The COVID-19 pandemic has had an unexpected impact on premature birth rates, a leading cause of neonatal morbidity and mortality. Research suggests that lockdowns may have inadvertently reduced modifiable risk factors such as infection, obesity, and environmental pollutants. Studies in California and Denmark reveal significant decreases in very preterm and premature births, especially among those with underlying conditions like hypertension and diabetes. These declines may be due to reduced exposure to environmental pollutants, changes in work-related stress, and altered healthcare practices. However, the situation in Shanghai presents a contrast, where the lockdown increased the risk of preterm birth among uninfected pregnant women, possibly due to stress from job loss and social isolation. The biobehavioral model emphasizes the importance of the prenatal environment and individual vulnerabilities in understanding spontaneous preterm delivery. The pandemic has also highlighted the need for preconception care, focusing on healthy birth spacing, chronic disease management, and mental health support. While the observed trends suggest a potential positive impact of lockdowns on premature births, the underlying mechanisms remain unclear. Future studies should explore the long-term effects of these changes and develop strategies to improve maternity care during public health crises. Recommendations include enhancing prenatal education, stress management, prenatal care accessibility, promoting healthy lifestyles, infection prevention, and establishing support systems for expectant parents. This preliminary evidence underscores the complex relationship between pandemics and preterm births, calling for further investigation into the causal links and implications for public health policy.