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\begin{document}

\title{Obstetrics state in non-epizootic area during early epidemic of COVID-19}



\author[1]{Chao Ji}%
\author[1]{Jiongbo Wang}%
\author[2]{Yichen Qin}%
\author[1]{Xipeng Zhang}%
\author[1]{Qian Zhang}%
\affil[1]{Qingdao Municipal Hospital Group}%
\affil[2]{The Third People's Hospital of Qingdao}%


\vspace{-1em}



  
  \date{May 08, 2024}


\begingroup
\let\center\flushleft
\let\endcenter\endflushleft
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\endgroup





\selectlanguage{english}
\begin{abstract}
Abstract Objective To study the impacts of obstetric complications and
anxiety among pregnant women in non-epizootic area which are caused by
COVID-19. Design Retrospective cohort. Setting China. Population or
sample the women who delivered in the third trimester of pregnancy in
Qingdao Municipal hospital for the year the months March and April, 2019
and 2020. Method This paper is based on the clinical data from This
paper makes a detailed analysis of the problems that can arise because
of special circumstances related with delivery history, personal
physical symptoms, anxiety index, adverse complications as well as
neonatal birth weight. Result Comparing with the same period between
2019 and 2020, maternal age(32.12\selectlanguage{ngerman}±5.32vs31.01±4.21, P\textless{}0.05)
and the ratio of macrosomia(12.10\%vs2.53\%)are increasing steadily.
Meanwhile, times of prenatal visits (10.49±2.15vs10.89±1.81,
P\textless{}0.05) and score of PHQ-9\selectlanguage{english}(1.46+-2.09vs4.96+-1.38,
P\textless{}0.05\selectlanguage{english})are to fall significantly\begin{CJK}{UTF8}{gbsn}。 \end{CJK}\selectlanguage{english}Conclusion It is helpful
to relieve the negative emotion of fear and anxiousness for the pregnant
women if they can be encouraged and soothed by social support. The
leading cause why regular checkups are decreasing is due to the fear of
the epidemic and the transport restrictions, which, in return, may
result in a lack of effective management in fetal weight. The COVID-19
had no giant effect on the third trimester of pregnant women. Government
as well as obstetric practitioners should strengthen the education of
fetal weight management during the pregnancy. Keywords Pregnancy;
COVID-19; obstetric complications; anxiety Tweetable abstract The
COVID-19 had no giant effect on the third trimester of pregnant women in
the non-epizootic area China.%
\end{abstract}%



\sloppy


Obstetrics state in non-epizootic area during early epidemic of COVID-19

Chao Ji\textsuperscript{a}, Jiongbo Wang\textsuperscript{a}, Yichen
Qin\textsuperscript{b}, Xipeng Zhang\textsuperscript{a}, Qian
Zhang\textsuperscript{a}*

a. Qingdao Municipal Hospital, 266011, Qingdao, China

b. The Third People's Hospital of Qingdao, 266041,Qingdao, China

Corresponding author

Name: Qian Zhang

Address: Qingdao Municipal Hospital, 266011, Qingdao, China

Telephone number: +86-18561728229

Email:\emph{zhangqian6368@sina.com}

\textbf{Running title}

Obstetrics state during early epidemic of COVID-19

\textbf{Abstract}

\textbf{Objective}

To study the impacts of obstetric complications and anxiety among
pregnant women in non-epizootic area which are caused by COVID-19.

\textbf{Design}

Retrospective cohort.

\textbf{Setting}

China.

\textbf{Population or sample}

the women who delivered in the third trimester of pregnancy in Qingdao
Municipal hospital for the year the months March and April, 2019 and
2020.

\textbf{Method}

This paper is based on the clinical data from This paper makes a
detailed analysis of the problems that can arise because of special
circumstances related with delivery history, personal physical symptoms,
anxiety index, adverse complications as well as neonatal birth weight.

\textbf{Result}

Comparing with the same period between 2019 and 2020, maternal
age(32.12\selectlanguage{ngerman}±5.32vs31.01±4.21, P\textless{}0.05) and the ratio of
macrosomia(12.10\%vs2.53\%)are increasing steadily. Meanwhile, times of
prenatal visits (10.49±2.15vs10.89±1.81, P\textless{}0.05) and score of
PHQ-9\selectlanguage{english}(1.46+-2.09vs4.96+-1.38, P\textless{}0.05\selectlanguage{english})are to fall
significantly\begin{CJK}{UTF8}{gbsn}。

\end{CJK}\selectlanguage{english}\textbf{Conclusion}

It is helpful to relieve the negative emotion of fear and anxiousness
for the pregnant women if they can be encouraged and soothed by social
support. The leading cause why regular checkups are decreasing is due to
the fear of the epidemic and the transport restrictions, which, in
return, may result in a lack of effective management in fetal weight.
The COVID-19 had no giant effect on the third trimester of pregnant
women. Government as well as obstetric practitioners should strengthen
the education of fetal weight management during the pregnancy.

\textbf{Keywords}

Pregnancy; COVID-19; obstetric complications; anxiety

\textbf{Tweetable abstract}

The COVID-19 had no giant effect on the third trimester of pregnant
women in the non-epizootic area China.

\textbf{Funding}

No funding.

\textbf{Introduction}

A deadly virus called coronavirus disease 2019(COVID-19)is running
rampant across the globe. The first cases of COVID-19 were reported from
Wuhan, China in Jan,2020 and spread across continents with an increasing
number of cases and deaths day by day. On January 30, 2020, the World
Health Organization (WHO) labeled the outbreak as a Public Health
Emergency of International Concern (PHEIC).~On February 12, 2020, the
WHO named the disease, caused by this coronavirus, ''Coronavirus Disease
2019 (COVID-19)''.~ More than 12million people worldwide have been
infected with COVID-19 and 500 thousands people have died because of an
infection with COVID-19.The WHO asserted that along the most common way
of infection by respiratory droplets, is a transmission by aerosol,
person-to-person and surface possible.

