bluuebunny/crossref_metadata_2025 huggingface dataset:
Barriers and Drivers of Cervical Cancer Screening in Gonaives, Haiti [08C]
Authors: Bien-Aimé Danta , Holter Virginia
Published: April 2020

INTRODUCTION:

Cervical cancer is the most common cancer and the second leading cause of cancer deaths in Haitian women. Early detection with early treatment that is completed at one clinic visit is an important strategy to target cervical cancer incidence and mortality rates but it is an underutilized resource.

METHODS:

An explanatory sequential mixed-method design is being used for a stratified sample of 200 women, ages 25 years and older, in Gonaives, Haiti. IRB approval was received and each participant consents to participate. Interviews estimate the proportion of women who have received cervical cancer screening. Quantitative data collected includes socio-demographic background and barriers to screening. Twenty women sampled from the quantitative population are to be interviewed about perceived barriers to screening. Ten healthcare providers will be interviewed about the challenges of cervical cancer screening in the community.

RESULTS:

Data has been analyzed from 58 participants, 88% are aware of cervical cancer, 21% have had screening and report no family history of cervical cancer. Of the 79% who had not been screened, 8% had a family history of cervical cancer, 92% do not consider a $5 fee as a barrier, 25% admitted fearing screening, 38% need partner approval, 96% state access to treatment influences their decision to screen, 50% prefer not to know if they have cervical cancer.

CONCLUSION:

Access to treatment is a strong predictor for cervical cancer screening. The results of this social research address the implementation and barriers of cervical cancer screening efforts for vulnerable populations in developing countries with limited resources.
Factors in Prenatal Vaccine Knowledge and Uptake Among Minority Pregnant Patients [10C]
Authors: Patapoff Kelly E. , Razi Yasmine Y. , Woods Gabriella , Stohl Hindi E. , Nelson Anita L.
Published: April 2020

INTRODUCTION:

To assess factors that predict acceptance or rejection of Tdap (Tetanus, Diphtheria, and Pertussis) vaccine in a clinic with uptake rates substantially higher than national averages in order to identify modifiable factors.

METHODS:

In summer 2019, we surveyed the generally low-income, English-speaking patients in the UCLA-Harbor Medical Center Obstetrics clinic in Torrance, California following an IRB-approved exempt protocol (#31225-02). Candidates were at least 18 years old and 32 weeks gestational age. With verbal consent, the survey was administered on a one-to-one basis with Chi-square analysis.

RESULTS:

A total of 97 patients was approached; 92 participated. 51% of subjects were age 20–27 (range 18–50); 52% were Hispanic/Latina, 25% African American, 5% Caucasian. Overall, 75% reported receiving the Tdap vaccine. Factors such as age (P=.18), ethnicity (P=.62), education (P=.85), and parity (P=.61) did not significantly differ between acceptors and non-acceptors of Tdap. Of the 23 Tdap non-acceptors, 13 said that they would still refuse vaccination even if they were reassured/counseled of its importance to newborn health. Most women (91%) who accepted the vaccine, reported that it had been recommended to them. 74% of acceptors said they understood why it was important to be vaccinated during pregnancy. Despite this claim of understanding, only 4% of women reported the father had received Tdap.

CONCLUSION:

None of demographic factors predicted rejection of Tdap. There may be factors outside vaccine literacy blocking uptake. Recommending Tdap strongly influences maternal uptake of the vaccine; but, understanding importance of Tdap did not translate into further action as illustrated by low spousal vaccination.
Impact of Minority Races on Clinical Trials on Progesterone for the Prevention of Preterm Labor [14C]
Authors: Bailey Josianne , Davis-Nelson Shareece , Martin Courtney , Mason Danielle , Yao Ruofan , Chan Elena
Published: April 2020

INTRODUCTION:

It is unclear if clinical trial populations are adequately diverse to address this concern. The objective of this study was to determine if the study populations in published literature on progesterone effect on preterm labor were diverse enough to demonstrate a benefit for minority races.

METHODS:

This was a meta-analysis by searching PubMed using the keywords: progesterone, preterm labor, and singleton. Included studies were randomized clinical trials that identified the racial composition and delivery within 48 hours as an outcome of interest. Population level modeling was performed on the pooled result by recalculating the rate of outcome for each study if the rate of outcome of a particular race was the same between intervention and placebo arms. Pooled results that remain statistically significant after race specific adjustments suggest minimal influence from that particular race, whereas a non-significant result suggests stronger influence from that race.

