Fourteen percent decrease in live births in Europe nine months after the start of the Covid pandemic and the first confinements

Europe saw a 14% drop in live births in January 2021, just nine to ten months after the first peak of the COVID-19 epidemic and the first lockdowns, compared to the average number of live births in January 2018 and 2019.

The researchers of the study published today (Friday) in Human Reproduction [1], one of the world’s leading reproductive medicine journals, say the decrease may be associated with the lockdowns imposed in many European countries rather than people infected with COVID-19 and experiencing problems as a result of the infection. , such as deaths, miscarriages or births. For this to be the case, there would have been a drop in live births just weeks or months after exposure to COVID-19, which they did not observe.

First author of the study, Dr Léo Pomar, a sonographer midwife at Lausanne University Hospital and associate professor at the Faculty of Health Sciences in Lausanne, Switzerland, said: “The decline in births nine months after the start of the pandemic appears to be more common in countries where health systems were struggling and hospital capacity was overstretched. This has led to lockdowns and social distancing measures to try to contain the pandemic.

“The longer the confinements, the fewer pregnancies there have been during this period, even in countries that are not severely affected by the pandemic. We believe that couples’ fears of a health and social crisis at the time of the first wave of COVID-19 contributed to the decline in live births nine months later.

Previous pandemics in the 20e and 21st centuries, such as the 1918 Spanish flu pandemic and the 2013 Ebola and 2016 Zika virus epidemics, have been associated with declining birth rates nine months after their peak. The reasons were the high parental death rates for the first two pandemics and the high fetal death rates resulting from direct exposure to Zika. Couples’ desire to postpone pregnancy in times of crisis also played a role. The researchers in the current study wondered if a similar trend would be seen after the COVID-19 pandemic.

They looked at data from 24 European countries [2] for the periods immediately before and after the first wave of the COVID-19 pandemic. They adjusted live birth rates to account for seasonal variations and found that January 2021 was the only month in which there was a significant drop in live births.

At the national level, decreases in birth rates in January 2021 were observed in Belgium (12% decrease), Estonia (13%), France (14%), Italy (17%), Latvia 15, 5%), in Lithuania (28%), Portugal (18%), Romania (23%), Russia (19%), Spain (23.5%), Ukraine (24%), England and Wales (13 %) and Scotland (14%). Seven countries had overcrowded intensive care units (more than 100% full) and six of them (Belgium, France, Italy, Spain, England and Scotland) saw substantial declines in birth rates. The seventh country, Denmark, did not. Only two of the nine countries in which there was a mild or moderate impact on intensive care units saw a drop in births nine months later.

March 2021 was the only month with a live birth rate similar to the pre-pandemic monthly rate, corresponding to a rebound nine to ten months after the lockdowns ended. However, the researchers say that this rebound does not seem to compensate for the drop in the birth rate in January 2021.

Further analysis showed that the duration of confinements was the only factor linked to the decline in live births in January 2021 compared to January 2018 and January 2019. 10% in January 2021. Sweden, which had no confinement but which recorded a high number of deaths, did not experience a drop in live births.

“The association we found with the duration of shutdowns may reflect a much more complex phenomenon, as shutdowns are government decisions used as a last resort to contain a pandemic. The duration of confinement has a direct impact on couples,” said Dr Pomar.

He said the information from this study was important for health services and policy makers. “This is particularly important for maternity services, which could adapt the workforce to births after pandemics: fewer pregnancies are expected at the time of pandemics, but a rebound in pregnancies could be observed after the end of these. The fact that the rebound in births does not seem to compensate for the decline in January 2021 could have long-term consequences on demography, particularly in Western Europe where we observe aging populations.

Dr Pomar and his colleagues plan to see if there are similar trends after subsequent waves of the pandemic and lockdowns. “Over time, the pandemic becomes endemic, its consequences during pregnancy are better known, vaccination is available, and it is possible that this decline in births has been mitigated in subsequent waves,” he said.

The limitations of the study are that it was based on national data, which may limit the ability to identify other potential factors contributing to a decrease or increase in live births, and the researchers only collected data only up to April 2021, making it impossible to identify seasonal birth differences for 2021.

Professor Christian De Geyter, from the University of Basel, Switzerland, was not involved in the research and is associate editor of the journal Human Reproduction. In a comment accompanying the article [3], he writes: “These observations are important because they show that human reproductive behavior, as evidenced by the numbers of live births, changes during dramatic events, epidemics and global crises. . . Fewer live births will lead to faster aging populations and lower economic growth. Some rebound in the number of live births after each of these crises can alleviate these stresses, but sequential multiple crises can also lead to no recovery in the number of live births. . . People are now aware that profound stressors during pregnancy can affect placental function, neonatal health, and even future fertility. . . Undulating fertility aspirations caused by seizures will invariably affect fertility treatment; in addition, temporal fluctuations in the number of live births will impact the strain on obstetric care units, schools and ultimately national socio-economic stability.

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