A Preparedness Model for Mother-Baby Linked Longitudinal Surveillance for Emerging Threats

Abstract

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 five-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 prospectively during pregnancy and/or retrospectively after birth of the infant. 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 demonstrated rapid adaptation for use during COVID-19. This innovative approach leverages existing data sources and rapidly collects data to inform 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.

Risk factors for illness severity among pregnant women with confirmed SARS-CoV-2 infection – Surveillance for Emerging Threats to Mothers and Babies Network, 20 state, local, and territorial health departments, March 29, 2020 -January 8, 2021

“…SET-NET is longitudinal surveillance of pregnant women and their infants to understand the effects of emerging and reemerging threats [6]. Supplementary pregnancy-related information is reported for women with laboratory confirmed SARS-CoV-2 infection (based on detection of SARS-CoV-2 in a clinical specimen by nucleic acid amplification testing) during pregnancy through the day of delivery in 2020 [7].…”

“…Supplementary pregnancy-related information is reported for women with laboratory confirmed SARS-CoV-2 infection (based on detection of SARS-CoV-2 in a clinical specimen by nucleic acid amplification testing) during pregnancy through the day of delivery in 2020 [7]. As of January 8, 2021, health departments from 20 jurisdictions (California [excluding Los Angeles County], Georgia, Houston, Kansas, Los Angeles County, Massachusetts, Michigan, Minnesota, Nebraska, Nevada, New Jersey, New York [excluding New York City], North Dakota, Oklahoma, Pennsylvania [excluding Philadelphia], Philadelphia, Puerto Rico, Tennessee, U.S. Virgin Islands, and Vermont) have contributed data [6]. Pregnancy status was ascertained through routine COVID-19 case surveillance or through matching of reported cases with other data sources (e.g., vital records, administrative data) to identify unreported pregnancy status or verify pregnancy status.…”

“…Data were abstracted using standard data elements; sources include routine public health investigations, vital records, laboratory reports, and medical records. SET-NET methodology has been previously described [6].…”

“…If data were not reported for an outcome, the outcome was assumed not to have occurred. Crude risk ratios (RR) for moderate-to-severe or critical illness were calculated for selected demographic characteristics within age group, race/ethnicity, health insurance type, healthcare worker status and selected clinical characteristics, including diagnosis of underlying medical condition (pre-pregnancy obesity [body mass index ≥30 kg/m], chronic lung disease, chronic hypertension, pregestational diabetes mellitus, cardiovascular disease, and immunosuppression), trimester of SARS-CoV-2 infection, and diagnosis of pregnancy-related condition (gestational diabetes and gestational hypertension) as reported through contact tracing, vital statistics, or medical records, compared to selected referent groups [6]. We also calculated crude risk ratios comparing risk of moderate-to-severe or critical illness among pregnant women with any one condition (underlying medical or pregnancy-related condition), any two conditions, and three or more conditions compared to those without report of any condition.…”

“…Public health jurisdictions report information, including pregnancy status, on confirmed and probable COVID-19 cases to CDC through the National Notifiable Diseases Surveillance System [5]. Through the Surveillance for Emerging Threats to Mothers and Babies Network (SET-NET), health departments from 20 jurisdictions collected supplementary information on pregnancy outcomes among women with SARS-CoV-2 infection confirmed by nucleic acid amplification testing and reported during March 29, 2020–January 8, 2021 [6]. To determine risk factors associated with COVID-19 illness severity, demographic and selected clinical characteristics were compared between pregnant women with moderate-to-severe or critical illness and those with asymptomatic infection or mild illness.…”