Preterm Births Flag Neighborhood Vulnerability to COVID-19

Disparities in preterm birth outcomes by neighborhood predicted the regional severity of the COVID-19 pandemic, researchers found.

Mothers who lived in neighborhoods with a higher prevalence of COVID-19 diagnoses were more than three times as likely to have had a preterm birth before 28 weeks (odds ratio 3.27, 95% CI 2.42-4.42), according to Ponnila Marinescu, MD, of the University of Rochester Medical Center in New York, and colleagues.

COVID-19 severity by ZIP code was also positively correlated with the number of residents below the poverty threshold, and inversely associated with median household income and educational attainment, Marinescu said in a presentation at the Society for Maternal-Fetal Medicine annual meeting.

“Our study illustrates that the geographic disparities in our regional preterm birth outcomes — ahead of the global pandemic — predicted community distribution of COVID-19,” Marinescu said. She stated that as an indicator of maternal and neonatal health, preterm birth can also be used as a vital statistic to measure communities’ access to healthcare given the wide disparities that still exist.

“Our collective role should thus be to take action, to advocate for and inspire socioeconomic policies that support economic vibrancy and promote optimal health outcomes in all communities,” she noted.

Black, indigenous, and other people of color have faced significant disparities during the COVID-19 pandemic, similar to the gaps these groups have faced in maternal and fetal health outcomes. In this study, Marinescu and colleagues aimed to investigate the geographical correlation between pre-pandemic preterm birth rates and subsequent COVID-19 infections.

The researchers conducted a retrospective cohort study using data from the Finger Lakes Region Perinatal and Obstetric database, including births from 2004 to 2018. Birth data were stratified by ZIP code, and merged with publicly available community socioeconomic data. ZIP code-level COVID-19 data from Monroe County in New York was also obtained. Categorized by median COVID-19 infection rates, ZIP codes were defined as “low,” “moderate,” or “high” infection level.

The researchers included nearly 124,000 births from 38 ZIP codes in their final analysis. The historical prevalence of preterm birth was associated with the prevalence of COVID-19 in 2020, but was only significant for extremely preterm births before 28 weeks, as well as periviable births.

Additionally, geographic information system mapping showed that the highest rate of overlap in the preterm birth rate before 28 weeks’ gestation and COVID-19 prevalence was in urban areas.

Marinescu acknowledged that this study only analyzed preterm birth and COVID-19 disparities in one mid-sized city, and results may not be generalizable to other populations. Additionally, the researchers focused on only one subset of socioeconomic factors and obstetric comorbidities, and these findings cannot determine how other maternal health outcomes might predict COVID-19 disease burden.