A study of New York City mothers enrolled in the NYU Children’s Health and Environment Study (NYU CHES) suggested the early months of the pandemic resulted in fewer women planning or attempting to become pregnant, which may have long-term effects on fertility rates.

In the cross-sectional study of 1,179 mothers, published in JAMA Network Open, nearly half of women who had been trying to become pregnant reported that they had ceased attempting to conceive in the first few months of the city’s initial COVID-19 wave in April 2020. More than a third who had been contemplating trying for pregnancy pre-COVID reported they were no longer considering it. Further, fewer than half those women who ceased trying to become pregnant thought they would resume trying after the pandemic.

Though early evidence drawn from vital statistics data has demonstrated a steeper decline in U.S. births since the onset of the pandemic, this is the first epidemiologic study of U.S. women in an area heavily impacted by COVID-19.

Impact on Decision-making

The pandemic appears to have exacerbated existing social and financial pressures that were already negatively impacting pregnancy intention and, consequently, the U.S. birth rate. The study’s findings indicated that women with higher stress levels, lower education, and greater financial insecurity were more likely to cease trying or planning to become pregnant.

“Women’s decision-making when it comes to building families tends to track closely with financial and social dynamics,” notes Linda G. Kahn, PhD, MPH, assistant professor in pediatrics and population health. “The COVID-19 pandemic has exposed underlying weaknesses in our social support system for women and families, and appears to be accelerating a decline in the U.S. birth rate that began with the 2008 recession.”

More Research Opportunities

One of NYU Langone’s largest National Institutes of Health-funded studies, the NYU CHES database contains bio samples and exposure data from more than 3,500 New York City women enrolled during the first trimester of pregnancy. The cohort represents a diverse cross-section of race, ethnicity, education, and incomes. Data gathered are used to examine environmental impacts on pregnant women and their children.

“It would be interesting to investigate whether similar declines in pregnancy intention followed outbreaks in other ‘hotspots’ across the nation, as well as whether the availability of vaccination has moderated this response.”

Linda G. Kahn, PhD, MPH

According to Dr. Kahn and co-author Shilpi S. Mehta-Lee, MD, clinical associate professor in obstetrics and gynecology and site director for the Division of Maternal-Fetal Medicine at NYU Langone Hospital-Brooklyn, geographic information in the database affords unique research opportunities.

Considerations for Pregnancy Delay

In addition to the broader economic and social ramifications of a declining birth rate in conjunction with an aging population, postponing pregnancy has consequences on the individual level.

Older women may require costly fertility treatments when they are ready to conceive, an option that is out of reach for many and one that is not without risks to women and infants, the researchers say.

“Delaying childbearing creates several downstream clinical risks for women, including pregnancy complications such as hypertension and cardiovascular conditions associated with advanced maternal age and fertility treatments,” notes Dr. Mehta-Lee. “Assisted reproduction is not always the panacea patients assume it is, so we need to keep these factors in mind when counseling patients about their ability to have children later in life.”