Other Maternal Child Health Data Capacity Efforts

During the current reporting period, a Social Security Disability Insurance/Title V measure monitoring and tracking system was maintained for use by the Maternal and Child Health Bureau staff. The monitoring system contains data for numerous Title V outcome and performance indicators and many of the SSDI minimum/core indicators, such as low birth weight, preterm birth, infant mortality, and teen births. The data is presented at the race and jurisdictional levels, for years 2010-2020 (where data is available), in an easy-to-use, interactive format that allows staff to print graphs and disseminate needed information. The monitoring system also provides comparisons to United States (US) rates, where available. Additionally, the indicators in the SSDI minimum/core dataset were monitored with the assistance of the Minimum/Core Dataset Implementation Guide and Training Module, to monitor Maryland’s progress and compare it with other states.

Aligned with our project plan, a Memorandum of Agreement (MOA) was maintained to use SSDI funds to support an administrative assistant in the Vital Statistics Administration to improve Maternal and Child Health Bureau epidemiologists’ access to birth and death certificate vital statistics data.

The annual Maternal Mortality Review Legislative Report for 2021 was completed in July of 2022 and is currently in the final stages of review. The annual Child Fatality Review (CFR) Legislative Report for 2021 was completed in September  of 2022 and is also in the final stages of review. Data on child fatality was presented at quarterly Maryland CFR State Team meetings in 2021 and 2022. MCHB Epidemiology staff maintained access to ImmuNet, Maryland’s Immunization Information System Database, to allow for access to immunization records for child fatality cases. SSDI staff continued collaboration with the Office of the Chief Medical Examiner to solve issues related to child fatality data collection and dissemination to the state and local teams for analysis. Maryland is also continuing participation in the Centers for Disease Control’s Sudden Unexpected Infant Death (SUID) and Sudden Death in the Young (SDY) Case Registry Surveillance grant initiative which started September 30, 2018 and ends September 29, 2023. The final 2020 SUID data was completed and submitted to the CDC in December of 2021.

The MCHB epidemiology team worked with the Maternal, Infant, and Early Childhood Home Visiting program to update their statewide needs assessment. The MCHB epidemiology team provided data on 23 indicators, including preterm birth, low birth weight, infant mortality, prenatal care, maternal education, poverty, unemployment, Medicaid enrollment, and crime. The MIECHV needs assessment was updated in July of 2021, which highlighted the elevated indicators across the state.  

The MCHB epidemiology team also worked with the Babies Born Healthy (BBH) Initiative, which aims to reduce infant mortality in Maryland and address the gap of excess infant mortality between Black and White populations. BBH was undergoing a refresh, and the MCHB epidemiology team provided data over from 2010–2019 (most available data at the time) to understand infant deaths, preterm births, low birth rates, and prenatal care access. The information was used to inform jurisdictions to invest to decrease the infant mortality rate.

To understand cannabis use amongst Maryland birthing people, the Maryland Medical Cannabis Commission reached out to the MCHB Epidemiology and Pregnancy Risk Assessment Monitoring System team. Due to a legislatively mandated Maryland Cannabis Use Baseline Study and report (MCUBS), the MMCC requested data that would help them understand the insurance status for those who report marijuana use and assess concurrent use of marijuana during pregnancy. MCHB epidemiology provided the following demographics information: In 2020, the majority of respondents who reported using marijuana were among ages 30-34 (317 respondents). The majority were also White, non-Hispanic (371 respondents), followed by Black non-Hispanic (251 respondents) and Hispanic (205 respondents). In 2020, the majority of respondents who reported using marijuana were covered by insurance supplied by their job (445 respondents) and stated they received breastfeeding information from a breastfeeding/lactation specialist (717 respondents). A large proportion of respondents who reported using marijuana had breastfed at some point (824 respondents). The data helped to inform the development of an informational fact sheet.

In addition, in response to an increased awareness of disability influencing a number of public health outcomes, Maryland’s Maternal and Child Health Bureau collaborated with the Environmental Health Bureau to analyze responses to questions of varying topics as they relate to a respondent’s disability status. The goal of this project was to understand whether women with any disability responded differently to selected PRAMS questionnaire indicators compared to women without a disability. In the analysis, women with any disability reported having postpartum depression at a rate twice that of women without a disability. A focus brief was developed on on disability for Maryland women giving birth 2019-2020 that described the demographics and responses of birthing people with and without a disability

SSDI is continuing to support the assessment and evaluation of neonatal abstinence syndrome (NAS) and substance exposed newborns (SEN) data in Maryland. Using Health Services Cost Review Commission (HSCRC) newborn discharge data MCHB epidemiologists have examined NAS and SEN trends based on ICD-9 coding but have noticed significant changes in the codes used to identify NAS and SEN under ICD-10. These findings are frequently shared with internal and external stakeholders to begin a discussion about how to better measure and track NAS and SEN. In 2022, MCHB epidemiologists presented a data analysis on NAS to all 32 birthing hospitals in the State.  

