Table 1. Maternal and hospital characteristics of deliveries occurring from April through December of 2019 and 2020, Premier Healthcare Database Special COVID-19 Release, United States
|
|
2019
|
|
2020
|
|
Characteristics
|
n
|
%
|
n
|
%
|
Total deliveries
|
662,770
|
|
610,716
|
|
Maternal age (mean, SD)
|
29
|
5.8
|
29
|
5.8
|
Maternal race and ethnicitya
|
|
|
|
|
|
Non-Hispanic White
|
358,484
|
54.0
|
329,907
|
53.7
|
|
Hispanic
|
113,322
|
17.1
|
110,212
|
17.9
|
|
Non-Hispanic Black
|
92,388
|
13.9
|
88,813
|
14.5
|
|
Non-Hispanic Asian
|
29,777
|
4.5
|
26,706
|
4.3
|
|
Non-Hispanic Other
|
50,951
|
7.7
|
40,592
|
6.6
|
|
Missing
|
18,698
|
2.8
|
17,863
|
2.9
|
Marital status
|
|
|
|
|
|
Married
|
320,420
|
48.3
|
289,520
|
47.2
|
|
Single
|
266,728
|
40.2
|
251,634
|
41.0
|
|
Other
|
70,424
|
10.6
|
65,876
|
10.7
|
|
Unknown
|
6,048
|
0.9
|
7,063
|
1.2
|
Primary payorb
|
|
|
|
|
|
Private
|
333,695
|
50.3
|
308,858
|
50.3
|
|
Medicaid
|
286,231
|
43.1
|
266,696
|
43.4
|
|
Self-pay
|
14,866
|
2.2
|
11,373
|
1.9
|
|
Other
|
28,828
|
4.3
|
27,166
|
4.4
|
Census divisionc
|
|
|
|
|
|
East North Central
|
104,432
|
15.7
|
99,504
|
16.2
|
|
East South Central
|
49,242
|
7.4
|
46,184
|
7.5
|
|
Middle Atlantic
|
85,016
|
12.8
|
75,175
|
12.2
|
|
Mountain
|
47,630
|
7.2
|
44,612
|
7.3
|
|
New England
|
12,040
|
1.8
|
12,186
|
2.0
|
|
Pacific
|
80,993
|
12.2
|
62,148
|
10.1
|
|
South Atlantic
|
165,558
|
25.0
|
162,799
|
26.5
|
|
West North Central
|
40,820
|
6.2
|
37,538
|
6.1
|
|
West South Central
|
77,889
|
11.7
|
73,947
|
12.0
|
Hospital locationd
|
|
|
|
|
|
Urban
|
581,946
|
87.7
|
538,636
|
87.7
|
|
Rural
|
81,674
|
12.3
|
75,457
|
12.3
|
Maternal comorbidities
|
|
|
|
|
|
Hypertensive disorders of pregnancye
|
99,324
|
15.0
|
101,013
|
16.5
|
|
Diabetes (T1/T2, gestational, other)
|
63,989
|
9.6
|
68,432
|
11.1
|
|
Type 1 or type 2 diabetes
|
7,419
|
1.1
|
7,630
|
1.2
|
|
Gestational diabetes
|
55,738
|
8.4
|
59,852
|
9.8
|
|
Obesity
|
84,417
|
12.7
|
91,670
|
14.9
|
Abbreviations: SD = Standard deviation; T1/T2 = Type 1 or Type 2
a. Maternal race and ethnicity collected separately and combined; Women with records indicating Hispanic ethnicity were considered Hispanic, regardless of recorded or missing race. Women missing Hispanic ethnicity or categorized as non-Hispanic were classified as non-Hispanic and assigned their recorded race.
