Breaking Down Silos to Address COVID-19 in Maternal and Child Health:
May 2021

​Two Examples of State Collaborative Approaches to Turn Data into Action

Camille Delgado-López, MPH, Puerto Rico Department of Health
Elizabeth Harvey, PhD, MPH, Tennessee Department of Health
Alyson K. Northrup, MS, Association of Maternal & Child Health Programs
Nia Sutton, MPH, CHES, Association of Maternal & Child Health Programs
Van T. Tong, MPH, Centers for Disease Control and Prevention

International outbreaks of infectious disease remind us of our interconnectedness as a global community. The 2016 Zika virus epidemic underscored both the importance of working globally to inform domestic infectious disease response as well as the unique impacts of public health emergencies on pregnant people and their babies. The ongoing COVID-19 pandemic provides the latest illustration that infectious disease knows no borders and that special attention must be paid to impacts on maternal and child health (MCH) populations. 

Public health emergencies like Zika and COVID-19 have led MCH professionals to bridge gaps – in public health authorities, between agencies and with stakeholders, and in available surveillance datasets – to ensure that the impacts of public health emergencies on MCH populations are monitored and prioritized. The international and domestic response to Zika served as a catalyst for the creation of the Surveillance for Emerging Threats to Mothers and Babies Network (SET-NET) at the National Center on Birth Defects and Developmental Disabilities (NCBDDD) within the Centers for Disease Control and Prevention (CDC).[i] Through SET-NET, state, local, and territorial health departments work with CDC to identify the impact of emerging and reemerging public health threats to pregnant people and their infants. 

CDC contacted jurisdictions in April 2020 to voluntarily participate in surveillance of pregnant women with COVID-19. The goals were to understand the epidemiology of COVID-19 in pregnancy on both mother and infant and inform clinical guidance. The experiences of two SET-NET grantees – the Puerto Rico Department of Health and the Tennessee Department of Health – demonstrate how leveraging existing data infrastructure and key relationships enabled them to quickly adapt their surveillance systems to monitor the impact of COVID-19 on pregnant people and infants and translate data to action.  

In Puerto Rico, the SET-NET team drafted the Secretary of Health’s administrative order establishing the mandatory report of positive COVID-19 tests from pregnant people to SET-NET and ensured a “pregnancy status” variable was included in the BioPortal, the Department of Health’s comprehensive repository of COVID-19 data. SET-NET data were shared on an ongoing basis with PROGyn, a non-profit organization dedicated to education and information exchange among women’s health care providers. Established partnerships with PROGyn and the Puerto Rico Birth Defects Surveillance and Prevention System enhanced SET-NET capacity to monitor the impact of COVID-19 on pregnancy and birth outcomes. 

The Tennessee Department of Health (TDH) used SET-NET COVID-19 pregnancy data and stakeholder feedback to inform action and programmatic alignment. Through surveillance, TDH staff observed a disproportionate burden of COVID-19 among Hispanic pregnant people; this prompted the creation and dissemination of a Spanish-language public service announcement for pregnant people. Additionally, when TDH staff noticed maternal deaths due to COVID-19, staff collaborated with the Maternal Mortality Review Committee to prioritize the review of COVID-19 pregnancy-associated deaths and issued a COVID-19-focused quarterly notification to all birthing hospitals in Tennessee regarding findings and guidance related to COVID-19 and pregnancy.

Both the Puerto Rico Department of Health and the Tennessee Department of Health contributed COVID-19 SET-NET data to an analysis by CDC of data from 16 jurisdictions regarding birth and infant outcomes following laboratory-confirmed SARS-CoV-2 (the virus that causes COVID-19) infection in pregnancy. This analysis led to a finding published in CDC’s Morbidity and Mortality Weekly that pregnant women with SARS-CoV-2 infection may be at increased risk for preterm delivery compared to pregnant women not infected with SARS-CoV-2.[ii] SET-NET sites continue to report COVID-19 data during pregnancy to CDC; these data are publicly reported through the CDC Data tracker

Building on lessons learned from COVID-19 and previous public health emergencies, the Association of Maternal & Child Health Programs (AMCHP) is developing a comprehensive, web-based toolkit to enhance the capabilities of agencies that serve MCH populations to prepare for and respond to public health emergencies. The forthcoming toolkit will identify characteristics of systems that are prepared to deliver an equity-centered and evidence-based emergency response. Many of these systems characteristics are supported by the SET-NET model and demonstrated by SET-NET grantees like Puerto Rico and Tennessee, including: 1) collaboration with national partners to leverage support; 2) interdepartmental collaboration between state MCH staff and state emergency preparedness staff; and 3) data collection that describes the impact of the emergency on MCH populations.

The authors will discuss these topics in more depth and be available for live Q&A during a workshop at the upcoming virtual AMCHP 2021 Annual Conference on Tues., May 25 from 2:30pm – 3:40pm ET.

[i] Woodworth KR, Reynolds MR, Burkel V, et al. A Preparedness Model for Mother-Baby Linked Longitudinal Surveillance for Emerging Threats. Matern Child Health J. 2021;25(2):198-206. doi:10.1007/s10995-020-03106-y

[ii] Woodworth KR, Olsen EO, Neelam V, et al. Birth and Infant Outcomes Following Laboratory-Confirmed SARS-CoV-2 Infection in Pregnancy — SET-NET, 16 Jurisdictions, March 29–October 14, 2020. MMWR Morb Mortal Wkly Rep 2020;69:1635–1640. DOI: