COVID-19疫情對剖腹產的影響

Impact of COVID-19 on cesarean section rates

目標：本研究旨在比較COVID-19疫情對於生產行為與產科介入的改變，並分析疫情前後不同風險的孕產婦之間的差距變化，探討疫情本身是否會加劇台灣持續上升的剖腹產率與催生或引產利用的影響。方法：本研究使用衛生福利部資料科學中心的健保申報資料進行分析，分別以2019年與2021年有分娩事實之孕產婦做為主要研究對象，並根據孕齡或有任一孕期間危險因子來判定是否為高風險族群。研究共納入246,660位產婦，利用差異中的差異分析方法，以多元線性機率模型分析疫情是否會影響不同風險族群間使用剖腹產和催生或引產。結果：不論疫情前後，高風險產婦的剖腹產機率較高（邊際效果=0.077，p<0.001），但催生或引產的機率較低（邊際效果=-0.009，p<0.001）。疫情提高剖腹產的機率，但模型加入控制變項後此效果不顯著（邊際效果=0.003，p=0.138）；疫情也提高催生或引產的機率（邊際效果=0.061，p<0.001），且疫情期間，催生或引產的使用在非高風險族群的使用有較大幅度的增加，使不同風險族群間使用催生或引產的差距擴大（邊際效果=-0.010，p<0.001）。結論：台灣醫療體系面對疫情壓力，雖然疫情前後整體生產模式保持穩定，但額外的產科介入是疫情的代價之一。（台灣衛誌2024；43(5)：477-487）

Objectives: This study aimed to assess whether the COVID-19 pandemic has contributed to an increase in cesarean section (C-section) rates and how it has influenced the utilization of induction among pregnant women with different risk levels. Methods: We used Taiwan National Health Insurance Claims Data linked to the Birth Registry to analyze 246,660 cases of delivery hospitalizations of women in 2019 or 2021. High-risk pregnancies were identified on the basis of maternal age or the presence of medical risk factors during pregnancy. A difference-in-difference approach was adopted, wherein linear probability models were used to assess the impact of the pandemic on C-section and induction rates among different risk groups. Results: Multivariable analysis revealed significant positive associations between pregnancy risk levels and outcomes. High-risk pregnancies were associated with a higher C-section rate (marginal effect = 0.077, p < .001) and a lower induction rate (marginal effect =−0.009, p < .001). Although the pandemic was associated with an increase in C-section rates, this association was not significant (marginal effect = 0.003, p = .138). However, the pandemic had a significant effect on induction rates (marginal effect = 0.061, p < .001), with a significant larger difference between high- and low-risk groups during the pandemic (marginal effect =−0.010, p < .001). Conclusions: Although the overall mode of delivery remained stable during the pandemic, the increase in obstetric interventions reflects both the adaptations made by maternity units and the broader impact of pandemic-related stress on healthcare systems. These findings underscore the need to evaluate the long-term effects of such external pressures on obstetric care. (Taiwan J Public Health. 2024;43(5):477-487)