Ukraine has experienced overlapping shocks from the COVID-19 pandemic and a full-scale war, with
potential impacts on maternal and perinatal health. We examined national-level changes in these outcomes
between 2019 and 2024.
 In this population-based ecological study, publicly available Ministry of Health data were analysed to
examine trends in deliveries, births, and maternal and perinatal outcomes. Changes were assessed using
pairwise comparisons, absolute risk differences, and effect sizes. Annual estimates were compared with prepandemic, preceding-year, and wartime estimates. Deliveries and births declined by approximately 40%, predominantly during the first wartime year. Between 2019 and 2024 (298,066 and 176,842 deliveries, respectively), the prevalence of diabetes in pregnancy increased from 0.88% (n = 2634) to 2.66% (n = 4707), hypertensive disorders from 3.80% (n = 11,332) to 5.45% (n = 9633), severe postpartum haemorrhage from 0.36% (n = 1070) to 0.53% (n = 941). Among 302,190 and 179,192 births, respectively, preterm births increased from 5.59% (n = 16,907) to 6.25% (n = 11,195), very low birthweights from 1.05% (n = 3184) to 1.29% (n = 2305), and extremely low birthweights from 0.44% (n = 1335) to 0.60% (n = 1068). Pregnancy-related and perinatal mortality, particularly stillbirths, were higher during the second year of the pandemic but not during wartime. Early neonatal mortality did not change throughout.  Overlapping crises were associated with fewer births and increased maternal morbidity. Although pregnancy-related and perinatal mortality increased during the pandemic, their relative stability during wartime may suggest preservation of maternal and newborn services, potentially supported by international assistance. Continued support for maternal and neonatal healthcare services remains important in crisis-affected settings.  No funding was received.