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Monthly Birth Counts for Maternal Coronavirus Disease (COVID-19):
Technical Notes
Counts for maternal coronavirus disease (COVID-19) are based on supplemental reports sent to the National Center for Health Statistics (NCHS) by state vital records offices that are collecting information on reported cases of COVID-19 occurring at any time during pregnancy. A listing of reported COVID-19 cases among women giving birth are sent to NCHS on a monthly basis, and the number of states reporting this information varies by month. It is important to note that the incidence of COVID-19 cases among the general population can differ widely by state and by month and the states shown in the table below are not representative of the United States as a whole. It is also important to note that states have varying approaches to capturing information on maternal COVID-19 and different time requirements for reporting births. Accordingly, data may be incomplete, especially for births occurring recently. Counts for earlier months will be updated and may increase as new data are received by NCHS.
Nature and sources of data
National data on maternal COVID-19 are currently not available. Although maternal COVID-19 is not included on the U.S. Standard Certificate of Live Birth, selected states have begun to collect information on maternal COVID-19 and are reporting this supplemental information to NCHS on a monthly basis. The information is sent independently of the standard birth record and of the standard birth record data transmission.
Maternal COVID-19 (both confirmed and presumed) counts are based on supplemental reports of maternal COVID-19 collected by state vital records offices and reported to NCHS monthly. It is important to note that:
- States have different methods for collecting maternal COVID-19 information (not all states are collecting maternal COVID-19 directly on the birth certificate; see below); and
- These data are reported to NCHS outside of the usual process for submission of standard birth certificate data and do not undergo standard NCHS review prior to posting. Counts of maternal COVID-19 cases may not include all maternal COVID-19 cases that occurred in reporting areas during a given time period, especially for more recent periods.
Maternal COVID-19 reporting
Three states and the District of Columbia reported maternal COVID-19 to NCHS for March 2020, seven states and the District of Columbia for April, eight states and the District of Columbia for May and ten states and the District of Columbia for June. As more states begin collecting and reporting information on maternal COVID-19, they will be added to the monthly update.
State-specific information on methods for collecting maternal COVID-19 information and periods of reporting are as follows:
|
Jurisdiction
|
Date data collection began |
Data collection method |
| Alabama | 3/1/2020 | Reports confirmed or presumed cases of maternal COVID-19 reported in the medical notes section of the electronic birth reporting system and birth database. Also matches birth file with COVID-19 positive tests from Alabama National Electronic Disease Surveillance System. |
| Alaska | 4/13/2020 | Indicates that confirmed or presumed COVID-19 was present during pregnancy in the “Other Infections of Interest” section of the birth certificate item “Infections present and/or treated during this pregnancy.” |
| California | 6/10/2020 | Reports confirmed or presumed cases of maternal COVID-19 reported in the “Complications and Procedures of Pregnancy and Concurrent Illnesses” item of the birth certificate. |
| District of Columbia | 3/10/2020 | Indicates that confirmed or presumed COVID-19 was present during pregnancy in the “Infections present and/or treated during this pregnancy” and “Characteristics of Labor and Delivery” items of the birth certificate. Cases verified with hospital medical records. |
| Idaho | 5/1/20 | Indicates that confirmed or presumed COVID-19 was present during pregnancy in the “Infections present and/or treated during this pregnancy” item of the birth certificate. |
| Maine | 6/1/20 | Indicates that confirmed or presumed COVID-19 was present during pregnancy in the “Pregnancy Factors” tab under the “Obstetric Procedures” item of the birth certificate. |
| Maryland | 4/8/2020 | Developed a COVID-19 birth data collection form for completion by birthing facilities for mothers with confirmed (positive laboratory test) or suspected disease. |
| North Dakota | 3/1/2020 | Requires birthing hospitals to submit paper-based monthly reports identifying COVID-19 positive mothers. |
| New Hampshire | 4/10/2020 | Indicates that confirmed or presumed COVID-19 was present during pregnancy in the “Other Infections” section of the birth certificate item “Infections present and/or treated during this pregnancy.” |
| North Dakota | 3/1/2020 | Requires birthing hospitals to submit paper-based monthly reports identifying COVID-19 positive mothers. |
| Ohio | 3/1/2020 | Links birth file with infectious disease reports for confirmed COVID-19 cases from the Ohio Disease Reporting System. |
| West Virginia | 4/13/2020 | Indicates that confirmed or presumed COVID-19 was present during pregnancy in the “Other Infections” section on the birth certificate item “Infections present and/or treated during this pregnancy.” |
Completeness of data
Differences in reporting methods used by states to identify cases of maternal COVID-19 may result in varying levels of completeness by state. Limited information is available on the quality of infections data reported on the birth certificate, however, underreporting of specific infections has been observed in some jurisdictions (1); accordingly, maternal COVID-19 may also be underreported.
Cases of maternal COVID-19 for a given month are reported to NCHS during the following month. Although this may impact initial data completeness, particularly in states where births are not required to be reported for up to 10 days following delivery, counts for previously released months are revised based on new data received since the previous release. As a result, counts for earlier months may change with the addition of updated data, and the reliability of counts should improve with each monthly release.
State of Occurrence
Counts are reported by state of occurrence, which is the state in which the birth took place. State of occurrence may not be the same as the state of residence. Birth data are typically reported by state of residence and state birth totals for 2019 will differ from those published elsewhere.
Total births
The total number of monthly births shown are based on provisional 2019 data, which represent nearly 100% of U.S. births reported in 2019 (2). These monthly state-specific provisional counts provide an estimate of the number of births a state can expect each month in 2020. Births have been declining in recent years and 2020 total births may be lower than in 2019 (3).
Comparing data from different states
The incidence of COVID-19 cases among the general population can differ widely by state and by month and the states shown in the table below are not representative of the United States as a whole. State approaches to collecting information on maternal COVID-19 and state birth reporting requirements vary. State vital records reporting may also be affected or delayed by COVID-19 response activities. Policies for testing for maternal COVID-19 may vary by care provider and hospital. The completeness and accuracy of the individual state reporting of maternal COVID-19 is unclear and differences in collection methods make comparisons across states problematic.
Source
NCHS, National Vital Statistics System.
References
- Gregory ECW, Ely DM. Trends and characteristics of sexually transmitted infections during pregnancy: United States, 2016-2018 [PDF – 253 KB]. National Vital Statistics Report. Vol 69 (3): Hyattsville, Maryland. National Center for Health Statistics. 2020.
- Driscoll AK, Osterman MJK, Hamilton BE, Martin JA. Quarterly provisional estimates for selected birth indicators, Quarter 1, 2017-Quarter 4, 2019. National Center for Health Statistics. National Vital Statistics System, Vital Statistics Rapid Release Program. 2020.
- Hamilton BE, Martin JA, Osterman MJK. Births: Provisional data for 2019 [PDF – 372 KB]. Vital Statistics Rapid Release; no 8. Hyattsville, MD: National Center for Health Statistics. May 2020.