{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T16:22:18Z","timestamp":1787761338993,"version":"build-2784847793"},"reference-count":30,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2021,11,12]],"date-time":"2021-11-12T00:00:00Z","timestamp":1636675200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2021,11,12]],"date-time":"2021-11-12T00:00:00Z","timestamp":1636675200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Pregnancy Childbirth"],"published-print":{"date-parts":[[2021,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>The COVID-19 pandemic led to regional or nationwide lockdowns as part of risk mitigation measurements in many countries worldwide. Recent studies suggest an unexpected and unprecedented decrease in preterm births during the initial COVID-19 lockdowns in the first half of 2020. The objective of the current study was to assess the effects of the two months of the initial national COVID-19 lockdown period on the incidence of very and extremely preterm birth in the Netherlands, stratified by either spontaneous or iatrogenic onset of delivery, in both singleton and multiple pregnancies.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>Retrospective cohort study using data from all 10 perinatal centers in the Netherlands on very and extremely preterm births during the initial COVID-19 lockdown from March 15 to May 15, 2020. Incidences of very and extremely preterm birth were calculated using an estimate of the total number of births in the Netherlands in this period. As reference, we used data from the corresponding calendar period in 2015\u20132018 from the national perinatal registry (Perined). We differentiated between spontaneous versus iatrogenic onset of delivery and between singleton versus multiple pregnancies.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>The incidence of total preterm birth &lt;\u200932\u2009weeks in singleton pregnancies was 6.1\u2030 in the study period in 2020 versus 6.5\u2030 in the corresponding period in 2015\u20132018. The decrease in preterm births in singletons was solely due to a significant decrease in iatrogenic preterm births, both &lt;\u200932\u2009weeks (OR 0.71; 95%CI 0.53 to 0.95) and\u2009&lt;\u200928\u2009weeks (OR 0.53; 95%CI 0.29 to 0.97). For multiple pregnancies, an increase in preterm births &lt;\u200928\u2009weeks was observed (OR 2.43; 95%CI 1.35 to 4.39).<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusion<\/jats:title>\n                <jats:p>This study shows a decrease in iatrogenic preterm births during the initial COVID-19-related lockdown in the Netherlands in singletons. Future studies should focus on the mechanism of action of lockdown measures and reduction of preterm birth and the effects of perinatal outcome.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s12884-021-04249-8","type":"journal-article","created":{"date-parts":[[2021,11,12]],"date-time":"2021-11-12T07:04:04Z","timestamp":1636700644000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":27,"title":["Association between COVID-19 lockdown measures and the incidence of iatrogenic versus spontaneous very preterm births in the Netherlands: a retrospective study"],"prefix":"10.1186","volume":"21","author":[{"given":"J.","family":"Klumper","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"B. M.","family":"Kazemier","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J. V.","family":"Been","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"K. W. M.","family":"Bloemenkamp","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M. A.","family":"de Boer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J. J. H. M.","family":"Erwich","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"W.","family":"Heidema","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"F. J. C. M.","family":"Klumper","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S. W. A. Nij","family":"Bijvank","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S. G.","family":"Oei","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M. A.","family":"Oudijk","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S.","family":"Schoenmakers","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A. S.","family":"van Teeffelen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C. J. M.","family":"de Groot","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2021,11,12]]},"reference":[{"key":"4249_CR1","unstructured":"WHO Director-General\u2019s opening remarks at the media briefing on COVID-19 - 11 March 2020. https:\/\/www.who.int\/dg\/speeches\/detail\/who-director-general-s-opening-remarks-at-the-media-briefing-on-covid-19%2D%2D-11-march-2020. (Accessed at Jan 25, 2021)."