Changes in Prenatal Testing During the COVID-19 Pandemic

Objective: The coronavirus disease 2019 (COVID-19) pandemic disrupted healthcare delivery, including prenatal care. The study objective was to assess if timing of routine prenatal testing changed during the COVID-19 pandemic. Methods: Retrospective observational cohort study using claims data from a regional insurer (Highmark) and electronic health record data from two academic health systems (Penn Medicine and Yale New Haven) to compare prenatal testing timing in the pre-pandemic (03/10/2018-12/31/2018 and 03/10/2019-12/31/2019) and early COVID-19 pandemic (03/10/2020-12/31/2020) periods. Primary outcomes were second trimester fetal anatomy ultrasounds and gestational diabetes (GDM) testing. A secondary analysis examined first trimester ultrasounds. Results: The three datasets included 31,474 pregnant patients. Mean gestational age for second trimester anatomy ultrasounds increased from the pre-pandemic to COVID-19 period (Highmark 19.4 vs. 19.6 weeks; Penn: 20.1 vs. 20.4 weeks; Yale: 18.8 vs. 19.2 weeks, all p \u3c 0.001). There was a detectable decrease in the proportion of patients who completed the anatomy survey \u3c20 weeks\u27 gestation across datasets, which did not persist at \u3c23 weeks\u27 gestation. There were no consistent changes in timing of GDM screening. There were significant reductions in the proportion of patients with first trimester ultrasounds in the academic institutions (Penn: 57.7% vs. 40.6% and Yale: 78.7% vs. 65.5%, both p \u3c 0.001) but not Highmark. Findings were similar with multivariable adjustment. Conclusion: While some prenatal testing happened later in pregnancy during the pandemic, pregnant patients continued to receive appropriately timed testing. Despite disruptions in care delivery, prenatal screening remained a priority for patients and providers during the COVID-19 pandemic

A Multidimensional and Longitudinal Exploratory Study of the Stability of Pregnancy Contexts in the United States

Objective: Evaluate the longitudinal stability of six pregnancy contexts, including intention, in a diverse cohort of individuals experiencing delivery, abortion, or miscarriage. Methods: We enrolled individuals 16?44 years of age with pregnancies <24 weeks gestation in this longitudinal study between June 2014 and June 2015 in four US urban clinics. We assessed six pregnancy contexts (intention, wantedness, planning, timing, desirability, and happiness) at enrollment and 3-month follow-up. We constructed three-level categorical measures for each context defined as favorable, ambivalent, or unfavorable. We used Wilcoxon sign tests to evaluate changes in paired observations between pregnancy context measures over time and by pregnancy outcome. Results: Among 121 participants at median gestational age of 7 weeks and 3 days, we found intention, wantedness, planning, timing, and happiness remained unchanged from enrollment in early pregnancy to 3-month follow-up. Individuals demonstrated changes in desirability; pregnancy assessments shifted toward less desirable from enrollment to follow-up (p?=?0.01) (i.e., desired to ambivalent, or ambivalent to undesired). Among participants choosing delivery (57%), assessments shifted toward more favorable planning (i.e., unplanned to ambivalent, or ambivalent to planned) (p?<?0.01), and less favorable desirability (i.e., desired to ambivalent or ambivalent to undesired) (p?<?0.01) at follow-up. Among participants choosing abortion (28%), assessments shifted toward more unfavorable planning (i.e., planned to ambivalent, or ambivalent to unplanned) at follow-up (p?<?0.01). Conclusion: In multidimensional, longitudinal assessment, pregnant participants' perspectives on five of six pregnancy contexts remained unchanged between enrollment and 3-month follow-up; only desirability shifted. Pregnancy planning perspectives differed by pregnancy outcome. Human Research Subjects Protection Program: 1310012926

Measuring health utility in varying pregnancy contexts among a diverse cohort of pregnant women.

ObjectiveTo contribute to decision analysis by estimating utility, defined as an individual's valuation of specific health states, for different pregnancy contexts.Study designCross-sectional analysis of data from pregnant women recruited at pregnancy testing clinics during June 2014-June 2015. Utility was measured using the visual analog scale (VAS), PROMIS GSF-derived utility, standard gamble (SG), and time-trade-off (TTO) approaches. Six dimensions of pregnancy context were assessed including: intention, desirability, planning, timing, wantedness, and happiness. Multivariable regression modeling was used to examine the associations between pregnancy context and utility while controlling for women's sociodemographic and health characteristics.ResultsAmong 123 participants with diverse characteristics, aged 27±6 years, with mean gestation of 7.5±3 weeks, few reported optimal pregnancy contexts. Mean utility of the pregnancy state varied across contexts, whether measured with VAS (0.28-0.91), PROMIS GSF-derived utility (0.66-0.75), SG (0.985-1.00) or TTO (0.9990-0.99999). The VAS-derived mean utility score for unintended pregnancy was 0.68 (95% CI 0.59, 0.77). Multivariable regression analysis demonstrated significant disutility of unintended pregnancy, as well as all other unfavorable pregnancy contexts, when measured by VAS. In contrast, PROMIS GSF-derived utility only detected a significant reduction in utility among ambivalent compared to wanted pregnancy, while SG and TTO did not show meaningful differences in utility across pregnancy contexts.ConclusionsUnintended pregnancy is associated with significant patient-reported disutility, as is pregnancy occurring in other unfavorable contexts. VAS-based measurements provide the most nuanced measures of the utility for pregnancy in varying contexts.ImplicationsDecision analyses, including assessments of the cost-effectiveness of pregnancy related interventions, should incorporate measures of the utility of pregnancy in various contexts