Although it failed to prove that pregnant women, as a vulnerable group
of people, suffer from high risk of vertical transmission of COVID-19 in
the late third trimester reported\textsuperscript{{[}1{]}}, they still
be frightened and need additional precautions. Not only the
immunosuppression of pregnancy, such as gestational diabetes mellitus
(GDM) and preeclampsia, may impact severity of symptoms caused by
COVID-19, also the negative emotions like anxiety, depression and stress
can have a negative effect. The social instability also has negative
influence on pregnant women which may lead to a passive perinatal
outcome. Based on current researches, more attention was paid to the
COVID-19 infected pregnant women. Few obstetric original researches
existed about adverse~impact on the health of pregnant women in the
non-epizootic area.

{\label{although-it-failed-to-prove-that-pregnant-women-as-a-vulnerable-group-of-people-suffer-from-high-risk-of-vertical-transmission-of-covid-19-in-the-late-third-trimester-reported1-they-still-be-frightened-and-need-additional-precautions.-not-only-the-immunosuppression-of-pregnancy-such-as-gestational-diabetes-mellitus-gdm-and-preeclampsia-may-impact-severity-of-symptoms-caused-by-covid-19-also-the-negative-emotions-like-anxiety-depression-and-stress-can-have-a-negative-effect.-the-social-instability-also-has-negative-influence-on-pregnant-women-which-may-lead-to-a-passive-perinatal-outcome.-based-on-current-researches-more-attention-was-paid-to-the-covid-19-infected-pregnant-women.-few-obstetric-original-researches-existed-about-adverseimpact-on-the-health-of-pregnant-women-in-the-non-epizootic-area.}}

Given the importance of the issue and the lack of sufficient evidence,
the present study aimed to review obstetric data of our hospital to find
out the influence of this disease on the Chinese pregnant women.

{\label{given-the-importance-of-the-issue-and-the-lack-of-sufficient-evidence-the-present-study-aimed-to-review-obstetric-data-of-our-hospital-to-find-out-the-influence-of-this-disease-on-the-chinese-pregnant-women.}}



\section*{Materials and methods}

{\label{materials-and-methods}}

We conducted a retrospective by reviewing 822 medical records of
delivered women whom admitted to Qingdao~Municipal~Hospital from March 1
to April 30, 2019 and 2020.Information we collected can be summarized as
follows. The maternal characteristics which include delivery history,
personal physical signs, adverse complications as well as neonatal birth
weight were analyzed. The patient health questionnaire(PHQ-9) is the
tool for anxiety evaluation. All information was obtained from a
customized data collection form. We compared the data of two years and
found evidence to prove the detriment due to COVID-19.All descriptive
and statistical analyses were performed using SPSS version 26.0. A p
value of less than 0.05 was considered to indicate statistical
significance (two-sided).

{\label{we-conducted-a-retrospective-by-reviewing-822-medical-records-of-delivered-women-whom-admitted-to-qingdaomunicipalhospital-from-march-1-to-april-30-2019-and-2020.information-we-collected-can-be-summarized-as-follows.-the-maternal-characteristics-which-include-delivery-history-personal-physical-signs-adverse-complications-as-well-as-neonatal-birth-weight-were-analyzed.-the-patient-health-questionnairephq-9-is-the-tool-for-anxiety-evaluation.-all-information-was-obtained-from-a-customized-data-collection-form.-we-compared-the-data-of-two-years-and-found-evidence-to-prove-the-detriment-due-to-covid-19.all-descriptive-and-statistical-analyses-were-performed-using-spss-version-26.0.-a-p-value-of-less-than-0.05-was-considered-to-indicate-statistical-significance-two-sided.}}



\section*{Result}

{\label{result}}

A total 822 pregnant women were involved into our research and 347
delivered in 2020 and the rest in 2019. The table 1 lists the comparison
of two groups about mother characteristics. Maternal age
(32.12\selectlanguage{ngerman}±5.32vs31.01±4.21) and times of prenatal visits
(10.49±2.15vs10.89±1.81) had the remarkable statistical
significance(P\textless{}0.05). Score of PHQ-9 in 2019(4.96±1.38) was
higher than it in 2020(1.46±2.09)(P\textless{}0.05). There was no
conspicuous distinction in Gestational weight gain (GWG).

{\label{a-total-822-pregnant-women-were-involved-into-our-research-and-347-delivered-in-2020-and-the-rest-in-2019.-the-table-1-lists-the-comparison-of-two-groups-about-mother-characteristics.-maternal-age-32.125.32vs31.014.21-and-times-of-prenatal-visits-10.492.15vs10.891.81-had-the-remarkable-statistical-significancep0.05.-score-of-phq-9-in-20194.961.38-was-higher-than-it-in-20201.462.09p0.05.-there-was-no-conspicuous-distinction-in-gestational-weight-gain-gwg.}}

On the concept of adverse complication, macrosomia(n=12) was the unique
meaningfully contrastive index in the Table 2. The other complications
failed to perform difference in this two years, as well number of
caesarean.

{\label{on-the-concept-of-adverse-complication-macrosomian12-was-the-unique-meaningfully-contrastive-index-in-the-table-2.-the-other-complications-failed-to-perform-difference-in-this-two-years-as-well-number-of-caesarean.}}

There were 486 newborn in 2019 and 355 in 2020 according to table 3. The
birth weight of two group (3440.96±540.22vs3371.55±526.24) exhibited the
consistency with P\textgreater{}0.05.

{\label{there-were-486-newborn-in-2019-and-355-in-2020-according-to-table-3.-the-birth-weight-of-two-group-3440.96540.22vs3371.55526.24-exhibited-the-consistency-with-p0.05.}}



\section*{Discussion}

{\label{discussion}}

The WHO constantly publishes the~latest worldwide timeline of the
evolution of the COVID-19.It became a global pandemic due to the
characteristics of high infectivity, transmitting speed and
fatality\textsuperscript{{[}2{]}}. It has spread to over 200 countries
and claimed 50thousands people's lives, since it emerged in 2020.

