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One of the provisions implemented to contain the spread of Covid-19 infections in Italy was the lockdown. Effects of the lockdown on childbirth outcomes and on the well-being of both the mother and the child have not yet been defined. An inadequate diet during pregnancy and a reduced physical activity can predispose women to become overweight or obese and trigger the development of various complications and maternal-fetal adverse outcomes. This is a retrospective study including all consecutive patients who delivered at University Hospi

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007), a score above the national average on appropriate use of imaging-a measure of low-value care (odds ratio = 1.04, p 0.042), and higher HCAHPS patient experience scores (b = 0.12, p 0.012). The degree of Lean implementation was not associated with any of the other 6 performance measures. Lean is an organizationwide sociotechnical performance improvement system. As such, the actual degree of implementation throughout the organization as opposed to mere adoption is, based on the present findings, more likely to be associated w