{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T19:41:49Z","timestamp":1790883709312,"version":"4.1.0"},"reference-count":70,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2025,8,1]],"date-time":"2025-08-01T00:00:00Z","timestamp":1754006400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"University of Oradea"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: Preterm birth and stillbirth are primary adverse pregnancy outcomes. Research during the COVID-19 pandemic revealed reductions in preterm birth in some countries, while stillbirth rates increased or remained unchanged. These findings suggest the presence of preventable risk factors associated with changes in physical activity and lower exposure to community-acquired infections due to lockdown measures, altered social interaction patterns or reduced access to antenatal care. Assessing seasonal variation may offer insights into whether lifestyle changes during the COVID-19 lockdown period influenced preterm birth rates. Materials and Methods: This retrospective cohort study used data from the electronic medical records of Bihor and Sibiu counties. Preterm deliveries (&lt;37 weeks) and stillbirths during the COVID-19 pandemic (2020 and 2021) were compared with the corresponding pre-pandemic (2018 and 2019) and post-pandemic (2022 and 2023) period. Preterm birth rates during summer and winter in the pre-pandemic, pandemic, and post-pandemic years were analyzed. A comparison with rates during strict lockdown was made. Results: Out of 52,021 newborn infants, 4473 were born preterm. Preterm birth rates remained stable across all three periods (p = 0.13), and no significant seasonal pattern was identified (p = 0.65). In contrast, stillbirth rates increased notably during the strict lockdown period, with the median incidence almost doubling compared to other periods (0.87%, p = 0.05), while remaining unchanged during the rest of the pandemic (p = 0.52). Conclusions: Our study found that preterm birth rates remained unaffected by the pandemic and lockdown periods, while stillbirths increased significantly during the strict lockdown. These findings highlight the importance of maintaining access to timely antenatal care during public health emergencies to prevent adverse perinatal outcomes.<\/jats:p>","DOI":"10.3390\/medicina61081398","type":"journal-article","created":{"date-parts":[[2025,8,1]],"date-time":"2025-08-01T08:51:41Z","timestamp":1754038301000},"page":"1398","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Seasonal Patterns of Preterm Birth During the COVID-19 Pandemic: A Retrospective Cohort Study in Romania"],"prefix":"10.3390","volume":"61","author":[{"given":"Paula","family":"Trif","sequence":"first","affiliation":[{"name":"Doctoral School of Biomedical Sciences, University of Oradea, 410087 Oradea, Romania"},{"name":"Department of Preclinical Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, 410087 Oradea, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6456-5770","authenticated-orcid":false,"given":"Cristian","family":"Sava","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Emergency County Hospital Bihor, 410167 Oradea, Romania"},{"name":"Department of Medical Sciences, Faculty of Medicine and Pharmacy, University of Oradea, 410087 Oradea, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5225-1758","authenticated-orcid":false,"given":"Diana","family":"Mudura","sequence":"additional","affiliation":[{"name":"Department of Neonatology, Emergency County Hospital Bihor, 410167 Oradea, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Boris W.","family":"Kramer","sequence":"additional","affiliation":[{"name":"Department of Neonatology, Poznan University of Medical Sciences, 61-701 Poznan, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4165-8816","authenticated-orcid":false,"given":"Radu","family":"Gali\u0219","sequence":"additional","affiliation":[{"name":"Department of Medical Sciences, Faculty of Medicine and Pharmacy, University of Oradea, 410087 Oradea, Romania"},{"name":"Department of Neonatology, Emergency County Hospital Bihor, 410167 Oradea, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2233-4218","authenticated-orcid":false,"given":"Maria Livia","family":"Ognean","sequence":"additional","affiliation":[{"name":"Department of Neonatology, Clinical County Emergency Hospital, 550245 