Agenda COVID-19 Surveillance in Pregnancy Health Disparities - - PowerPoint PPT Presentation

Tennessee Health Disparities Task Force

Agenda

COVID-19 Surveillance in Pregnancy Health Disparities Dashboard Member Comments/Announcements

Office of Health Disparities Elimination October 15, 2020

https://www.tn.gov/health/health-program-areas/dmhde/covid-19-health-disparity-task-force.html

COVID-19 Surveillance in Pregnancy

Health Disparities Task Force Meeting

Elizabeth Harvey, PhD, MPH | October 15, 2020

Surveillance Objectives

Pregnancy and Infant Linked Outcomes (PILOT)

– Objective: Better understand the epidemiology of COVID-19 among pregnant women and infants and inform clinical guidance in obstetric and infant settings

Clinical course of disease, including severity of disease, treatments, mortality Timing of COVID-19 infection, presence of symptoms, underlying risk factors Adverse fetal and birth

• utcomes of infants born

to mothers with COVID-19 infection Frequency and risk factors for neonates testing positive for COVID-19 infection

Case Report Form Data

Timeliness: Daily Pregnancy Identifier

– Pregnancy indicator – Other NBS fields:

• Estimated Due Date
• OB/GYN Provider

COVID-19 in Pregnancy Data Infrastructure

COVID-19 Pregnancy Surveillance Database

COVID-19 CRF Data from NBS SARS-CoV-2 Laboratory Data from NBS Demographic Data from NBS Birth Certificate (provisional) Fetal Death Records (provisional) Death Data (provisional) iCMS Data Medical Record Abstraction Data

CRF, Case Report Form NBS, NEDSS Base System iCMS, Neometrics Internet Case Management System

Case Report Form Data

National COVID-19 in Pregnancy Surveillance

https://www.cdc.gov/coronavirus/2019-ncov/cases-updates/special-populations/pregnancy-data-on-covid-19.html

TN Pregnancy Indicator Regional Map

Among all COVID-19 confirmed cases, 0.7% have pregnancy indicator checked (1,530/208,606) Frequency distribution of pregnant COVID-19 confirmed cases vary by region (9-288)

Data Source: Tennessee Department of Health, Division of Communicable and Environmental Diseases and Emergency Preparedness. NBS COVID-19 Case Report Form Data. 10/13/2020. These provisional data aim to guide the Tennessee Department of Health, are for internal use only and should not be distributed further.

Current active COVID-19 confirmed cases among pregnant women: 28 Average of new COVID-19 confirmed cases among pregnant women per week over last four completed weeks: 43

TN Pregnancy Indicator Epi Curve

Data Source: Tennessee Department of Health, Division of Communicable and Environmental Diseases and Emergency Preparedness. NBS COVID-19 Case Report Form Data. 10/13/2020. These provisional data aim to guide the Tennessee Department of Health, are for internal use only and should not be distributed further.

TN Pregnancy Indicator Ethnic Disparities

Data Source: Tennessee Department of Health, Division of Communicable and Environmental Diseases and Emergency Preparedness. NBS COVID-19 Case Report Form Data. 10/13/2020. These provisional data aim to guide the Tennessee Department of Health, are for internal use only and should not be distributed further. These provisional data calculations include missing and unknown values.

TN Pregnancy Indicator Ethnic Disparities

Data Source: Tennessee Department of Health, Division of Communicable and Environmental Diseases and Emergency Preparedness. NBS COVID-19 Case Report Form Data. 10/13/2020. Division of Vital Records and Statistics. Birth Statistical File, Provisional 2020 File 10/13/2020. These provisional data aim to guide the Tennessee Department of Health, are for internal use only and should not be distributed further. These provisional data calculations include missing and unknown values.

TN Pregnancy Indicator Racial Disparities

Data Source: Tennessee Department of Health, Division of Communicable and Environmental Diseases and Emergency Preparedness. NBS COVID-19 Case Report Form Data. 10/13/2020. These provisional data aim to guide the Tennessee Department of Health, are for internal use only and should not be distributed further. These provisional data calculations include missing and unknown values.

TN Pregnancy Indicator Racial Disparities

Data Source: Tennessee Department of Health, Division of Communicable and Environmental Diseases and Emergency Preparedness. NBS COVID-19 Case Report Form Data. 10/13/2020. Division of Vital Records and Statistics. Birth Statistical File, Provisional 2020 File 10/13/2020. These provisional data aim to guide the Tennessee Department of Health, are for internal use only and should not be distributed further. These provisional data calculations include missing and unknown values.

