{"doi":"10.1111/ppe.12925","title":"Early coronavirus disease 2019 restrictive measures and changes in maternal characteristics, use of assisted reproductive technology, and stillbirth","abstract":"<jats:title>Abstract</jats:title><jats:sec><jats:title>Background</jats:title><jats:p>The initial COVID‐19 pandemic response−related effects on conceptions following the use of assisted reproductive technologies (ART), and on changes in the maternal characteristics of women who conceived during the early vs. pre‐pandemic period, have been understudied.</jats:p></jats:sec><jats:sec><jats:title>Objectives</jats:title><jats:p>To examine the effects of ART clinic closures in the United States (US) in March 2020 on the frequency of ART‐conceived live births, multiple births and stillbirths; and to describe changes in the characteristics of women who conceived in the early pandemic period.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>Population‐based cohort study including all births in the US from January 2015 to December 2020 (22,907,688 live births; 134,537 stillbirths). Interrupted time series (ITS) methodology was used to estimate rate ratios (RR) of expected versus observed rates in December 2020 (i.e., among births conceived mainly in March 2020). Demographic and clinical characteristics were compared between mothers who conceived in March 2020 versus March 2015–2019.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>Overall, 1.1% of live births and 1.7% of stillbirths were conceived by ART. ART‐conceived live births decreased by 57.0% in December 2020 (observed vs. expected RR 0.43, 95% confidence interval [CI] 0.40, 0.45), and these declines occurred in all subgroups of women. Multiple births also declined in December 2020. Stillbirth rates increased in December 2020 in ART‐conceived births (RR 2.55, 95% CI 1.63, 3.92) but remained unchanged in the non‐ART group. Maternal characteristics of women who conceived in the early pandemic versus pre‐pandemic period differed and included an increased prevalence of pre‐pregnancy obesity class 3 and chronic hypertension.</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>The early pandemic closure of ART clinics resulted in a substantial decline in ART‐conceived live births and multiple births in December 2020 and an increase in the proportion of stillbirths among ART‐conceived births. Women who conceived in the early pandemic period also had an increased prevalence of obesity and chronic hypertension.</jats:p></jats:sec>","journal":"Paediatric and Perinatal Epidemiology","year":2023,"id":652116,"datarank":0.37273599746820013,"base_score":2.4849066497880004,"endowment":2.4849066497880004,"self_citation_contribution":0.37273599746820013,"citation_network_contribution":0.0,"self_endowment_contribution":0.37273599746820013,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":11,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":null,"is_data_producer":false,"deposit_databanks":null,"is_oa":false,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":null,"fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":1104125,"name":"Jeffrey N. Bone","orcid":"0000-0001-7704-1677","position":1,"is_corresponding":false},{"id":1110803,"name":"Giulia M. Muraca","orcid":"0000-0003-4618-0839","position":2,"is_corresponding":false},{"id":1110802,"name":"Neda Razaz","orcid":"0000-0002-1273-0110","position":3,"is_corresponding":false},{"id":1110804,"name":"Amélie Boutin","orcid":"0000-0003-1907-2920","position":4,"is_corresponding":false},{"id":426113,"name":"Justin S. Brandt","orcid":"0000-0002-3194-1087","position":5,"is_corresponding":false},{"id":1110805,"name":"Mohamed A. Bedaiwy","orcid":"0000-0002-3454-8555","position":6,"is_corresponding":false},{"id":364475,"name":"Cande V. Ananth","orcid":"0000-0002-0410-2595","position":7,"is_corresponding":false},{"id":661642,"name":"K.S. Joseph","orcid":"0000-0003-2317-5607","position":8,"is_corresponding":false},{"id":1110801,"name":"Sarka Lisonkova","orcid":"0000-0002-1220-310X","position":0,"is_corresponding":false}],"reference_count":0,"raw_metadata":{"has_enrichment":true,"resolved":true,"title":"Early coronavirus disease 2019 restrictive measures and changes in maternal characteristics, use of assisted reproductive technology, and stillbirth","abstract":"<jats:title>Abstract</jats:title><jats:sec><jats:title>Background</jats:title><jats:p>The initial COVID‐19 pandemic response−related effects on conceptions following the use of assisted reproductive technologies (ART), and on changes in the maternal characteristics of women who conceived during the early vs. pre‐pandemic period, have been understudied.</jats:p></jats:sec><jats:sec><jats:title>Objectives</jats:title><jats:p>To examine the effects of ART clinic closures in the United States (US) in March 2020 on the frequency of ART‐conceived live births, multiple births and stillbirths; and to describe changes in the characteristics of women who conceived in the early pandemic period.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>Population‐based cohort study including all births in the US from January 2015 to December 2020 (22,907,688 live births; 134,537 stillbirths). Interrupted time series (ITS) methodology was used to estimate rate ratios (RR) of expected versus observed rates in December 2020 (i.e., among births conceived mainly in March 2020). Demographic and clinical characteristics were compared between mothers who conceived in March 2020 versus March 2015–2019.