A meta-analysis of global stillbirth rates during the COVID-19 pandemic.
Background The global effect of the COVID-19 pandemic has had an impact
on pregnancy and outcomes. There has been recently some conflicting
evidence on the stillbirths during the COVID-19 pandemic. This
meta-analysis attempts to resolve this through a systematic approach.
Objectives To analyse and determine the impact of COVID-19 on the
stillbirth rate. Search strategy We searched PubMed, Embase, Cochrane
library, ClinicalTrials.gov and Web of Science from inception to 05
March 2021 with no language restriction for this meta-analysis.
Selection criteria Publications (a) with stillbirth data on pregnant
women with COVID-19 (b) comparing stillbirth rates in pregnant women
with and without COVID-19 and (c), comparing stillbirth rates before and
during the pandemic. Data collection and Analysis The included studies
were all observational studies, and we used the Newcastle Ottawa score
for risk of bias. We performed the meta-analysis using Comprehensive
meta-analysis software, version 3. Main results A total of 29 studies
were included in the meta-analysis; from 17 of these, the SB rate was 7
per 1000 in pregnant women with COVID-19. This rate was much higher
(34/1000) in low- and middle-income countries. The odds ratio of
stillbirth in pregnant women with COVID-19 compared to those without was
1.89. However, there was no significant difference in population SB
rates before and during the pandemic. Conclusions There is some evidence
that the stillbirth rate has increased during the COVID-19 pandemic, but
this is mainly in low- and middle-income countries. Inadequate access to
healthcare during the pandemic could be a contributing factor.