{\label{the-who-constantly-publishes-thelatest-worldwide-timeline-of-the-evolution-of-the-covid-19.it-became-a-global-pandemic-due-to-the-characteristics-of-high-infectivity-transmitting-speed-and-fatality2.-it-has-spread-to-over-200-countries-and-claimed-50thousands-peoples-lives-since-it-emerged-in-2020.}}

With the development of modern transport, tens of millions of people
have been leaving their homelands in search of a better job or
education. But come the spring festival, not only migrant workers, also
students rush back to their hometown. Due to the increased number of
people travelling during Spring festival, the COVID-19 can spread easier
and faster. Governments take~varying~degrees of preventive~measures,
including asking for mask wearing, shutting down the businesses, schools
and patients quarantine, etc. At present, global surveillance and
control faced with serious challenge, the prevention and control of
COVID-19 infection among pregnant women and the potential hazard of
vertical transmission have come to the concerned schedule. However, the
original research about adverse~impact on the health pregnant women in
the non-epizootic area was rarely.

{\label{with-the-development-of-modern-transport-tens-of-millions-of-people-have-been-leaving-their-homelands-in-search-of-a-better-job-or-education.-but-come-the-spring-festival-not-only-migrant-workers-also-students-rush-back-to-their-hometown.-due-to-the-increased-number-of-people-travelling-during-spring-festival-the-covid-19-can-spread-easier-and-faster.-governments-takevaryingdegrees-of-preventivemeasures-including-asking-for-mask-wearing-shutting-down-the-businesses-schools-and-patients-quarantine-etc.-at-present-global-surveillance-and-control-faced-with-serious-challenge-the-prevention-and-control-of-covid-19-infection-among-pregnant-women-and-the-potential-hazard-of-vertical-transmission-have-come-to-the-concerned-schedule.-however-the-original-research-about-adverseimpact-on-the-health-pregnant-women-in-the-non-epizootic-area-was-rarely.}}



There are three transmission elements of infectious diseases : source of
infection, route of transmission and susceptible population. The
maternal immune system of pregnant women is in a dilemma that it need to
establish immunologic tolerance to the allogeneic fetus, while to defend
the bodies from the invasion of pathogenic microorganisms.~The maternal
immunological states keep being in flux through the pregnant progress.
Pregnancy drives women into a partial immune~deficiency
state\textsuperscript{{[}3{]}}. It takes for granted that pregnant women
own more possibility of infection on account of the COVID-19.Whereas
some latest Chinese researches\textsuperscript{{[}1, 4,
5{]}}drew~the~conclusion that pregnant women presented the equal
opportunity of COVID-19 infection, compared with non-pregnant patients.
This consequence shocks the common sense of the public, but still it may
come to light if more cases are analyzed and geographic limitation is
ruled out. Several evidences could prove the infection insurability
between mothers and fetuses. We must keep vigilant to its potential
risks. Researches prove that infection could activate the immune system
and rise the level of some immune factors such as TNF-\selectlanguage{greek}α \selectlanguage{english}and IL-17a,
which could lead to brain development abnormalities, preterm labor, even
fetal loss\textsuperscript{{[}6, 7{]}}.And fever as the most common and
initial symptom of COVID-19 infection could be associated with increased
attention-deficit/hyperactivity disorder in the
offspring\textsuperscript{{[}3{]}}.

{\label{there-are-three-transmission-elements-of-infectious-diseases-source-of-infection-route-of-transmission-and-susceptible-population.-the-maternal-immune-system-of-pregnant-women-is-in-a-dilemma-that-it-need-to-establish-immunologic-tolerance-to-the-allogeneic-fetus-while-to-defend-the-bodies-from-the-invasion-of-pathogenic-microorganisms.the-maternal-immunological-states-keep-being-in-flux-through-the-pregnant-progress.-pregnancy-drives-women-into-a-partial-immunedeficiency-state3.-it-takes-for-granted-that-pregnant-women-own-more-possibility-of-infection-on-account-of-the-covid-19.whereas-some-latest-chinese-researches1-4-5drewtheconclusion-that-pregnant-women-presented-the-equal-opportunity-of-covid-19-infection-compared-with-non-pregnant-patients.-this-consequence-shocks-the-common-sense-of-the-public-but-still-it-may-come-to-light-if-more-cases-are-analyzed-and-geographic-limitation-is-ruled-out.-several-evidences-could-prove-the-infection-insurability-between-mothers-and-fetuses.-we-must-keep-vigilant-to-its-potential-risks.-researches-prove-that-infection-could-activate-the-immune-system-and-rise-the-level-of-some-immune-factors-such-as-tnf-ux3b1-and-il-17a-which-could-lead-to-brain-development-abnormalities-preterm-labor-even-fetal-loss6-7.and-fever-as-the-most-common-and-initial-symptom-of-covid-19-infection-could-be-associated-with-increased-attention-deficithyperactivity-disorder-in-the-offspring3.}}



It was obviously that the average maternal age of the pregnant in 2020
is more advanced compare with 2019,even merely about one year gap. This
result confirmed the global trend of postponement of child birth, both
in developing and developed countries. An increasing number of
well-educated women whom stepping into the workforce, with better and
higher education, work and socioeconomic pressure, attitude to marriage
and fertility make their maternal age been prolonged continually. The
average age of primipara was 21 years in 1972 and in 2016 it reached
26.3 years\textsuperscript{{[}8{]}}.Advanced maternal age is usually
defined as being 35years, which is believed to relate to varying
complication and adverse outcomes\textsuperscript{{[}9{]}}.In our study,
maternal age of two group women was less than 35 and little different
existed in absolute value. Therefore, the impact of age can be ignored
from the discussion of the result.

{\label{it-was-obviously-that-the-average-maternal-age-of-the-pregnant-in-2020-is-more-advanced-compare-with-2019even-merely-about-one-year-gap.-this-result-confirmed-the-global-trend-of-postponement-of-child-birth-both-in-developing-and-developed-countries.-an-increasing-number-of-well-educated-women-whom-stepping-into-the-workforce-with-better-and-higher-education-work-and-socioeconomic-pressure-attitude-to-marriage-and-fertility-make-their-maternal-age-been-prolonged-continually.-the-average-age-of-primipara-was-21-years-in-1972-and-in-2016-it-reached-26.3-years8.advanced-maternal-age-is-usually-defined-as-being-35years-which-is-believed-to-relate-to-varying-complication-and-adverse-outcomes9.in-our-study-maternal-age-of-two-group-women-was-less-than-35-and-little-different-existed-in-absolute-value.-therefore-the-impact-of-age-can-be-ignored-from-the-discussion-of-the-result.}}



