Research to study COVID-19 effects on preterm birth

According to the World Health Organization, one in 10 babies worldwide is born before 37 weeks of gestation each year.

While researchers don’t fully understand why babies are born prematurely, the many long-term effects of premature birth have been widely documented.

Babies born prematurely may have more health problems at birth and later in life than full-term infants. They can have intellectual and developmental disabilities, or problems with their lungs, brain, eyes, and other organs, according to the March of Dimes. Nemours has previously led work to successfully understand and treat preterm birth and its related complications in partnership with other hospital systems and organizations in the region, notably ChristianaCare and the March of Dimes. But preventing preterm birth has been a larger challenge.

During the COVID-19 pandemic, however, studies are showing that preterm birth rates are actually down.

“I began to hear anecdotal evidence of a drop in preterm births here in Delaware,” said Jay Greenspan, MD, a neonatologist at Nemours/A.I. duPont Hospital for Children. “If we can actually document that the rate is dropping, the next question we need to ask is ‘why?’ Could a silver lining of the COVID-19 pandemic really be a drop in preterm births? If so, what’s the cause, what can we learn, and how do we apply that post-pandemic?”

What started as a question blossomed into a consortium involving some of the country’s most esteemed institutions and researchers, known as the AQUEDUCT, or Advancing Quality, Utilization, and Equity for the Dyad: Understanding Care Together, Perinatal Research Collaborative. This group includes researchers from Nemours Children’s Health System, Children’s Hospital of Philadelphia, Yale University and Northwestern University. The study is being funded by $300,000 in grants from Highmark Blue Cross Blue Shield Delaware’s donor-advised fund, BluePrints for the Community, and Independence Blue Cross.

“Highmark was really intrigued by this finding,” said Nick Moriello, president of Highmark Blue Cross Blue Shield Delaware. “As Delaware’s largest health insurer, it is critical we understand factors that impact the health of those we serve, in order to ultimately improve the way we approach care. We have a great relationship with Nemours, and for our two Delaware-based organizations to be able to band together with other health leaders is really remarkable.”

The research builds on earlier analyses performed by Heather H. Burris, MD, an attending neonatologist at CHOP and co-lead investigator of the research, and colleagues, using local data on the impact of COVID-19 on preterm births and stillbirths in Philadelphia. In this new collaborative, the members of AQUEDUCT will analyze a national cohort of patients insured by Highmark who were pregnant and/or delivering between 2018 and 2020, with the COVID-19 era defined as beginning in March 2020.

“What we want to analyze is whether the COVID-19 pandemic actually has had an impact on birth outcomes and prenatal care,” said Greenspan, also a co-lead investigator of the research. “If there is a notable drop in preterm births, this data can also help us see where the drop is occurring – does it cross socioeconomic lines or specific demographics such as age, race, and geography? This unique collaboration of payers and esteemed academic healthcare centers coming together to answer important questions like these is really unprecedented.”

The researchers will look at both spontaneous and medically indicated preterm births as well as stillbirth rates, using data from the large, diverse AQUEDUCT cohort to assess the impact of the pandemic on these outcomes, which could provide important information about the drivers of preterm birth. The research team will also examine how often patients attended prenatal visits and what tests they underwent at each appointment.

In analyzing the data, the researchers intend to assess the demographics of the mother along with infant health metrics and hospital characteristics, including whether it is an urban or rural hospital and has a neonatal intensive care unit.