RESULTS:

There were 52 clinical trials identified, nine of which met requirement for in-depth review. Progesterone decreased risk of preterm labor (RR 0.84, 95% CI [0.76–0.93]). Race adjusted pooled results were significant for Hispanic (RR 0.84, 95% CI [0.76–0.93]) and Asian (RR 0.86, 95% CI [0.78–0.95]), but not significant for white (RR 0.97, 95% CI [0.88–1.07]) or black (RR 0.91, 95% CI [0.82–1.01]).

CONCLUSION:

In studies on progesterone for preterm labor, Hispanic and Asian races were underrepresented, whereas white and black races were major contributors.
Predictors of Trust Towards Physicians Among Black Americans [18C]
Authors: Hansen Anna C. , McLouth Christopher , O'Brien John , Oser Carrie
Published: April 2020

INTRODUCTION:

Severe racial disparities exist among American women with respect to fetal, neonatal, and maternal outcomes. Few studies have examined the relationship between black women's trust towards physicians and pregnancy outcomes, drug use, or incarceration.

METHODS:

This project utilizes survey data from the Black Women in the Study of Epidemics Project (NIDA R01-DA011967). IRB approval was obtained. Between 2008–2011, 643 women completed a baseline interview concerning health status and care utilization, including 240 incarcerated women and 197 women on probation. Approximately half reported current drug use. Follow-up interviews occurred at 6-, 12-, and 18-months. Physician trust was measured continuously using a validated 11-item scale (Anderson & Derrick, 1990). Data analysis was performed using mixed models to account for the longitudinal data.

RESULTS:

Drug use at baseline, current pregnancy, and past history of a birth-related problem were all significantly related to physician trust. Women who had ever experienced a birth-related problem and women who reported drug use at baseline had lower levels of physician trust than women who had not experienced these problems (P<.05). Women who were currently pregnant endorsed a higher level of trust in their physician than women who were not pregnant (P<.05). Baseline incarceration status was not significantly related to physician trust.

CONCLUSION:

Given the established relationship between high physician trust and favorable patient outcomes, future interventions must address disparities in black women's trust, with specific focus on drug-using women and women with past birth complications. Pregnancy should be considered an opportune time to enhance trust between patient and physician.
Race/Ethnic Differences on Postpartum Re-presentation [19C]
Authors: Smithson Sarah , Greene Naomi , Campbell Diahnn , Esakoff Tania
Published: April 2020

INTRODUCTION:

Racial disparities may contribute to risk for postpartum readmission. We aim to identify racial/ethnic differences in indications for postpartum re-presentation.

METHODS:

This cohort study was conducted at a large urban US medical center. Demographic and obstetric data were collected on all patients who delivered within the study window (2012–2018) and re-presented for evaluation within 30 days of discharge from delivery admission. Indications for re-presentation were divided into the following categories; hypertension, infection (endometritis, urinary tract infection, wound infection), hemorrhage, and other (upper respiratory infection, edema, mastitis, etc). We evaluated the association between race and indication using chi square tests and performed logistic regression to account for potential confounding.

RESULTS:

A total of 1217 re-presented for evaluation within the study window. Black women were more likely to re-present for hypertension (P=.002). The adjusted odds ratio for black women re-presenting for hypertension versus white women was 2.09 (1.32, 3.33). In univariate analysis, black women were less likely to re-present for postpartum hemorrhage. However, this did not remain significant after adjusting for confounders. There were no statistically significant associations between race/ethnicity and the other indication groups.

CONCLUSION:

Black women are more likely to re-present for evaluation of hypertension within 30 days of delivery discharge. This association held true even after adjusting for age, BMI, delivery method, gestational age, multifetal gestation, and marital status. This group may most benefit from outpatient resources such as telemedicine and close follow up for blood pressure monitoring and medication adjustments.
Racial and Socioeconomic Differences in Social Work Reporting Patterns for Positive THC in Pregnancy [21C]
Authors: Ndife Kenneth , Hoffman Shelley , Peters Hannah , Edmonds Brownsyne Tucker
Published: April 2020

INTRODUCTION:

Women of color and low socioeconomic status (SES) are more often reported to child protective services (CPS) upon testing positive for drug use in pregnancy. We set out to examine CPS reporting and referral patterns by race and SES among hospital social workers (SW) for pregnant women testing positive for isolated marijuana use.