},{"issue":"1","key":"4249_CR2","doi-asserted-by":"publisher","first-page":"88","DOI":"10.1056\/NEJMc2009166","volume":"383","author":"O De Filippo","year":"2020","unstructured":"De Filippo O, D'Ascenzo F, Angelini F, Bocchino PP, Conrotto F, Saglietto A, et al. Reduced rate of hospital admissions for ACS during Covid-19 outbreak in northern Italy. N Engl J Med. 2020;383(1):88\u20139.","journal-title":"N Engl J Med"},{"issue":"38","key":"4249_CR3","doi-asserted-by":"publisher","first-page":"1347","DOI":"10.15585\/mmwr.mm6938e1","volume":"69","author":"MJ Delahoy","year":"2020","unstructured":"Delahoy MJ, Whitaker M, O'Halloran A, Chai SJ, Kirley PD, Alden N, et al. Characteristics and maternal and birth outcomes of hospitalized pregnant women with laboratory-confirmed COVID-19 - COVID-NET, 13 states, march 1-august 22, 2020. MMWR Morb Mortal Wkly Rep. 2020;69(38):1347\u201354.","journal-title":"MMWR Morb Mortal Wkly Rep"},{"key":"4249_CR4","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.m3320","volume":"370","author":"J Allotey","year":"2020","unstructured":"Allotey J, Stallings E, Bonet M, Yap M, Chatterjee S, Kew T, et al. Clinical manifestations, risk factors, and maternal and perinatal outcomes of coronavirus disease 2019 in pregnancy: living systematic review and meta-analysis. BMJ. 2020;370:m3320.","journal-title":"BMJ."},{"issue":"11","key":"4249_CR5","doi-asserted-by":"publisher","first-page":"e604","DOI":"10.1016\/S2468-2667(20)30223-1","volume":"5","author":"JV Been","year":"2020","unstructured":"Been JV, Burgos Ochoa L, Bertens LCM, Schoenmakers S, Steegers EAP, Reiss IKM. Impact of COVID-19 mitigation measures on the incidence of preterm birth: a national quasi-experimental study. Lancet Public Health. 2020;5(11):e604\u2013e11.","journal-title":"Lancet Public Health"},{"issue":"1","key":"4249_CR6","doi-asserted-by":"publisher","first-page":"93","DOI":"10.1136\/archdischild-2020-319990","volume":"106","author":"G Hedermann","year":"2021","unstructured":"Hedermann G, Hedley PL, Baekvad-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;106(1):93\u20135.","journal-title":"Arch Dis Child Fetal Neonatal Ed"},{"key":"4249_CR7","doi-asserted-by":"crossref","unstructured":"Philip RK, Purtill H, Reidy E, Daly M, Imcha M, McGrath D, e.a. Unprecedented reduction in births of very low birthweight (Vlbw) and extremely low birthweight (Elbw) infants during the COVID-19 lockdown in Ireland: a \u2018natural experiment\u2019 allowing analysis of data from the prior two decades. BMJ Global Health. 2020;5(9):e003075.","DOI":"10.1136\/bmjgh-2020-003075"},{"issue":"1","key":"4249_CR8","doi-asserted-by":"publisher","first-page":"e37","DOI":"10.1016\/S2214-109X(18)30451-0","volume":"7","author":"S Chawanpaiboon","year":"2019","unstructured":"Chawanpaiboon S, Vogel JP, Moller AB, Lumbiganon P, Petzold M, Hogan D, et al. Global, regional, and national estimates of levels of preterm birth in 2014: a systematic review and modelling analysis. Lancet Glob Health. 2019;7(1):e37\u201346.","journal-title":"Lancet Glob Health"},{"key":"4249_CR9","unstructured":"March of Dimes, PMNCH, Save the Children, WHO. Born Too soon: the global action report on preterm birth. Eds CP Howson, MV Kinney, JE Lawn. World Health Organization. Geneva; 2012. https:\/\/www.who.int\/pmnch\/media\/news\/2012\/201204_borntoosoon-report.pdf. Accessed 25 Jan 2021."},{"key":"4249_CR10","unstructured":"Dutch Society for Obstetrics and Gynaecology. Nota verwijzing naar een perinatologisch centrum, version 1.0; Dutch Society for Obstetrics and Gynaecology, 2007. https:\/\/www.nvog.nl\/kwaliteitsdocumenten\/notas\/attachment\/nota-verwijzing-naar-een-perinatologisch-centrum-1-0-19-09-2007\/. (Accessed Jan 25, 2021)."