Sibiu, Romania"},{"name":"Faculty of Medicine, Lucian Blaga University, 550024 Sibiu, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alin","family":"Iuhas","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Emergency County Hospital Bihor, 410167 Oradea, Romania"},{"name":"Department of Medical Sciences, Faculty of Medicine and Pharmacy, University of Oradea, 410087 Oradea, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claudia Maria","family":"Jurca","sequence":"additional","affiliation":[{"name":"Department of Preclinical Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, 410087 Oradea, Romania"},{"name":"Regional Center of Medical Genetics Bihor, County Emergency Clinical Hospital Oradea (Part of ERN ITHACA), 410469 Oradea, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,8,1]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"106","DOI":"10.1016\/S2352-4642(21)00311-4","article-title":"Global, regional, and national causes of under-5 mortality in 2000\u201319: An updated systematic analysis with implications for the Sustainable Development Goals","volume":"6","author":"Perin","year":"2022","journal-title":"Lancet Child Adolesc. Health"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"103.e101","DOI":"10.1016\/j.ajog.2016.01.004","article-title":"Preterm neonatal morbidity and mortality by gestational age: A contemporary cohort","volume":"215","author":"Manuck","year":"2016","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Toma, A.I., Dima, V., Alexe, A., Bojan, C., Neme\u0219, A.F., Gon\u021b, B.F., Arghirescu, A., Necula, A.I., Fieraru, A., and Stoiciu, R. (2024). Early Intervention Guided by the General Movements Examination at Term Corrected Age\u2014Short Term Outcomes. Life, 14.","DOI":"10.3390\/life14040480"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"F238","DOI":"10.1136\/adc.2005.087031","article-title":"Unstudied infants: Outcomes of moderately premature infants in the neonatal intensive care unit","volume":"91","author":"Escobar","year":"2006","journal-title":"Arch. Dis. Child. Fetal Neonatal Ed."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"81","DOI":"10.1053\/j.semperi.2006.02.006","article-title":"The Near-Term (Late Preterm) Human Brain and Risk for Periventricular Leukomalacia: A Review","volume":"30","author":"Kinney","year":"2006","journal-title":"Semin. Perinatol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1665","DOI":"10.1007\/s00431-021-03950-2","article-title":"Improving long-term health outcomes of preterm infants: How to implement the findings of nutritional intervention studies into daily clinical practice","volume":"180","author":"Ruys","year":"2021","journal-title":"Eur. J. Pediatr."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1406","DOI":"10.3109\/14767058.2011.636103","article-title":"Preterm birth seasonality in Greece: An epidemiological study","volume":"25","author":"Baroutis","year":"2012","journal-title":"J. Matern.-Fetal Neonatal Med."},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Zorgniotti, A.W. (1991). Seasonal Patterns of Births and Conception Throughout the World. Temperature and Environmental Effects on the Testis, Springer.","DOI":"10.1007\/978-1-4684-5913-5"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"444","DOI":"10.1001\/jamapediatrics.2013.18","article-title":"Nurse Staffing and NICU Infection Rates","volume":"167","author":"Rogowski","year":"2013","journal-title":"JAMA Pediatr."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"F195","DOI":"10.1136\/archdischild-2015-309435","article-title":"The effects of a one-to-one nurse-to-patient ratio on the mortality rate in neonatal intensive care: A retrospective, longitudinal, population-based study","volume":"101","author":"Watson","year":"2016","journal-title":"Arch. Dis. Child. Fetal Neonatal Ed."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"F99","DOI":"10.1136\/adc.2006.102988","article-title":"Nurse staffing in relation to risk-adjusted mortality in neonatal care","volume":"92","author":"Redshaw","year":"2007","journal-title":"Arch. Dis. Child. Fetal Neonatal Ed."