b. Private payor includes managed care and commercial indemnity
c. East North Central: Indiana, Illinois, Michigan, Ohio, Wisconsin; East South Central: Alabama, Kentucky, Mississippi, Tennessee; Middle Atlantic: New Jersey, New York, Pennsylvania; Mountain: Arizona, Colorado, Idaho, New Mexico, Montana, Utah, Nevada, Wyoming; New England: Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island, Vermont; Pacific: Alaska, California, Hawaii, Oregon, Washington; South Atlantic: Delaware, District of Columbia, Florida, Georgia, Maryland, North Carolina, South Carolina, Virginia, West Virginia; West North Central: Iowa, Kansas, Minnesota, Missouri, Nebraska, North Dakota, South Dakota; West South Central: Arkansas, Louisiana, Oklahoma, Texas
d. The U.S. Census defines an urban area as a territory whose core census block groups or blocks have a population density of at least 1000 people per square mile, and surrounding census blocks have an overall density of at least 500 people per square mile. Rural areas are considered territory outside the definition of urban.
e. Includes chronic hypertension, gestational hypertension, chronic hypertension with superimposed pre-eclampsia, pre-eclampsia, HELLP syndrome, and eclampsia
Table 2. Association between adverse pregnancy outcomes among pregnancies being delivered in April-December 2020 compared to April-December 2019, Premier Healthcare Database Special COVID-19 Release, United States
|
2019
|
|
2020
|
|
|
|
|
n
|
%
|
n
|
%
|
Prevalence ratio (95% CI)
|
Adjusted prevalence ratio (95% CI)
|
Total
|
663,620
|
|
614,093
|
|
|
|
Adverse maternal outcomes
|
|
|
|
|
|
|
Intensive care unit admissiona
|
10,964
|
1.7
|
9,480
|
1.5
|
0.93 (0.91, 0.96)
|
0.90 (0.87, 0.92)a
|
In hospital death
|
33
|
5 per 100,000
|
53
|
9 per 100,000
|
1.74 (1.12, 2.68)
|
1.68 (1.09, 2.59)b
|
|
|
|
|
|
|
|
Pregnancy outcomes
|
|
|
|
|
|
|
Livebirth
|
659,663
|
99.4
|
610,303
|
99.4
|
1.00 (1.00, 1.00)
|
1.00 (1.00, 1.00)c
|
Stillbirth
|
3,957
|
0.6
|
3,790
|
0.6
|
1.03 (0.98, 1.07)
|
1.02 (0.98, 1.07)c
|
Preterm birth
|
61,101
|
9.2
|
56,158
|
9.1
|
0.99 (0.98, 1.00)
|
0.96 (0.95, 0.97)c
|
|
|
|
|
|
|
|
Mode of delivery
|
|
|
|
|
|
|
Vaginal
|
458,464
|
69.1
|
419,869
|
68.4
|
0.99 (0.98, 0.99)
|
1.00 (1.00, 1.00)c
|
Cesarean
|
205,156
|
30.9
|
194,224
|
31.6
|
1.03 (1.03, 1.04)
|
1.01 (1.00, 1.01)c
|
|
|
|
|
|
|
|
Cesarean delivery characteristics
|
|
|
|
|
|
|
..with PROM
|
15,231
|
7.4
|
15,083
|
7.8
|
1.05 (1.02, 1.07)
|
1.06 (1.04, 1.08)c
|
..with prolonged labor
|
2,109
|
1.0
|
2,105
|
1.1
|
1.05 (0.99, 1.12)
|
1.06 (1.00, 1.13)c
|
..with attempted forceps or vacuum
|
1,176
|
0.6
|
1,149
|
0.6
|
1.03 (0.95, 1.12)
|
1.06 (0.98, 1.15)c
|
..with augmentation or induction of labor
|
9,082
|
4.4
|
8,777
|
4.5
|
1.02 (0.99, 1.05)
|
0.99 (0.97, 1.02)c
|
|
|
|
|
|
|
|
SMFM cesarean delivery designation
|
|
|
|
|
|
|
Low-riskd
|
65,952
|
32.2
|
64,369
|
33.1
|
1.03 (1.02, 1.04)
|