We can precisely find out the recession of quantity of deliveries and
frequency of prenatal visits in 2020 in our research, compared to 2019.
Prenatal care services aim at lowering maternal and neonatal morbidity
and mortality and improving the quality of global population.~By means
of prenatal physical examination, history taking and imagological and
laboratory examination, obstetricscan offer the helpful advice and
suggestion for lifestyles, identify the complications associated with
pregnancy and provide the appropriate treatment, the treatment
that~pregnant women might benefit from. For example, the pregnant women
whose frequency of prenatal visits was insufficient suffered higher risk
of perinatal complications, especially
macrosomia\textsuperscript{{[}10{]}}, which is the same result in our
research. And the prenatal care can efficiently stem the congenital
syphilis cases\textsuperscript{{[}11{]}} and pregnancy-induced
hypertension\textsuperscript{{[}12{]}}.We believe that people,
especially the pregnant, reduce the need of regular hospital check-ups,
even refuse to walk out the door to preventCOVID-19 because of fear and
worry. It also means they chose to cut down the frequency of
prenatal~care services as well as fail to get the professional obstetric
advises from doctors, which might avoid certain obstetric complications.
What's more, it is well-known that the childbearing age women held a
large percentage of floating population and migrant workers. The
non-indigenous pregnant women hold nearly half of the patients of our
clinic. Atthe same time, the Chinese government took a series of
measurements to cut-off the dissemination way. Because of
self-protection of native pregnant and traffic restriction of~ecdemic
ones, the selective prenatal~visits and patient's loss explained the
change of frequency of prenatal visits.

{\label{we-can-precisely-find-out-the-recession-of-quantity-of-deliveries-and-frequency-of-prenatal-visits-in-2020-in-our-research-compared-to-2019.-prenatal-care-services-aim-at-lowering-maternal-and-neonatal-morbidity-and-mortality-and-improving-the-quality-of-global-population.by-means-of-prenatal-physical-examination-history-taking-and-imagological-and-laboratory-examination-obstetricscan-offer-the-helpful-advice-and-suggestion-for-lifestyles-identify-the-complications-associated-with-pregnancy-and-provide-the-appropriate-treatment-the-treatment-thatpregnant-women-might-benefit-from.-for-example-the-pregnant-women-whose-frequency-of-prenatal-visits-was-insufficient-suffered-higher-risk-of-perinatal-complications-especially-macrosomia10-which-is-the-same-result-in-our-research.-and-the-prenatal-care-can-efficiently-stem-the-congenital-syphilis-cases11-and-pregnancy-induced-hypertension12.we-believe-that-people-especially-the-pregnant-reduce-the-need-of-regular-hospital-check-ups-even-refuse-to-walk-out-the-door-to-preventcovid-19-because-of-fear-and-worry.-it-also-means-they-chose-to-cut-down-the-frequency-of-prenatalcare-services-as-well-as-fail-to-get-the-professional-obstetric-advises-from-doctors-which-might-avoid-certain-obstetric-complications.-whats-more-it-is-well-known-that-the-childbearing-age-women-held-a-large-percentage-of-floating-population-and-migrant-workers.-the-non-indigenous-pregnant-women-hold-nearly-half-of-the-patients-of-our-clinic.-atthe-same-time-the-chinese-government-took-a-series-of-measurements-to-cut-off-the-dissemination-way.-because-of-self-protection-of-native-pregnant-and-traffic-restriction-ofecdemic-ones-the-selective-prenatalvisits-and-patients-loss-explained-the-change-of-frequency-of-prenatal-visits.}}

In China, 11.1\% and 10.3\% of pregnant women were suffering from
anxiety and depression, respectively\textsuperscript{{[}13{]}}.On the
surface, pregnancy is a constantly changing process for physiological
structure. In fact, endogenous hormone levels and stimulation from
external environment catalyze psychological activities. It is a
susceptible period that the negative life stuff could lead to prenatal
anxiety and depression, which have been global public health problems in
the last decade \textsuperscript{{[}14{]}}.Except for pregnancy-related
anxiety and depression, the panic for COVID-19, as an updated socially
channel, aggravates these pathogenic factors. During this epidemic, the
worldwide economy suffered a~hard blow. Pregnant women, especially elder
ones, confront salary cuts and unemployment, which threatens their
socioeconomic status, which accelerates depression and age-related
anxiety\textsuperscript{{[}13{]}}. While prenatal anxiety and depression
to a certain extent may be treated as a common occurrence during
pregnancy, an important life-phase for a women, from a girl to a mom,
high levels of them may have long-lasting adversely influence on both
the her behavior and her child's future development, such as preterm
birth\textsuperscript{{[}15{]}}, low birth
weight\textsuperscript{{[}16{]}} and weight
increase\textsuperscript{{[}17{]}}.~Nonetheless, our research failed to
validate the hypothesis above and a opposite result showed. The results
of psychological assessment during hospital admission show equivalent
score of two years' women. Women's weight increase, rate of preterm
birth and neonates' birth weight in our research suggest the parallel
consequence. It turned out that pregnant women, who delivered in March
and April, 2020 avoid the additional anxiety and depression on account
of COVID-19. The feasible explanation is the better family concern. When
it comes to scores of health related quality of life (HRQoL), pregnant
women, especially during the third trimester, got the significantly
lower one than non-pregnant women of the same age, and some
sociodemographic factors which could improve the well-being, involving
the social support and partner support.~Researches declared the
importance of social support during pregnancy, especially family
care\textsuperscript{~{[}16{]}}. Pregnant women who are in absence of
social support tend to be pessimistic and suffer from low self-esteem or
self-worth\textsuperscript{{[}17{]}}. Thanks to the epidemic, less work
makes family members pay more attention to the pregnant ones, which can
moderate the stimulation from life stuff and exoteric environment. When
a pregnant woman gets adequate social support from her family and
friends who provide nutrient-rich diet, physical and mental solicitude,
and medical suggestion, she is motivated to take care of herself which
is a true indicator of her HRQoL, which could decrease negative
affection such as depression and anxiety. Moreover, more consideration
from the partner could elevate marital satisfaction and the pregnant
women who have higher marital satisfaction have a healthier life
attitude, which means satisfying diets and less abnormal psychological
problems\textsuperscript{~{[}18{]}}. A long-term and stable marriage
relationship could increase the happiness and counteract external
pressure from the society.

