Why are there less premature births during lockdowns?

Since record began, the number of babies born premature (before 37 weeks’ gestation) has increased exponentially every year. A recent estimate by the World Health Organization put the recent number of premature babies born preterm at 15 million per annum. The reason behind this steady increase has long baffled the clinical community. Now, as an indirect result of lockdowns, we may be closer than ever to understanding why.

It all began with doctors in Ireland and Denmark noticing a remarkable reduction in premature births (especially the earliest and most dangerous) during the first strictest months of lockdown last spring.  After publishing their preliminary findings, neonatal intensive care units around the world began to share a similar story – with some hospitals reporting a decrease of up to 90%.

In Denmark, between 12 March and 14 April, the number of premature babies born extremely premature (under 28 weeks) fell by 90% compared to the static rate of the previous five years. Meanwhile, in Ireland, a similar study looked at the number of babies born that weighed less than 3.3 pounds between January and April in 2020. In a normal year, the number of low-weight babies (closely correlated with preterm) would average eight per every thousand. But during the early months of lockdown, the average number of very low-weight babies delivered fell by nearly three-quarters, to just over two babies per thousand.

A follow on study from the Netherlands that was recently published in the Lancet Public Health, yielded even stronger evidence of an association between lockdowns and a smaller number of early births. Researchers studied newborn blood screening data collected from 1.5 million infants collected between 2010 to 2020. Over 56,000 of those babies were born after lockdown. The researchers found a reduction of up to 23% across all ages of premature babies – not only the earliest ones.

Preventing premature birth – the Holy Grail of prenatal care

More than 1 million children die every year due to complications caused by premature birth, making it the leading cause of death among children before they reach the age of five. Also, infants that are born preterm are at far greater risk of developing long-term health problems, including respiratory illnesses, learning disabilities, vision and hearing problems, and muscle movement disorders such as cerebral palsy. Therefore, the costs to children and their families — financially, emotionally and in long-term health effects — can be great. The best way to avoid these costs would be to prevent early births in the first place. However, the reasons for premature birth are still poorly understood.

Why could lockdowns reduced premature birth?

There is strong evidence that depression, stress and anxiety during pregnancy can be a significant factor. While the global pandemic is likely to have increased levels of all three, you could argue that staying home has meant pregnant women have spent less time commuting to and from work, and have been removed from physically demanding workplaces – a factor also known to increase the risk of preterm births.

Another theory is that immune-related responses can increase the risk of preterm birth, and that restricting social contact during lockdown has helped pregnant women to reduce their exposure to bacteria and viruses. Perhaps there is an argument there that – as we enter flu season – pregnant women should consider the wider benefits of social distancing, face masks and frequent hand-washing. Similarly, reduced travel during lockdown caused a reduction in air pollution. Multiple studies over the years have shown that exposure to air pollution in pregnancy is associated with increased risk of preterm birth by increasing toxic chemicals in the blood and causing immune system stress, which can weaken the placenta surrounding the fetus and lead to preterm birth.

It is important to note that while insightful, none of the studies have been able to pin down any single contributing factor as being the cause of fewer premature births. The Danish, Irish and Dutch researchers are now part of an international consortium of nearly 40 nations sharing data.  

Until we are able to prevent preterm birth, it is important to fund solutions that prevent the worst consequences of being born too soon.

Giving premature babies a fighting chance

Respiratory Distress Syndrome (RDS), the leading cause of death and health complications in preterm babies, affects roughly one-quarter of babies born with a low birth weight. Caused by immature lung development, babies diagnosed with RDS are likely to stay hospitalised far longer, suffer a greater risk of mortality and could also be left with lifelong medical and neurodevelopmental disorders. Until recently, there was no predictive RDS test available. Diagnosis is traditionally only confirmed when symptoms that indicate oxygen depletion, such as bluish skin and grunting noises, develop. Predicting which babies are at risk of RDS can drastically improve a baby’s chances. Without diagnosis within the first hour of life, treatment is often too late and sub-optimal. 

Using AI to predict disease in premature babies

At SIME Diagnostics, we are using machine-learning algorithms and cloud computing to deliver the world’s first predictive test for RDS. This clinically proven digital test has the potential to revolutionise respiratory medicine in neonatal intensive care units. By screening for RDS at birth, medical professionals will be able to deliver early targeted treatment; enabling them to improve clinical outcomes, prevent chronic conditions caused by RDS and reduce the costs of hospital care.

An exciting time for healthcare innovation

This is just one way in which machine learning algorithms and cloud computing can deliver test results with speed and precision. This technology can be applied across a wide range of different medical areas. But in our view, saving the lives of premature babies deserves to be placed at the top of the list. So, while news stories of fewer premature babies during lockdown might be welcome, speculating on the likely causes will only take us so far. There is so much we can be doing, in terms of diagnosis and preventative testing, that – with the right investment – will make a significant impact on reducing the devastating consequences of premature birth.