Every three months, the HDR UK Impact Committee consider dozens of articles and select the most impactful examples, ranked against core pillars of the HDR UK ethos: research quality, team science, scale, open science, patient and public involvement, patient impact and diversity.

In July, the committee chose Changes in preterm birth and stillbirth during COVID-19 lockdowns in 26 countries’ by Calvert et al., as their winning publication, amongst strong competition.

The challenge 

This study explored changes to preterm birth and stillbirth, in the context of Covid-19 lockdowns. Preterm birth is the leading cause of infant mortality worldwide and can lead to a range of adverse outcomes across the life course. Whilst previous studies had highlighted large variation in changes to preterm birth rates and stillbirths at a country-by-country level, it was unclear whether this was due to differences in lockdown impacts, or influenced by other elements, such as the study design, or underlying differences in rates.

Additionally, although most preterm births happen spontaneously, some are planned to reduce other risks, including stillbirth. Previous studies had tended to look at preterm birth alone, without contextualising it in relation to stillbirths, thus leaving us unable to tell whether changes in preterm births led to positive or negative outcomes.

The solution

To work out the answer to these questions, the authors analysed an impressive 52 million births from 26 countries. Their findings indicated small relative overall reductions in the rates of preterm births following lockdown. When stratified by income level, the reductions in spontaneous preterm births were only seen in high-income countries. However, these reductions in preterm births did not appear to be associated with increases in stillbirths among high-income countries, with the exception of Brazil. Although the changes seen were relatively small, at a global level, this study suggests that around 50,000 preterm births were averted in the first month of lockdown alone. Understanding more about why this happened has the potential for implications in clinical practice.

The impact

The committee scored this paper highly in the team science and scale categories and were impressed with this large-scale multi-site global study. Methods were clearly described and code was available from the authors, with signposting to data access through respective controllers. Of particular note was the Patient and Public Involvement and Engagement (PPIE) aspects of this study, which included patient representatives in each country, with the paper including a supplementary discussion section written by the public and patient partners. The committee scored this paper highly for the potential for important real-world impact.

HDR UK is acknowledged as a source of funding.