TN Pregnancy Indicator Data Quality

Among women of reproductive age (15-44), 48% of all COVID-19 confirmed cases have missing/unknown information for the pregnancy indicator on the CRF

Data Source: Tennessee Department of Health, Division of Communicable and Environmental Diseases and Emergency Preparedness. NBS COVID-19 Case Report Form Data. 10/8/2020. These provisional data aim to guide the Tennessee Department of Health, are for internal use only and should not be distributed further. These provisional data calculations include missing and unknown values.

47.9 42.8 12.4 2.5

10 20 30 40 50 60 70 80 90 100 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38

Percent MMWR Week

Missing Unknown

Centralized Case Investigations Start

Linkage to Vital Records Data

Vital Records Linkage Results

Data Source: Tennessee Department of Health, Division of Communicable and Environmental Diseases and Emergency Preparedness. NBS COVID-19 Case Report Form Data. 10/5/2020. Division of Vital Records and Statistics. Birth Statistical File, Provisional 2020 File 10/5/2020. These provisional data aim to guide the Tennessee Department of Health, are for internal use only and should not be distributed further.

Disparities in Maternal Indicators

Black women had more than twice the prevalence

• f a first positive

SARS CoV-2 test at delivery hospitalization compared to white women (18.3% vs. 9.1%; p=0.08)

8.3 18.3 16.2 16.7 9.1 14.3 10 20 30 40 50 60 70 80 90 100

Asian, non- Hispanic Black, non- Hispanic Hispanic or Latino Multiple or

• ther race,

non-Hispanic White, non- Hispanic Overall

Percent

First Positive Test at Delivery Hospitalization

16.7 21.2 14.9 6.7 14.0 16.1 10 20 30 40 50 60 70 80 90 100 Asian, non- Hispanic Black, non- Hispanic Hispanic or Latino Multiple or

• ther race,

non-Hispanic White, non- Hispanic Overall

Percent

Hospitalization due to COVID-19

85.7 62.5 63.0 64.3 73.0 66.8 10 20 30 40 50 60 70 80 90 100 Asian, non- Hispanic Black, non- Hispanic Hispanic or Latino Multiple or

• ther race,

non-Hispanic White, non- Hispanic Overall

Percent

Symptomatic Status

(p=0.08) (p=0.4) (p=0.2)

Data Source: Tennessee Department of Health, Division of Communicable and Environmental Diseases and Emergency Preparedness. NBS COVID-19 Case Report Form Data. 10/5/2020. Division of Vital Records and Statistics. Birth Statistical File, Provisional 2020 File 10/5/2020

Vital Records Linkage Results

Data Source: Tennessee Department of Health, Division of Communicable and Environmental Diseases and Emergency Preparedness. NBS COVID-19 Case Report Form Data. 10/5/2020. Division of Vital Records and Statistics. Birth Statistical File, Provisional 2020 File 10/5/2020. These provisional data aim to guide the Tennessee Department of Health, are for internal use only and should not be distributed further.

80.0 83.9 78.7 70.0 78.1 80.0 10 20 30 40 50 60 70 80 90 100 Asian, non- Hispanic Black, non- Hispanic Hispanic or Latino Multiple or

• ther race,

non-Hispanic White, non- Hispanic Overall

Infant Tested

0.0 18.4 7.5 4.2 7.3 10.3 10 20 30 40 50 60 70 80 90 100 Asian, non- Hispanic Black, non- Hispanic Hispanic or Latino Multiple or

• ther race,

non-Hispanic White, non- Hispanic Overall

Percent

Low Birthweight

8.3 17.3 12.1 8.3 11.2 13.1 10 20 30 40 50 60 70 80 90 100 Asian, non- Hispanic Black, non- Hispanic Hispanic or Latino Multiple or

• ther race,

non-Hispanic White, non- Hispanic Overall

Percent

Preterm Births

Racial Disparities in Infant Indicators

• Black infants had more

than twice the prevalence of low birthweight compared to white infants (18.4% vs. 7.3%; p=0.002)

(p=0.4) (p=0.7) (p=0.002)

Data Source: Tennessee Department of Health, Division of Communicable and Environmental Diseases and Emergency Preparedness. NBS COVID-19 Case Report Form Data. 10/5/2020. Division of Vital Records and Statistics. Birth Statistical File, Provisional 2020 File 10/5/2020