},{"key":"4249_CR11","first-page":"A2701","volume":"154","author":"MW De Laat","year":"2010","unstructured":"De Laat MW, Wiegerinck MM, Walther FJ, Richtlijn., et al. Perinataal beleid bij extreme vroeggeboorte. Ned Tijdschr Geneeskd. 2010;154:A2701.","journal-title":"Ned Tijdschr Geneeskd"},{"key":"4249_CR12","unstructured":"National Institute for Public Health and the Environment. Policy framework for Prenatal and Neonatal Screening. National Institute for Public Health and the Environment, 2018. https:\/\/www.rivm.nl\/documenten\/policy-framework-for-prenatal-and-neonatal-screening. (Accessed Jan 25, 2021)."},{"key":"4249_CR13","unstructured":"National Institute for Public Health and the Environment. Screening tests for newborn babies. National Institute for Public Health and the Environment, 2018. https:\/\/www.pns.nl\/documenten\/screeningen-bij-pasgeborenen. (Accessed Jan 25, 2021)."},{"key":"4249_CR14","unstructured":"Ministry of Public Health, Welfare, and Sports. Draaiboek hielprikscreening: bijzondere situaties. National Institute for Public Health and the Environment, 2019. https:\/\/draaiboekhielprikscreening.rivm.nl\/uitvoering-hielprik\/bijzondere-situaties. (Accessed Jan 25, 2021)."},{"key":"4249_CR15","unstructured":"Perined. Perinatale zorg in Nederland anno 2019: landelijke perinatale cijfers en duiding. 2020."},{"key":"4249_CR16","unstructured":"National Institute for Public Health and the Environment Monitor van de neonatale hielprikscreening 2019. National Institute for Public Health and the Environment, 2019. https:\/\/www.pns.nl\/documenten\/monitor-van-neonatale-hielprikscreening-2019. (Accessed Jan 25, 2021)."},{"key":"4249_CR17","doi-asserted-by":"crossref","unstructured":"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 Neonatal Ed. 2020.","DOI":"10.1136\/archdischild-2020-320682"},{"issue":"1","key":"4249_CR18","doi-asserted-by":"publisher","first-page":"87","DOI":"10.1001\/jama.2020.20991","volume":"325","author":"SC Handley","year":"2021","unstructured":"Handley SC, Mullin AM, Elovitz MA, Gerson KD, Montoya-Williams D, Lorch SA, et al. Changes in preterm birth phenotypes and stillbirth at 2 Philadelphia hospitals during the SARS-CoV-2 pandemic, march-June 2020. JAMA. 2021;325(1):87\u20139.","journal-title":"JAMA."},{"key":"4249_CR19","doi-asserted-by":"crossref","unstructured":"Meyer R, Bart Y, Tsur A, Yinon Y, Friedrich L, Maixner N, e.a. A marked decrease in preterm deliveries during the coronavirus disease 2019 pandemic. Am J Obstet Gynecol. 2021;224(2):234\u20137.","DOI":"10.1016\/j.ajog.2020.10.017"},{"key":"4249_CR20","doi-asserted-by":"crossref","unstructured":"Pasternak B, Neovius M, S\u00f6derling J, Ahlberg M, Norman M, Ludvigsson JF, e.a. Preterm birth and stillbirth during the covid-19 pandemic in sweden: a nationwide cohort study. Ann Intern Med. 2021;174(6):873\u20135.","DOI":"10.7326\/M20-6367"},{"key":"4249_CR21","doi-asserted-by":"publisher","first-page":"172","DOI":"10.1016\/j.ejogrb.2020.10.023","volume":"255","author":"S McDonnell","year":"2020","unstructured":"McDonnell S, McNamee E, Lindow SW, O'Connell MP. The impact of the Covid-19 pandemic on maternity services: a review of maternal and neonatal outcomes before, during and after the pandemic. Eur J Obstet Gynecol Reprod Biol. 2020;255:172\u20136.","journal-title":"Eur J Obstet Gynecol Reprod Biol"},{"issue":"10","key":"4249_CR22","doi-asserted-by":"publisher","first-page":"e1273","DOI":"10.1016\/S2214-109X(20)30345-4","volume":"8","author":"KC Ashish","year":"2020","unstructured":"Ashish KC, Gurung R, Kinney MV, Sunny AK, Moinuddin M, Basnet O, et al. Effect of the COVID-19 pandemic response on intrapartum care, stillbirth, and neonatal mortality outcomes in Nepal: a prospective observational study. Lancet Glob Health. 2020;8(10):e1273\u2013e81.","journal-title":"Lancet Glob Health"},{"issue":"9606","key":"4249_CR23","doi-asserted-by":"publisher","first-page":"75","DOI":"10.1016\/S0140-6736(08)60074-4","volume":"371","author":"RL Goldenberg","year":"2008","unstructured":"Goldenberg RL, Culhane JF, Iams JD, Romero R. Epidemiology and causes of preterm birth. Lancet. 2008;371(9606):75\u201384.","journal-title":"Lancet."