The emerging evidence suggests pregnant people are at enhanced risk of complications from COVID-19. Now, a group of Democrats are trying to plug holes in how the government tracks the virus’ impact on pregnancy, put new resources into maternal health and ensure that pregnant individuals are ultimately eligible for any new treatments and vaccines, according to a bill shared first with The 19th.

The bill, unveiled Monday and spearheaded by Sen. Elizabeth Warren and Rep. Lauren Underwood, comes as health experts are sounding the alarm that COVID-19 could worsen the nation’s already devastating maternal mortality crisis. 

In 2018, the most recent year for which federal data is available, 17.4 maternal deaths were recorded for every 100,000 live births. Black people died at more than double the rate of White ones. Meanwhile, data published this June by the Centers for Disease Control and Prevention suggested that pregnant individuals were at an elevated risk of requiring intensive care — including intubation — if they contracted COVID-19. 

The CDC data only included the race of 80 percent of people. But even that snapshot suggested Black and Latina women — who, nationally, are contracting COVID-19 at elevated rates — were “disproportionately affected by COVID-19 during pregnancy.”

Beyond physical health complications and disparities, maternal health experts have worried that the pandemic — which has placed new layers of psychological distress on women and transgender people — will exacerbate existing shortfalls in the national response to postpartum depression and anxiety, another area where Black and Latinx individuals are already underserved.

“COVID-19  and the maternal mortality and morbidity crises are hitting our country hard — and hitting Black communities and Indian Country the hardest,” Warren said. “Our bill will ensure the federal government’s response to the coronavirus pandemic centers pregnant people and confronts the systemic racism and discrimination in our health care system.”

The Warren-Underwood bill purports to alleviate this burden through a variety of mechanisms, including:

• Mandating more robust data collection to show precisely how the coronavirus affects pregnancy across race, ethnicity and geography
• Requiring that at least one of the COVID-19 vaccines developed in the U.S. be developed and approved for safe use in pregnant people
• Directing the development of pregnant worker protections through an “emergency temporary standard” — a short-term, enforceable measure from the Occupational Safety and Health Administration that would address COVID-specific worker concerns, such as personal protective equipment requirements, social distancing rules and other strategies to mitigate the spread of exposure.
• Having the CDC implement a public health information campaign concerning COVID-19 and pregnancy
• Requiring the Government Accountability Office (GAO) to monitor maternal health during the pandemic and report to Congress on how COVID-19 affects maternal and infant outcomes, including preterm birth rates, labor and delivery outcomes, prenatal and postpartum mental health and C-section rates
• Creating a federal task force to promote “positive birthing experiences” during the pandemic — focusing in particular on pregnancy outcomes for non-White people and women in rural areas — and funding non-clinical health care workers, such as community health workers, to monitor postpartum health.

The bill’s path to law isn’t obvious, at least in the short term. No Republicans have signed on, and Congress is already at a standstill over the next round of stimulus funding. Still, the proposals the bill  outlines would take aim at some of the issues researchers have consistently highlighted as shortcomings in the nation’s COVID-19 response. 

Data collection is a critical hole in the nation’s approach to maternal health generally, but particularly when it comes to COVID-19, experts say.

“We need to be able to to collect the data and report it back along known structural fault lines so resources can be directed to people most affected,” said Katy Kozhimannil, an associate professor at the University of Minnesota and director of its rural health research center, who provided input on the bill. “It’s essential to understanding what’s happening.”

Generally, states vary in their comprehensiveness around collecting incidence data about deaths and illnesses associated with pregnancy. Current public-facing federal data doesn’t consistently include race and ethnicity for pregnant people who develop COVID-19. There’s no clear picture of whether patients were asymptomatic, or why they were admitted for hospital care. 

“We’re worlds behind other countries in reporting any data in maternal morbidity,” Kozhimannil added.

The vaccine question is another big one. The federal government has poured billions of dollars into developing an immunization for COVID-19. But so far, none have indicated plans to include pregnant people in clinical trials. Moderna and Pfizer, which are both launching late-stage trials in the United States, have listed pregnancy as a reason to be excluded. 

The debate over when and how to test vaccines on pregnant individuals is complex. And, under the bill, companies that do not include pregnant people in COVID vaccine trials would be required to “provide scientific and ethical justification.”

Given their high risk — as well as the prevalence of cisgender women of childbearing age amongst health care workers, teachers and other frontline workers — getting some kind of vaccine for them approved is a high priority, said Dr. Geeta Swamy, an OB/GYN and vice president for research at Duke University. (Data illustrating the gender breakdown of frontline workers does not account for transgender and nonbinary people in the workforce. But other data suggests that they are also at elevated risk for COVID-19.)

From a research standpoint, she added, ensuring even a single vaccine that works during pregnancy means including them in the trials for maybe three or four different candidates.

“We don’t necessarily need a lot of options,” she said. “In the vaccine world, we just need one that works.”

So far, Congress hasn’t passed any legislation specifically focused on the pandemic’s maternal impact. In some ways, that’s unsurprising, Kozhimannil argued— pregnancy is often treated as a niche issue, even though almost 4 million live births occur each year.

“The assumption is that birth is not universal and fundamental, and something we should be prioritizing,” she said. “Being the developed country with the worst maternal health in the world should shame us into action.”