INTRODUCTION:
The rate of COVID-19 infection varies across different regions in the United States. However, there are limited data evaluating the vaccination rates and subsequent infection among the pregnant population with regard to geographical location. The primary aim of the study was to determine the COVID-19 vaccination rate and subsequent infection rate among pregnant people in each U.S. census region.
METHODS:
A retrospective data collection of pregnant people from January 2020 to March 2022 was performed using the Cerner Real-World Data from 106 centers. The four census regions were defined by the U.S. Census Bureau. Breakthrough infection was defined as a positive COVID-19 test during or after pregnancy among immunized mothers. Because the database was fully de-identified, IRB approval was not required.
RESULTS:
The study included 389,764 pregnant persons, of which 44,846 were vaccinated. The rate of vaccination against COVID-19 was 14.57%, 11.80%, 11.71%, and 5.24% in the South, West, Northeast, and Midwest census regions, respectively. The COVID-19 infection rate after vaccination was 1.70%, 1.31%, 0.36%, and 0.06% in the Northeast, South, Midwest, and West census regions, respectively.
CONCLUSION:
The reported 11% vaccination rate suggests low utilization among pregnant people; that said, breakthrough infections rates appeared extremely low, suggesting robust protection. The study is limited in that it queried hospital-based vaccinations and breakthrough infections and is unable to capture larger community-based data. Further studies may compare vaccination and infection trends with nonpregnant patient populations.
INTRODUCTION:
Gestational Diabetes (GDM) complicates 5-6% of pregnancies in the US. Current recommendations are a fasting plasma glucose (FPG) or 75 g glucose tolerance test (GTT) at 6 weeks postpartum. FPG value is often obtained in the immediate postpartum period to screen for continued hyperglycemia. There is no recommendation for this however, and given the cost of checking FPG, we questioned if this practice would routinely affect clinical outcomes or predict the outcomes of 2 hr GTT.
METHODS:
A retrospective chart review was used to collect FPG and 6 week GTT results. Logistic regression and Chi Square analysis was used to evaluate OR to determine if there was a significant correlation between FPG and 2 hr GTT. An in-patient FPG (cpt 82962) was $28.00. This was applied to the total number of GDMs to calculate cost to the system.
RESULTS:
We found no difference in 6 wk postpartum GTT results based upon FPG (OR 1.01, 95% CI 0.97-1.06). FPG was greater than 99 mg/dL in 15.6% of patients, and the pass rate for GTT was 72.5%. There were no patients who failed GTT, however 27.5% demonstrated glucose intolerance. In our limited sample (n=167), there was a total of $4,676 spent on FPG.
CONCLUSION:
We found no correlation between FPG and 2 hr GTT. Given approximately 4 million births each year with GDM rates of 5%, over $5.5 million may be spent on FPG every year. As the FPG does not appear to add useful information to a patient's care, this provides an opportunity to reduce associated costs.
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