},{"key":"4249_CR24","doi-asserted-by":"crossref","unstructured":"Meher S, Duley L. Rest during pregnancy for preventing pre-eclampsia and its complications in women with normal blood pressure. Cochrane Database Syst Rev. 2006;(2):CD005939.","DOI":"10.1002\/14651858.CD005939"},{"key":"4249_CR25","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.m2326","volume":"369","author":"EJ Verweij","year":"2020","unstructured":"Verweij EJ, M'Hamdi HI, Steegers EAP, Reiss IKM, Schoenmakers S. Collateral damage of the covid-19 pandemic: a Dutch perinatal perspective. BMJ. 2020;369:m2326.","journal-title":"BMJ."},{"issue":"10","key":"4249_CR26","doi-asserted-by":"publisher","first-page":"1229","DOI":"10.1111\/1471-0528.16381","volume":"127","author":"X Liu","year":"2020","unstructured":"Liu X, Chen M, Wang Y, Sun L, Zhang J, Shi Y, et al. Prenatal anxiety and obstetric decisions among pregnant women in Wuhan and Chongqing during the COVID-19 outbreak: a cross-sectional study. BJOG. 2020;127(10):1229\u201340.","journal-title":"BJOG."},{"issue":"9","key":"4249_CR27","doi-asserted-by":"publisher","first-page":"e1116","DOI":"10.1016\/S2214-109X(20)30319-3","volume":"8","author":"V Kumari","year":"2020","unstructured":"Kumari V, Mehta K, Choudhary R. COVID-19 outbreak and decreased hospitalisation of pregnant women in labour. Lancet Glob Health. 2020;8(9):e1116\u2013e7.","journal-title":"Lancet Glob Health"},{"issue":"7","key":"4249_CR28","doi-asserted-by":"publisher","first-page":"1132","DOI":"10.1093\/jamia\/ocaa072","volume":"27","author":"DM Mann","year":"2020","unstructured":"Mann DM, Chen J, Chunara R, Testa PA, Nov O. COVID-19 transforms health care through telemedicine: evidence from the field. J Am Med Inform Assoc. 2020;27(7):1132\u20135.","journal-title":"J Am Med Inform Assoc"},{"issue":"1","key":"4249_CR29","doi-asserted-by":"publisher","first-page":"86","DOI":"10.1001\/jama.2020.21369","volume":"325","author":"J Stowe","year":"2021","unstructured":"Stowe J, Smith H, Thurland K, Ramsay ME, Andrews N, Ladhani SN. Stillbirths during the COVID-19 pandemic in England, April-June 2020. JAMA. 2021;325(1):86\u20137.","journal-title":"JAMA."},{"issue":"10261","key":"4249_CR30","doi-asserted-by":"publisher","first-page":"1490","DOI":"10.1016\/S0140-6736(20)32235-2","volume":"396","author":"SJ Stock","year":"2020","unstructured":"Stock SJ, Brockway M, Zoega H, Been JV, Sheikh A, Bhutta ZA, et al. Enabling a healthy start for vulnerable newborns. Lancet. 2020;396(10261):1490.","journal-title":"Lancet."}],"container-title":["BMC Pregnancy and Childbirth"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12884-021-04249-8.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12884-021-04249-8\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12884-021-04249-8.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,11,12]],"date-time":"2021-11-12T07:05:06Z","timestamp":1636700706000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmcpregnancychildbirth.biomedcentral.com\/articles\/10.1186\/s12884-021-04249-8"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,11,12]]},"references-count":30,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2021,12]]}},"alternative-id":["4249"],"URL":"https:\/\/doi.org\/10.1186\/s12884-021-04249-8","relation":{},"ISSN":["1471-2393"],"issn-type":[{"value":"1471-2393","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,11,12]]},"assertion":[{"value":"26 May 2021","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"19 October 2021","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"12 November 2021","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"All methods were carried out in accordance with relevant guidelines and regulations. According to Dutch regulations, the need for written consent was waived by the Medical Research Ethics committee since the data cannot be traced to the individual person. The Medical Research Ethics Committee at the Amsterdam University Medical Centers, location VUmc, approved this study (approval number 2020.480).Second, The National Institute for Public Health and the Environment approved the study protocol for using Praeventis data. Third, Perined approved the use of their data (approval number 20.14) for the years 2015\u20132018.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare that they have no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"767"}}