRAMS) data, we evaluated maternal and infant characteristics during the pre-COVID and COVID periods (pre-COVID: 2016-2019; COVID: 2020-2022) for preterm birth, low birthweight, and cesarean delivery, and performed multivariable logistic regression models for each outcome. Compared with births in pre-COVID, births during COVID had a higher prevalence of older mothers with diabetes and hypertension. Overall, Non-Hispanic Black (NHB) and Hispanic mothers had less favorable perinatal health outcomes compared to Non-Hispanic White (NHW) mothers. In testing of time*race/ethnicity interaction, Hispanic infants had lower odds of low birthweight during COVID. While disparities were not exacerbated during COVID, they remained persistent, with NHB and Hispanic mothers having less favorable perinatal health outcomes. Further research is needed to investigate potential longer-term health implications for maternal and infant health.
GemmillA, CaseyJA, CatalanoR, KarasekD, MargerisonCE, BrucknerT.Changes in preterm birth and caesarean deliveries in the United States during the SARS-CoV-2 pandemic. Paediatr Perinat Epidemiol. 2022;36(4):485–489.
2.
ChmielewskaB, BarrattI, TownsendR, . Effects of the COVID-19 pandemic on maternal and perinatal outcomes: A systematic review and meta-analysis. Lancet Glob Health. 2021;9(6):e759–e772.
3.
Hidalgo-LopezosaP, Jimenez-RuzA, Carmona-TorresJM, Hidalgo-MaestreM, Rodriguez-BorregoMA, Lopez-SotoPJ.Sociodemographic factors associated with preterm birth and low birth weight: A cross-sectional study. Women Birth. 2019;32(6):e538–e543.
4.
YangJ, D’SouzaR, KharratA, . COVID-19 pandemic and population-level pregnancy and neonatal outcomes: A living systematic review and meta-analysis. Acta Obstet Gynecol Scand. 2021;100(10):1756–1770.
5.
OhumaEO, MollerAB, BradleyE, . National, regional, and global estimates of preterm birth in 2020, with trends from 2010: A systematic analysis. Lancet. 2023;402(10409):1261–1271.
6.
ManuckTA.Racial and ethnic differences in preterm birth: A complex, multifactorial problem. Semin Perinatol. 2017;41(8):511–518.
7.
MartinJA, HamiltonBE, OstermanMJ.Births in the United States, 2021. NCHS Data Brief. 2022;(442):1–8.
8.
JohnsonJD, GreenCA, VladutiuCJ, ManuckTA.Racial disparities in prematurity persist among women of high socioeconomic status. Am J Obstet Gynecol MFM. 2020;2(3):100104.
9.
DenchD, JoyceT, MinkoffH.United States preterm birth rate and COVID-19. Pediatrics. 2022;149(5):e2021055495.
10.
Kern-GoldbergerAR, SheilsNE, VenturaMEM, . Patterns of prenatal care delivery and obstetric outcomes before and during the COVID-19 pandemic. Am J Perinatol. 2023;40(6):582–588.
11.
Centers for Disease Control and Prevention. Geographic Division or Region—Health. United States: National Center for Health Statistics; 2024. Available from:www.cdc.gov/nchs/hus/sources-definitions/geographic-region.htm
12.
StevensonDK, WinnVD, ShawGM, EnglandSK, WongRJ.Solving the puzzle of preterm birth. Clin Perinatol. 2024;51(2):291–300.
13.
BurrisHH, BaccarelliAA, WrightRO, WrightRJ.Epigenetics: Linking social and environmental exposures to preterm birth. Pediatr Res. 2016;79(1-2):136–140.
14.
BurrisHH, HackerMR.Birth outcome racial disparities: A result of intersecting social and environmental factors. Semin Perinatol. 2017;41(6):360–366.
15.
HwangSS, WeikelBW, HannanKE, BourqueSL.Impact of coronavirus disease-19 “stay-at-home” orders on preterm birth in Colorado. J Pediatr. 2022;242:238.e1–241.e1.
16.
RuizJM, HamannHA, MehlMR, O’ConnorM-F.The Hispanic health paradox: From epidemiological phenomenon to contribution opportunities for psychological science. Group Process Intergr Relat. 2016;19(4):462–476.
