Perinatal outcomes during wartime: a multicenter retrospective cohort study in Israel, 2022–2024

Background: Armed conflicts disrupt healthcare services and expose pregnant women to significant psychological stress, potentially increasing adverse pregnancy outcomes. This study aimed to assess the impact of wartime on pregnancy and birth outcomes amongst Israeli parturients. Methods: A retrospective cohort study analyzing deliveries at seven university-affiliated hospitals between October 7, 2022, and April 7, 2024. The cohort was divided into two groups: the conflict-exposed group (study group, consisting of women who delivered during the approximately six months following October 7, 2023) and the control group (women who delivered during the same period the previous year). Data extracted from electronic medical records included maternal demographics, comorbidities, and obstetric and neonatal outcomes. Statistical analyses included effect size calculations and multivariable logistic regression, adjusting for relevant maternal confounders. Results: A total of 30,868 births were included, with 15,384 in the study group and 15,484 in the control group. No significant differences were observed in maternal demographics or comorbidities. The conflict-exposed group had higher rates of premature rupture of membranes (PROM) (15.4% vs. 11.5%, P < 0.001, respectively), preterm premature rupture of membranes (PPROM) (3.4% vs. 3%, P = 0.022, respectively), gestational diabetes mellitus (GDM) (10.8% vs. 10.0%, P = 0.018, respectively), and postpartum hemorrhage (PPH) (4.4% vs. 3.6%, P = 0.001, respectively), compared to the control group. The analysis revealed no significant differences in the rates of preterm births and neonatal birth weight below 2,500 g. Effect size analyses and multivariable regression confirmed these associations, demonstrating that conflict exposure was independently linked to increased risks of PROM, PPROM, GDM, and PPH. Conclusions: Exposure to wartime conditions is associated with an increased risk of various pregnancy and delivery complications, including GDM, PPROM, and PPH. These findings highlight the need for further research into the impacts of war-related stress on pregnancy outcomes and underscore the importance of providing psychological and medical support during wartime.