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Original article

Vol. 155 No. 9 (2025)

Initial COVID-19-related restrictions (lockdown) in 2020 and birth outcomes in Switzerland: an observational study based on statistics of outpatient midwifery services

Cite this as:
Swiss Med Wkly. 2025;155:4319
Published
30.09.2025

Summary

AIMS: Heterogeneous results regarding changes in the risk of preterm births and other perinatal outcomes during COVID-19-related restrictions (lockdowns) have been reported. We aimed to investigate the association between adverse birth outcomes and the initial COVID-19-related lockdown in Switzerland in 2020.

AIMS: Heterogeneous results regarding changes in the risk of preterm births and other perinatal outcomes during COVID-19-related restrictions (lockdowns) have been reported. We aimed to investigate the association between adverse birth outcomes and the initial COVID-19-related lockdown in Switzerland in 2020.

METHODS: We included singleton births recorded in the nationwide statistics of outpatient midwifery services in Switzerland (2018–2020). Using logistic regression, we estimated odds ratios (ORs) with 95% confidence intervals (CIs) for the risk of three birth outcomes between 16 March 2020 and 10 May 2020 (lockdown period) compared to any time between January 2018 and the start of the lockdown period. The outcomes of interest were preterm birth (<37 weeks), caesarean section and an Apgar score <7 at 5 minutes of age. Analyses were adjusted for calendar day and month and for geographical region. We conducted sensitivity analyses by geographic region.

RESULTS: Of 218,273 singleton births between January 2018 and December 2020, 5.3% were preterm births, 30.2% were caesarean sections and 2.2% resulted in a newborn with an Apgar score <7 at 5 minutes. The risk of preterm birth was slightly but not statistically significantly higher during the lockdown period in Switzerland (OR: 1.09, 95% CI: 0.97–1.22). This was driven by an OR for preterm birth of 2.05 (95% CI: 1.10–3.85) for the canton of Ticino, which accounted for most COVID-19 infections during this time, but with no meaningful change in risk of preterm birth in other regions of Switzerland. We did not observe any change in the proportion of caesarean sections during the lockdown period. The Switzerland-wide risk of a recorded Apgar score <7 at 5 minutes had an OR of 1.41 (95% CI: 1.19–1.69), again driven by the highest OR of 4.60 (95% CI: 1.70–12.34) in the canton of Ticino as well as increased ORs in Geneva (2.40, 95% CI: 1.20–4.70) and Bern (2.84, 95% CI: 1.79–4.48).

CONCLUSIONS: The risk of birth outcomes remained unchanged during the first COVID-19 lockdown in 2020 in most parts of Switzerland. The cause of the observed increased risk of preterm birth in Ticino needs to be followed up, as sample size was small and a chance finding cannot be ruled out.