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>Overall, 1.1% of live births and 1.7% of stillbirths were conceived by ART. ART‐conceived live births decreased by 57.0% in December 2020 (observed vs. expected RR 0.43, 95% confidence interval [CI] 0.40, 0.45), and these declines occurred in all subgroups of women. Multiple births also declined in December 2020. Stillbirth rates increased in December 2020 in ART‐conceived births (RR 2.55, 95% CI 1.63, 3.92) but remained unchanged in the non‐ART group. Maternal characteristics of women who conceived in the early pandemic versus pre‐pandemic period differed and included an increased prevalence of pre‐pregnancy obesity class 3 and chronic hypertension.</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>The early pandemic closure of ART clinics resulted in a substantial decline in ART‐conceived live births and multiple births in December 2020 and an increase in the proportion of stillbirths among ART‐conceived births. Women who conceived in the early pandemic period also had an increased prevalence of obesity and chronic hypertension.</jats:p></jats:sec>","is_dataset_classified":null,"base_score":2.4849066497880004,"endowment":2.4849066497880004,"datacite_reuse_total":0,"file_count":0,"downloads":0,"views":0,"has_version_chain":false,"is_dataset":false,"is_oa":false,"pmid":"36038519","pmcid":"PMC9539106","openalex_id":"https://openalex.org/W4293680330","authors":[],"funders":[{"funder_name":"Forskningsrådet om Hälsa, Arbetsliv och Välfärd","grant_id":"2019‐00041","title":null},{"funder_name":"Institute of Human Development, Child and Youth Health","grant_id":"F17‐02161","title":null},{"funder_name":"National Heart, Lung, and Blood Institute","grant_id":"R01‐HL150065","title":null},{"funder_name":"National Institute of Environmental Health Sciences","grant_id":"R01‐ES033190","title":null},{"funder_name":"NIEHS NIH HHS","grant_id":"R01 ES033190","title":null},{"funder_name":"NHLBI NIH HHS","grant_id":"R01 HL150065","title":null},{"funder_name":"National Institutes of Health","grant_id":"5R01HL150065-02","title":"Cardiovascular Health After Placental Abruption (CHAP)"},{"funder_name":"National Institutes of Health","grant_id":"5R01ES033190-04","title":"Ambient Air Pollution, Weather, and Placental Abruption (APWA)"},{"funder_name":"Canadian Institutes of Health Research","grant_id":"unidentified","title":"unidentified"},{"funder_name":"Michael Smith Foundation for Health Research","grant_id":"","title":null}],"total_grants":10,"fwci":1.9479,"citation_percentile":0.86320794,"influential_citations":0,"citation_trend":[{"year":2022,"count":1},{"year":2023,"count":3},{"year":2024,"count":6},{"year":2025,"count":1}],"oa_status":"hybrid","license":"cc-by-nc-nd","oa_locations":[{"url":"https://doi.org/10.1111/ppe.12925","host_type":"journal"},{"url":"https://doi.org/10.1111/ppe.12925","host_type":"publisher"},{"url":"https://onlinelibrary.wiley.com/doi/pdf/10.1111/ppe.12925","host_type":"publisher"},{"url":"https://onlinelibrary.wiley.com/doi/full-xml/10.1111/ppe.12925","host_type":"publisher"},{"url":"https://pubmed.ncbi.nlm.nih.gov/36038519","host_type":"repository"},{"url":"https://www.ncbi.nlm.nih.gov/pmc/articles/9539106","host_type":"repository"},{"url":"https://europepmc.org/articles/PMC9539106","host_type":"Europe_PMC"},{"url":"https://europepmc.org/articles/PMC9539106?pdf=render","host_type":"Europe_PMC"},{"url":"http://dx.doi.org/10.1111/ppe.12925","host_type":""}],"fields_of_study":["COVID-19 Impact on Reproduction","Assisted Reproductive Technology and Twin Pregnancy","Reproductive Health and Technologies","03 medical and health sciences","0302 clinical medicine","Pregnancy","Infant, Newborn","Female","United States","Humans","Infant, Premature","Pregnancy Outcome","Infant, Low Birth Weight","Stillbirth","Premature Birth","Cohort Studies","Pandemics","Population Surveillance","COVID-19","Reproductive Techniques, Assisted","Obesity","Hypertension"],"mesh_terms":["COVID-19","Female","Humans","Hypertension","Infant, Low Birth Weight","Infant, Newborn","Infant, Premature","Obesity","Population Surveillance","Pregnancy","Pregnancy Outcome","United States","Cohort Studies","Reproductive Techniques, Assisted","Premature Birth","Stillbirth","Pandemics"],"keywords":["Medicine","Pandemic","Demography","Assisted reproductive technology","Confidence interval","Population","Live birth","Pregnancy","Coronavirus disease 2019 (COVID-19)","Obstetrics","Disease","Infectious disease (medical specialty)","Infertility","Environmental health","Conception","Stillbirth","Multiple Birth","Pandemic Response","Coronavirus Disease 2019","Reproductive Techniques, Assisted","Infant, Newborn","Pregnancy Outcome","COVID-19","Original Articles","Infant, Low Birth Weight","United States","Cohort Studies","Population Surveillance","Hypertension","Humans","Premature Birth","Female","Obesity","Pandemics","Infant, Premature"],"sdg_mappings":[{"sdg_number":3,"sdg_label":"3. 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