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Research Letter • LETTRE D'INFORMATION| Volume 43, ISSUE 2, P165-166, February 2021

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Canadian Surveillance of COVID-19 in Pregnancy (CANCOVID-Preg): A Rapidly Coordinated National Response Using Established Regional Infrastructures

      As the world continues to respond to the COVID-19 pandemic, robust evidence in specific populations is critical to guide clinical care and public health policy. The maternal-newborn population requires unique consideration owing to its increased vulnerability to respiratory infections and to medical interventions used to treat infection, as well as unique infection prevention and control needs during labour, delivery, and the postpartum period.
      In response to the need for quality evidence to support optimal clinical care of pregnant women and their infants, a large collaboration of researchers and clinicians across Canada rapidly initiated Canadian Surveillance of COVID-19 in Pregnancy (CANCOVID-Preg) to collect comprehensive information on outcomes for infected pregnant individuals and their newborns (https://ridprogram.med.ubc.ca/cancovid-preg/). When COVID-19 was declared a pandemic, reproductive infectious disease specialists across Canada began to conceptualize a national surveillance program through an existing network. Within 2 weeks of the pandemic being declared, national meetings and protocol development were initiated. The first all-member meeting occurred at 7 weeks, when organizational structures had been launched in all regions. This was accomplished before any funding was received, due to exemplary individual commitment in each region of the country. Calls for COVID-19–specific funding allowed for dedicated funding to be secured within 3 months. This pan-Canadian team, with representation from every province and territory, is a remarkable example of national collaboration. Our overall aim is to generate Canadian-specific clinical and epidemiological data on the impact of SARS-CoV-2 infection during pregnancy on maternal, fetal, and neonatal health.
      Functioning as an observational surveillance program, cases in each province/territory are identified through public health reporting or clinical case identification, with regionally adapted data collection according to a common standardized protocol. Ontario is leveraging the existing infrastructure of the Better Outcomes Registry & Network to collect parallel data for inclusion. Case ascertainment extends back to March 1, 2020, and will continue through the duration of the pandemic. The surveillance-based approach allows for a far reach into rural and remote communities. Not only will this project provide timely data to inform public health, it also will function as a platform for additional research by allowing researchers to obtain patient consent and collect biospecimens from a subset of affected pregnancies. As of September 25, 2020, more than 860 COVID-19–affected pregnancies have been identified across Canada.
      To facilitate use of data, a steering committee was established with operating principles of transparency, equitable data access, and international data sharing. This project is endorsed by the Public Health Agency of Canada, the Canadian Paediatric Society, and the Society of Obstetricians and Gynaecologists of Canada. Data collection has been harmonized with a number of other international registries for COVID-19 in pregnancy, including COVI-Preg,
      • Panchaud A
      • Favre G
      • Pomar L
      • et al.
      An international registry for emergent pathogens and pregnancy..
      the U.K. COVID in pregnancy registry, and the Global Research in Pregnancy and the Newborn Collaboration: COVID-19, led by a U.S.-based group and linked to the World Health Organization. Our neonatal data collection has been harmonized with iNeo, which is collecting data internationally on infants born to women with COVID-19 (http://www.ineonetwork.org/). There will be other opportunities for data sharing and collaboration with different international consortia, including those assessing the impact of COVID-19 on coagulopathy and thrombosis, with which we have harmonized data (ISTH COV-PREG-Coag Registry

      Pregnancy and COVID-19 associated coagulopathy registry (COV-PREG-COAG). Available at: https://redcap.isth.org/surveys/?s=4JPX9W98RH. Accessed on November 8, 2020.

      ). Given that many adverse outcomes in pregnancy may be low in frequency, international collaboration is critical to achieve numbers adequate to detect elevated risk and result in an improved global understanding of COVID-19 in pregnancy.
      CANCOVID-Preg is an example of a swift national response to an emerging pathogen that could be mobilized in future epidemics to provide rapid, high-quality data to support the public health response and clinical care of pregnant women and their families.

      REFERENCES

        • Panchaud A
        • Favre G
        • Pomar L
        • et al.
        An international registry for emergent pathogens and pregnancy..
        Lancet. 2020; 395: 1483-1484
      1. Pregnancy and COVID-19 associated coagulopathy registry (COV-PREG-COAG). Available at: https://redcap.isth.org/surveys/?s=4JPX9W98RH. Accessed on November 8, 2020.