References

  1. 1. Hedermann G, Hedley PL, Bækvad-Hansen M, Hjalgrim H, Rostgaard K, Poorisrisak P, et al. Danish premature birth rates during the COVID-19 lockdown. Arch Dis Child Fetal Neonatal Ed. 2021 Jan;106(1):93–5. doi: https://doi.org/10.1136/archdischild-2020-319990
  2. 2. Been JV, Burgos Ochoa L, Bertens LC, Schoenmakers S, Steegers EA, Reiss IK. Impact of COVID-19 mitigation measures on the incidence of preterm birth: a national quasi-experimental study. Lancet Public Health. 2020 Nov;5(11):e604–11. 10.1016/S2468-2667(20)30223-1
  3. 3. Matheson A, McGannon CJ, Malhotra A, Palmer KR, Stewart AE, Wallace EM, et al. Prematurity Rates During the Coronavirus Disease 2019 (COVID-19) Pandemic Lockdown in Melbourne, Australia. Obstet Gynecol. 2021 Mar;137(3):405–7. doi: https://doi.org/10.1097/AOG.0000000000004236
  4. 4. Einarsdóttir K, Swift EM, Zoega H. Changes in obstetric interventions and preterm birth during COVID-19: A nationwide study from Iceland. Acta Obstet Gynecol Scand. 2021 Oct;100(10):1924–30. doi: https://doi.org/10.1111/aogs.14231
  5. 5. Cuestas E, Gómez-Flores ME, Charras MD, Peyrano AJ, Montenegro C, Sosa-Boye I, et al. Association between COVID-19 mandatory lockdown and decreased incidence of preterm births and neonatal mortality. J Perinatol. 2021 Oct;41(10):2566–9. 10.1038/s41372-021-01116-4
  6. 6. Meyer R, Bart Y, Tsur A, Yinon Y, Friedrich L, Maixner N, et al. A marked decrease in preterm deliveries during the coronavirus disease 2019 pandemic. Am J Obstet Gynecol. 2021 Feb;224(2):234–7. doi: https://doi.org/10.1016/j.ajog.2020.10.017
  7. 7. Rusconi F, Puglia M, Pacifici M, Brescianini S, Gagliardi L, Nannavecchia AM, et al.; AIE Perinatal Health Working Group. Pregnancy outcomes in Italy during COVID-19 pandemic: a population-based cohort study. BJOG. 2022 Oct;130(3):276–84. doi: https://doi.org/10.1111/1471-0528.17315
  8. 8. Pasternak B, Neovius M, Söderling J, Ahlberg M, Norman M, Ludvigsson JF, et al. Preterm Birth and Stillbirth During the COVID-19 Pandemic in Sweden: A Nationwide Cohort Study. Ann Intern Med. 2021 Jun;174(6):873–5. doi: https://doi.org/10.7326/M20-6367
  9. 9. De Curtis M, Villani L, Polo A. Increase of stillbirth and decrease of late preterm infants during the COVID-19 pandemic lockdown. Arch Dis Child Fetal Neonatol Ed. 2021 Jul;106(4):456. doi: https://doi.org/10.1136/archdischild-2020-320682.
  10. 10. Main EK, Chang SC, Carpenter AM, Wise PH, Stevenson DK, Shaw GM, et al. Singleton preterm birth rates for racial and ethnic groups during the coronavirus disease 2019 pandemic in California. Am J Obstet Gynecol. 2021 Feb;224(2):239–41. doi: https://doi.org/10.1016/j.ajog.2020.10.033
  11. 11. Briozzo L, Tomasso G, Viroga S, Nozar F, Bianchi A. Impact of mitigation measures against the COVID 19 pandemic on the perinatal results of the reference maternity hospital in Uruguay. J Matern Fetal Neonatal Med. 2022 Dec;35(25):5060–2. doi: https://doi.org/10.1080/14767058.2021.1874911
  12. 12. Calvert C, Brockway MM, Zoega H, Miller JE, Been JV, Amegah AK, et al. Changes in preterm birth and stillbirth during COVID-19 lockdowns in 26 countries. Nat Hum Behav. 2023 Apr;7(4):529–44. doi: https://doi.org/10.1038/s41562-023-01522-y
  13. 13. Adams M, Schulzke SM, Rogdo B, Meyer P, McDougall J, Stocker M, et al.; Swiss Neonatal Network. Impact of SARS-CoV-2 on incidence, treatment and outcome of very preterm born infants in Switzerland: a retrospective, population-based cohort study. Swiss Med Wkly. 2022 May;152(19–20):w30174. doi: https://doi.org/10.4414/SMW.2022.w30174
  14. 14. Cincera T, Conde N, von Felten S, Leeners B, von Orelli S. Did the first wave of the COVID-19 pandemic impact the cesarean delivery rate? A retrospective cohort study at a primary care center in Switzerland. J Perinat Med. 2022 Dec;51(5):614–22. 10.1515/jpm-2022-0378
  15. 15. Swiss Federal Authorities. Die Bundesversammlung der Schweizerischen Eidgenossenschaft. SR 818.101. Federal Act of 28 September 2012 on Controlling Communicable Human Diseases (Epidemics Act, EpidA). Available from: https://www.fedlex.admin.ch/eli/cc/2015/297/en
  16. 16. Bundesamt für Gesundheit (BAG). BAG: Massnahmen und Verordnungen [Internet]. 2022 [cited 2023 Sep 5]. Available from: https://www.bag.admin.ch/bag/de/home/gesetze-und-bewilligungen/gesetzgebung/gesetzgebung-mensch-gesundheit/gesetzgebung-covid-19.html#-1876551640
  17. 17. Coronavirus: Bundesrat erklärt die «ausserordentliche Lage» und verschärft die Massnahmen [Internet]. 2020 [cited 2023 Aug 8]. Available from: https://www.bag.admin.ch/bag/en/home/das-bag/aktuell/medienmitteilungen.msg-id-78454.html