Meeting the optimal fetal development and sufficient nutrition for
mother is the basic requirement for a healthy, balanced diet. A study
with Asian subjects indicated that the total energy expenditure of women
during their pregnancy was significantly lower than that before they
became pregnant\textsuperscript{{[}19{]}}.In the Chinese tradition, a
big newborn symbolizes jubilation and abundance. Although many women
realize the importance of balanced diet during pregnancy, lack of
professional introduction and food cravings, a strong
impetus\textsuperscript{{[}20{]}}, during pregnancy facilitate excess
calorie intake. As a result, women get more GWG during this period. In
current, thanks to the propaganda and education from obstetric stuff,
Chinese pregnant women have become sensitive and learned to control the
GWG, based on appropriate growth rate of the fetus. This achievement can
be found out in our research that there was no significant disparity of
GWG in 2019 and 2020. However, clinically, less GWG might correspond to
heavier fetal weight. In our study, the average weight of newborns in
2020 was equal to it in 2019, whereas the rate of macrosomia was higher.
Physical activity is the main pathway to accelerate the energy
expenditure. The benefits of physical activity during pregnancy include
improved physical fitness, reduced risk of excessive weight gain,
reduced risk of preeclampsia and pre-term birth, reduced low back pain,
improved sleep, reduced anxiety and depressive symptoms, and improved
health perception and self-reported body
image\textsuperscript{{[}21{]}}.It is recommended that, without medical
restrictions of physical activity and under the applicable exercise
intensity, pregnant women should aim to perform 30 min for most days of
the week with the guidelines published by the United States or 60 min of
aerobic exercise for 2--3 times per week suggested by the Japanese
guidelines\textsuperscript{{[}22{]}}. Nevertheless, the pregnant women
who reach the recommended level of physical activity are in the~minority
both in the developed and developing
countries\textsuperscript{{[}23{]}}.On one hand, the Asia's idea about
lifestyle during duration of pregnancy is highly diverse compared to
western world, especially in China. The~continuation~of the family line
is an extremely important affair in Chinese tradition. Hence pregnant
women spontaneously avoid doing some things which might have negative
influence on pregnancy and fetus and the intensity of exercise is lower
than the occidental. On another hand, A meta-analysis found out an
opposite correlation between physical activity and the occurrence of
macrosomia\textsuperscript{{[}24{]}}. This is a possible explanation for
high level of macrosomia emerging in our study.



\section*{Limitation}

{\label{limitation}}

Our study has the following limitations: First, inconsideration of
Chinese government's effective control and the limited sample resource,
the study we conducted is only in one regional hospital in Qingdao and
the cases were from the same month of two different years. The
quantities and representativeness of sample was finite. Second, as a
cross-sectional design study, we could not identify the ultimate
influence on the pregnant who was in the first two trimesters. Third;
the hospital admission psychological assessment is conducted by PHQ-9
rather than psychologist, which may weaken the accuracy. Thus, the
conclusion can be only for reference for analyzing the global obstetric
situation under the shadow of COVID- 19. Further information could be
collected to verify the validity of our research.

{\label{our-study-has-the-following-limitations-first-inconsideration-of-chinese-governments-effective-control-and-the-limited-sample-resource-the-study-we-conducted-is-only-in-one-regional-hospital-in-qingdao-and-the-cases-were-from-the-same-month-of-two-different-years.-the-quantities-and-representativeness-of-sample-was-finite.-second-as-a-cross-sectional-design-study-we-could-not-identify-the-ultimate-influence-on-the-pregnant-who-was-in-the-first-two-trimesters.-third-the-hospital-admission-psychological-assessment-is-conducted-by-phq-9-rather-than-psychologist-which-may-weaken-the-accuracy.-thus-the-conclusion-can-be-only-for-reference-for-analyzing-the-global-obstetric-situation-under-the-shadow-of-covid--19.-further-information-could-be-collected-to-verify-the-validity-of-our-research.}}



\section*{Conclusion}

{\label{conclusion}}

COVID-19 is a high-scale catastrophes for mankind, not only the severe
symptoms and death rate also may affect pregnant woman in several
aspects. It doesn't only reduce the regular prenatal examination also
reduce the basic exercise during all terms of pregnancy. The government
and medical practitioners should take more measures to enhance the
antenatal care service both online and off and eliminate the indefinite
information. Efficient epidemic control is the fundamental solution to
exclude the negative influence on the pregnant due to COVID-19.

{\label{covid-19-is-a-high-scale-catastrophes-for-mankind-not-only-the-severe-symptoms-and-death-rate-also-may-affect-pregnant-woman-in-several-aspects.-it-doesnt-only-reduce-the-regular-prenatal-examination-also-reduce-the-basic-exercise-during-all-terms-of-pregnancy.-the-government-and-medical-practitioners-should-take-more-measures-to-enhance-the-antenatal-care-service-both-online-and-off-and-eliminate-the-indefinite-information.-efficient-epidemic-control-is-the-fundamental-solution-to-exclude-the-negative-influence-on-the-pregnant-due-to-covid-19.}}



\section*{Disclosure of interests}

{\label{disclosure-of-interests}}

None declared. Completed disclosure of interest forms are available to
view online as supporting information.

\textbf{Contribution to authorship}

Conceptualisation was by Chao Ji and Qian Zhang; data curation was by
Jiongbo Wang , Xipeng Zhang and Xipeng Zhang; formal analysis was by
Chao Ji and Jiongbo Wang; and writing was by Chao Ji, Yichen Qin, Qian
Zhang..

\textbf{Details of ethics approval}

The current study was reviewed and qualified as an exemption by the
Institutional Review Board of Qingdao Municipal Hospital, Qingdao, China
(2020\begin{CJK}{UTF8}{gbsn}临审字第\end{CJK}\selectlanguage{english}052\begin{CJK}{UTF8}{gbsn}号\end{CJK}\selectlanguage{english}) on 29 July 2020. Because the study analyzed publicly
available data, no consent was obtained from the women by the authors.
The principles expressed in the Declaration of Helsinki have been
adhered to.

\textbf{Funding}

No funding.

