A recent national study in India has revealed a concerning rise in stillbirth rates following the COVID-19 pandemic. The study, which analyzed births between 2019 and 2022, found a 44% increase in stillbirths in the post-COVID period. This increase highlights significant gaps in pregnancy care during and after the pandemic.
The study, published in BMC Pregnancy and Childbirth, was conducted by researchers from the Public Health Foundation of India (PHFI) with support from the Indian Council of Medical Research (ICMR). It encompassed a nationally representative mortality survey covering nearly one million people across nine states: Assam, Gujarat, Haryana, Jharkhand, Kerala, Maharashtra, Odisha, Tamil Nadu, and Uttar Pradesh.
The data indicates a rise in India's stillbirth rate from 12.7 per 1,000 births before COVID-19 to 14.4 during the pandemic, and then a sharp increase to 18.3 per 1,000 births in the post-COVID period. The increase was more prominent in rural areas, where rates reached nearly 20 per 1,000 births, compared to about 14 in urban areas, underscoring disparities in access to timely antenatal care and emergency obstetric services.
The researchers attribute the rise in stillbirths to disrupted antenatal care, delayed referrals, and weakened pregnancy and delivery services during and after the COVID-19 pandemic. The study involved detailed interviews related to 745 stillbirths, revealing that 44.7% occurred in public hospitals, 39.2% in private hospitals, and 16.1% at home. The dominant place of delivery varied across states, with private hospitals reporting most stillbirths in Kerala (66.7%), Gujarat (60%), and Haryana (50%), while public hospitals accounted for the majority in Odisha (72.6%), Assam (69.6%), Maharashtra (54.8%), and Tamil Nadu (54.6%). These differences reflect variations in health system utilization across the country.
Globally, a CDC study examining 1.2 million deliveries in 736 U.S. hospitals between March 2020 and September 2021 found that women with COVID-19 were at increased risk for stillbirth. This study revealed that approximately 1 in 80 deliveries resulted in stillbirths among COVID-19-infected mothers, compared to 1 in 155 for uninfected mothers. The risk was even higher for those with chronic conditions like high blood pressure and complications requiring intensive care or ventilator support. The rise in stillbirth rates was observed from March 2020, and the risk quadrupled when the Delta variant became dominant in July 2021.
Another CDC study indicated that the risk of stillbirth nearly doubled for those who had COVID-19 during pregnancy, and during the spread of the Delta variant, that risk was four times higher. Doctors discovered that some stillbirths resulted from COVID-19 directly infiltrating the placenta, a condition named SARS-CoV-2 placentitis.
These findings emphasize the importance of vaccination during pregnancy and highlight the need for strengthened antenatal care and obstetric services to mitigate the risk of stillbirths, particularly in times of public health crises. Although stillbirth rates had been declining for decades in the U.S. prior to 2020, the pandemic has interrupted this progress.
