Prolonged wartime exposure in northern Israel did not increase preterm birth rates or adverse neonatal outcomes
Background
Maternal psychological stress is a known factor associated with adverse obstetric and neonatal outcomes, notably preterm birth and low birthweight. Warfare represents an extreme and prolonged source of acute and chronic stress, yet its specific impact on pregnancy outcomes remains largely undefined. Understanding this relationship is crucial for public health planning and maternal care in conflict zones, as current assumptions often link high stress directly to poorer birth outcomes, potentially leading to over-medicalization or misdirected interventions.
Study Design
This retrospective cohort study analyzed 699 deliveries at ZIV Medical Center during a 6-month conflict period (post-October 7, 2023) and compared them to 7821 pre-war deliveries from 2021 until October 6, 2023. The primary outcome was preterm birth (<37 weeks). Secondary outcomes included early preterm birth (<34 weeks), rates of labor induction, mode of delivery, maternal complications, and neonatal outcomes. Multivariate logistic regression was employed to identify independent predictors of preterm birth, controlling for potential confounders.
Results
Despite prolonged wartime exposure, preterm birth rates were found to be similar between the conflict and pre-war cohorts. Specifically, preterm birth (<37 weeks) was 6.6% during the conflict versus 5.5% pre-war, and early preterm birth (<34 weeks) was 2.1% versus 1.5%. Notably, labor induction rates were significantly lower during the conflict period: oxytocin use dropped from 38.7% to 23.7%, cervical ripening balloon use from 7.7% to 3.3%, and prostaglandins from 6.5% to 4.1%. This reduction in intervention coincided with a decrease in maternal complications, including postpartum hemorrhage, which fell from 12% pre-war to 7.9% during the conflict. Neonatal outcomes, such as birthweight distribution, NICU admissions, and survival rates, remained comparable or showed slight improvements.
Prolonged wartime exposure was not associated with increased rates of preterm birth or adverse neonatal outcomes, challenging assumptions about direct negative impacts of acute stress on these specific metrics.
Key Findings
- Preterm birth rates (<37 weeks) were similar during conflict (6.6%) vs. pre-war (5.5%).
- Early preterm birth rates (<34 weeks) were similar during conflict (2.1%) vs. pre-war (1.5%).
- Labor induction with
oxytocindecreased significantly from 38.7% pre-war to 23.7% during conflict. - Postpartum hemorrhage rates decreased from 12% pre-war to 7.9% during conflict.
- Neonatal outcomes (birthweight,
NICUadmissions, survival) were comparable or slightly improved.
Why It Matters
This study offers a counter-intuitive but significant finding: prolonged wartime stress does not automatically translate into increased preterm birth rates or adverse neonatal outcomes. This suggests a remarkable resilience in maternal and fetal health, even under extreme duress. For clinicians and public health officials in conflict zones, this implies that while stress mitigation is important, resources might be better focused on other critical aspects of maternal care rather than solely on preventing stress-induced preterm births. The observed reduction in obstetric interventions and maternal complications during wartime also warrants further investigation, potentially highlighting areas where routine medical practices could be re-evaluated for necessity, though causality cannot be established from this study. This research shifts the narrative from inevitable negative outcomes to one of potential resilience and adaptation.
war
stress
preterm-birth
neonatal-outcomes
israel
obstetrics