METHODS:

Retrospective chart review study of pregnant women seeking obstetrical care at a Midwestern academic hospital in 2017. Patients were included if their lab work indicated one or more positive tetrahydrocannabinol (THC) drug screening results, with no other illicit drug use reported or screened positive throughout pregnancy. Lab reports, provider referrals to SW, SW notes, and reporting to CPS were collected. This study was approved by the IRB.

RESULTS:

Seventy-seven patients met eligibility criteria. 63.6% were white and 77.8% were publicly insured. The average age was 25 years (18–37). However, documentation and reporting by providers and SW's were inconsistent, raising concerns regarding the quality and reliability reporting procedures. We noted the following inconsistencies: 1) Provider notification of SW varied, 2) inconsistent reporting by SW to DCS, 3) lack of standardized documentation in medical record.

CONCLUSION:

We identified numerous barriers to collecting the data needed to assess the relationship between race, SES, and CPS reporting. Uniform and universally applied reporting procedures are needed for future assessment, measurement and quality control in this arena. Given the widespread movement toward decriminalization, it will be important to document and study the impact of marijuana use in pregnancy on services and penalties rendered.
Racial Differences in Substance Use Patterns During Pregnancy [23C]
Authors: Gottula Jessica , Thomas Megan , Devaiah Ganga , Lambers Donna , Dhanraj Dave
Published: April 2020

INTRODUCTION:

Substance use during pregnancy remains a significant public health problem. Studies have reported racial differences in substance use, however this has not been addressed in the pregnant population. This study describes associations between maternal race and substance use patterns in pregnancy.

METHODS:

A retrospective study of singleton births from August 2013 through December 2014 was conducted using universal urine drug screen (UDS) collected at the initiation of prenatal care. Excluded were multiple gestations and preterm deliveries. The data is shown by frequency of substance use (no use, any use, use of specific substances) and maternal race (Caucasian, African American, Asian).

RESULTS:

2,270 patients met study criteria. There were 1,030 (45%) Caucasians, 802 (35%) African Americans, and 117 (5%) Asians identified. Caucasian and African Americans had approximately the same rates of substance use, 30.0% and 32.5% respectively. It is notable that 93.1% of African Americans with a positive UDS were positive for only THC, compared to 63.8% of Caucasians. Polysubstance use was much higher in Caucasians than any other racial group, with 31.7% of Caucasian users positive for opiates, 12.0% for benzos, and 5.8% for cocaine. No Asians had a positive UDS.

CONCLUSION:

Our study addresses the racial differences of substance use during pregnancy, specifically detailing the substances used. Our study strongly suggests the need for local and state initiatives to better understand the racial trends for substance use in pregnancy in order to tailor prenatal care interventions that optimize pregnancy outcomes.
Opioid Maintenance Therapy (OMT) Outcomes on Maternal Weight Gain [24E]
Authors: Davis Jay , Heiselman Cassandra , Staszewski Cara , Cochrane Elizabeth , Gruttadauria Michelle , Garretto Diana
Published: April 2020

INTRODUCTION:

The Institute of Medicine's (IOM) guidelines provide recommendations for appropriate gestational weight gain based solely on pre-pregnancy body mass index (BMI). Opioid use disorders (OUD) are known risk factors for poor nutrition and inadequate weight gain. We sought to compare methadone vs buprenorphine OMT effects on obtaining appropriate maternal weight gain.

METHODS:

We conducted an IRB approved retrospective cohort study using electronic medical records from an academic center between 2007 and 2017. Inclusion criteria: women with a singleton pregnancy receiving OMT with either methadone or buprenorphine. Exclusion criteria: women with a pre-viable delivery, multiple gestation pregnancy, or anomalous fetus incompatible with life. We compared both OMT groups for differences in insufficient, appropriate, or excessive weight gain based upon IOM's guidelines. P-value <.05 was considered significant.