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"S510","DOI":"10.1016\/j.ajog.2023.11.994","article-title":"966 Seasonality and the causes of spontaneous preterm birth","volume":"230","author":"Choi","year":"2024","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"234","DOI":"10.1093\/oxfordjournals.aje.a114381","article-title":"Seasonality of preterm birth in the collaborative project: Demographic factors","volume":"124","author":"Cooperstock","year":"1986","journal-title":"Am. J. Epidemiol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"451","DOI":"10.1016\/j.envres.2011.01.023","article-title":"The influence of season and ambient temperature on birth outcomes: A review of the epidemiological literature","volume":"111","author":"Strand","year":"2011","journal-title":"Environ. Res."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"e208243","DOI":"10.1001\/jamanetworkopen.2020.8243","article-title":"Association of Air Pollution and Heat Exposure With Preterm Birth, Low Birth Weight, and Stillbirth in the US: A Systematic Review","volume":"3","author":"Bekkar","year":"2020","journal-title":"JAMA Netw. Open"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"91","DOI":"10.1093\/ije\/21.1.91","article-title":"Seasonality of Preterm Births in Japan","volume":"21","author":"Matsuda","year":"1992","journal-title":"Int. J. Epidemiol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"735","DOI":"10.1093\/oxfordjournals.humrep.a137729","article-title":"Seasonality in human reproduction: An update","volume":"7","author":"Rojansky","year":"1992","journal-title":"Hum. Reprod."},{"key":"ref_18","unstructured":"Krombholz, H. (2023). Global Patterns of Seasonal Variation in Human Birth Rates\u2014Influence of Climate and Economic and Social Factors. PsychArchives."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"404","DOI":"10.1002\/ijgo.15379","article-title":"Impact of 2\u2009years of COVID-19 pandemic on preterm birth: Experience from a tertiary center of obstetrics in western Germany","volume":"166","author":"Nagel","year":"2024","journal-title":"Int. J. Gynecol. Obstet."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"93","DOI":"10.1136\/archdischild-2020-319990","article-title":"Danish premature birth rates during the COVID-19 lockdown","volume":"106","author":"Hedermann","year":"2021","journal-title":"Arch. Dis. Child. Fetal Neonatal Ed."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"100258","DOI":"10.1016\/j.ajogmf.2020.100258","article-title":"Decreased incidence of preterm birth during coronavirus disease 2019 pandemic","volume":"2","author":"Berghella","year":"2020","journal-title":"Am. J. Obstet. Gynecol. MFM"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"405","DOI":"10.1097\/AOG.0000000000004236","article-title":"Prematurity Rates During the Coronavirus Disease 2019 (COVID-19) Pandemic Lockdown in Melbourne, Australia","volume":"137","author":"Matheson","year":"2021","journal-title":"Obstet. Gynecol."},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Galis, R., Trif, P., Mudura, D., Murvai, R., Daina, L.G., Szasz, F., Negrini, R., Hatos, A., Gyarmati, B.F., and Daly, M.C. (2024). Preterm birth and stillbirth during COVID-19 pandemic in Bihor County\/Romania. Front. Reprod. Health, 6.","DOI":"10.3389\/frph.2024.1286496"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"e003075","DOI":"10.1136\/bmjgh-2020-003075","article-title":"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","volume":"5","author":"Roy","year":"2020","journal-title":"BMJ Glob. Health"},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Dong, M., Qian, R., Wang, J., Fan, J., Ye, Y., Zhou, H., Win, B., Reid, E., Zheng, S., and Lv, Y. (2021). Associations of COVID-19 lockdown with gestational length and preterm birth in China. BMC Pregnancy Childbirth, 21.","DOI":"10.1186\/s12884-021-04268-5"},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Klumper, J., Kazemier, B.M., Been, J.V., Bloemenkamp, K.W.M., de Boer, M.A., Erwich, J.J.H.M., Heidema, W., Klumper, F.J.C.M., Bijvank, S.W.A.N., and Oei, S.G. (2021). Association between COVID-19 lockdown measures and the incidence of iatrogenic versus spontaneous very preterm births in the Netherlands: A retrospective study. BMC Pregnancy Childbirth, 21.","DOI":"10.1186\/s12884-021-04249-8"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1997","DOI":"10.1007\/s00431-021-03984-6","article-title":"Lack of changes in preterm delivery and stillbirths during COVID-19 lockdown in a European region","volume":"180","author":"Arnaez","year":"2021","journal-title":"Eur. J. Pediatr."