The Impact of the Pandemic on Pregnancy: A Research Response

Maternal health and health disparities are key priorities for the U.S. Department of Health and Human Services (HHS). Our commitment continues through ongoing research at the National Institutes of Health (NIH) to address life-threatening pregnancy complications. The statistics surrounding maternal mortality and morbidity are staggering: On average, every 12 hours, a woman dies from complications from pregnancy or giving birth, according to the Centers for Disease Control and Prevention (CDC) and 60% of these deaths are preventable. Black and American Indian/Alaska Native women are about three times as likely to die from a pregnancy-related cause, compared to white women, Hispanic women and Asian/Pacific Islander women.

In May, the Eunice Kennedy Shriver National Institute on Child Health and Human Development (NICHD) together with the NIH Office of Research on Women’s Health hosted researchers across the country for a two-day virtual NIH workshop exploring the conditions that increase the risk of maternal deaths and pregnancy complications.

Now, with the added concerns of the coronavirus pandemic, there is much more we need to know to help ensure healthy pregnancies and healthy babies. Because SARS-CoV-2, the virus that causes COVID-19, is new, we want to learn about its short- and long-term impact on pregnant women and their infants. NICHD recently launched a study to understand the effects of the COVID-19 pandemic during and after pregnancy.

Researchers with the NICHD-funded Maternal-Fetal Medicine Units (MFMU) Network are analyzing the medical records of up to 21,000 women to evaluate whether health care changes implemented as a result of the pandemic have led to higher rates of pregnancy-related death and complications, as well as cesarean delivery. The study will be conducted at 12 MFMU Network sites across the United States. These sites cover more than 160,000 deliveries a year, and their racial, ethnic, and geographic diversity are nationally representative. 

Accelerating Diagnostics

Earlier this year, NIH launched the Rapid Acceleration of Diagnostics (RADx) initiative to speed development, commercialization, and implementation of technologies for COVID-19 testing. Accurate, fast, easy-to-use, and widely accessible testing is critical to an effective response to the COVID-19 crisis. Part of this initiative, called RADx-UP, aims to understand the factors associated with disparities in COVID-19 testing among pregnant and postpartum women, as well as other underserved populations. Funding opportunities are available until August 7, 2020.

Research and Evidence

Through research that now is underway, we hope to provide answers and shed light on the many unknown factors confounding this pandemic. Maternal deaths and pregnancy complications can be prevented, and our research is key to developing and implementing best prevention practices. SARS-CoV-2 represents a new challenge and an opportunity to ensure that we include pregnant women in research, address special concerns related to pregnancy, and create systems that allow us to track long-term outcomes.