1.04 (1.03, 1.04)c
|
High-riske
|
139,204
|
67.9
|
129,855
|
66.9
|
0.98 (0.98, 0.99)
|
0.98 (0.98, 0.99)c
|
....Due to maternal factorse
|
4,609
|
2.3
|
4,838
|
2.5
|
1.11 (1.06, 1.15)
|
1.07 (1.03, 1.12)c
|
....Due to preterm birth
|
26,944
|
13.1
|
25,667
|
13.2
|
1.01 (0.99, 1.02)
|
0.98 (0.96, 0.99)c
|
....Due to stillborn
|
727
|
0.4
|
719
|
0.4
|
1.03 (0.93, 1.15)
|
1.02 (0.92, 1.14)c
|
....Due to malpresentation
|
26,555
|
12.9
|
25,204
|
13.0
|
1.00 (0.99, 1.02)
|
1.01 (0.99, 1.02)c
|
....Due to fetal factors
|
234
|
0.1
|
224
|
0.1
|
1.01 (0.84, 1.21)
|
1.00 (0.83, 1.20)c
|
....Due to uterine/placental factors
|
105,848
|
51.6
|
97,937
|
50.4
|
0.97 (0.97, 0.98)
|
0.97 (0.97, 0.98)c
|
....Due to conduct of labor
|
2,553
|
1.2
|
2,642
|
1.4
|
1.09 (1.04, 1.15)
|
1.11 (1.05, 1.17)c
|
|
|
|
|
|
|
|
Readmission within 30 days of delivery
|
8,224
|
1.2
|
7,665
|
1.3
|
1.01 (0.98, 1.04)
|
0.97 (0.94, 1.00)c
|
Abbreviations: CI = confidence interval; PROM = Premature rupture of membranes; SMFM = Society for Maternal-Fetal Medicine
|
a. Model adjusted for individual women nested within hospitals (to account for within person and facility correlation), continuous maternal age, payor, hypertensive disorders, diabetes, and obesity
|
b. Model adjusted for hospital (to account for within facility correlation), categorized maternal age (15-19, 20-24, 25-29, 30-34, 35-39, 40-45), payor, hypertensive disorders, diabetes, and obesity
|
c. Models adjusted for hospital (to account for within facility correlation), continuous maternal age, division, payor, hypertensive disorders, diabetes, and obesity
|
d. A cesarean delivery without any high-risk factors was considered a delivery at low-risk of cesarean delivery
|
e. A delivery with medical factors making it high-risk for cesarean delivery; factors are not mutually exclusive
|
Table 3. Association between delivery length of stay among pregnancies being delivered in April-December 2020 compared to April-December 2019, Premier Healthcare Database Special COVID-19 Release, United States
|
|
Prevalence ratioa
|
Adjusted prevalence ratioa,b
|
Vaginal deliveries
|
|
|
…2 daysc
|
1.00
|
1.00
|
…< 1 day
|
1.23 (1.13, 1.34)
|
1.32 (1.21, 1.44)
|
…1 day
|
1.36 (1.35, 1.37)
|
1.39 (1.38, 1.40)
|
…≥ 3 days
|
0.93 (0.92-0.94)
|
0.90 (0.90, 0.91)
|
Cesarean deliveries
|
|
|
…3 daysc
|
1.00
|
1.00
|
…< 1 day
|
1.38 (1.27, 1.50)
|
1.53 (1.40, 1.66)
|
…1-2 days
|
1.30 (1.29, 1.31)
|
1.32 (1.31, 1.32)
|
…4 days
|
0.99 (0.98, 1.00)
|
0.96 (0.95, 0.98)
|
…≥ 5 days
|
1.01 (1.00, 1.03)
|
0.94 (0.92, 0.95)
|
a. Separate models were run comparing 2020 deliveries to 2019 deliveries for each length of stay category, compared to the reference category
|
b. Model adjusted for individual women nested within hospital (to account for within person and facility correlation), census division, continuous maternal age, payor, hypertensive disorders, diabetes, and obesity
|
c. Reference category
|