HCR.20.084 – Exploring the link between COVID-19 lockdown measures and perinatal outcomes using natural experiments

Route: Health care research, sickness prevention and treatment

Cluster question: 091 Pregnancy, childbirth, and menopause - can we make them better for women?

Preterm birth is the primary contributor to early-life mortality and morbidity worldwide, but opportunities for prevention are extremely limited. Substantial reductions in preterm births have emerged as a remarkable bystander effect of national COVID-19 lockdown measures in the Netherlands (−15 to −23%) and elsewhere (up to −90%). This natural experiment provides a unique opportunity to assess causality of hotly debated risk factors for preterm birth and to explore underlying mechanisms.

The world changed rapidly in a myriad of ways following spread of the COVID-19 pandemic and consequential lockdown measures. Travel restrictions led to unprecedented reductions in air pollution, and viral infection rates dropped as a result of physical distancing and hygienic measures. Work-home balance changed for many women, impacting stress levels, as did care-seeking behaviour and care provision. Such alterations likely differentially affected various subgroups of pregnant women. We will employ robust quasi-experimental techniques to explore the contributions of each of these factors to the observed link between lockdown measures and changes in perinatal outcomes.

This truly multidisciplinary consortium will bring together expertise from academia, governmental bodies, non-profit organisations, and public representatives. Longitudinal pregnancy and neonatal data from the national perinatal registry will be used to explore chronological changes in care seeking and provision, and will be linked to socio-economic indicators and spatio-temporal patterning of air quality. Ongoing data collection within the Generation R Next pregnancy/birth cohort provides a unique opportunity to explore biological mechanisms through quantifying biomarkers for pollution exposure, stress and inflammation, and assessing epigenome-wide changes in DNA methylation. Our participation in the global iPOP consortium, a growing international network investigating the link between lockdown measures and perinatal outcomes, allows rapid bidirectional knowledge transfer. Through unravelling key mechanisms responsible for preterm birth reductions, our project has the potential to inform future development of much-needed novel preventive strategies.


air pollution, antenatal care, COVID-19, Infection, lockdown, maternal stress, natural experiment, Pregnancy, Preterm birth, Prevention

Other organisations

Amsterdam UMC, Erasmus School of Economics, Generation R Next, iPOP collaboration, Perined, Rijksinstituut voor Volksgezondheid en Milieu (RIVM), Usher Institute (The University of Edinburgh), Vereniging van Ouders van Couveusekinderen


Organisation Erasmus MC (EMC)
Name Dr. J.V. (Jasper) Been
E-mail j.been@erasmusmc.nl
Website https://www.erasmusmc.nl/en/sophia/research/researchers/been-jasper