Impact of the COVID-19 pandemic on obstetrical care and maternal, perinatal and early childhood outcomes in Ontario

A central goal of pregnancy care is to give children the best possible start in life through improving the health of mothers and identifying/modifying risk factors. The COVID-19 pandemic has resulted in profound system-wide changes in pregnancy care. Virtual care was rapidly introduced to reduce in-person prenatal visits, to reduce spread of infection. In the third wave of the pandemic, severe illness in pregnancy increased across Canada. In some cases, severe COVID-19 infection in pregnancy requires delivery of premature infants to improve the health of the mother; prematurity can have significant negative long-term health effects for children and their families. In response to the rise in severe illness in pregnancy, pregnant women were prioritized for COVID-19 vaccination. Vaccination in pregnancy and during breastfeeding may confer protection to children after birth, but the impact of vaccination on early childhood outcomes is not yet determined. The impact of (i) new patterns of pregnancy care, (ii) the burden of COVID-19 infection itself in pregnancy, and (iii) vaccine uptake in pregnancy on outcomes of children, is largely unknown. Further investigation is warranted to determine if changes in obstetrical care (eg. virtual care) may be safely continued in subsequent lockdowns and after the pandemic, and to evaluate perinatal and childhood outcomes after COVID-19 infection and/or vaccination in pregnancy. Increasing knowledge of the safety/ benefits of vaccination in pregnancy is important to inform decision-making. COVID-19 is not a socially neutral disease: marginalized populations are disproportionately affected with COVID-19 infection. Health outcomes of children born to affected mothers may inform interventions aimed to further reduce directly-related and indirectly-related health inequities for these children in Ontario. We will engage families of babies born prematurely during the pandemic to discuss supports that may improve their long-term outcomes.