RESULTS:

181 pregnancies were analyzed. 51% (n=93) received buprenorphine and 49% (n=88) received methadone. Patients in the methadone arm were more likely to be prescribed medications at a methadone/pain clinic vs OB provider (P<.05). Baseline demographics for both groups were similar in age, parity, race and BMI. There were no statistically significant differences in inadequate, appropriate, or excessive weight gain between the 2 groups (P=.47). Additionally, there were no statistical differences between the groups regarding recommended weight gain, regardless of BMI (P=.53).

CONCLUSION:

The findings amongst our cohorts revealed there is no superiority of either OMT selection to achieve the recommended weight gain in pregnancy. This data illustrates that the decision to select the optimal OMT should be guided by other factors than achieving the ideal weight gain.
Narcotic Use After Cesarean: Separate Versus Combined Regimens of Oxycodone and Acetaminophen [22E]
Authors: Birchall Courtney , Maines Jaimie , Pauli Jaimey M.
Published: April 2020

INTRODUCTION:

In the management of post-cesarean analgesia narcotic medications remain a mainstay of treatment. It is well documented that NSAIDS and acetaminophen help reduce the amount of narcotic needed to control post-operative pain, however there is still no consensus on which multimodal regimen is superior. In our study we investigate the impact of different analgesic regimens on narcotic use during post-cesarean hospitalization.

METHODS:

This study is a part of a larger IRB approved study examining the impact of an Enhanced Recovery After Surgery (ERAS) protocol for cesarean deliveries. Data collected from 2/1/19–5/31/19 were part of the retrospective chart review of patients who underwent cesarean section. The study was powered to detect a 30% reduction in narcotic use between groups with of 86 per group. Statistical analysis was completed using SAS.

RESULTS:

The primary outcome was intravenous morphine mg equivalents (mEq) per 12-hour period while hospitalized. Analysis was performed on two dosing regimens: oxycodone (ordered separately from acetaminophen) (N=67), and combined oxycodone-acetaminophen (N=83). Ninety-five percent of patients additionally received NSAIDS in the form of ketorolac and/or ibuprofen. After controlling for potential confounders, patients in the oxycodone group received an average of 4.6 mEq/12 hours compared to the combination oxycodone-acetaminophen group who averaged 5.7 mEq/12 hours, P=.01. Over an average length of stay of 80.8 hours this equaled a difference of 7.41 mEq or 14.82 mg oxycodone, a 19.3% reduction.

CONCLUSION:

Our findings suggest that for patients undergoing cesarean section a regimen of oxycodone and acetaminophen ordered separately may lead to a clinically significant decrease in narcotic use during admission.
Factors Associated With High Inpatient Utilization of Oxycodone After Cesarean Delivery [14E]
Authors: Prasannan Lakha , Blitz Matthew J. , Rochelson Burton L. , Marchbein Harvey
Published: April 2020

INTRODUCTION:

Few large studies have comprehensively evaluated which factors are associated with increased inpatient opioid analgesia after cesarean delivery. Our objective was to determine if specific maternal and peripartum risk factors are associated with high inpatient utilization of oxycodone after cesarean section.

METHODS:

IRB approved, retrospective case-control study of live singleton cesarean deliveries at 37 weeks of gestation or greater at a tertiary university hospital from 2013–2016. Patients were excluded for NSAID or opioid allergies, and incomplete medical records. Cases were patients with high oxycodone utilization (>90th percentile) and controls were those with normal oxycodone utilization (≤90th percentile). Patient demographics and clinical characteristics were examined to determine if they were associated with high oxycodone utilization. Statistical significance P<.05.

RESULTS:

A total of 7,415 deliveries were included. In this population, high utilization of oxycodone equated to greater than 42 mg/day (n=742). Maternal demographic factors associated with high utilization included advanced maternal age, Caucasian race, pre-pregnancy obesity, and multiparity. Peripartum factors associated with high utilization included prolonged postpartum hospitalization, repeat cesarean delivery, and increased birth weight. Among the social factors evaluated, smoking was associated with increased oxycodone use but prior drug use was not. Maternal comorbidities such as diabetes and hypertension, and pregnancy complications such as preeclampsia and obstetrical hemorrhage were not significantly associated with increased oxycodone use.