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    GAO's analysis of U.S. Energy Information Administration (EIA) data and interviews with industry stakeholders shows that the repeal of the U.S. crude oil export ban is associated with increased crude oil exports—from less than half a million barrels per day in 2015 to almost 3 million barrels per day in 2019. The repeal of the ban expanded the market for U.S. crude oil to overseas buyers and, along with other market factors, allowed U.S. crude oil producers to charge higher prices relative to comparable foreign crude oil. Higher prices and an expanded market for U.S. crude oil further incentivized domestic crude oil production, which had been growing since the shale oil boom began around 2009 (see figure). During the period after the repeal, total U.S. imports of crude oil remained largely unchanged. Annual Production and Exports of U.S. Crude Oil, 2009-2019 GAO's analysis found limited effects associated with the repeal of the ban on the production, export, and import of domestic refined petroleum products, such as gasoline. However, profit margins—which are determined in part by the costs a refiner pays for the crude oil and the earnings a refiner receives from the sale of refined products—likely decreased as the prices refiners paid for domestic crude oil increased relative to international prices. Because gasoline prices are largely determined on the global market, U.S. refiners could not pass on to consumers the additional costs associated with the increase in crude oil prices, resulting in decreased profit margins for U.S. refiners. Finally, after the repeal of the crude oil export ban, the U.S. shipping industry experienced a decline as demand fell for U.S. tankers—known as Jones Act tankers—used to move domestic crude oil between U.S. ports. The increase in the relative price of domestic crude oils associated with the repeal of the export ban may have resulted in some U.S. refineries deciding to use more foreign crude oil. Foreign crude oil is typically transported by foreign tankers, reducing the demand for Jones Act tankers compared to what it would have been if the export ban had remained in place, according to six of the seven shipping industry stakeholders GAO interviewed. Between 1975 and the end of 2015, the Energy Policy and Conservation Act directed a ban on nearly all exports of U.S. crude oil. This ban was not considered a significant policy issue when U.S. oil production was declining and import volumes were increasing. However, U.S. crude oil production roughly doubled from 2009 to 2015, due in part to a boom in shale oil production made possible by advancements in drilling technologies. In December 2015, Congress effectively repealed the ban, allowing the free export of U.S. crude oil worldwide. GAO was asked to provide information on the effects of repealing the crude oil export ban. This report describes the effects of the repeal of the crude oil export ban on the domestic crude oil production, petroleum refining, and related sectors of the U.S. shipping industry. GAO analyzed data from EIA and other federal databases to determine the effects of repealing the export ban. GAO also interviewed a nongeneralizeable sample of economists, market analysts, and stakeholders from the oil and gas, refining, and shipping industries. GAO's analysis focused on the repeal of the crude oil export ban and any effects of the repeal on U.S. crude oil and related industries through March 2020. For more information, contact Frank Rusco at (202) 512-3841 or ruscof@gao.gov.
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  • High-Risk Series: Dedicated Leadership Needed to Address Limited Progress in Most High-Risk Areas
    In U.S GAO News
    Overall ratings in 2021 for 20 of GAO's 2019 high-risk areas remain unchanged, and five regressed. Seven areas improved, one to the point of removal from the High-Risk List. Two new areas are being added, bringing our 2021 High-Risk List to 36 areas. Where there has been improvement in high-risk areas, congressional actions, in addition to those by executive agencies, have been critical in spurring progress. GAO is removing Department of Defense (DOD) Support Infrastructure Management from the High-Risk List. Among other things, DOD has more efficiently utilized military installation space; reduced its infrastructure footprint and use of leases, reportedly saving millions of dollars; and improved its use of installation agreements, reducing base support costs GAO is narrowing the scope of three high-risk areas by removing segments of the areas due to progress that has been made. The affected areas are: (1) Federal Real Property (Costly Leasing) because the General Services Administration has reduced its reliance on costly leases and improved monitoring efforts; (2) DOD Contract Management (Acquisition Workforce) because DOD has significantly rebuilt its acquisition workforce; and (3) Management of Federal Oil and Gas Resources (Offshore Oil and Gas Oversight) because the Department of the Interior's Bureau of Safety and Environmental Enforcement has implemented reforms improving offshore oil and gas oversight. National Efforts to Prevent, Respond to, and Recover from Drug Misuse is being added to the High-Risk List. National rates of drug misuse have been increasing, and drug misuse has resulted in significant loss of life and harmful effects to society and the economy. GAO identified several challenges in the federal government's response, such as a need for greater leadership and coordination of the national effort, strategic guidance that fulfills all statutory requirements, and more effective implementation and monitoring. Emergency Loans for Small Businesses also is being added. The Small Business Administration has provided hundreds of billions of dollars' worth of loans and advances to help small businesses recover from adverse economic impacts created by COVID-19. While loans have greatly aided many small businesses, evidence of fraud and significant program integrity risks need much greater oversight and management attention. Nine existing high-risk areas also need more focused attention (see table). 