Study examines impact of COVID pandemic on birth outcomes in Wales

Researchers in the UK have looked at the impact of the COVID-19 (coronavirus disease 2019) pandemic on the population birth outcomes in 2020, detailing the experiences of the expectant mothers from immunization rates for babies to self-reported levels of stress and anxiety in the mothers, compared to pre-COVID years.

A pre-print version of the research paper is available on the medRxiv* server.

Study: Population birth outcomes in 2020 and experiences of expectant mothers during the COVID-19 pandemic: a ‘Born in Wales’ mixed methods study using routine data. Image Credit: NIAID

Hope Jones and colleagues observe that while implemented public health and non-pharmaceutical interventions (i.e., social distancing, lockdowns, self-isolation) were effective in controlling the virus spread, these measures also imposed significant changes in primary and secondary care services, such as the care provided to pregnant women and young mothers.

In the current study, the research team from University Medical School, Wales, Public Health Wales, Cardiff, and Cardiff University, in the United Kingdom, investigated the different impacts on the population-level birth outcomes due to the COVID-19, assessing the expectant women's experiences of pregnancy during this period.

They found that while the expectant women had a negative impact, this experience did not translate to adverse birth outcomes during the pandemic.

"This study aims to examine the impact of changes in maternity care due to COVID on (a) population birth outcomes including stillbirths, mortality, prematurity, birth weight, rates of Caesarean sections (C-sections) and vaccination rates before and during the pandemic and b) women's experience of pregnancy during the coronavirus pandemic."

The Study

The researchers used data from SAIL Databank and performed a comparative study. The SAIL (Secure Anonymised Information Linkage) databank is a privacy-protecting trusted research environment (TRE), consisting of routinely collected population and health data (~5 million) – providing anonymized person-based data for research and analysis. The researchers inform that the data used for this study included: National Community Child Health (NCCH), Annual District Death Extract (ADDE) from the Office for National Statistics (ONS) mortality register, Patient Episode Dataset for Wales (PEDW), Welsh Demographic Service Dataset (WDSD), Welsh Longitudinal General Practice (WLGP), and COVID-19 Polymerase chain reaction (PCR) testing data (PATD).

They assessed the population-level birth outcomes in Wales, such as stillbirths, prematurity, birth weight, and Cesarean section births – during 2016-2019, the pre-pandemic period, and during 2020.

The study comprised two parts: analysis of data from SAIL on pregnancy and birth outcomes in Wales, before and during the pandemic, and an online survey on the expectant mothers' experiences.

To address the stress questions, the researchers used the Pregnancy Risk Assessment Monitoring System (PRAMS),  Patients Health Questionnaire (PHQ-9) and the General Anxiety Disorder (GAD-7).

The researchers also compared the first primary immunizations of the baby during these periods. They surveyed self-reports from 215 expectant mothers (aged 16+) on their experiences of pregnancy during the pandemic in Wales. They analyzed the qualitative survey data using codebook thematic analysis, generating themes from an open-ended question.

The findings

There were a number of significant findings in this study, including the incidence of stillbirths, preterm births, Cesarean sections, primary immunization rates, and responses to the mental health questionnaire.

Preterm mortality rates by year

2020 saw fewer births than the previous average, with no significant difference between annual outcomes including gestation and birth weight, stillbirth, rates of Cesarean sections for infants born in 2020 compared to previous years.

During the first lockdown, the researchers observed late-term births (>42 weeks gestation). During the second lockdown, they found a decrease in moderate to late preterm births (32-36 weeks gestation). Thus, a small increase in preterm mortality may be a temporal increase year on year with no association with the pandemic.

All babies received their immunizations – except a few were delayed in timing the shots (administered within 28-days of due date) at 8 weeks and 16 weeks. At 12 weeks, the babies received their shots on time.

Seventy-one percent (71%) of the mothers experienced anxiety, stress, and loneliness. Because of the pandemic-related restrictions, these mothers expected a negative impact – attending scans without their partners, giving birth alone, or minimal contact with the midwives. Most of the stressed mothers reported feeling nervous, anxious, or on edge.


Anxiety, pregnancy-related anxiety, and psychosocial stress among pregnant women are common. This is also associated with adverse birth outcomes, such as premature birth, low birth weight, and associated clinical complications.

However, despite maternal stress and anxiety, it did not translate into adverse birth outcomes during the COVID-19.

Across the UK and Europe, studies report regional variations and impacts in this perspective. While a similar study assessing women's pregnancy experience during the pandemic conducted in Wales was lacking, the researchers also write that combining the results of such a study with national data on objective measures of neonatal and obstetric outcomes was also not examined so far.

This throws an important light on the need for safe face-to-face maternity care and familial support, emphasizing the changes to maternity and neonatal care, as well as the direct impact of COVID-19 in Wales.

*Important Notice

medRxiv publishes preliminary scientific reports that are not peer-reviewed and, therefore, should not be regarded as conclusive, guide clinical practice/health-related behavior, or treated as established information.

Journal reference:
  • Population birth outcomes in 2020 and experiences of expectant mothers during the COVID-19 pandemic: a 'Born in Wales' mixed methods study using routine data, Hope Jones, Mike Seaborne, Laura Cowley, David Odd, Shantini Paranjothy, Ashley Akbari, Sinead Brophy, medRxiv, 2021.08.23.21262209; doi:,

Posted in: Child Health News | Medical Research News | Women's Health News | Disease/Infection News

Tags: Anxiety, Anxiety Disorder, Baby, Birth Weight, Cesarean Section, Child Health, Coronavirus, Coronavirus Disease COVID-19, Immunization, Medical School, Mental Health, Mortality, Pandemic, Polymerase, Polymerase Chain Reaction, Pregnancy, Premature Birth, Public Health, Research, Stillbirth, Stress, Virus

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Written by

Dr. Ramya Dwivedi

Ramya has a Ph.D. in Biotechnology from the National Chemical Laboratories (CSIR-NCL), in Pune. Her work consisted of functionalizing nanoparticles with different molecules of biological interest, studying the reaction system and establishing useful applications.

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