UH Studies How COVID-19 Impacts Labor and Delivery Patients

Universal testing aids effort to assess racial and socioeconomic disparities

Innovations in Obstetrics & Gynecology | Fall 2020

Justin Lappen, MD

Manesha Putra, MD

University Hospitals has been actively working to understand how COVID-19 is affecting pregnant women and their care. “The CDC recently published data…demonstrating that pregnant women were hospitalized and admitted to the ICU [due to COVID-19] more frequently than non-pregnant women,” says Justin Lappen, MD, Maternal and Fetal Medicine with UH and Associate Professor at Case Western Reserve University School of Medicine.

UH Division of Maternal Fetal Medicine researchers, including Dr. Lappen and his colleague Manesha Putra, MD, Maternal and Fetal Medicine with UH, and Clinical Instructor, Department of Reproductive Biolology, School of Medicine, have conducted a study to understand racial and socioeconomic disparities in pregnant women who test positive for SARS-CoV-2. They continue to explore other research pathways to help support the care of women throughout their pregnancies.

UNIVERSAL TESTING AT UH

Researchers have been able to gain valuable insights due to the wealth of data UH has made available. The health system began testing early on in the pandemic; it soon implemented a universal testing policy for labor and delivery patients. “We saw reports of significant proportions of women who were admitted to labor and delivery in other regions testing positive,” Dr. Putra says. “Beginning on April 17, we started doing universal testing for all women who are admitted to labor and delivery.”

Universal testing remains a debated strategy, particularly in areas with a low prevalence of COVID-19 cases. “There isn’t an absolute recommended approach on labor and delivery that has been endorsed by any of our national professional societies,” Dr. Lappen says. “It has been left up to individual institutions to make that decision based on the prevalence in their communities and other factors.”

UH decided to implement universal testing of its labor and delivery patients and will continue to do so going forward. This policy helps the health system find asymptomatic patients, including those women who may have other factors that put them at risk for adverse pregnancy and health outcomes. “We feel that universal testing is a way to promote health equity during the pandemic,” Dr. Lappen says.

RACIAL AND SOCIOECONOMIC DISPARITIES

Racial and socioeconomic disparities are well-documented in healthcare. “We do know that disparities exist in obstetric care,” Dr. Putra says. “We wanted to see if this holds true in regard to COVID-19 and pregnancy.” He, Dr. Lappen and several of their colleagues conducted a study to examine this question. The manuscript is currently in the peer-review process.

The study authors examined data on pregnant women tested for SARS-CoV-2 from March 11 to July 1 at UH: a total of 1,748 obstetric patients. They then determined the race and socioeconomic status of these women based on several factors, such as insurance status and zip code. “We saw non-Hispanic Black women in our community are disproportionately affected by COVID-19,” Dr. Putra says.

He cautions that interpreting any kind of disparity data like this is very challenging. “Our general recommendation is to admit that there is a problem. The big take home point for the study: racial disparity does exist. We should all work together to try to overcome this.”

MORE RESEARCH AHEAD

While this study does shed light on COVID-19 and pregnancy, there remains much more work to be done. Dr. Putra is also interested in examining how in-person visits, an essential part of prenatal care, correlate with test positivity. “We are validating to see if it will be feasible for us to study different types of visits and see if there is one type of visit that has a higher risk of transmission,” he says.

On a larger scale, UH is participating in a national research network with approximately 20 different centers around the country. This research initiative will compare 2019 pregnancy outcomes to 2020 pregnancy outcomes. “It would be both significant and disheartening if we saw an increased risk of adverse obstetric outcomes in women without COVID-19 due to lapses in care, unmet care needs or other downstream effects of the pandemic,” Dr. Lappen says. “This will absolutely inform our approach to caring for women in a different phase of this pandemic or another pandemic.”

Nancy Cossler, MD, chief of system quality for obstetrics at UH and vice chair of quality and patient safety at University Hospitals MacDonald Women’s Hospital, and Megan Albertini, RN, senior quality improvement RN at UH, led the collection of pregnancy-related data during the pandemic through the MAC Quality Initiative.

Dr. Putra and Dr. Lappen credit this effort as instrumental in conducting their research on COVID-19 and pregnant women. “I think from the beginning of the pandemic, our department and the institutional review board realized that this was an opportunity to make this a real-time research priority that would directly impact patient care,” Dr. Lappen says.

To contact Drs. Lappen or Putra regarding their research, call 216-553-1537.