Abstract Background Although most studies indicate maternal SARS-CoV-2 infection and COVID-19 vaccination are not associated with neonatal birth defects, it is relevant to examine whether the disease burdens changed during the COVID-19 pandemic, as other influencing factors may have also changed. We aimed to compare incidence of congenital anomalies among live births before and during the pandemic. Methods Using public birth data, all live births from 2016 to 2022 in the United States of America (US) were retrospectively included. Incidences of selected congenital anomalies identified from birth certificate, including anencephaly, meningomyelocele/spina bifida, cyanotic congenital heart disease (CCHD), congenital diaphragmatic hernia, omphalocele, gastroschisis, limb reduction defect, cleft lip, cleft palate, Down syndrome, chromosomal disorder, and hypospadias, were estimated and compared by calendar year of birth using logistic regression. Findings: A total of 26,345,765 live-born infants from 2016 to 2022 were included. The mean gestational age of the infants was 38.4 (SD 2.1) weeks, 48.9% were female, and 96.7% were singleton. The overall risk of congenital anomalies peaked in 2018 (3.51‰, 95%CI 3.45-3.57‰) and has since shown a decreasing trend (3.38‰ 3.32 3.44‰ in 2019, and 3.35‰ 3.29-3.41‰ in 2022). Using 2019 as a reference, the risk did not differ in 2020 and 2021 (odds ratio OR 1.01 0.98-1.03 and 1.00 0.98-1.03, respectively, after adjusting for maternal age, ethnicity/race, and socioeconomic status), but it was significantly lower in 2022 (OR 0.97 0.95-0.99). For most congenital anomalies, their risks during the pandemic (2020-2022) remained unchanged or showed a decreasing trend (i.e., gastroschisis, Down syndrome, and hypospadias) compared to 2019. However, CCHD risk was significantly increased since 2019 (59 57-62 per 100,000), peaking in 2021 (68 65-71 per 100,000; OR 1.12 1.05-1.18). The peak in monthly CCHD risk in 2021 occurred approximately 3 months after the peak in monthly COVID-19-caused death in the female general population. These results were consistently observed when stratified by gestational age (≥37 or 37 weeks). Interpretation: Although there was no increase in the overall incidence of congenital anomalies among live births during the COVID-19 pandemic in the US, CCHD risk significantly increased, which warrants further investigation and monitoring.
Chen et al. (Sat,) studied this question.