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 Frequency and risk Adverse fetal and birth disease, including factors for neonates outcomes of infants born severity of disease, testing positive for to mothers with treatments, mortality COVID-19 infection COVID-19 infection Timing of COVID-19 infection, presence of symptoms, underlying risk factors
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 Birth Fetal Death Certificate Records (provisional ) (provisional) Demographic Death Data Data from (provisional) NBS SARS-CoV-2 Laboratory iCMS Data Data from NBS COVID-19 Medical COVID-19 Pregnancy Record CRF Data Surveillance Abstraction from NBS Data Database 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.
TN Pregnancy Indicator Epi Curve 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 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 100 90 Centralized Case Investigations Start 80 70 60 Percent 47.9 42.8 50 Missing 40 Unknown 30 20 12.4 10 2.5 0 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 MMWR Week 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.
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 First Positive Test at Delivery Hospitalization 100 of a first positive 90 80 SARS CoV-2 test at delivery 70 Percent 60 50 hospitalization compared 40 30 18.3 16.7 16.2 to white women 14.3 20 9.1 8.3 10 0 (18.3% vs. 9.1%; p=0.08) Asian, non- Black, non- Hispanic or Multiple or White, non- Overall Hispanic Hispanic Latino other race, Hispanic (p=0.08) non-Hispanic Symptomatic Status 100 85.7 90 100 Hospitalization due to COVID-19 90 80 73.0 66.8 80 64.3 70 63.0 62.5 70 Percent 60 60 Percent 50 50 40 40 30 21.2 16.7 16.1 14.9 14.0 30 20 6.7 10 20 0 10 Asian, non- Black, non- Hispanic or Multiple or White, non- Overall (p=0.4) 0 Hispanic Hispanic Latino other race, Hispanic Asian, non- Black, non- Hispanic or Multiple or White, non- Overall non-Hispanic (p=0.2) Hispanic Hispanic Latino other race, Hispanic non-Hispanic 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.
Racial Disparities in Infant Indicators • Black infants had more than twice the 100 Low Birthweight 90 prevalence of low 80 70 60 Percent birthweight compared 50 40 to white infants 30 18.4 20 10.3 7.5 7.3 (18.4% vs. 7.3%; p=0.002) 4.2 10 0.0 0 Asian, non- Black, non- Hispanic or Multiple or White, non- Overall (p=0.002) Hispanic Hispanic Latino other race, Hispanic non-Hispanic Infant Tested 100 90 100 80 83.9 90 Preterm Births 80.0 80.0 78.7 78.1 70 80 70.0 60 Percent 70 50 60 40 50 30 17.3 40 20 13.1 12.1 11.2 8.3 8.3 30 10 20 0 10 Asian, non- Black, non- Hispanic or Multiple or White, non- Overall (p=0.4) Hispanic Hispanic Latino other race, Hispanic 0 non-Hispanic Asian, non- Black, non- Hispanic or Multiple or White, non- Overall (p=0.7) Hispanic Hispanic Latino other race, Hispanic non-Hispanic 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 MMWR, Morbidity and Mortality Weekly Report ICU, intensive care unit https://www.cdc.gov/mmwr/volumes/69/wr/mm6938e1.htm
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