We used data from the Cerner COVID-19 De-Identified Data Cohort, which provides patient-level information on diagnoses, laboratory tests, procedures, medication, and encounter information over the patient-visit continuum. Cerner obtains its data from participating hospitals as described in detail as follows. “Cerner Real-World Data is extracted from the EMR of hospitals in which Cerner has a data use agreement. Encounters may include pharmacy, clinical and microbiology laboratory, admission, and billing information from affiliated patient care locations. All admissions, medication orders and dispensing, laboratory orders and specimens are date and time stamped, providing a temporal relationship between treatment patterns and clinical information. Cerner Corporation has established Health Insurance Portability and Accountability Act-compliant operating policies to establish deidentification for Cerner Real-World Data.” [17, 18]

Cerner extracts its data from the electronic health record systems (EHRs) of participating US hospitals—for the COVID-19 De-Identified Data Cohort, data from 62 health systems were used. It then subjects the data to rigorous cleaning and standardization, including the use of a multipoint-match algorithm to identify and remove duplicate records. Records are also standardized across disparate EHR coding systems and fully de-identified. The most recent data refresh, used for this analysis, was performed in June 2020. The records of patients identified as having an encounter associated with a 1) diagnosis code of possible exposure or infection of COVID-19 or 2) positive lab result for COVID-19 testing (several types of tests were performed but confidentiality of the tests cannot be revealed within the manuscript) were included in the data set. These were referred to as the COVID-19 “associated” cohort. A more specific sub-cohort was restricted only to those patients that had an encounter associated with a 1) diagnosis code of COVID-19 infection or 2) a recent positive lab result (up to two weeks prior) of COVID-19 infection. These were referred to as the COVID-19 “positive” cohort. This cohort was provided to compare with the results of the larger COVID-19 “associated” cohort in supplemental analyses. To provide further insight into these patients’ health histories, available medical information since January 1, 2015, was also included. Of all valid patients from both cohorts, only female patients of adult reproductive age (18–44 years old) were included for analysis. The University of Utah Institutional Review Board has determined that this study does not meet the definitions of Human Subjects Research for using secondary data with no intervention or interaction with an individual, and for having no identifiable private information in the data. Thus, requirements of the informed consent for this study and ethical approval for this study were waived by the University of Utah Institutional Review Board (IRB #136696). All methods were performed in accordance with the relevant guidelines and regulations​.

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