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Regional perinatal research collaborative shares findings of study on pre-term births during COVID

• Research points to commitment to obstetric care and virtual access as key factors in ensuring quality prenatal care during the pandemic

Wilmington, Del. (May 26, 2023) — In 2021, Highmark Blue Cross Blue Shield Delaware partnered with some of the country’s most esteemed institutions and researchers, known as the AQUEDUCT Perinatal Research Collaborative, to investigate anecdotal evidence of decreases in preterm births during the COVID-19 pandemic. The AQUEDUCT Perinatal Research Collaborative (Advancing Quality, Utilization, and Equity for the Dyad: Understanding Care Together) included researchers from Children's Hospital of Philadelphia, Nemours Children’s Health, Northwestern University, University of Pennsylvania and Yale University, with funding and support from the Independence Blue Cross Foundation, and Highmark Blue Cross Blue Shield Delaware’s donor-advised fund BluePrints for the Community.

“This research project was a new endeavor for us at Highmark Delaware, but the longstanding relationships with our esteemed colleagues across the region and our shared desire to improve health for all are what inspired us to support,” said Nick Moriello, president of Highmark Blue Cross Blue Shield Delaware.

According to the World Health Organization, one in ten babies worldwide is born preterm. While the serious impacts of preterm birth are known, it is less well known why preterm birth occurs. The AQUEDUCT team expected to find a drop in preterm births within their geographical region, mirroring the trend in other parts of the country and even globally.

Utilizing electronic medical records data from Penn Medicine and Yale, as well as payer data from Highmark Blue Cross Blue Shield Delaware, the research built on earlier analyses of Philadelphia-focused data regarding the impact of COVID-19 on preterm births, stillbirths, and healthcare utilization. A national cohort of Highmark-insured patients who were pregnant and/or delivering between 2018 and 2020 was then analyzed, with the COVID-19 era defined as beginning in March 2020.

“We expected to see a similar drop in preterm birth during the pandemic that was observed in Europe. In contrast, we saw no significant changes in preterm birth. Our findings suggest the protective environmental and social factors abroad may not have been the same here in Philadelphia and New Haven,” said Heather H. Burris, MD, MPH, an attending neonatologist at CHOP and co-lead investigator of the research. “However, we were reassured by the healthcare system’s commitment to prenatal care during the pandemic; prenatal testing and related screenings remained a priority for patients and providers and occurred on time, despite disruptions and delays in many aspects of care caused by the pandemic.”

The pandemic encouraged rapid adaptation to telehealth care. Highmark alone saw a 3,600 percent increase in utilization in 2020 over 2019, with little drop in usage in 2021 over 2020, 3.3 million and 3.5 million claims, respectively, across its footprint in Delaware, Pennsylvania and West Virginia. Telemedicine users tended to initiate prenatal care earlier and had more total visits, earlier timing of ultrasounds, and earlier diabetes screening during pregnancy compared with nonusers. There were no significant differences in delivery mode or stillbirth rates associated with telemedicine, but virtual healthcare options certainly supported the health journey during a time when in-person contact was limited.

“The findings of this study demonstrate the insights we can gain as a healthcare industry through partnership, collaboration and community engagement,” said Jay Greenspan, MD, co-lead investigator of the research and emeritus professor of pediatrics, Sidney Kimmel Medical College, Thomas Jefferson University, Nemours Children’s Hospital, Delaware. “As technology like telehealth and virtual visits continue to alter the healthcare landscape, it is more important than ever to bring together the best and brightest minds to better understand pediatric challenges like preterm birth rates.”

To learn out more about the study’s findings:

• Frontiers in Pediatrics (Published 9 Nov 2022)
  Changes in prenatal testing during the COVID-19 pandemic 
• Telemedicine and e-Health (Published online ahead of print on 6 Sep 2022) 
  The Uptake of Telemedicine in Obstetric Care During the Early Acute Phase of the Coronavirus 2019 Pandemic 
• Journal of Perinatology (Published 16 Aug 2022) 
  Changes in preterm birth during the COVID-19 pandemic by duration of exposure and race and ethnicity