COVID-19 Prevalence and Trends Among Pregnant and Postpartum Individuals in Maine by Rurality and Pregnancy Conditions

Objective: To estimate COVID-19 diagnosis prevalence and trends among pregnant and postpartum individuals in Maine by rurality and common pregnancy conditions. Methods: We used the Maine Health Data Organization's All Payer Claims Data to identify deliveries during 2020-2021. We identified COVID-19 during pregnancy (Apr 2020 to Dec 2021 deliveries) and during the first 6 months postpartum (Apr 2020 to Jun 2021 deliveries) using the ICD-10 diagnosis code U071 on medical claims. We used Joinpoint regression software to model trends. We stratified the analysis by rurality of residence (based on ZIP code) and by common pregnancy conditions: gestational diabetes (GDM), hypertensive disorders of pregnancy (HDP), and prenatal depression. Results: We included 13,457 deliveries in our pregnancy and 9,143 deliveries in our postpartum analysis. COVID-19 diagnosis prevalence among pregnant individuals increased from 0.5% in Apr 2020 to 10.5% in Dec 2021 (Oct 2020 was the start of slope [0.43 per month], p<.01). COVID-19 diagnosis prevalence postpartum increased from 0.9% in Apr 2020 to 3.2% in June 2021 deliveries (slope=0.12 per month, p<.01). Trends in prevalence of COVID-19 diagnosis among pregnant individuals living in urban areas were distinct from those living in rural areas (p=.02), with a steeper slope during the first months of the pandemic in urban areas, followed by a later increase among rural residents. Trends among postpartum individuals living in urban areas were distinct from those living in rural areas (p=.03), with a steeper slope for rural residents over the course of the pandemic. Trends in persons with prenatal depression showed a steeper increase in COVID-19 diagnosis prevalence in pregnancy after Dec 2020 (p<.01) and postpartum overall (p<.01) compared to those without prenatal depression. Individuals without GDM and individuals without HDP had steeper increases in COVID-19 diagnosis prevalence in postpartum compared to those without GDM (p<.01) and those without HDP (p=.03). Conclusion: COVID-19 diagnosis among pregnant and postpartum individuals in Maine showed distinct patterns by rurality of residence and select pregnancy conditions. This information can be used for assessing the impact of the COVID-19 pandemic on maternal and infant health. ### Competing Interest Statement Kristin Palmsten receives research contracts from AbbVie, GSK, and Sanofi that are unrelated to this study. The remaining authors declare no conflicts of interest. ### Funding Statement The research reported in this publication was supported by the Eunice Kennedy Shriver National Institute of Child Health & Human Development of the National Institutes of Health under Award Number R15HD101793. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: This study was determined to be exempt from human subject review by the University of Southern Maine's Institutional Review Board. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes We used the Maine Health Data Organization's All Payer Claims Data as authorized under Data Request Number 2021040501.