Emerging Literature

MMWR September 25, 2020 (1/2)

Among 598 hospitalized pregnant women with COVID-19, 55% were asymptomatic at admission Severe illness occurred among symptomatic pregnant women – ICU admissions (16%), mechanical ventilation (8%), and death (1%) Pregnancy losses occurred for 2% of pregnancies completed during COVID-19- associated hospitalizations – Experienced by both symptomatic and asymptomatic women

https://www.cdc.gov/mmwr/volumes/69/wr/mm6938e1.htm

MMWR, Morbidity and Mortality Weekly Report ICU, intensive care unit

MMWR September 25, 2020 (2/2)

Prevalence of pre-pregnancy obesity and gestational diabetes were higher among pregnant women hospitalized for COVID- 19–related illness (e.g., worsening respiratory status) than among those admitted for pregnancy-related treatment or procedures (e.g., delivery) and found to have COVID-19 infection Intensive care was required for 30% (13/43) of pregnant women admitted for COVID-19, and one pregnant woman died from COVID-19 infection

https://www.cdc.gov/mmwr/volumes/69/wr/mm6938e2.htm

MMWR, Morbidity and Mortality Weekly Report

Next Steps

TN Programmatic Alignment

Maternal Mortality Review Committee (MMRC)

– Identify pregnancy-associated deaths due to COVID-19 infection – MMRC reviewed COVID 19-related cases in September 2020

Early Hearing Detection & Intervention (EHDI)

– Provide EHDI a list of pregnant women with a first positive SARS CoV-2 test at delivery hospitalization for follow-up

Pregnancy Risk Assessment Monitoring System (PRAMS)

Implement COVID-19 Supplement on topics, including:

– Support person during labor and delivery – Resources utilized for postpartum care – Impacts to postpartum visits – Difficulties in attending virtual care appointments – Difficulties getting birth control due to pandemic – COVID-19 confirmed or suspected infection during or after a pregnancy – Impacts of pandemic on baby’s healthcare and family – Protection measures and difficulties in implementing protection measures

Public Facing Dashboard (Updated Monthly)

Other Communications

Stakeholder Groups

– Perinatal Advisory Committee – Tennessee Health Disparities Task Force – Tennessee Regional Health Director Calls – State Epidemiological Outcomes Workgroup – CDC SET-NET Data Use Working Group – CDC Division of Reproductive Health

Upcoming Publications

– A Preparedness Model for Mother-Baby Linked Longitudinal Surveillance for Emerging Threats – Validation of Pregnancy Status on the COVID-19 Case Report Form among Pregnancies Completed through July 31, 2020 — Illinois, Massachusetts, and Tennessee – Birth and Infant Outcomes among Pregnant Women with Laboratory-Confirmed SARS-CoV-2 Infection —13 Jurisdictions, March 29–September 21, 2020

https://www.tn.gov/health/cedep/ncov/covid-19-resources-information-in-spanish.html

Longitudinal Infant Follow-Up

Key surveillance questions for infants born to women with COVID-19 infection during pregnancy

– What proportion are fed breastmilk vs. formula? – What is the frequency of post-natal COVID-19 infection? – What are the growth patterns of these infants? – What is the range and frequency of other adverse infant

• utcomes?

– Are they receiving recommended in-person outpatient follow-up and does this differ by maternal characteristics (demographics, socioeconomic indicators, timing of maternal infection)?

Data collection efforts

– Cohort of infants born to women with COVID-19 infection during pregnancy – Information from both the 2- and 6-month well-child visits – Collected from pediatrician(s) after 6-month well-child visit

How else can we use these data?

Other research questions? Other opportunities for data translation to other groups?

– Community groups? – OB/MFM groups?

Other communication materials that would be helpful?

– Infographics? – Commercials? – Radio spots?

COVID-19 in Pregnancy Team

Lizzie Harvey Lindsey Sizemore Heather Wingate Jessica Schultz Miranda Smith Sammy Chao Laura Price Shamia Roberts Morgan McDonald Angela Easterling Melissa Moon Rebecca Lakey Peggy Shover Erika Kirtz Carolina Clark Kate Lolley Pamela Talley Jason Cummins

Thank You!

Questions?

Elizabeth.Harvey@tn.gov Lindsey.Sizemore@tn.gov

Member Comments (5 min.) Q & A

Questions??

Please contact Monique Anthony at 629-215-0642

• r

Minority.Health@tn.gov