CONCLUSION:

After term cesarean deliveries, a number of maternal and peripartum factors are associated with increased inpatient oxycodone utilization. Our findings may help identify patient subgroups that necessitate interventions to prevent development of prolonged postoperative opioid use.
Opioid Use Disorder: A Poorly Understood Cause of Maternal Mortality in the United States [26E]
Authors: Mitra Anjali , Brandt Justin , Rosen Todd , Ananth Cande , Schuster Meike
Published: April 2020

INTRODUCTION:

Maternal opioid use disorder (OUD) is a burgeoning public health issue with profound effects on perinatal morbidity and mortality in the US. However, whether OUD is implicated in maternal deaths, and if OUD is associated with temporal changes in maternal deaths in the US remains poorly understood.

METHODS:

This is a cross-sectional analysis of maternal deaths in the US from 1999–2017 using death certificate data from the Centers for Disease Control and Prevention. Maternal mortality was defined as any death during pregnancy or within 365 days after delivery. Opioid-attributable deaths were identified using ICD-10 codes. Changes in maternal mortality ratios (MMR) per 100,000 live births among OUD between 1999–00 to 2016–17 were quantified by rate ratios (RR), derived from log-linear regression models, before and after adjusting for maternal age and race/ethnicity.

RESULTS:

5.6% (n=1,225) of 21,918 maternal deaths between 1999–2017 were identified as OUD-related. The overall MMR from OUD increased from 11.2 to 48.5 per 100,000 live births between 1999 to 2017, a 76.9% relative increase. The RR (95% confidence interval [CI]) of OUD-related MMR in 2000–10 and 2016–17, compared to 1999–00 (reference), were 43.1 (95% CI 13.7–135.5), and 155.0 (95% CI 49.9–483.0), respectively. By 2017, the MMR from opioids in white women increased to 5.0 per 100,000 while in black women it was 4.0 per 100,000.

CONCLUSION:

OUD is a growing cause of maternal mortality in the US, which affects white more than black women.
Takes Two to Make Three: Pregnant Women With Substance Use Disorder's Intentions for Partner's Role [36E]
Authors: Smid Marcela Carolina , Charles Jasmin , Cavin Tyler , Cochran Gerald , Varner Michael , Gordon Adam
Published: April 2020

INTRODUCTION:

Nearly 9 out 10 pregnant women with substance use disorder (SUD) have unintended pregnancies. Little is known about women with SUD's intentions regarding their partner's role in their life. The objective of this study was to determine the proportion of pregnant women with SUD who plan on current partner and/or “father of the baby” involvement in their life and to characterize partner drug use.

METHODS:

An anonymous survey was distributed from December 2018—September 2019 to pregnant women seeking care in specialty multi-disciplinary prenatal clinic for women with SUD. Descriptive statistics were used to describe participant's responses.

RESULTS:

We collected 110 individual surveys. More than 7 out of 10 pregnant women reported that they planned partner involvement in their life (n=78, 71%) or their infant's life (n=80, 73%). The majority (n=55, 51%) planned for partner attendance at all or most prenatal visits. 54% (n=59) reported partner drug use in the past year, specifically opioids (n=39, 66%), methamphetamines (n=35, 59%), marijuana (n=31, 52%), cocaine (n=16, 27%), benzodiazepines (n=9, 15%) and other (n=3,5) (66% used two or more substances). On a Likert scale (1 not interested—10 really interested), women reported a median score of 8 (range 1–10) when rating interest in partner drug treatment access within the prenatal setting, peer support for partners, education for partners about maternal addiction treatment, parenting and special care for infants.

CONCLUSION:

Because most pregnant women with SUD intend partner involvement, further studies on the role of partner in maternal pregnancy and SUD trajectories are urgently needed.
Pregnancy-Related Weight and Postpartum Depressive Symptoms: Do the Relationships Differ by Race/Ethnicity? [31E]
Authors: Green Tiffany , Son Yena , Simuzingili Muloongo , Mezuk Briana , Hagiwara Nao
Published: April 2020

INTRODUCTION:

There are significant racial/ethnic disparities in the prevalence of postpartum depression. Prior research suggests that the relationships between weight status and depression may vary by race/ethnicity among the general population. However, few studies have investigated whether race/ethnicity moderates the relationships between pregnancy-related weight and postpartum depressive symptoms (PPDS). This study examines the relationships between pregnancy-related weight and maternal PPDS overall and by race/ethnicity.

METHODS:

This study used data from the Early Childhood Longitudinal Study-Birth Cohort (N≈6950). Ordinary least squares and logistic regression were used to examine whether pregnancy-related weight, including preconception obesity and gestational weight gain, were associated with PPDS. Stratified analyses were used to assess whether these relationships varied by race/ethnicity.