In July 2020, the Maryland Department of Health relaunched the Maryland Perinatal-Neonatal Quality Collaborative which is being led by Health Quality Innovators (HQI).The collaborative works with all 32 birthing hospitals in Maryland. The current collaborative focuses on maternal hypertension and newborn antibiotic stewardship. MCHB epidemiologists provided statistics through 2021 Q4 on maternal severe hypertension using inpatient hospitalization data using guidance from the Alliance for the Innovation on Maternal Health (AIM) Program. MCHB epidemiologists provide data support for these efforts using data from HSCRC, VSA, and PRAMS.

In September 2019, Maryland was granted a funding opportunity through the Health Resources and Services Administration (HRSA), and MDH convened the Maryland Maternal Health Improvement Task Force. This collaboration between Johns Hopkins University, Maryland Department of Health, Maryland Patient Safety Center and the University of Maryland, Baltimore County will address the needs of pregnant and postpartum women in Maryland, through coordinated innovation in the areas of data, resource availability, and hospital and community care. MCH epidemiologists support the work of the task force to provide state maternal health data, and perinatal health data. The current work of the team is to support data related to severe maternal morbidity to create a surveillance and review process of maternal data using HSCRC data. The team has also started initial exploration revising Maryland’s definition of SMM given the omission of transfusions in recent HRSA reports. Additionally, MCH epidemiologists have prepared reports on relevant maternal health trends for the Maryland Maternal Health Innovation (MDMOM) program. Participation in this workgroup will continue for the duration of the grant and will support data integration and development of a maternal health dashboard.  

In July 2020, MCH was granted funding through the Centers of Disease Control and Prevention to expand surveillance activities to include surveillance of COVID-19 in pregnancy and monitor pregnancy and infant outcomes under Project W: Surveillance and Monitoring of Emerging Infectious Diseases and Other Health Threats to study infants with congenital exposure within the CDC’s Surveillance for Emerging Threats to Mothers and Babies Network (SET-NET) approach. Two staff were hired to perform data linkages and conduct medical record abstraction. The epidemiology team developed a detailed data process document outlining the flow of data. The project involves multiple partners, including a health information exchange system, the Chesapeake Regional Information System for our Patients (CRISP) and the Vital Statistics Administration. 2020 and 2021 COVID-19 pregnancies identified using CRISP and the National Electronic Disease Surveillance System (NEDSS)  were linked to the VSA live birth files to analyze maternal demographics and prenatal health. Using this linked data, epidemiologists completed a COVID-19 data brief and presentation comparing all live births in Maryland in 2019 to births with a positive test in 2020. Additionally, the team is participating in a SET-NET communications campaign with the American Academy of Pediatrics to communicate relevant findings to pediatricians and pediatric healthcare providers. The epidemiologists complete data tasks required by the CDC such as medical record abstraction and attend programmatic meetings. Epidemiologists complete other data tasks when necessary for program advancement.

SSDI staff are continuing education and staying abreast of current health topics by attending webinars and conferences related to maternal and child health, epidemiology,  and health equity. The MCHB epidemiology team plans to attend  the 20203 CityMatCH Leadership and MCH Epidemiology Virtual Conference in September 2023.

SSDI staff provided data analysis on maternal and child health indicators to support the Babies Born Healthy program. The program was initiated in 2016 to target jurisdictions with the highest numbers and rates of infant mortality in the state of Maryland. During state fiscal year 2022 (July 1, 2021-June 30, 2022), a refresh of the Babies Born Healthy program was conducted, to focus program priorities on decreasing racial disparities in infant mortality. Additional data analysis was conducted by SSDI staff to identify priority jurisdictions for the new iteration of Babies Born Healthy.

In the spring and summer of 2021, MDH drafted a Maryland Maternal Health Improvement Plan (MHIP) to help improve how agencies, organizations, community groups, and residents work together to reduce maternal deaths and complications in Maryland over the next five years. MCHB epidemiologists provided data analysis related to maternal mortality (MMR) such as rates and disparity metrics. Additionally, data analysis on severe maternal morbidity (SMM) was conducted to include racial breakdowns on SMM rates over a 10-year period with projections through 2026. The epidemiology team assisted with calculating the projected reduction of  MMR and SMM over time to reduce racial disparities, particularly among the Black, non-Hispanic population. In 2022, MCHB epidemiologists continued to provide data.

Fetal, infant, and maternal data was used to create maternal and infant health (MIH) profiles for each of the 24 jurisdictions in the state. The profiles summarize maternal and child health indicators for each jurisdiction as well as compare to other jurisdictions and the state overall for 2016-2020. The MIH profiles will help inform jurisdictions of at-risk populations and areas of improvement as related to maternal and infant health. The MIH profiles were disseminated in the fall of 2022 and will be updated on an annual basis.

MCHB epidemiologists have been heavily involved in updating the client visit record (CVR) form that will yield data needed for the Family Planning Annual Report (FPAR) 2.0 collection. Activities include reviewing and comparing currently collected family planning data with data to be collected in FPAR 2.0, revising the current CVR form and sharing it with Ahler’s & Associates, the vendor that manages the family planning database system. MCHB epidemiologists will also assist with submission of data to the FPAR 2.0 online database in 2023.