BACKGROUND: Despite concerns about worsening pregnancy outcomes resulting from healthcare restrictions, economic difficulties and increased stress during the COVID-19 pandemic, preterm birth (PTB) rates declined in some countries in 2020, while stillbirth rates appeared stable. Like other shocks, the pandemic may have exacerbated existing socioeconomic disparities in pregnancy, but this remains to be established. Our objective was to investigate changes in PTB and stillbirth by socioeconomic status (SES) in European countries. METHODS: The Euro-Peristat network implemented this study within the Population Health Information Research Infrastructure (PHIRI) project. A common data model was developed to collect aggregated tables from routine birth data for 2015-2020. SES was based on mother's educational level or area-level deprivation/maternal occupation if education was unavailable and harmonized into low, medium and high SES. Country-specific relative risks (RRs) of PTB and stillbirth for March to December 2020, adjusted for linear trends from 2015 to 2019, by SES group were pooled using random effects meta-analysis. RESULTS: Twenty-one countries provided data on perinatal outcomes by SES. PTB declined by an average 4% in 2020 {pooled RR: 0.96 [95% confidence intervals (CIs): 0.94-0.97]} with similar estimates across all SES groups. Stillbirths rose by 5% [RR: 1.05 (95% CI: 0.99-1.10)], with increases of between 3 and 6% across the three SES groups, with overlapping confidence limits. CONCLUSIONS: PTB decreases were similar regardless of SES group, while stillbirth rates rose without marked differences between groups.

3rd Faculty of Medicine Charles University Prague Czechia

Centre for Network Biomedical Research in Epidemiology and Public Health Madrid Spain

Denmark Statistics Copenhagen Denmark

Department for Research Studies Assessment and Statistics French Ministry of Health Paris France

Department of Child Life and Health University of Edinburgh Edinburgh UK

Department of Epidemiology and Biostatistics National Research Institute of Mother and Child Warsaw Poland

Department of Epidemiology and Statistics Directorate of Health Luxembourg Luxembourg

Department of Evaluation and Analysis Epidemiology and Methodological Support Unit Karolinska Institute Stockholm Sweden

Department of Health Sciences College of Life Sciences University of Leicester Leicester UK

Department of Knowledge Brokers THL Finnish Institute for Health and Welfare Helsinki Finland

Department of Obstetrics and Gynecology Research Unit University Medical Centre Ljubljana Slovenia

Department of Public Health University of Copenhagen Copenhagen Denmark

Directorate for Social Statistics and Welfare Italian Statistical Institute Rome Italy

Division of Mental and Physical Health Norwegian Institute of Public Health Bergen Norway

Division of Obstetrics and Feto Maternal Medicine Department of Obstetrics and Gynecology Medical University of Vienna Vienna Austria

Division of Public Health Croatian Institute of Public Health Zagreb Croatia

EPIUnit University of Porto Porto Portugal

Estonian Institute for Population Studies Tallinn University Tallinn Estonia

Federal Statistical Office Neuchâtel Switzerland

Health Monitoring Unit Ministry of Health Nicosia Cyprus

Health Statistics Department Health Information Centre Institute of Hygiene Vilnius Lithuania

Information Services Division Public Health Scotland Edinburgh UK

Institute for the Care of Mother and Child Prague Czechia

Institute of Molecular Medicine and Surgery Karolinska Institute Stockholm Sweden

National Health Information Center Bratislava Slovakia

National Obstetric Information System Directorate for Health Information and Research Pieta Malta

Obstetrical Perinatal and Pediatric Epidemiology Research Team INSERM INRAE Paris Cité University Paris France

Public Health and Preventive Medicine Department University of Valencia Valencia Spain

Public Health General Directorate Valencia Regional Public Health Authority Valencia Spain

Social Data Department Institute for Quality Assurance and Transparency in Healthcare Berlin Germany

The Centre for Disease Prevention and Control of Latvia Riga Latvia

The National Perinatal Reporting System Health Pricing Office Dublin Ireland

The Netherlands Perinatal Registry Utrecht Netherlands

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