Stillbirths and maternal death have increased dramatically during the coronavirus pandemic, new research suggests.
The findings, which were published in the Lancet Global Health journal, examined 40 studies from 17 countries.
It looked at six million pregnancies for 2020 and provided the first global assessment of the effects of the pandemic on antenatal, birth and postnatal results.
Outcomes were particularly poor in lower and middle-income countries, the study found.
Analysis of the pooled data suggested the chances of having a stillbirth increased by 28 per cent from before the pandemic.
The report said fear of infection by expectant mothers and reduced maternity services could be blamed for the rise.
Data from India and Mexico also showed the risk of mothers dying during pregnancy or childbirth increased by more than a third.
The number of ectopic pregnancies, where the fertilised egg implants itself outside the uterus, increased almost six-fold during the pandemic across all studies.
The report also revealed worsening mental health for pregnant women and new mothers, with six studies reporting an increase in postnatal depression and maternal anxiety.
The surge in poor pregnancy outcomes was probably driven by pressure on healthcare systems caused by Covid-19, rather than lockdown, the report said.
The varying outcomes could be partially explained by inefficiencies in healthcare systems. But different national pandemic responses did not seem to affect the findings.
It was also found that the number of preterm births – those that occur before 37 weeks of pregnancy – dropped significantly in higher-income countries, where maternal services were likely to be of a higher standard.
“The Covid-19 pandemic has had a profound impact on healthcare systems around the world," said Prof Asma Khalil of St George’s University of London, the lead author of the study.
"Disruption to services, nationwide lockdowns, and fear of attending healthcare facilities mean that the adverse effects of Covid-19 are expected to have health consequences that extend beyond the deaths and disease caused by the virus.
"It is clear from our study and others that the disruption caused by the pandemic has led to the avoidable deaths of mothers and babies, especially in low and middle-income countries.
"We urge policymakers and healthcare leaders to prioritise safe, accessible and equitable maternity care within the strategic response to the pandemic and aftermath, to reduce adverse pregnancy outcomes worldwide.”