SCIENTIFIC
Changes in Large for Gestation and Small for Gestation Births During the COVID-19 Era
AUTHORS : Tricia N . Moran , MD 1
Alicia A . Moise , MD 2 Audrey N . Miller , MD 3 Rebecca Burke , MD 4 Lesley Cottrell , PhD 5 Kelsey Haarbauer , MD 5 M . Cody Smith , MD 5 Mark J . Polak , MD 5
All authors were affiliated with the Department of Pediatrics at the West Virginia University School of Medicine ( WVU SoM ) at the time of the research . Current affilitations include University of Virginia , 1 University of Oklahoma , 2 Nationwide Children ' s Hospital , 3 Pennsylvania State University , 4 and WVU SoM . 5
INTRODUCTION
The COVID-19 pandemic has impacted healthcare directly through the need to respond to infection but also through significant societal changes that have been made to reduce transmission of infection . There is a particular concern for if , and how , the pandemic and the associated isolation and societal changes might affect vulnerable groups such as pregnant women and the developing fetus . Both professional journals and the national press have reported changes in birth outcomes , including fewer births of preterm infants and more stillbirths , as well as increased maternal substance use since the beginning of the pandemic . 1 – 4
In our rural tertiary center in the North Central Appalachian region , 5 the awareness and action toward the pandemic lagged behind other regions of the United States ( US ). However , anxiety , fear , and a societal response toward the pandemic was noted by February 2020 with stay-athome orders issued by mid-March 2020 .
ABSTRACT
BACKGROUND The COVID-19 pandemic has impacted pregnancy and the fetus . We observed a significant change in the incidence of both large for gestational age ( LGA ) and small for gestational age ( SGA ) infants since the beginning of the COVID-19 pandemic .
METHODS Through chart review , COVID-19 pandemic group ( C ) was defined as infants born between March 1 , 2020 , and November 15 , 2021 . The pre-pandemic period ( PC ) was from January 1 , 2016 , to February 29 , 2020 . Infant birth , treatment , and health outcomes and maternal behaviors and health outcomes were extracted from the charts for review .
During the pandemic period , we anecdotally noted an increase in the proportion of infants who were large for gestational age ( LGA ) at birth and a decrease in the proportion of small for gestational age ( SGA ) infants born at our center who were admitted to either our newborn nursery or our neonatal intensive care unit ( NICU ). This trend prompted further investigation into any potential associations with changes in maternal health outcomes during the period of quarantine and stay-at-home and safer-at-home orders in the surrounding region . As such , the objective of this project was to assess if , and how , the prevalence of LGA and SGA babies differed over the course of the COVID-19 pandemic at our center . Additionally , we explored potential differences in maternal characteristics that might be associated with these changes in the pre-pandemic era versus during the ongoing pandemic period .
METHODS STUDY DESIGN , SETTING , AND PARTICIPANTS
After local Institutional Review Board approval , we conducted a dual retrospective / prospective chart review of infants in our newborn center . The pandemic cohort
RESULTS In the PC era , 495 / 6611 ( 7.5 %) infants were born LGA , and during the C era , 411 / 3815 ( 10.8 %) infants were born LGA ( p < 0.05 ). In the PC era , 520 / 6611 ( 7.9 %) infants were born SGA and during the C era , 128 / 3815 ( 3.4 %) infants were born SGA ( p < 0.01 ).
CONCLUSION We have seen a significant increase in LGA newborns during the C period . Our data also shows a decrease in the proportion of SGA newborns despite an increase in maternal smoking and hypertension . Continued monitoring of issues of pregnancy and fetal well-being during this ongoing pandemic period are warranted .
( C ) was defined as infants born between March 1 , 2020 , and November 15 , 2021 . Electronic medical records of infants delivered prior to the pandemic ( PC ) between January 1 , 2016 , and February 29 , 2020 , were reviewed for comparison .
OUTCOMES
Infant delivery history , postnatal treatment during the newborn hospitalization , and health outcomes as well as maternal health status ( body mass index , or BMI ; hypertension ; diabetes ) and behaviors were extracted from the charts for review . The frequency of maternal tobacco use was ascertained by the maternal report and documented in the electronic medical record . Maternal use of opiates , cannabis , and cocaine was ascertained by the maternal report and confirmed by maternal urine drug screening and infant umbilical cord toxicology testing .
As a standard practice at our institution , birth weights are measured for all infants and plotted on the Fenton Growth Chart . 6 Newborn cases were included for further review if they were coded as LGA ( birth weight > 90th percentile for gestational age or birth weight greater than 4000g )
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