\textbf{Acknowledgements}

None.



\section*{References}

{\label{references}}

1. H, C., et al., Clinical characteristics and intrauterine vertical
transmission potential of COVID-19 infection in nine pregnant women: a
retrospective review of medical records. Lancet (London, England), 2020.
395(10226): p. 809-815.

2. Singhal, T., A Review of Coronavirus Disease-2019 (COVID-19). Indian
J Pediatr, 2020. 87(4): p. 281-286.

3. H, L., et al., Why are pregnant women susceptible to COVID-19? An
immunological viewpoint. Journal of reproductive immunology, 2020. 139:
p. 103122.

4. H, Z., et al., Clinical analysis of 10 neonates born to mothers with
2019-nCoV pneumonia. Translational pediatrics, 2020. 9(1): p. 51-60.

5. Wang, X., et al., A case of 2019 Novel Coronavirus in a pregnant
woman with preterm delivery. Clin Infect Dis, 2020.

6. GB, C., et al., The maternal interleukin-17a pathway in mice promotes
autism-like phenotypes in offspring. Science (New York, N.Y.), 2016.
351(6276): p. 933-9.

7. M, F., et al., Systemic Inflammatory Response to Malaria During
Pregnancy Is Associated With Pregnancy Loss and Preterm Delivery.
Clinical infectious diseases : an official publication of the Infectious
Diseases Society of America, 2017. 65(10): p. 1729-1735.

8. Quoctrung B, Miller CC. The Age That Women Have Babies: How a Gap
DividesAmerica. Available
athttps://www.nytimes.com/interactive/2018/08/04/upshot/up-birth-age-gap.html?searchResultPosition=,
Accessed October 10, 2019. 1.

9. MA, M., et al., Advanced maternal age pregnancy and its adverse
obstetrical and perinatal outcomes in Ayder comprehensive specialized
hospital, Northern Ethiopia, 2017: a comparative cross-sectional study.
BMC pregnancy and childbirth, 2020. 20(1): p. 60.

10. N, B.Y., et al., Inadequate Prenatal Visit and Home Delivery as
Determinants of Perinatal Outcomes: Does Parity Matter? Journal of
pregnancy, 2019. 2019: p. 9024258.

11. EZ, M., et al., Attributable fraction of congenital syphilis due to
the lack of prenatal care. Revista da Sociedade Brasileira de Medicina
Tropical, 2019. 52: p. e20180532.

12. S, O., et al., Correction: Associations of psychosocial factors with
pregnancy healthy life styles. PloS one, 2018. 13(5): p. e0197389.

13. X, M., et al., The impact of resilience on prenatal anxiety and
depression among pregnant women in Shanghai. Journal of affective
disorders, 2019. 250: p. 57-64.

14. A, B., et al., Identifying the women at risk of antenatal anxiety
and depression: A systematic review. Journal of affective disorders,
2016. 191: p. 62-77.

15. ZB, K. and B. M, The association between pregnancy-specific anxiety
and preterm birth: a cohort study. African health sciences, 2018. 18(3):
p. 569-575.

16. YT, K., et al., Prevalence and Risk Factors of Maternal Anxiety in
Late Pregnancy in China. International journal of environmental research
and public health, 2016. 13(5).

17. A, K., et al., Perceived psychosocial stress and gestational weight
gain among women with gestational diabetes. PloS one, 2017. 12(3): p.
e0174290.

18. S, O., et al., Associations of psychosocial factors with pregnancy
healthy life styles. PloS one, 2018. 13(1): p. e0191723.

19. S, N., et al., Current Insights into Exercise-based Cardiac
Rehabilitation in Patients with Coronary Heart Disease and Chronic Heart
Failure. International journal of sports medicine, 2020.

20. LE, F., et al., Dietary Change during Pregnancy and Women's Reasons
for Change. Nutrients, 2018. 10(8).

21. AL, H., et al., Attitudes, barriers and enablers to physical
activity in pregnant women: a systematic review. Journal of
physiotherapy, 2018. 64(1): p. 24-32.

22. CWH, C., A.Y. E, and L. BMH, Effectiveness of Physical Activity
Interventions on Pregnancy-Related Outcomes among Pregnant Women: A
Systematic Review. International journal of environmental research and
public health, 2019. 16(10).

23. A, L., et al., Relationship between Physical Activity and Health
Related Quality of Life among Pregnant Women. African journal of
reproductive health, 2018. 22(3): p. 80-89.

24. M, M., et al., The impact of physical activity during pregnancy on
maternal weight and obstetric outcomes. Ginekologia polska, 2018. 89(2):
p. 80-88.

\textbf{Supporting information}

\section*{Table 1 Maternal
characteristics}

{\label{table-1-maternal-characteristics}}\selectlanguage{english}
\begin{longtable}[]{@{}llll@{}}
\toprule
\begin{minipage}[b]{0.24\columnwidth}\raggedright\strut
\section*{}

{\label{section-37}}\strut
\end{minipage} & \begin{minipage}[b]{0.24\columnwidth}\raggedright\strut
\section*{\texorpdfstring{2020
(\emph{n~~}=\emph{~~}347)}{2020 (n~~=~~347)}}

{\label{n347}}\strut
\end{minipage} & \begin{minipage}[b]{0.24\columnwidth}\raggedright\strut
\section*{\texorpdfstring{2019(\emph{n~~}=\emph{~~}475)}{2019(n~~=~~475)}}

{\label{n475}}\strut
\end{minipage} & \begin{minipage}[b]{0.24\columnwidth}\raggedright\strut
\section*{P}

{\label{p}}\strut
\end{minipage}\tabularnewline
\midrule
\endhead
\begin{minipage}[t]{0.24\columnwidth}\raggedright\strut
\section*{Maternal age (years)}

{\label{maternal-age-years}}\strut
\end{minipage} & \begin{minipage}[t]{0.24\columnwidth}\raggedright\strut
\selectlanguage{ngerman}\section*{32.12±5.32}

{\label{section-10}}\strut
\end{minipage} & \begin{minipage}[t]{0.24\columnwidth}\raggedright\strut
\selectlanguage{ngerman}\section*{31.01±4.21}