2021 High-Risk List Areas Requiring Significant Attention High-risk areas that regressed since 2019 High-risk areas that need additional attention USPS Financial Viability IT Acquisitions and Operations Decennial Census Limiting the Federal Government's Fiscal Exposure by Better Managing Climate Change Risks Ensuring the Cybersecurity of the Nation U.S. Government's Environmental Liability Strategic Human Capital Management Improving Federal Oversight of Food Safety EPA's Process for Assessing and Controlling Toxic Chemicals   Source: GAO. | GAO-21-119SP   GAO's 2021 High-Risk List High-risk area Change since 2019 Strengthening the Foundation for Efficiency and Effectiveness Strategic Human Capital Management ↓ Managing Federal Real Propertya ↑ Funding the Nation's Surface Transportation Systemb c n/a Modernizing the U.S. Financial Regulatory Systemb ● Resolving the Federal Role in Housing Financeb ● USPS Financial Viabilityb ↓ Management of Federal Oil and Gas Resourcesa ● Limiting the Federal Government's Fiscal Exposure by Better Managing Climate Change Risksb ● Improving the Management of IT Acquisitions and Operations ● Improving Federal Management of Programs That Serve Tribes and Their Members ● Decennial Census ↓ U.S. Government's Environmental Liabilityb ● Emergency Loans for Small Businesses (new)c n/a Transforming DOD Program Management DOD Weapon Systems Acquisition ● DOD Financial Management ↑ DOD Business Systems Modernization ● DOD Approach to Business Transformation ● Ensuring Public Safety and Security Government-wide Personnel Security Clearance Processb ↑ Ensuring the Cybersecurity of the Nationb ↓ Strengthening Department of Homeland Security Management Functions ● Ensuring the Effective Protection of Technologies Critical to U.S. National Security Interests ● Improving Federal Oversight of Food Safetyb ● Protecting Public Health through Enhanced Oversight of Medical Products ● Transforming EPA's Process for Assessing and Controlling Toxic Chemicals ↓ National Efforts to Prevent, Respond to, and Recover from Drug Misuse (new)c n/a Managing Federal Contracting More Effectively VA Acquisition Managementd n/a DOE's Contract and Project Management for the National Nuclear Security Administration and Office of Environmental Management ↑ NASA Acquisition Management ↑ DOD Contract Managementa ● Assessing the Efficiency and Effectiveness of Tax Law Administration Enforcement of Tax Lawsb ● Modernizing and Safeguarding Insurance and Benefit Programs Medicare Program & Improper Paymentse ● Strengthening Medicaid Program Integrityb ● Improving and Modernizing Federal Disability Programs ● Pension Benefit Guaranty Corporation Insurance Programsb c n/a National Flood Insurance Programb ● Managing Risks and Improving VA Health Careb ↑ (↑ indicates area progressed on one or more criteria since 2019; ↓ indicates area declined on one or more criteria ; ● indicates no change; n/a = not applicable) Source: GAO. | GAO-21-119SP aRatings for a segment within this high-risk area improved sufficiently that the segment was removed. bLegislation is likely to be necessary in order to effectively address this high-risk area. cNot rated, because this high-risk area is newly added or primarily involves congressional action. dRated for the first time, because this high-risk area was newly added in 2019. eOnly rated on one segment; we did not rate other elements of the Medicare program. The federal government is one of the world's largest and most complex entities; about $6.6 trillion in outlays in fiscal year 2020 funded a broad array of programs and operations. GAO's High-Risk Series identifies government operations with vulnerabilities to fraud, waste, abuse, and mismanagement, or in need of transformation to address economy, efficiency, or effectiveness challenges. This biennial update describes the status of high-risk areas, outlines actions that are still needed to assure further progress, and identifies any new high-risk areas needing attention by the executive branch and Congress. Solutions to high-risk problems save billions of dollars, improve service to the public, and strengthen government performance and accountability. GAO uses five criteria to assess progress in addressing high-risk areas: (1) leadership commitment, (2) agency capacity, (3) an action plan, (4) monitoring efforts, and (5) demonstrated progress. This report describes GAO's views on progress made and what remains to be done to bring about lasting solutions for each high-risk area. Addressing GAO's hundreds of open recommendations across the high-risk areas and continued congressional oversight and action are essential to achieving greater progress. For more information, contact Michelle Sager at (202) 512-6806 or sagerm@gao.gov.
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    In Crime News
    A Kinston, North Carolina, woman was sentenced today to 30 months in prison for conspiring to file false tax returns for her clients.
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    In Crime News
    The U.S. Environmental Protection Agency (EPA) and the U.S. Department of Justice announced a settlement today that will require Midwest Can Company, one of the largest manufacturers of portable fuel containers in the United States, to pay a $1.7 million civil penalty to resolve Clean Air Act violations.
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  • [Protest of GSA Contract Award for Office Space]
    In U.S GAO News