17.
RuizJM, SteffenP, SmithTB.Hispanic mortality paradox: A systematic review and meta-analysis of the longitudinal literature. Am J Public Health. 2013;103(3):e52–e60.
18.
HeronM.Deaths: Leading causes for 2012. Natl Vital Stat Rep. 2015;64(10):1–93.
19.
MozaffarianD, BenjaminEJ, GoAS, . Heart disease and stroke statistics—2015 update: A report from the American Heart Association. Circulation. 2015;131(4):e29–322.
20.
PriceSN, FloresM, HamannHA, RuizJM.Ethnic differences in survival among lung cancer patients: A systematic review. JNCI Cancer Spectr. 2021;5(5):pkab062.
21.
Montoya-WilliamsD, WilliamsonVG, CardelM, Fuentes-AfflickE, Maldonado-MolinaM, ThompsonL.The Hispanic/Latinx perinatal paradox in the United States: A scoping review and recommendations to guide future research. J Immigr Minor Health. 2021;23(5):1078–1091.
22.
SchaafJM, LiemSM, MolBW, Abu-HannaA, RavelliAC.Ethnic and racial disparities in the risk of preterm birth: A systematic review and meta-analysis. Am J Perinatol. 2013;30(6):433–450.
23.
MartinJA, HamiltonBE, OstermanMJK, DriscollAK, DrakeP.Births: Final data for 2016. National Vital Statistics Reports (Vol 67 no 1). Hyattsville, MD: National Center for Health Statistics. 2018.
24.
MathewsTJ, DriscollAK.Trends in infant mortality in the United States, 2005-2014. NCHS Data Brief. 2017;(279):1–8.
25.
LueckenLJ, JewellSL, MacKinnonDP.Maternal acculturation and the growth of impoverished Mexican American infants. Obesity (Silver Spring). 2017;25(2):445–451.
26.
Johnelle SparksP.One size does not fit all: An examination of low birthweight disparities among a diverse set of racial/ethnic groups. Matern Child Health J. 2009;13(6):769–779.
27.
McGladeMS, SahaS, DahlstromME.The Latina paradox: An opportunity for restructuring prenatal care delivery. Am J Public Health. 2004;94(12):2062–2065.
28.
Montoya-WilliamsD, BurrisH, Fuentes-AfflickE.Perinatal outcomes in medicaid expansion and nonexpansion states among Hispanic women. JAMA. 2019;322(9):893–894.
29.
Velasco-MondragonE, JimenezA, Palladino-DavisAG, DavisD, Escamilla-CejudoJA.Hispanic health in the USA: A scoping review of the literature. Public Health Rev. 2016;37:31.
30.
ElyDM, DriscollAK.Infant mortality in the United States, 2022: Data from the period linked birth/infant death file. Natl Vital Stat Rep. 2024;73(5):1–19.
31.
CzeislerME, MarynakK, ClarkeKEN, . Delay or avoidance of medical care because of COVID-19-related concerns—United States, June 2020. MMWR Morb Mortal Wkly Rep. 2020;69(36):1250–1257.
32.
ViraniSS, AlonsoA, AparicioHJ, . Heart disease and stroke statistics-2021 update: A report from the American Heart Association. Circulation. 2021;143(8):e254–e743.
33.
BiancalanaE, ParoliniF, MengozziA, SoliniA.Short-term impact of COVID-19 lockdown on metabolic control of patients with well-controlled type 2 diabetes: A single-centre observational study. Acta Diabetol. 2021;58(4):431–436.
34.
CohenRA, ChaAE.Health insurance coverage: Early release of estimates from the National Health Interview Survey, 2022. National Center for Health Statistics. May 2023. DOI: 10.15620/cdc:127055
35.
MastenY, SongH, EsperatCR, McMurryLJ.A maternity care home model of enhanced prenatal care to reduce preterm birth rate and NICU use. Birth. 2022;49(1):107–115.
36.
HeamanMI, MartensPJ, BrownellMD, ChartierMJ, DerksenSA, HelewaME.The association of inadequate and intensive prenatal care with maternal, fetal, and infant outcomes: A population-based study in Manitoba, Canada. J Obstet Gynaecol Can. 2019;41(7):947–959.
