Elizabeth Rochin, PhD, RN, NE-BC

The National Perinatal Information Center (NPIC) routinely captures information surrounding chronic illness, including patients with coded comorbidities such as diabetes, hypertension and obesity. For the time period of 2018 – 2019, NPIC reviewed 658,465 MDC-14 Obstetric discharge records, and 572,277 linked Mother/ Baby discharge records to assess impact of these conditions on an obstetric population. What is important to note is that the rate of diabetes, hypertension and obesity in this national database tends to have no improvement over the time period of 2018-2019, and in fact shows slow to moderate increases over time: 

Important to note are these conditions within the conversation of COVID-19. Pre-existing comorbidities within the obstetric population have been described in the literature during the COVID-19 pandemic (Breslin et al, 2020; Chow et al 2020; Blitz et al, 2020). The most common pre-existing comorbidities described in the COVID-19 literature are obesity, diabetes, hypertension, and pulmonary involvement, such as asthma. There continues to be emphasis and interest in how existing comorbidities may impact the severity and outcomes of COVID-19 within the obstetric population. NPIC will be following this information closely in 2020 and into 2021 for trends that may yield additional value to perinatal care, particularly for its role in fetal and neonatal outcomes. 

Mothers who find themselves with newborns admitted to the NICU may have barriers to participating in the care of their newborn: reliable transportation, availability of nutritious food, secure housing, environmental stressors. Add to those the presence of maternal chronic illness, and the care paradigm shifts to caring for both sick newborn and sick mother. These mothers and newborns may face many obstacles in their care that compound already present barriers to care. These obstacles may include disjointed health care systems with policies that vary between sites and locations, disjointed communication between providers in multiple systems, a lack of coordination in patient management, and the absence of policies and procedures that facilitate coordination of care, or lack of care coordination necessary for community care handoff (Agency for Healthcare Research and Quality, 2018). 

Populations that are at greatest risk to lack of primary and preconception care are those who continue to suffer from implicit, unconscious and systemic bias, including: 

1. Black and Brown women; 
2. Transgender women; 
3. Morbidly obese women; 
4. Undocumented women; 
5. Women with history of trauma; 
6. Women lacking insurance or ability to pay for care; 
7. Women with history of Opioid Use Disorder; 
8. Incarcerated women 

COVID-19 has brought to light already existing barriers to care, and simply magnified them. Access to primary care has never been more readily available, and at the same time, never more difficult to acquire for at-risk populations. 

From a perinatal standpoint, it is imperative that primary care and preconception care receive the attention and funding they deserve to assure optimal outcomes for mothers and newborns. The costs of care related to undervalued and underfunded primary care in rural, urban and community environments will continue to result in maternal chronic illness that can potentially be avoided by effective and coordinated management between providers and their community counterparts. 

The National Perinatal Information Center will continue to engage in the conversation of population health and its impact on perinatology, neonatology and the well-being of the smallest of patients within our healthcare community. 

References:: 

• Agency for Healthcare Research and Quality (2018). National center for excellence in care coordination. Care coordination. https://www.ahrq.gov/ncepcr/care/coordination.html 
• Agrawal, P. (2015). Maternal mortality and morbidity in the United States of America. Bulletin of the World Health Organization, (93)105, https://www.who.int/bulletin/volumes/93/3/14-148627/en/ 
• Blitz, M.J., Rochelson, B., Minkoff, H…Nimaroff, M. (2020). Maternal mortality among women with coronavirus disease 2019 admitted to the intensive care unit. American Journal of Obstetrics and Gynecology, 14 June 2020 DOI: 10.1016/j.ajog.2020.06.020 
• Breslin, N., Baptiste, C…Goffman, D. (2020). Coronavirus disease 2019 infection among asymptomatic and symptomatic pregnant women: Two weeks of confirmed presentations to an affiliated pair of New York City hospitals. American Journal of Obstetrics & Gynecology, 2(2), 1-7. 
• Centers for Disease Control Foundation (2017). Report from maternal mortality review committees: A view into their critical role. https://www.cdcfoundation.org/sites/default/files/upload/pdf/MMRIAReport.pdf 
• Chow, N., Fleming-Dutra, K., Gierke, R., Hall, A., Hughes, M., Pilishvilli, T., Ritchey, M., Roguski, K., Skoff, T. & Ussery, E. (2020). Preliminary estimates of the prevalence of selected underlying health conditions among patients with coronavirus disease 2019 — United States, February 12–March 28, 2020. Morbidity & Mortality Weekly Report, 69(13), 382-386.