# IMPACT OF COVID-19 EXPOSURE ON U.S. BIRTH OUTCOMES

> **NIH NIH R21** · UNIVERSITY OF WISCONSIN-MADISON · 2021 · $239,918

## Abstract

THE IMPACT OF COVID-19 ON U.S. BIRTH OUTCOMES
ABSTRACT
The COVID-19 pandemic will shape most domains of life in the US. Among the most enduring will be effects
on the health of the next generation of Americans. Over 4 million pregnancies are currently in progress in the
US. Between 1-3 million pregnancies will be initiated over the next six months. Prenatal exposure to large-
scale health and economic events have serious implications for birth outcomes, including delivery conditions,
pregnancy duration, and birthweight. These outcomes, in turn, predict welfare throughout life—education,
earnings, and even lifespan. Pandemic effects on pregnancy will have implications that last decades.
 Currently we have little systematic population-level evidence on newborn health with which to make
policy decisions about COVID management. Evidence is urgently needed because COVID-19 has shaped
well-established predictors of pregnancy health, including infection exposure, stress, economic precarity, and
health care access. These individual-level factors are shaped by community-level dynamics like infection
spread, distancing policies, and economic decline. Because these factors differ across the U.S., the impact of
COVID-19 on birth outcomes is likely stronger among vulnerable groups defined by location, race, ethnicity,
and socioeconomic disadvantage, potentially exacerbating inequality in infant health.
 This research estimates the effects of COVID-19 on birth outcomes at the population level, over time, and
across groups defined by different sources of disadvantage. To provide the earliest possible evidence, we use
birth records obtained at the state level with early release. We focus on six states that provide large and
diverse samples in areas in which the pandemic unfolded with significant variation: Alabama, Arizona, Florida,
Hawaii, New Jersey, and Wisconsin. The analysis uses causal inference techniques and explicitly incorporates
changes to fertility and the composition of pregnancies. Aim 1 estimates the effect of local-level exposure to
COVID-19 on birth outcomes, including intrauterine growth restriction, birthweight, and delivery complications.
Aim 2 tests for differences in COVID-19 effects on birth outcomes by maternal age, race, nativity, economic
disadvantage, and pre-pandemic, local-level economic conditions and health care infrastructure. Establishing
across-group differences is critical for understanding how the pandemic will shape early-life inequality. Aim 3
addresses a serious form of bias in prenatal exposure estimates—selection into birth—by modeling the change
in the number and composition of women giving birth as a result of COVID-19 exposure. We use this
information to adjust estimates of COVID-19 effects on infant health, while also providing the earliest evidence
of COVID effects on population fertility. The research provides a rapid, comprehensive assessment of the
impact on birth outcomes across localities in which the pandemic u...

## Key facts

- **NIH application ID:** 10234629
- **Project number:** 1R21HD105361-01
- **Recipient organization:** UNIVERSITY OF WISCONSIN-MADISON
- **Principal Investigator:** JENNA E. NOBLES
- **Activity code:** R21 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2021
- **Award amount:** $239,918
- **Award type:** 1
- **Project period:** 2021-08-10 → 2023-07-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10234629

## Citation

> US National Institutes of Health, RePORTER application 10234629, IMPACT OF COVID-19 EXPOSURE ON U.S. BIRTH OUTCOMES (1R21HD105361-01). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/10234629. Licensed CC0.

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