RESULTS:

Preconception obesity was associated with higher levels of postpartum depressive symptoms (β=1.208, 95% CI 0.995–1.467). In contrast, gestational weight gain adequacy was not associated with PPDS. Among non-Hispanic (NH) whites, preconception obesity was positively associated with PPDS (β=1.016, 95% CI 0.448–1.584). In contrast, among Hispanics, preconception overweight was associated with lower levels of depressive symptoms (β=-0.887, 95% CI -1.580 to -0.195). There were no statistically significant relationships between pregnancy-related weight and PPDS among NH black or Asian women. However, both NH blacks and Asians were significantly more likely to report PPDS compared to NH whites.

CONCLUSION:

Pregnancy-related weight is associated with higher levels of PPDS, but only among NH white women. Addressing preconception weight could help to reduce overall levels of PPDS but doing so might not mitigate racial/ethnic disparities in postpartum mental health.
Obstetric Provider Perspectives on Opioid Prescribing After Childbirth [23E]
Authors: Osmundson Sarah S. , Iwelu Chibbi , Dawoud Febronia , Pourali Sarah P. , Carpenter Heidi , Graves Connie
Published: April 2020

INTRODUCTION:

To evaluate how practice design and provider demographics inform opioid prescribing after childbirth.

METHODS:

We conducted a survey of obstetric providers in 4 hospital systems including 2 academic medical centers (n=121), a community-based hospital (n=55), and a free-standing birth center (n=9), which collectively perform 15,000 deliveries annually. “High prescribers” were defined as providers who routinely prescribed opioids after vaginal birth or reported opioid prescribing after cesarean in the top quartile compared to peers.

RESULTS:

Between 6/10/2019–7/31/2019, 192 of 234 (82%) eligible providers completed the survey. Respondents reported prescribing a median of 15 tablets (IQR 12–20) after cesarean and 10% routinely prescribed opioids after vaginal birth. Overall, 63% of respondents endorsed that they would limit opioid prescribing even with increased patient calls. However, 46% responded that very few/no calls were an acceptable frequency after cesarean and 2/3 said <10% of women would be acceptable. High prescribers (n=49, 26%) were older and more likely to come from non-academic hospitals and state that their income or reputation depended on patient satisfaction. They were more likely to take home call and answered more calls per shift. They were less likely to consider overprescribing a major concern after childbirth or desire more prescribing education. After adjusting for covariates, increasing years in practice (aOR 1.06 [1.03–1.11]) and taking call from home (aOR 4.48, [1.27–15.75]) were significantly associated with being a high prescriber.

CONCLUSION:

While obstetric providers endorse reducing opioid prescribing, patient complaints could temper this enthusiasm. Strategies to reduce opioid prescribing after childbirth should consider provider practice structure.
Obesity in Early Pregnancy Has a Stronger Association to Pre-eclampsia and Diabetes Than Weight Gain [28D]
Authors: Roman Tania , Boyd Angela R. , Munoz Jessian L.
Published: April 2020

INTRODUCTION:

To evaluate the association of obesity in early gestation and weight gain during pregnancy to pre-eclampsia, pre-gestational and gestational diabetes rates.

METHODS:

We conducted a retrospective cohort study at our center from January 2013 to December 2015. Women with singleton pregnancies, who started prenatal care at less than 20 weeks, and who completed delivery at our center were included. The primary outcome was pre-eclampsia. Secondary outcomes were pre-gestational (PGDM) and gestational diabetes (GDM). Body mass index (BMI) was taken from the initial OB visit and stratified into five different categories: 18–24.9, 25–29.9, 30.0–34.9, 35.0–39.9, and ≥40 kg/m2. Obesity was defined as BMI ≥30 kg/m2. Weight gain was stratified into four different categories: <5, 5–10, 11–15, >15 kg. Statistical analysis was performed using Chi-square test for group comparisons. A P-value of <0.05 was considered significant.

RESULTS:

687 women met inclusion criteria and were included in this study. There was a direct relationship between pre-eclampsia and increasing BMI (9.25%, 10.61%, 15.58%, 15.79%, 20.0%, P=.0795). When BMI was divided into non-obese (<30) versus obese (≥30), there was a significant association with pre-eclampsia (P=.0127). There was a significant association with PGDM as BMI increased (P<.0001); as well as a trend to higher rates of GDM. There was no association between pre-eclampsia and weight gained during pregnancy (P=.912).