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"529","DOI":"10.1038\/s41562-023-01522-y","article-title":"Changes in preterm birth and stillbirth during COVID-19 lockdowns in 26 countries","volume":"7","author":"Calvert","year":"2023","journal-title":"Nat. Hum. Behav."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"e759","DOI":"10.1016\/S2214-109X(21)00079-6","article-title":"Effects of the COVID-19 pandemic on maternal and perinatal outcomes: A systematic review and meta-analysis","volume":"9","author":"Chmielewska","year":"2021","journal-title":"Lancet Glob. Health"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"i58","DOI":"10.1093\/eurpub\/ckad186","article-title":"Socioeconomic disparities in changes to preterm birth and stillbirth rates during the first year of the COVID-19 pandemic: A study of 21 European countries","volume":"34","author":"Zeitlin","year":"2024","journal-title":"Eur. J. Public Health"},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Bobei, T.-I., Haj Hamoud, B., Sima, R.-M., Gorecki, G.-P., Poenaru, M.-O., Olaru, O.-G., and Ples, L. (2022). The Impact of SARS-CoV-2 Infection on Premature Birth\u2014Our Experience as COVID Center. Medicina, 58.","DOI":"10.3390\/medicina58050587"},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Nemes, A.F., Toma, A.I., Dima, V., Serboiu, S.C., Necula, A.I., Stoiciu, R., Ulmeanu, A.I., Marinescu, A., and Ulmeanu, C. (2024). Use of Lung Ultrasound in Reducing Radiation Exposure in Neonates with Respiratory Distress: A Quality Management Project. Medicina, 60.","DOI":"10.3390\/medicina60020308"},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"Chicea, R., Neagu, A.D., Chicea, E.D., Grindeanu, A.S., Bratu, D.G., Boicean, A.G., Roman, M.D., Fleac\u0103, S.R., Chicea, L.M., and Teacoe, D.A. (2023). Impact of SARS-CoV-2 Infection on Maternal and Neonatal Outcome in Correlation with Sociodemographic Aspects: A Retrospective Case-Control Study. J. Clin. Med., 12.","DOI":"10.3390\/jcm12196322"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"19","DOI":"10.2478\/jccm-2024-0010","article-title":"Neonatal Resuscitation Practices in Romania: A Survey of the Romanian Association of Neonatology (ANR) and the Union of European Neonatal and Perinatal Societies (UENPS)","volume":"10","author":"Cucerea","year":"2024","journal-title":"J. Crit. Care Med."},{"key":"ref_35","unstructured":"(2025, May 11). The Weather Channel. Available online: https:\/\/weather.com\/weather\/tenday\/l\/6bd9f7b1ac9946cd9944ef844989e1a4641dac9a960e32af74885094d561d50f."},{"key":"ref_36","unstructured":"(2025, May 11). Wikipedia. Sibiu County. Available online: https:\/\/en.wikipedia.org\/wiki\/Sibiu_County."},{"key":"ref_37","unstructured":"(2025, May 11). Wikipedia. Bihor County. Available online: https:\/\/en.wikipedia.org\/wiki\/Bihor_County."},{"key":"ref_38","unstructured":"Ministerul S\u0103n\u0103t\u0103\u0163ii (2012). Ordinul Ministerului S\u0103n\u0103t\u0103\u021bii nr. 359\/2012, Ministerul S\u0103n\u0103t\u0103\u0163ii."},{"key":"ref_39","first-page":"291","article-title":"The effect of transport on the rate of severe intraventricular hemorrhage in very low birth weight infants","volume":"95","author":"Towers","year":"2000","journal-title":"Obstet. Gynecol."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"449","DOI":"10.1055\/s-2007-994178","article-title":"An Analysis of Neonatal Morbidity and Mortality in Maternal (In Utero) and Neonatal Transports at 24\u201334 Weeks\u2019 Gestation","volume":"14","author":"Shlossman","year":"1997","journal-title":"Am. J. Perinatol."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"289","DOI":"10.1097\/PCC.0b013e318172dbfd","article-title":"A prospective review of adverse events during interhospital transfers of neonates by a dedicated neonatal transfer service","volume":"9","author":"Lim","year":"2008","journal-title":"Pediatr. Crit. Care Med."},{"key":"ref_42","unstructured":"Institutul National de Statistica (2021). Evenimente Demografice Anul 2020, Institutul National de Statistica."},{"key":"ref_43","unstructured":"Ministerul S\u0103n\u0103t\u0103\u0163ii (2021). Buletin Infromativ\u2014Miscarea Naturala a Populatiei nr. 10\/2021, Institutul National de Sanatate Publica, Centrul Na\u0163ional de Statistic\u0103 \u015fi Informatic\u0103 \u00een S\u0103n\u0103tate Public\u0103."