{\label{section-11}}\strut
\end{minipage} & \begin{minipage}[t]{0.24\columnwidth}\raggedright\strut
\section*{0.000*}

{\label{section-12}}\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.24\columnwidth}\raggedright\strut
\section*{Delivery gestational
week(weeks)}

{\label{delivery-gestational-weekweeks}}\strut
\end{minipage} & \begin{minipage}[t]{0.24\columnwidth}\raggedright\strut
\selectlanguage{ngerman}\section*{39.18±2.21}

{\label{section-13}}\strut
\end{minipage} & \begin{minipage}[t]{0.24\columnwidth}\raggedright\strut
\selectlanguage{ngerman}\section*{39.35±1.57}

{\label{section-14}}\strut
\end{minipage} & \begin{minipage}[t]{0.24\columnwidth}\raggedright\strut
\section*{0.202}

{\label{section-15}}\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.24\columnwidth}\raggedright\strut
\section*{Times of pregnancy}

{\label{times-of-pregnancy}}\strut
\end{minipage} & \begin{minipage}[t]{0.24\columnwidth}\raggedright\strut
\selectlanguage{ngerman}\section*{2.14±1.19}

{\label{section-16}}\strut
\end{minipage} & \begin{minipage}[t]{0.24\columnwidth}\raggedright\strut
\selectlanguage{ngerman}\section*{2.07±1.15}

{\label{section-17}}\strut
\end{minipage} & \begin{minipage}[t]{0.24\columnwidth}\raggedright\strut
\section*{0.411}

{\label{section-18}}\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.24\columnwidth}\raggedright\strut
\section*{Times of delivery}

{\label{times-of-delivery}}\strut
\end{minipage} & \begin{minipage}[t]{0.24\columnwidth}\raggedright\strut
\selectlanguage{ngerman}\section*{1.47±0.55}

{\label{section-19}}\strut
\end{minipage} & \begin{minipage}[t]{0.24\columnwidth}\raggedright\strut
\selectlanguage{ngerman}\section*{1.48±0.58}

{\label{section-20}}\strut
\end{minipage} & \begin{minipage}[t]{0.24\columnwidth}\raggedright\strut
\section*{0.937}

{\label{section-21}}\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.24\columnwidth}\raggedright\strut
\section*{\texorpdfstring{Body mass
index(kg/m\textsuperscript{2})}{Body mass index(kg/m2)}}

{\label{body-mass-indexkgm2}}\strut
\end{minipage} & \begin{minipage}[t]{0.24\columnwidth}\raggedright\strut
\selectlanguage{ngerman}\section*{28.40±3.49}

{\label{section-22}}\strut
\end{minipage} & \begin{minipage}[t]{0.24\columnwidth}\raggedright\strut
\selectlanguage{ngerman}\section*{28.23±3.67}

{\label{section-23}}\strut
\end{minipage} & \begin{minipage}[t]{0.24\columnwidth}\raggedright\strut
\section*{0.513}

{\label{section-24}}\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.24\columnwidth}\raggedright\strut
\section*{Times of prenatal visits}

{\label{times-of-prenatal-visits}}\strut
\end{minipage} & \begin{minipage}[t]{0.24\columnwidth}\raggedright\strut
\selectlanguage{ngerman}\section*{10.49±2.15}

{\label{section-25}}\strut
\end{minipage} & \begin{minipage}[t]{0.24\columnwidth}\raggedright\strut
\selectlanguage{ngerman}\section*{10.89±1.81}

{\label{section-26}}\strut
\end{minipage} & \begin{minipage}[t]{0.24\columnwidth}\raggedright\strut
\section*{0.004*}

{\label{section-27}}\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.24\columnwidth}\raggedright\strut
\section*{GWG(kg)}

{\label{gwgkg}}\strut
\end{minipage} & \begin{minipage}[t]{0.24\columnwidth}\raggedright\strut
\selectlanguage{ngerman}\section*{14.99±4.99}

{\label{section-28}}\strut
\end{minipage} & \begin{minipage}[t]{0.24\columnwidth}\raggedright\strut
\selectlanguage{ngerman}\section*{15.61±5.32}

{\label{section-29}}\strut
\end{minipage} & \begin{minipage}[t]{0.24\columnwidth}\raggedright\strut
\section*{0.088}

{\label{section-30}}\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.24\columnwidth}\raggedright\strut
\section*{Length of hospital(days)}

{\label{length-of-hospitaldays}}\strut
\end{minipage} & \begin{minipage}[t]{0.24\columnwidth}\raggedright\strut
\selectlanguage{ngerman}\section*{4.90±1.43}

{\label{section-31}}\strut
\end{minipage} & \begin{minipage}[t]{0.24\columnwidth}\raggedright\strut
\selectlanguage{ngerman}\section*{4.96±1.38}

{\label{section-32}}\strut
\end{minipage} & \begin{minipage}[t]{0.24\columnwidth}\raggedright\strut
\section*{0.553}

{\label{section-33}}\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.24\columnwidth}\raggedright\strut
\section*{Score of PHQ-9}

{\label{score-of-phq-9}}\strut
\end{minipage} & \begin{minipage}[t]{0.24\columnwidth}\raggedright\strut
\selectlanguage{ngerman}\section*{1.46±2.09}

{\label{section-34}}\strut
\end{minipage} & \begin{minipage}[t]{0.24\columnwidth}\raggedright\strut
\selectlanguage{ngerman}\section*{2.02±2.22}

{\label{section-35}}\strut
\end{minipage} & \begin{minipage}[t]{0.24\columnwidth}\raggedright\strut
\section*{0.000*}

{\label{section-36}}\strut
\end{minipage}\tabularnewline
\bottomrule
\end{longtable}



\section*{Table 2Adverse Complication}

{\label{table-2adverse-complication}}\selectlanguage{english}
\begin{longtable}[]{@{}llllll@{}}
\toprule
\begin{minipage}[b]{0.16\columnwidth}\raggedright\strut
\section*{}

{\label{section-88}}\strut
\end{minipage} & \begin{minipage}[b]{0.16\columnwidth}\raggedright\strut
\section*{\texorpdfstring{2020
(\emph{n~~}=\emph{~~}347)}{2020 (n~~=~~347)}}