CONCLUSION:

Obesity appears to be more important than weight gained during pregnancy in the development of pre-eclampsia and gestational diabetes. This highlights the importance of pre-conception weight reduction and optimization for the prevention of morbidity in pregnancy.
Optimizing Care for Mothers and Newborns Affected by Opioid Use Disorder [27E]
Authors: Rodriguez Tatiahna Rivera , Goodman Jean R.
Published: April 2020

INTRODUCTION:

Recent years have seen a rise in maternal opioid-related deaths and Neonatal Abstinence Syndrome (NAS). Screening with a validated, standardized tool can streamline identification of pregnant women with Opioid Use Disorder (OUD). The NIDA Quick Screen (NIDA) is a tool that has not been validated in this population and may help identify those with OUD.

METHODS:

All pregnant women receiving care at Loyola University Medical Center Outpatient Center between January 2019 and July 2019 were eligible for NIDA screening at two time points: New Obstetric Visit and/or Return Obstetric Visit. NIDA, which screens for tobacco, alcohol, nonprescription medication use, and illicit drug use, was administered as standard of care by a nurse or research assistant at the start of the visit. A chart review of screened patients was then completed to validate results. *IRB and/or animal use committee approval was waived for this study.

RESULTS:

Out of 187 eligible patients screened, 4 (2.14%) resulted positive for OUD by systematic chart review. Of the patients identified for OUD, 3 (75%) were using prescribed opioids and 1 (25%) was using non-prescribed opioids (heroin). None (0%) of the patients with OUD (prescribed) screened positive by NIDA. Conversely, the patient with OUD (non-prescribed) screened positive via “illicit drug use.”

CONCLUSION:

As evidenced by the study, NIDA is not sufficiently sensitive to capture the nuances of current opioid use, specifically prescription medication, in the pregnant population. Additionally, the inability of NIDA to indicate whether opioid use is current or previous, is a critical limitation in obstetric care.
Postpartum Depression Risk Following Prenatal Diagnosis of Major Fetal Anomalies [29E]
Authors: Herrera Christina L. , Byrne John J. , Schell Rachel C. , Nelson David B. , Dashe Jodi S.
Published: April 2020

INTRODUCTION:

To evaluate how the diagnosis of major fetal anomalies and resulting pregnancy outcomes affected the risk of postpartum depression, as assessed by the Edinburgh Postnatal Depression Scale (EPDS).

METHODS:

Singleton pregnancies with prenatal diagnosis of major fetal anomalies were ascertained from prospectively-maintained databases that included perinatal outcomes and subsequent EPDS responses from 1/2010 to 5/2018. EPDS scores ≥13 were considered positive and prompted referral for mental health follow-up, which was verified by electronic chart review. Statistical analyses were performed using odds ratios and χ2 with P<.05 considered significant. IRB approval was obtained.

RESULTS:

912 women had a prenatal diagnosis of an anomalous fetus and postpartum EPDS screening, and 82 (9%) screened positive. Positive screening was more common with multiple fetal anomalies (15.3% vs 8.0%, P=.004) or aneuploidy (17.1% vs 8.6%, P=.02). Pregnancies complicated by fetal death (N=79, 8.6%), neonatal death (N=52, 5.7%), and termination for anomaly (N=69, 7.6%) were significantly more likely to screen positive than those with neonatal survival to discharge (all OR >2, P<.001). 34 (40%) screen-positive women attended their follow-up appointment with a mental health provider, and 18 (53%) were diagnosed with a depressive disorder.

CONCLUSION:

Women with prenatal diagnosis of major fetal anomalies and perinatal loss had a two-fold increased likelihood for positive depression screening using EPDS. More than half of screen positive women who seek mental health follow-up were diagnosed with a depressive disorder. Effective screening with intervention is warranted in this vulnerable population.
Methadone and Gestational Weight Gain [21E]
Authors: Rosenthal Emily , Cruz Yury , McCurdy Rebekah
Published: April 2020

INTRODUCTION:

Treatment of patients with opioid use disorder (OUD) with either methadone or buprenorphine is recommended in pregnancy. An association between weight gain and methadone has been reported outside of pregnancy. We sought to identify factors associated with excessive gestational weight gain in patients with OUD on methadone.