},{"key":"ref_44","first-page":"216","article-title":"Pharmacotherapeutical considerations in the treatment and management of neonatal hyperammonaemia","volume":"66","author":"Jurca","year":"2018","journal-title":"Farmacia"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"hoae052","DOI":"10.1093\/hropen\/hoae052","article-title":"Birth rate decline in the later phase of the COVID-19 pandemic: The role of policy interventions, vaccination programmes, and economic uncertainty","volume":"2024","author":"Zeman","year":"2024","journal-title":"Hum. Reprod. Open"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"2921","DOI":"10.1093\/humrep\/deac215","article-title":"Impact of the first wave of the COVID-19 pandemic on birth rates in Europe: A time series analysis in 24 countries","volume":"37","author":"Pomar","year":"2022","journal-title":"Hum. Reprod."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"101604","DOI":"10.1016\/j.ssmph.2024.101604","article-title":"Baby Bump or Baby Slump? COVID-19, Lockdowns, and their Effects on Births in Australia","volume":"25","author":"Wooden","year":"2024","journal-title":"SSM\u2014Popul. Health"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1111\/padr.12544","article-title":"Pandemic Roller-Coaster? Birth Trends in Higher-Income Countries During the COVID-19 Pandemic","volume":"50","author":"Sobotka","year":"2024","journal-title":"Popul. Dev. Rev."},{"key":"ref_49","doi-asserted-by":"crossref","unstructured":"Murvai, V.R., Gali\u0219, R., Panaitescu, A., Radu, C.M., Ghitea, T.C., Trif, P., Oni\u021ba-Avram, M., Vesa, A.A., and Huniadi, A. (2025). Antiphospholipid syndrome in pregnancy: A comprehensive literature review. BMC Pregnancy Childbirth, 25.","DOI":"10.1186\/s12884-025-07471-w"},{"key":"ref_50","doi-asserted-by":"crossref","unstructured":"Vaccaro, C., Mahmoud, F., Aboulatta, L., Aloud, B., and Eltonsy, S. (2021). The impact of COVID-19 first wave national lockdowns on perinatal outcomes: A rapid review and meta-analysis. BMC Pregnancy Childbirth, 21.","DOI":"10.1186\/s12884-021-04156-y"},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"273","DOI":"10.1111\/aogs.14318","article-title":"COVID-19 pandemic and population-level pregnancy and neonatal outcomes in general population: A living systematic review and meta-analysis (Update#2: November 20, 2021)","volume":"101","author":"Yang","year":"2022","journal-title":"Acta Obstet. Gynecol. Scand."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"1108","DOI":"10.1093\/aje\/kwq170","article-title":"High Ambient Temperature and the Risk of Preterm Delivery","volume":"172","author":"Basu","year":"2010","journal-title":"Am. J. Epidemiol."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"1280","DOI":"10.1111\/j.1471-0528.2006.01055.x","article-title":"Seasonal patterns and preterm birth: A systematic review of the literature and an analysis in a London-based cohort","volume":"113","author":"Lee","year":"2006","journal-title":"BJOG Int. J. Obstet. Gynaecol."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"1492","DOI":"10.1093\/humrep\/dep040","article-title":"Trends and seasonality in birth frequency: A comparison of Muslim and Jewish populations in southern Israel: Daily time series analysis of 200 009 births, 1988\u20132005","volume":"24","author":"Friger","year":"2009","journal-title":"Hum. Reprod."},{"key":"ref_55","first-page":"247","article-title":"The Influence of Meteorological Factors and Atmospheric Pollutants on the Risk of Preterm Birth","volume":"185","author":"Pedersen","year":"2017","journal-title":"Am. J. Epidemiol."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"e2145800","DOI":"10.1001\/jamanetworkopen.2021.45800","article-title":"Assessment of Seasonality and Extremely Preterm Birth in Denmark","volume":"5","author":"Hviid","year":"2022","journal-title":"JAMA Netw. Open"},{"key":"ref_57","unstructured":"Ministerul S\u0103n\u0103t\u0103\u0163ii (2020). Mortalitate Perinatala, Institutul National de Sanatate Publica, Centrul Na\u0163ional de Statistic\u0103 \u015fi Informatic\u0103 \u00een S\u0103n\u0103tate Public\u0103."},{"key":"ref_58","unstructured":"Ministerul S\u0103n\u0103t\u0103\u0163ii (2021). Mortalitate Perinatala 2021, Institutul National de Sanatate Publica."