ABSTRACT
On March 11, 2020, the World Health Organization declared the novel coronavirus (COVID-19) outbreak a global pandemic. In April 2020, the Pregnancy and Infant Linked Outcomes Team (PILOT) was established within the Centers for Disease Control and Prevention's (CDC) COVID-19 response structure, specifically to focus on better understanding the impact of COVID-19 in pregnancy. A total of 71 CDC staff deployed to PILOT, collectively contributing more than 99,000 hours to the response over the course of the team's 25-month activation. PILOT led or collaborated on the publication of over 40 manuscripts, managed several clinical guidance documents, and coordinated and provided subject matter expertise to three funded research studies with academic partners. The team developed six CDC webpages, a toolkit for pregnant people and new parents, and disseminated scientific findings with over 350 social media posts on Facebook, Twitter, Snapchat, LinkedIn, and Instagram with nearly 77 million total impressions. In this, we will summarize the work of PILOT, and other parts of the CDC COVID-19 response, including teams focused on vaccine effectiveness and safety, and surveillance and research activities outside of the CDC. We will review several key contributions to our understanding of COVID-19 in pregnancy: (1) pregnant people are at greater risk of severe illness from COVID-19, including hospitalization, admission to an intensive care unit, and the need for mechanical ventilation, compared with nonpregnant women of reproductive age;(2) pregnant people with COVID-19 are more likely to experience complications that can affect their pregnancy and developing baby, including stillbirth and preterm delivery, compared to pregnant people without COVID-19;(3) there are no recognized maternal or fetal adverse effects of COVID-19 vaccines in pregnancy;and (4) COVID-19 vaccine during pregnancy is effective in preventing severe illness, hospitalization and death among pregnant people, as well as preventing severe illness in infants up to age six months.
ABSTRACT
Background: Public health emergencies such as Zika virus (ZIKV) highlighted the urgent need for coordinated pregnancy and infant surveillance. Creation of the US Zika Pregnancy and Infant Registry allowed public health officials to monitor outcomes for >7,400 pregnancies with laboratory evidence of confirmed or possible ZIKV infection. CDC adapted the USZPIR to establish the Surveillance for Emerging Threats to Mothers and Babies Network, to monitor health threats, including syphilis, to mothers and babies. Methods: In 2019, CDC funded three health departments to conduct linked-longitudinal surveillance for syphilis. Variables were selected from existing data sources with input from subject matter experts, a cross-CDC working group, and feedback from health departments to answer key surveillance questions. Questions include information on prenatal care and the frequency and range of adverse pregnancy, infant, and early childhood outcomes. Variables include general mother-baby surveillance variables and syphilis-specific variables. Results: General variables include maternal demographics, birth outcomes, pregnancy and birth complications, and infant health outcomes up to 2 years of age. Syphilis-specific variables include stage of syphilis, maternal and infant treatment, and infant clinical complications. The approach sets standards for consistent and systematic surveillance for mother-baby pairs from data sources such as case report forms, vital records, medical records, and electronic lab reporting. Conclusions: Mother-baby linked longitudinal surveillance of syphilis will create a mother-baby linked surveillance dataset to describe missed opportunities for prenatal care, screening/treatment during pregnancy, and adverse clinical and developmental outcomes of prenatally exposed children. This innovative surveillance approach will be used to inform clinical guidance and strategies to reduce exposure risk or adverse outcomes, direct public health action, and strengthen testing. The surveillance network can also serve as a preparedness network to protect mothers and babies and is designed to readily pivot in response to future emerging threats, such as coronavirus disease 2019.