The association of COVID-19 lockdowns with adverse birth and pregnancy outcomes in 28 high-income countries: a systematic review and meta-analysis

Iona Hindes (), Hawa Nuralhuda Sarwar, Benjamin Y. Gravesteijn, Jennifer Jardine, Lizbeth Burgos-Ochoa, Jasper V. Been, Dominik Zenner and Stamatina Iliodromiti
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Iona Hindes: Queen Mary University London
Hawa Nuralhuda Sarwar: Queen Mary University London
Benjamin Y. Gravesteijn: Amsterdam University Medical Centre
Jennifer Jardine: Queen Mary University London
Lizbeth Burgos-Ochoa: University Medical Centre Rotterdam
Jasper V. Been: University Medical Centre Rotterdam
Dominik Zenner: Queen Mary University London
Stamatina Iliodromiti: Queen Mary University London

Nature Human Behaviour, 2025, vol. 9, issue 7, 1420-1430

Abstract: Abstract We conducted a systematic review and meta-analysis to review the association of lockdowns with adverse birth and pregnancy outcomes (ABPOs) and related inequalities, in high-income countries (HICs). Databases (EMBASE, MEDLINE/PubMed and Web of Science) were searched from 1 January 2019 to 22 June 2023 for original observational studies based in HICs that compared the rates of ABPOs, before and during lockdowns. The risk of bias was assessed using the Newcastle–Ottawa tool for cohort studies. We ran random-effects meta-analyses and subgroup analyses per region, lockdown period, ethnicity group and deprivation level and adjusted for underlying temporal trends. A total of 132 studies were meta-analysed from 28 HICs. Reduced rates of preterm birth (reported by 26 studies) were associated with the first lockdown (relative risk 0.96, 95% confidence interval 0.93–0.99), 11 studies adjusted for long-term trends and the association remained (0.97, 0.95–0.99), and subgroup analysis found that this association varied by continental region. Ten studies reported positive screening rates for possible depression antenatally, and lockdown was associated with increases in positive screening rates (1.37, 1.06–1.78). No other ABPOs were associated with lockdowns. Investigation of inequalities was limited due to data availability and heterogeneity; further research is warranted on the effect of lockdowns on health inequalities. This study was funded by the National Institute of Health Research, School of Primary Care Research and registered on PROSPERO (CRD42022327448).

Date: 2025
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DOI: 10.1038/s41562-025-02139-z

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