COVID-19 and Recurrent Pregnancy Loss: Impact of Deferred Care on Perinatal Outcomes of Socio-Economically Diverse Population

Recurrent pregnancy loss (RPL), defined as two pregnancy losses before 20 weeks from the last recorded period, occurs in up to 5% of all couples trying to conceive. The complexity of the pregnancy period can dramatically increase if women experience pregnancy loss. The management of RPL involves a multidisciplinary approach to diagnose and treat any potential cause(s) of the recurrent losses and to provide emotional support. Due to the COVID-19 pandemic, the community has been isolating for several months, which comes with significant inherent stress, and has impacted the quality of pregnancy care. The full extent of the pandemic's impact on RPL and comprehensive healthcare needs has yet to be determined. The British Columbia (BC) RPL Clinic is a specialized care centre providing care for RPL patients over the past 15 years. The overall goal of this study is to examine the impact of the deferred care due to the COVID-19 pandemic on the delivery of multidisciplinary care for RPL patients, and assess how to maintain care in periods of social disruption. Using the existing RPL prospective study data (n=650), and linkage with the BC Perinatal Data Registry (BCPDR) that collects data for all births in BC, we will analyze how the pandemic has impacted access to and use of the multidisciplinary RPL care, and pregnancy outcomes in the RPL population. The RPL database will be divided into pre-COVID-19 pandemic phase (March 1, 2018 and February 28, 2020), and COVID-19 pandemic phase (March 1, 2020 and August 31, 2022). Our analysis will identify risk factors for adverse perinatal outcomes and propose tailored interventions for high-risk women (e.g., mandatory in-person visits) in order to reduce the adverse pandemic-related effects. Our findings will offer insight into the impact of the COVID-19 pandemic on reproductive health care, and generate evidence to inform clinical practice and policy concerning RPL management.