Pregnancy context and women’s health-related quality of life

ObjectiveThe objective was to quantify the association of pregnancy context and health-related quality of life (HRQoL).Study designEnglish- or Spanish-speaking women, aged 16-44, with pregnancies <24 weeks' gestation were enrolled in this cross-sectional study between June 2014 and June 2015. Participants completed self-assessments of pregnancy "context," including timing, intention, wantedness, desirability, happiness, and planning (measured with the London Measure of Unplanned Pregnancy). HRQoL was measured using the Patient Reported Outcomes Measurement Information System Global Short Form. Associations between measures of pregnancy context and HRQoL scores in the lowest tertile were examined using multivariable logistic regression to adjust for potential confounding variables.ResultsWe enrolled 161 participants (mean age=27.2±6.6 years). Only 14% self-identified as White, non-Hispanic; 42% Hispanic; 37% Black, non-Hispanic; and 7% multiracial. Most (79%) participants were unmarried, and 75% were parenting. Mean gestational age was 9±4.6 weeks. In unadjusted models, women reporting mixed feelings about wanting to have a baby, an undesired pregnancy or feeling unhappy about learning of their pregnancy more frequently had low mental and physical HRQoL compared to women reporting wanted, desired, happy pregnancies. Women with an unplanned pregnancy or pregnancy occurring at the wrong time also had lower physical HRQoL than women reporting pregnancies that were planned or happened at the right time. However, after multivariate adjustment, including history of depression, pregnancy contexts were not associated with low mental or physical HRQoL.ConclusionsAfter adjusting for multiple confounders, pregnancy context is not significantly associated with HRQoL.ImplicationsThe focus on pregnancy intention in public health programs may not sufficiently assess multidimensional aspects of pregnancy context and may not align with patient-centered outcomes such as HRQoL

Clinical Validation of PROMIS Global Short Form in Pregnancy

Health-related quality of life (HRQoL) is an important patient-reported outcome, yet research regarding HRQoL during pregnancy is limited. We examined HRQoL during pregnancy using the Patient Reported Outcomes Measurement Information System (PROMIS) Global Short Form (GSF) and validated the GSF compared to legacy HRQoL measures. We evaluated HRQoL among 161 women seeking pregnancy care in urban clinic settings. Participants completed measures of HRQoL, social support, antenatal depression, and utility. Descriptive statistics and correlation coefficients were calculated. Participants averaged 27(±6.6) years and were culturally diverse: 42% self-identified as Hispanic, 37% Black, non-Hispanic, 14% White, non-Hispanic and 7% multiracial or other. Mean estimated gestational age was 9 (±4.6) weeks. PROMIS GSF Physical T-scores were significantly correlated with SF-12 Physical Component Score (PCS) and Mental Component Score (MCS) HRQoL measures (correlation coefficient=0.40 and 0.49, p-value<0.0001, respectively), the Modified Kendler Social Support Index (MKSSI) (correlation coefficient=0.42, p-value<0.0001), and the Visual Analog Scale (VAS) measure of utility (correlation coefficient=0.19, p-value =0.04). GSF Mental T-scores were associated with SF-12 MCS and PCS (correlation coefficient=0.66, p-value<0.0001, and 0.26, p-value<0.01, respectively), MKSSI (correlation coefficient=0.50, p-value<0.0001), and VAS (correlation coefficient=0.29, p-value<0.01). GSF Physical and Mental scores were inversely associated with the Edinburgh Postpartum Depression Scale (EPDS), correlation coefficient= −0.62 and − 0.71, respectively (p-value<0.0001). GSF-derived utility measures demonstrate significant correlation with SF-12 PCS and MCS, MKSSI, EPDS, and VAS. Overall, PROMIS GSF domains demonstrate correlation with legacy HRQoL measures as well as validated measures of social support, depression, and utility among a diverse cohort of pregnant women