{\label{n347-1}}\strut
\end{minipage} & \begin{minipage}[b]{0.16\columnwidth}\raggedright\strut
\section*{\texorpdfstring{2020
(\emph{n~~}=\emph{~~}347)}{2020 (n~~=~~347)}}

{\label{n347-2}}\strut
\end{minipage} & \begin{minipage}[b]{0.16\columnwidth}\raggedright\strut
\section*{\texorpdfstring{2019
(\emph{n~~}=\emph{~~}475)}{2019 (n~~=~~475)}}

{\label{n475-1}}\strut
\end{minipage} & \begin{minipage}[b]{0.16\columnwidth}\raggedright\strut
\section*{\texorpdfstring{2019
(\emph{n~~}=\emph{~~}475)}{2019 (n~~=~~475)}}

{\label{n475-2}}\strut
\end{minipage} & \begin{minipage}[b]{0.16\columnwidth}\raggedright\strut
\section*{P}

{\label{p-1}}\strut
\end{minipage}\tabularnewline
\midrule
\endhead
\begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
\section*{}

{\label{section-39}}\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
\section*{n}

{\label{n}}\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
\section*{(\%)}

{\label{section-40}}\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
\section*{n}

{\label{n-1}}\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
\section*{(\%)}

{\label{section-41}}\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
\section*{}

{\label{section-42}}\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
\section*{Number of caesarean}

{\label{number-of-caesarean}}\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
\section*{152}

{\label{section-43}}\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
\section*{43.80}

{\label{section-44}}\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
\section*{191}

{\label{section-45}}\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
\section*{40.21}

{\label{section-46}}\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
\section*{0.302}

{\label{section-47}}\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
\section*{Macrosomia}

{\label{macrosomia}}\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
\section*{42}

{\label{section-48}}\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
\section*{12.10}

{\label{section-49}}\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
\section*{12}

{\label{section-50}}\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
\section*{2.53}

{\label{section-51}}\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
\section*{0.000*}

{\label{section-52}}\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
\section*{Gestational diabetes
mellitus}

{\label{gestational-diabetes-mellitus}}\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
\section*{63}

{\label{section-53}}\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
\section*{18.16}

{\label{section-54}}\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
\section*{108}

{\label{section-55}}\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
\section*{22.74}

{\label{section-56}}\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
\section*{0.110}

{\label{section-57}}\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
\section*{Gestational hypertension}

{\label{gestational-hypertension}}\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
\section*{27}

{\label{section-58}}\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
\section*{7.78}

{\label{section-59}}\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
\section*{35}

{\label{section-60}}\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
\section*{7.37}

{\label{section-61}}\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
\section*{0.825}

{\label{section-62}}\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
\section*{Fetal distress}

{\label{fetal-distress}}\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
\section*{29}

{\label{section-63}}\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
\section*{8.36}

{\label{section-64}}\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
\section*{28}

{\label{section-65}}\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
\section*{5.89}

{\label{section-66}}\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
\section*{0.170}

{\label{section-67}}\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
\section*{Premature rupture of
membrane}

{\label{premature-rupture-of-membrane}}\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
\section*{52}

{\label{section-68}}\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
\section*{14.99}

{\label{section-69}}\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
\section*{60}

{\label{section-70}}\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
\section*{12.63}

{\label{section-71}}\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
\section*{0.331}

{\label{section-72}}\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
\section*{Premature labour}

{\label{premature-labour}}\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
\section*{20}

{\label{section-73}}\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
\section*{5.76}

{\label{section-74}}\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
\section*{24}

{\label{section-75}}\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
\section*{5.05}

{\label{section-76}}\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
\section*{0.655}

{\label{section-77}}\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
\section*{Precipitate labour}

{\label{precipitate-labour}}\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
\section*{22}

{\label{section-78}}\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
\section*{6.34}

{\label{section-79}}\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
\section*{40}

{\label{section-80}}\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
\section*{8.42}

{\label{section-81}}\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
\section*{0.588}

{\label{section-82}}\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
\section*{Postpartum hemorrhage}

{\label{postpartum-hemorrhage}}\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
\section*{19}

{\label{section-83}}\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
\section*{5.48}

{\label{section-84}}\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
\section*{25}

{\label{section-85}}\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
\section*{5.26}

{\label{section-86}}\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
\section*{0.894}

{\label{section-87}}\strut
\end{minipage}\tabularnewline
\bottomrule
\end{longtable}



\section*{Table 3 Neonatal birth
weight}

{\label{table-3-neonatal-birth-weight}}\selectlanguage{english}
\begin{longtable}[]{@{}llll@{}}
\toprule
\begin{minipage}[b]{0.24\columnwidth}\raggedright\strut
\section*{}

{\label{section-93}}\strut
\end{minipage} & \begin{minipage}[b]{0.24\columnwidth}\raggedright\strut
\section*{\texorpdfstring{2020
(\emph{n~~}=\emph{~~}355)}{2020 (n~~=~~355)}}

{\label{n355}}\strut
\end{minipage} & \begin{minipage}[b]{0.24\columnwidth}\raggedright\strut
\section*{\texorpdfstring{2019
(\emph{n~~}=\emph{~}486)}{2019 (n~~=~486)}}

{\label{n486}}\strut
\end{minipage} & \begin{minipage}[b]{0.24\columnwidth}\raggedright\strut
\section*{P}

{\label{p-2}}\strut
\end{minipage}\tabularnewline
\midrule
\endhead
\begin{minipage}[t]{0.24\columnwidth}\raggedright\strut
\section*{Birth weight (g)}

{\label{birth-weight-g}}\strut
\end{minipage} & \begin{minipage}[t]{0.24\columnwidth}\raggedright\strut
\selectlanguage{ngerman}\section*{3440.96±540.22}

{\label{section-90}}\strut
\end{minipage} & \begin{minipage}[t]{0.24\columnwidth}\raggedright\strut
\selectlanguage{ngerman}\section*{3371.55±526.24}

{\label{section-91}}\strut
\end{minipage} & \begin{minipage}[t]{0.24\columnwidth}\raggedright\strut
\section*{0.062}

{\label{section-92}}\strut
\end{minipage}\tabularnewline
\bottomrule
\end{longtable}

\selectlanguage{english}
\FloatBarrier
\end{document}

