Coronavirus lockdowns leading to fewer premature births?

By Andreas Kluth

Here, at last, is some good news about the Covid-19 pandemic and the wholesale disruption to our lives it has caused: In many places with strict lockdowns this spring, there were far fewer premature births than is considered normal.

The trend doesn’t appear to be universal, but where it applies, the data are staggering. In Denmark, the number of babies born after less than 28 weeks of gestation — 40 weeks is the norm — dropped by 90% during the country’s month-long lockdown this spring. In one region of Ireland, the rate of preemies with very low birth weight was down by 73% between January and April compared with averages over the preceding two decades. Somewhat smaller decreases have been observed in parts of Canada, Australia and the Netherlands. Elsewhere, clinics and doctors are now scurrying to examine their own data.

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One reason to rejoice is, of course, that this means many parents had healthier, happier babies this spring. Premature birth and low gestational weight are associated with various medical complications, ranging from cerebral palsy or death in the worst cases to learning disabilities or visual problems in later life. For example, it’s why Stevie Wonder, an American singer who was born six weeks early, is blind.

But the bigger reason to cheer is that this phenomenon could eventually help us understand what causes premature birth in the first place, and thus how to prevent it. For now, we can only speculate, as the researchers behind the Danish and Irish work freely admit — their papers haven’t yet been peer-reviewed.

One explanation for fewer premature births may be the decreases in air pollution during the lockdowns, as fewer people drove or flew and factories belched less. Another factor could be that the moms-to-be had fewer infections generally — and thus less inflammation in their bodies — as we reduced contact with people and germs and obsessively washed hands.

But the most obvious and plausible reason appears to be that for many expecting moms, though decidedly not all, the lockdowns reduced stress. This may seem counterintuitive because a pandemic is itself a big a stressor. Moreover, the lockdowns deprived many people of their livelihood and thus caused additional financial and even existential anxiety.

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However, the pandemic and the shutdowns were not stressful for everybody. For the lucky ones, it was instead a time to slow down. People stayed at home, either working remotely or just resting, which is what pregnant women are advised to do anyway. The quotidian stressors of commuting and office life were gone. We had more opportunities to nap.

An additional factor lowering stress during pregnancy is feeling supported by partners and families. Studies have shown that the more fathers stay engaged, the better the mothers feel. And during the lockdown, the dads in their home offices had more opportunities to do just that.

Again, for some women, this same situation increased stress and anguish, because the lockdowns also led to tragic epidemics of domestic violence. As I’ve said in different contexts, in April and again last month, SARS-CoV-2 isn’t just nasty, it’s also hugely unfair because it treats us all differently.

But is stress even a plausible factor with pre-term births? Maternal anxiety and depression certainly appear to hurt fetuses. Some studies suggest that “stress seems to increase the risk of pre-term birth,” while others hypothesize that early labour may even be an evolutionary adaptation in scary situations. That said, the mechanisms and details remain a mystery.

Anecdotally, however, there’s always been a link. Just think of Thomas Hobbes, the English philosopher famous for his dark view of life being “solitary, poor, nasty, brutish and short.” Hobbes was born on a Friday in 1588, when his mother, only seven months pregnant, heard of the Spanish Armada, the fiercest naval war machine ever assembled, appearing off the coast of England. She was so frightened, she fell into labour immediately and, in Hobbes’s words, “fear and I were born twins together.”

We have to keep investigating the precise aetiology of pre-term births, of course. But certain insights seem to be no-brainers. Pregnant women should get as much rest, and as much support from their partners, as possible. Because this is a matter of public health, employers and governments should help with generous rules about maternity and paternity leave that starts before birth.

And individually, we should apply the lessons we learned during the lockdowns: to simplify our lives, and to decelerate. Because sometimes less really is more.