The impact of changes in health policies caused by COVID-19 on pregnancy outcomes in Iran during health crises: A retrospective quasi-experimental study

Effective decision-making and appropriate policy adoption during critical situations significantly impact people’s lives, particularly during crises like the COVID-19 pandemic. Countries affected by the pandemic, experienced disruptions in essential maternal healthcare services, resulting in increased complications. We hypothesized that new health policies developed during a crisis, influenced by economic and international factors, could impact pregnancy outcomes. This retrospective quasi-experimental study examined the effects of health policies implemented during the pandemic on birth outcomes. In a city in southern Iran, we analyzed all data from singleton pregnancies over 48 months (2018–2022). The measured outcomes included birth weight, gestational age, preterm birth (28–37 weeks), low birth weight (1000–2500 g), and stillbirth rates (absence of vital signs after 28 weeks). Descriptive statistics and two-sample t-tests were used to compare outcomes before and after implementing pandemic-related health policies. Interrupted time series analysis assessed both short-term and long-term effects on birth outcomes. During this study, there were 221,866 total births. In the short term, preterm birth had a negative trend (0.02 decrease, P = 0.003), and in the long term had a decrease trend about 0.001 (P = 0.003). The frequency of preterm births increased at a gentler slope. The preterm stillbirths had decreased trend before the policy changes (P = 0.003). Immediately after the changes, there was a 0.008 increase (P = 0.082) followed by a slow increase trend (P = 0.075). The increasing trend (P = 0.013) and descending slope (-0.0005) in the low birth weights over 37 weeks before the changes (P < 0.0001) were significant. After the change, there was an immediate increase (0.0032), and the trend continued (0.0004) at a gentler slope (P < 0.0001). Other observed changes were not statistically significant. This study highlights inefficient health policies’ short- and long-term impacts on key maternal and neonatal health indicators. Specifically, it demonstrates that ineffective public policies aimed at securing financial resources for families during pregnancy have adversely affected birth weight outcomes. Additionally, pandemic-related health policies have also not curbed the continuing rise in preterm birth rates. These findings reveal significant shortcomings in the social and economic aspects of public policies that affect the ineffective development of primary prevention strategies and services in a middle-income country.