Press Releases

Friday, May 26, 2023

Regional perinatal research collaborative shares findings of study on pre-term births during COVID

Research points to commitment to obstetric care and virtual access as key factors in ensuring quality prenatal care during the pandemic

Wilmington, Del. (May 26, 2023) – In 2021, Highmark Blue Cross Blue Shield Delaware partnered with some of the country’s most esteemed institutions and researchers, known as the AQUEDUCT Perinatal Research Collaborative, to investigate anecdotal evidence of decreases in preterm births during the COVID-19 pandemic. The AQUEDUCT Perinatal Research Collaborative (Advancing Quality, Utilization, and Equity for the Dyad: Understanding Care Together) included researchers from Children's Hospital of Philadelphia, Nemours Children’s Health, Northwestern University, University of Pennsylvania and Yale University, with funding and support from the Independence Blue Cross Foundation, and Highmark Blue Cross Blue Shield Delaware’s donor-advised fund BluePrints for the Community.

“This research project was a new endeavor for us at Highmark Delaware, but the longstanding relationships with our esteemed colleagues across the region and our shared desire to improve health for all are what inspired us to support,” said Nick Moriello, president of Highmark Blue Cross Blue Shield Delaware.

According to the World Health Organization, one in ten babies worldwide is born preterm. While the serious impacts of preterm birth are known, it is less well known why preterm birth occurs. The AQUEDUCT team expected to find a drop in preterm births within their geographical region, mirroring the trend in other parts of the country and even globally.

Utilizing electronic medical records data from Penn Medicine and Yale, as well as payer data from Highmark Blue Cross Blue Shield Delaware, the research built on earlier analyses of Philadelphia-focused data regarding the impact of COVID-19 on preterm births, stillbirths, and healthcare utilization. A national cohort of Highmark-insured patients who were pregnant and/or delivering between 2018 and 2020 was then analyzed, with the COVID-19 era defined as beginning in March 2020.

“We expected to see a similar drop in preterm birth during the pandemic that was observed in Europe. In contrast, we saw no significant changes in preterm birth. Our findings suggest the protective environmental and social factors abroad may not have been the same here in Philadelphia and New Haven,” said Heather H. Burris, MD, MPH, an attending neonatologist at CHOP and co-lead investigator of the research. “However, we were reassured by the healthcare system’s commitment to prenatal care during the pandemic; prenatal testing and related screenings remained a priority for patients and providers and occurred on time, despite disruptions and delays in many aspects of care caused by the pandemic.”

The pandemic encouraged rapid adaptation to telehealth care. Highmark alone saw a 3,600 percent increase in utilization in 2020 over 2019, with little drop in usage in 2021 over 2020, 3.3 million and 3.5 million claims, respectively, across its footprint in Delaware, Pennsylvania and West Virginia. Telemedicine users tended to initiate prenatal care earlier and had more total visits, earlier timing of ultrasounds, and earlier diabetes screening during pregnancy compared with nonusers. There were no significant differences in delivery mode or stillbirth rates associated with telemedicine, but virtual healthcare options certainly supported the health journey during a time when in-person contact was limited.

“The findings of this study demonstrate the insights we can gain as a healthcare industry through partnership, collaboration and community engagement,” said Jay Greenspan, MD, co-lead investigator of the research and emeritus professor of pediatrics, Sidney Kimmel Medical College, Thomas Jefferson University, Nemours Children’s Hospital, Delaware. “As technology like telehealth and virtual visits continue to alter the healthcare landscape, it is more important than ever to bring together the best and brightest minds to better understand pediatric challenges like preterm birth rates.”

To learn out more about the study’s findings:

About Highmark Blue Cross Blue Shield Delaware and BluePrints for the Community
Highmark Blue Cross Blue Shield Delaware serves approximately 500,000 members through the company’s health care benefits business. It is an influential company in the market generating an economic impact of $135 million and supporting more than 1,000 direct and indirect jobs across the state. Highmark Blue Cross Blue Shield Delaware has been named a Top Workplace in Delaware and a Top Workplace USA. Highmark Blue Cross Blue Shield Delaware is an independent licensee of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield companies. For more information, visit BluePrints for the Community, Highmark Delaware’s donor-advised fund at the Delaware Community Foundation, has invested over $35 million in community health programs and projects since its inception in 2007. It was established to increase access to care and reduce health care disparities in Delaware. Learn more at www.highmark/com/blueprints.

About Children’s Hospital of Philadelphia
A non-profit, charitable organization, Children’s Hospital of Philadelphia was founded in 1855 as the nation’s first pediatric hospital. Through its long-standing commitment to providing exceptional patient care, training new generations of pediatric healthcare professionals, and pioneering major research initiatives, the 595-bed hospital has fostered many discoveries that have benefited children worldwide. Its pediatric research program is among the largest in the country. The institution has a well-established history of providing advanced pediatric care close to home through its CHOP Care Network, which includes more than 50 primary care practices, specialty care and surgical centers, urgent care centers, and community hospital alliances throughout Pennsylvania and New Jersey, as well as an inpatient hospital with a dedicated pediatric emergency department in King of Prussia. In addition, its unique family-centered care and public service programs have brought Children’s Hospital of Philadelphia recognition as a leading advocate for children and adolescents. For more information, visit

About Nemours Children's Health
Nemours Children’s Health is one of the nation’s largest multistate pediatric health systems, which includes two free-standing children’s hospitals and a network of more than 70 primary and specialty care practices. Nemours Children’s seeks to transform the health of children by adopting a holistic health model that utilizes innovative, safe, and high-quality care, while also caring for the health of the whole child beyond medicine. Nemours Children’s also powers the world’s most-visited website for information on the health of children and teens, Nemours Nemours KidsHealth is a pioneer and leader in pediatric health content that has been trusted by millions worldwide for more than 25 years.

The Nemours Foundation, established through the legacy and philanthropy of Alfred I. duPont, provides pediatric clinical care, research, education, advocacy, and prevention programs to the children, families and communities it serves. For more information, visit

For more information, contact

Denee Crumrine