Maternal Characteristics and Adverse Neonatal Outcomes During the COVID ‐19 Pandemic and Maternal Characteristics During the Three‐Child Policy: A Retrospective Analysis

ABSTRACT During the COVID‐19 pandemic, studies showed a significant decrease in fertility rate among Chinese women of reproductive age. The Chinese government implemented the three‐child policy in an attempt to change the sustained low birth rate under the dual threat of population development and the pandemic. To separately evaluate the changes in maternal characteristics after the outbreak of the epidemic and the adjustment of fertility policies, as well as the relationship between the COVID‐19 pandemic and adverse neonate outcomes, a retrospective study was conducted at one hospital. We collected data on birthing women from medical record databases from January 1, 2017, to December 31, 2022. Records for a total of 93,547 neonates and a corresponding 88,857 maternal medical records were analyzed using SPSS software version 26. The differences in maternal and gestational characteristics between subgroups during the two periods were analyzed using Pearson's chi‐square test. We used univariate and multivariate analyses to assess the relationship between the COVID‐19 pandemic and neonatal outcomes. We found that during the epidemic, the proportion of pregnant women of advanced age (20.3% vs. 24.5%), mothers who gave birth ≥ 2 times (27.0% vs. 42.1%), and non‐IVF pregnant women (86.2% vs. 91.4%) decreased. After the implementation of the three‐child policy, the proportion of mothers who gave birth once (74.8% vs. 72.8%) increased significantly, while the proportion of mothers who gave birth ≥ 2 times (25.2% vs. 27.2%) decreased. In addition, the results of multivariate logistic regression analysis showed that the risk of cesarean birth (CB) in newborns increased (aOR 1.062, 95% CI 1.032–1.093, p < 0.001), but the risk of premature birth (PTB) (aOR 0.809, 95% CI 0.775–0.844, p < 0.001), low birth weight (LBW) (aOR 0.903, 95% CI 0.861–0.947, p < 0.001), macrosomia (aOR 0.890, 95% CI 0.824–0.960, p = 0.003), small for gestational age (SGA) (aOR 0.921, 95% CI 0.887–0.956, p < 0.001), and large for gestational age (LGA) (aOR 0.924, 95% CI 0.887–0.962, p < 0.001) were all reduced after the outbreak of the epidemic. In summary, during the COVID‐19 pandemic, the proportion of pregnant women under 35 years old, women without previous delivery history and women undergoing fertility therapy increased in this hospital. The incidence of adverse outcomes in newborns, including PTB, LBW, macrosomia, SGA, and LGA, was reduced. After the implementation of the three‐child policy, the proportion of multiparous women has decreased. This suggests that the threat of the pandemic has led to significant changes in fertility preferences in the area, but the incidence of adverse outcomes, except for cesarean birth, has decreased. However, exposure to COVID‐19 alone cannot be assumed as a significant impact on the neonatal outcomes; we need to pay more attention to the future development of these children and the impact of public events and policies on them.