Effect of the COVID-19 pandemic on maternal healthcare indices in Southern Iran: an interrupted time series analysis.

Objectives: Epidemics are anticipated to influence the coverage of health services. We assessed the impact of the COVID-19 pandemic on maternal healthcare indices and care providers' performance.

Setting: 1801 maternal healthcare centres under the auspices of Shiraz University of Medical Sciences, Shiraz, Southern Iran.

Participants: Approximately 63 000 pregnant women.

Primary And Secondary Outcome Measures: In this prospective ecological study, interrupted time series analysis was used to model and compare the trend of maternal healthcare indices before and after the COVID-19 pandemic announcement.

Results: The results showed a significant drop in count of preconception healthcare visits, first routine laboratory tests, first trimester prenatal care, first trimester sonography, prenatal screening for birth defects at weeks 11-13, prenatal care visits at weeks 16-20, second routine laboratory tests, second trimester sonography, prenatal care visits at weeks 24-30, prenatal care visits at weeks 31-34, postpartum care visits at days 10-15 and postpartum care visits at days 30-42 with the start of the COVID-19 pandemic (-50% (95% CI -48.68% to -51.36%), -19.67% (95% CI -22.12% to -17.15%), -25.88% (95% CI -28.46% to -23.21%), -23.84% (95% CI -26.26% to -21.34%), -20.16% (95% CI -23.01% to -17.20%), -18.53% (95% CI -21.25% to -15.71%), -28.63% (95% CI -31.03% to -26.14%), -27.48% (95% CI -30.07% to -24.79%), -31.08% (95% CI -33.43% to -28.61%), -31.84% (95% CI -34.35% to -29.23%), 32.55% (95% CI -35.12% to -29.89%) and -39.28% (95% CI -41.59% to -36.88%), respectively). Nevertheless, the trend in coverage of these services showed recovery in the subsequent months (8.36%, 10.55%, 5.74%, 8.01%, 4.40%, 5.06%, 11.20%, 7.58%, 7.38%, 7.80%, 9.59% and 9.61% per month, respectively).

Conclusions: Using ecological data during the COVID-19 pandemic era, we observed a 'level change and slope change' as the major pattern of interruption of maternal healthcare coverage, indicating a possible indirect effect rather than a causative relationship. Such relative predictability might assist with future pandemic planning.