Introduction Public health responses often lack the infrastructure to capture the impact of public health emergencies on pregnant women and infants, with limited mechanisms for linking pregnant women with their infants nationally to monitor long-term effects. In 2019, the Centers for Disease Control and Prevention (CDC), in close collaboration with state, local, and territorial health departments, began a 5-year initiative to establish population-based mother-baby linked longitudinal surveillance, the Surveillance for Emerging Threats to Mothers and Babies Network (SET-NET). Objectives The objective of this report is to describe an expanded surveillance approach that leverages and modernizes existing surveillance systems to address the impact of emerging health threats during pregnancy on pregnant women and their infants. Methods Mother-baby pairs are identified through prospective identification during pregnancy and/or identification of an infant with retrospective linking to maternal information. All data are obtained from existing data sources (e.g., electronic medical records, vital statistics, laboratory reports, and health department investigations and case reporting). Results Variables were selected for inclusion to address key surveillance questions proposed by CDC and health department subject matter experts. General variables include maternal demographics and health history, pregnancy and infant outcomes, maternal and infant laboratory results, and child health outcomes up to the second birthday. Exposure-specific modular variables are included for hepatitis C, syphilis, and Coronavirus Disease 2019 (COVID-19). The system is structured into four relational datasets (maternal, pregnancy outcomes and birth, infant/child follow-up, and laboratory testing). Discussion SET-NET provides a population-based mother-baby linked longitudinal surveillance approach and has already demonstrated rapid adaptation to COVID-19. This innovative approach leverages existing data sources and rapidly collects data and informs clinical guidance and practice. These data can help to reduce exposure risk and adverse outcomes among pregnant women and their infants, direct public health action, and strengthen public health systems.
S. Nicole Fehrenbach r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r
Although the medical expenditures for the treatment of acute glycemic and chronic complications of diabetes are well documented, little is known about the costs of treating general medical conditions among persons with diabetes. Accordingly, data from the 1991 National Hospital Discharge Survey and the 1987 National Medical Expenditure Survey were used to estimate the risk of hospitalization for general medical conditions among middle-aged (45-64 yr) and elderly (> or = 65 yr) persons with diabetes and the associated in-patient expenditures attributable to diabetes in the United States. In 1991, there were 371,814 hospitalizations of middle-aged persons with diabetes and 712,725 hospitalizations of elderly persons with diabetes for treatment of general medical conditions. Both middle-aged and elderly persons with diabetes remained hospitalized longer than their nondiabetic peers (8.1 vs. 6.3 days and 10.1 vs. 8.9 days, respectively). Compared to their nondiabetic peers, middle-aged persons with diabetes were at greatest risk of hospitalization for peritonitis/intestinal abscess [relative risk, 13.1; 95% confidence interval (CI), 12.5-13.8] and respiratory failure (relative risk, 5.0; 95% CI, 4.9-5.1) and elderly persons with diabetes were at greatest risk of hospitalization for liver diseases (relative risk, 3.0; 95% CI, 2.9-3.0) and septicemia (relative risk, 2.8; 95% CI, 2.8-2.9). In-patient expenditures for the treatment of general medical conditions attributable to diabetes were estimated at +4.12 billion, nearly twice the in-patient expenditures incurred for the treatment of chronic complications of diabetes. These results demonstrate the disproportionate resources devoted to treating patients with diabetes for conditions that are neither acute glycemic nor chronic complications of diabetes.
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