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"101568","DOI":"10.1016\/j.siny.2024.101568","article-title":"Surfactant therapy\u2014The conundrum of which infant should be given, when, which drug in what dose via which route of administration?","volume":"29","author":"Diggikar","year":"2024","journal-title":"Semin. Fetal Neonatal Med."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"1797","DOI":"10.1377\/hlthaff.2021.00659","article-title":"In Nigeria, Stillbirths and Newborn Deaths Increased During The COVID-19 Pandemic","volume":"40","author":"Okeke","year":"2021","journal-title":"Health Aff."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"e013021","DOI":"10.1136\/bmjgh-2023-013021","article-title":"Substantial increase in stillbirth rate during the COVID-19 pandemic: Results from a population-based study in the Indian state of Bihar","volume":"8","author":"Dandona","year":"2023","journal-title":"BMJ Glob. Health"},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"e1273","DOI":"10.1016\/S2214-109X(20)30345-4","article-title":"Effect of the COVID-19 pandemic response on intrapartum care, stillbirth, and neonatal mortality outcomes in Nepal: A prospective observational study","volume":"8","author":"Kc","year":"2020","journal-title":"Lancet Glob. Health"},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"215","DOI":"10.1515\/jpm-2023-0280","article-title":"Pregnancy and neonatal outcomes of SARS-CoV-2 infection discovered at the time of delivery: A tertiary center experience in North Italy","volume":"52","author":"Libretti","year":"2024","journal-title":"J. Perinat. Med."},{"key":"ref_64","first-page":"23333928231180561","article-title":"Stillbirth and Preterm Birth During Lockdown Periods in 5 Waves of COVID-19 Pandemic in Northern Iran: A Region-Wide Cohort Study in Mazandaran Province","volume":"10","author":"Farhadi","year":"2023","journal-title":"Health Serv. Res. Manag. Epidemiol."},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"491.e1","DOI":"10.1016\/j.ajog.2022.04.022","article-title":"Increase in preterm stillbirths in association with reduction in iatrogenic preterm births during COVID-19 lockdown in Australia: A multicenter cohort study","volume":"227","author":"Hui","year":"2022","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"395","DOI":"10.1007\/s10995-022-03585-1","article-title":"Disruptions in Accessing Women\u2019s Health Care Services: Evidence Using COVID-19 Health Services Disruption Survey","volume":"27","author":"Padmajam","year":"2023","journal-title":"Matern. Child Health J."},{"key":"ref_67","doi-asserted-by":"crossref","unstructured":"Ilea, C.D.N., Daina, M.D., Venter, A.C., \u0218uteu, C.L., Sab\u0103u, M., Badau, D., and Daina, L.G. (2023). The Motivation of Medical Staff and the Work Interestedness in the Context of the COVID-19 Pandemic, in a Tertiary Hospital in Romania. Healthcare, 11.","DOI":"10.3390\/healthcare11060813"},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"1405","DOI":"10.1097\/AOG.0000000000005412","article-title":"Obstetric Intervention and Perinatal Outcomes During the Coronavirus Disease 2019 (COVID-19) Pandemic","volume":"142","author":"Simon","year":"2023","journal-title":"Obstet. Gynecol."},{"key":"ref_69","doi-asserted-by":"crossref","unstructured":"Militaru, A., Armean, P., Ghita, N., and Andrei, D.P. (2025). Barriers to Healthcare Access During the Coronavirus Disease 2019 (COVID-19) Pandemic: A Cross-Sectional Study Among Romanian Patients with Chronic Illnesses and Confirmed SARS-CoV-2 Infection. Healthcare, 13.","DOI":"10.3390\/healthcare13111333"},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"384","DOI":"10.1057\/s41304-022-00383-9","article-title":"We are in this together: Stakeholder cooperation during COVID-19 in Romania","volume":"22","author":"Volintiru","year":"2023","journal-title":"Eur. Political Sci."}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/61\/8\/1398\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T18:20:52Z","timestamp":1760034052000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/61\/8\/1398"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,8,1]]},"references-count":70,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2025,8]]}},"alternative-id":["medicina61081398"],"URL":"https:\/\/doi.org\/10.3390\/medicina61081398","relation":{},"ISSN":["1648-9144"],"issn-type":[{"value":"1648-9144","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,8,1]]}}}