  18. 18. Statistik der Frei Praktizierenden Hebammen fpH [Internet]. 2018 [cited 2018 Aug 14]. Available from: http://www.hebamme.ch/de/heb/shv/stats.cfm
  19. 19. Grylka-Bäschlin S, Borner B. Ausführlicher Statistikbericht der frei praktizierenden Hebammen der Schweiz [Internet]. 2020 [cited 2023 Sep 5]. Available from: https://www.hebamme.ch/verbandsnews/statistikbericht-der-frei-praktizierenden-hebammen-der-schweiz-2020/
  20. 20. Grylka-Baeschlin S, Iglesias C, Erdin R, Pehlke-Milde J. Evaluation of a midwifery network to guarantee outpatient postpartum care: a mixed methods study. BMC Health Serv Res. 2020 Jun;20(1):565. doi: https://doi.org/10.1186/s12913-020-05359-3
  21. 21. Grylka-Bäschlin S, Borner B. Statistics of independent midwives in Switzerland [Internet]. [cited 2023 Oct 4]. Available from: https://www.zhaw.ch/en/health/health-research-and-development/midwifery/projects/statistics-of-independent-midwives-in-switzerland/
  22. 22. Bundesamt für Statistik BFS. Gesundheit der Neugeborenen [Internet]. [cited 2025 Apr 17]. Available from: https://www.bfs.admin.ch/bfs/de/home/statistiken/gesundheit/gesundheitszustand/gesundheit-neugeborenen.html
  23. 23. Michel A. Review of the Reliability and Validity of the Apgar Score. Adv Neonatal Care. 2022 Feb;22(1):28–34. doi: https://doi.org/10.1097/ANC.0000000000000859
  24. 24. Wing C, Simon K, Bello-Gomez RA. Designing Difference in Difference Studies: Best Practices for Public Health Policy Research. Annu Rev Public Health. 2018 Apr;39(1):453–69. doi: https://doi.org/10.1146/annurev-publhealth-040617-013507
  25. 25. Giachino M, Valera CB, Rodriguez Velásquez S, Dohrendorf-Wyss MA, Rozanova L, Flahault A. Understanding the dynamics of the covid-19 pandemic: A real-time analysis of switzerland’s first wave. Int J Environ Res Public Health. 2020 Nov;17(23):1–17. doi: https://doi.org/10.3390/ijerph17238825
  26. 26. Oakley LL, Örtqvist AK, Kinge J, Hansen AV, Petersen TG, Söderling J, et al. Preterm birth after the introduction of COVID-19 mitigation measures in Norway, Sweden, and Denmark: a registry-based difference-in-differences study. Am J Obstet Gynecol. 2022 Apr;226(4):550.e1–22. 10.1016/j.ajog.2021.11.034
  27. 27. Menter T, Mertz KD, Jiang S, Chen H, Monod C, Tzankov A, et al. Placental Pathology Findings during and after SARS-CoV-2 Infection: Features of Villitis and Malperfusion. Pathobiology. 2021;88(1):69–77. doi: https://doi.org/10.1159/000511324
  28. 28. Probst D. Corona-data.ch [Internet]. 2020. Available from: https://corona-data.ch/
  29. 29. Statistik B für. Säuglingssterblichkeit, Totgeburten [Internet]. 2023 [cited 2023 Sep 5]. Available from: https://www.bfs.admin.ch/bfs/de/home/statistiken/gesundheit/gesundheitszustand/sterblichkeit-todesursachen/saeuglings-totgeburten.html
  30. 30. Bähler C, Elmiger M, Signorell A. Helsana-Report: Corona. Auswirkungen der Corona-Pandemie auf die medizinsche Versorgung in der Schweiz [Internet]. 2021. Available from: https://reports.helsana.ch/wp-content/uploads/2021/09/Helsana-Report-Corona-Gesamtreport.pdf
  31. 31. Bergamin F, Mazidi S. Kompetenzabgrenzung zwischen Bund und Kantonen bei der Bekämpfung von Epidemien: Erste Einschätzungen unter besonderer Berücksichtigung der COVID-19-Verordnungen. Institut für Föderalismus. aus Sonderausgabe Newsletter IFF 2/2020. Vol. 41. Available from: https://www.unifr.ch/federalism/de/assets/public/files/Newsletter/IFF/Bergamin.Mazidi_Kompetenzabgrenzung%20zwischen%20Bund%20und%20Kantonen_COVID-19.pdf
  32. 32. Chmielewska B, Barratt I, Townsend R, Kalafat E, van der Meulen J, Gurol-Urganci I, et al. Effects of the COVID-19 pandemic on maternal and perinatal outcomes: a systematic review and meta-analysis. Lancet Glob Health. 2021 Jun;9(6):e759–72. 10.1016/S2214-109X(21)00079-6
  33. 33. Einarsdóttir K, Swift EM, Zoega H. Changes in obstetric interventions and preterm birth during COVID-19: A nationwide study from Iceland. Acta Obstet Gynecol Scand. 2021 Oct;100(10):1924–30. doi: https://doi.org/10.1111/aogs.14231
  34. 34. Gharacheh M, Kalan ME, Khalili N, Ranjbar F. An increase in cesarean section rate during the first wave of COVID-19 pandemic in Iran. BMC Public Health. 2023 May;23(1):936. doi: https://doi.org/10.1186/s12889-023-15907-1
  35. 35. Bundesamt für Statistik BFS. Anzahl und Rate der Kaiserschnitte nach Kanton und Wohnregion [Internet]. [cited 2025 Apr 17]. Available from: https://www.bfs.admin.ch/bfs/fr/home/actualites/quoi-de-neuf.assetdetail.28625247.html
  36. 36. Livingston J. Interrater reliability of the Apgar score in term and premature infants. Appl Nurs Res. 1990 Nov;3(4):164–5. doi: https://doi.org/10.1016/S0897-1897(05)80139-9