    A firm protested the General Services Administration (GSA) decision to increase its required office space under an existing contract, contending that since GSA failed to afford it an opportunity to bid on the additional space, GSA should: (1) resolicit its requirements; and (2) allow it an opportunity to bid on the current requirements. GAO held that it would not consider the protest, since there was a pending appeal concerning the initial award of the lease, which could ultimately render any GAO decision academic. Accordingly, the protest was dismissed.
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    In Crime News
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  • Former City Officials Sentenced for Accepting Bribes in Exchange for Cannabis Dispensary Permit
    In Crime News
    Two California men were each sentenced today to two years in prison for accepting bribes in return for a guarantee of a city permit to open a commercial cannabis dispensary.
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    In Crime News
    A Chicago federal jury found two former employees of Deutsche Bank, a global financial institution, guilty today of fraud charges for their respective roles in fraudulent and manipulative trading practices involving publicly-traded precious metals futures contracts.
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  • Electricity Grid Resilience: Climate Change Is Expected to Have Far-reaching Effects and DOE and FERC Should Take Actions
    In U.S GAO News
    What GAO Found Climate change is expected to have far-reaching effects on the electricity grid that could cost billions and could affect every aspect of the grid from generation, transmission, and distribution to demand for electricity, according to several reports GAO reviewed. The type and extent of these effects on the grid will vary by geographic location and other factors. For example, reports GAO reviewed stated that more frequent droughts and changing rainfall patterns may adversely affect hydroelectricity generation in Alaska and the Northwest and Southwest regions of the United States. Further, transmission capacity may be reduced or distribution lines damaged during increasing wildfire activity in some regions due to warmer temperatures and drier conditions. Moreover, climate change effects on the grid could cost utilities and customers billions, including the costs of power outages and infrastructure damage. Examples of Climate Change Effects on the Electricity Grid Since 2014, the Department of Energy (DOE) and the Federal Energy Regulatory Commission (FERC) have taken actions to enhance the resilience of the grid. For example, in 2015, DOE established a partnership with 18 utilities to plan for climate change. In 2018, FERC collected information from grid operators on grid resilience and their risks to hazards such as extreme weather. Nevertheless, opportunities exist for DOE and FERC to take additional actions to enhance grid resilience to climate change. For example, DOE identified climate change as a risk to energy infrastructure, including the grid, but it does not have an overall strategy to guide its efforts. GAO's Disaster Resilience Framework states that federal efforts can focus on risk reduction by creating resilience goals and linking those goals to an overarching strategy. Developing and implementing a department-wide strategy that defines goals and measures progress could help prioritize DOE's climate resilience efforts to ensure that resources are targeted effectively. Regarding FERC, it has not taken steps to identify or assess climate change risks to the grid and, therefore, is not well positioned to determine the actions needed to enhance resilience. Risk management involves identifying and assessing risks to understand the likelihood of impacts and their associated consequences. By doing so, FERC could then plan and implement appropriate actions to respond to the risks and achieve its objective of promoting resilience. Why GAO Did This Study According to the U.S. Global Change Research Program, changes in the earth's climate are under way and expected to increase, posing risks to the electricity grid that may affect the nation's economic and national security. Annual costs of weather-related power outages total billions of dollars and may increase with climate change, although resilience investments could help address potential effects, according to the research program. Private companies own most of the electricity grid, but the federal government plays a significant role in promoting grid resilience—the ability to adapt to changing conditions; withstand potentially disruptive events; and, if disrupted, to rapidly recover. DOE, the lead agency for grid resilience efforts, conducts research and provides information and technical assistance to industry. FERC reviews mandatory grid reliability standards. GAO was asked to examine U.S. energy infrastructure resilience. This report describes: (1) potential climate change effects on the electricity grid; and (2) actions DOE and FERC have taken since 2014 to enhance electricity grid resilience to climate change effects, and additional actions these agencies could take. GAO reviewed reports and interviewed agency officials and 55 relevant stakeholders.
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  • Houston-Area Physician and Anesthesiologist Sentenced to 84 Months in Prison for Role in Health Care Benefit Scheme
    In Crime News
    A Houston-area physician and anesthesiologist at two registered pain clinics, Texas Pain Solutions and Integra Medical Clinic, was sentenced today to seven years in prison for his role in fraudulently billing health care programs for at least $5 million dollars in medical tests and procedures, and for the role his fraud played in multiple patient deaths.
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    In Crime News
    A North Carolina woman was sentenced Monday to 50 years in prison followed by 20 years of supervised release for production and distribution of child pornography.
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