METHODS:

This is a retrospective cohort study of pregnant patients with OUD treated with methadone at our institution from 2012–2017. The primary outcome was gestational weight gain. We compared women with non-excessive vs. excessive gestational weight gain based on Institute of Medicine (IOM) guidelines, based on pre-gestational body mass index (BMI). Chi square and t-tests were used to compare baseline characteristics. Linear regression was used to determine an association between methadone dose and gestational weight gain, and multiple linear regression was used to adjust for covariates.

RESULTS:

There were 289 patients identified. Characteristics were similar between groups, with the exception of methadone dose (133.37 mg non-excessive weight gain vs. 150.57 mg excessive weight gain; 95% CI -32.28, -2.12; P=.026). There was a significant association between methadone dose and gestational weight gain (Pearson R=0.12; unstandardized β=0.036; 95% CI 0.002, 0.07; P=.04). In multiple linear regression, there was an inverse relationship between initial BMI and gestational weight gain (unstandardized β=-0.88; 95% CI 1.40, -0.35; P=.001). The association with methadone dose remained significant after adjusting for covariates (unstandardized β=0.057; 95% CI 0.016, 0.098; P=.007).

CONCLUSION:

Higher methadone dose is associated with increased gestational weight gain. Further study is needed to determine the nature of this association.
Pregnancy Outcomes by Type of Bariatric Surgery [32D]
Authors: Wlodarczyk Katarzyna , Harrison Rachel , Semons-Booker Kia , Braun Emilie , Lak Kathleen , Cruz Meredith
Published: April 2020

INTRODUCTION:

As obesity rates increase, more women of childbearing age opt for surgical intervention for weight loss. The objective of this study was to evaluate whether the mechanism of weight loss related to the type of bariatric surgery (malabsorptive vs. restrictive type) impacts pregnancy outcomes.

METHODS:

IRB approval was obtained. This was a single center, retrospective cohort study of 182 singleton pregnancies after bariatric surgery that delivered between 2006 and 2019. Women were separated based on malabsorptive or restrictive type of procedure. Pregnancy outcomes were compared using univariable and multivariable analyses.

RESULTS:

Of the 182 patients, 41 women had a restrictive procedure and 141 had a malabsorptive procedure. Women with malabsorptive procedures were more likely to have a baseline vitamin deficiency (72.0% vs 35.3%, P=.001), a lower early pregnancy BMI (34.3±6.7 vs 39.2±9.1, P=.001), and anemia at term (59.4% vs 33.3%, P=.004). A maternal composite outcome was not higher in malabsorptive versus restrictive surgeries (7.1% vs 2.4%, P=.271). A composite fetal outcome was also not higher in the malabsorptive group (27.7% vs 34.2%, P=.421). In multivariable analysis, there were no differences in maternal or neonatal outcomes between groups, although there was a trend for higher rates of SGA infants in the malabsorptive group (aOR 4.85, 95% CI 0.58–40.63).

CONCLUSION:

The type of bariatric procedure does not impact neonatal outcomes, rate of GDM or hypertension in pregnancy, or mean GA at delivery. Women with a malabsorptive procedure were frequently vitamin deficient, anemic, and had lower BMI in early pregnancy.
Novel Clinical Navigation System to Improve Prenatal Care for Patients With Diabetes in Pregnancy [27D]
Authors: Odisho Roumta , LeMoine Felicia , Castillo-Quek Jaimee , Chapple Andrew , Sutton Elizabeth , Boggs Karli Mizell
Published: April 2020

INTRODUCTION:

Treatment of diabetes in pregnancy requires coordination of resources by obstetric providers. In a high volume, high acuity, low resource academic practice with multiple providers, gaps in care can occur. The Louisiana State University Obstetric Clinic (LSU-OBGYN Clinic) developed a navigation system to guide patients with diabetes through prenatal and postnatal care. We aimed to test the effectiveness of the LSU-Diabetes Navigation System (LSU-DNS) to improve adherence to ACOG standard of care treatment of diabetes in pregnancy.

METHODS:

We conducted a retrospective cohort study with LSU-OBGYN Clinic patients with diabetes in pregnancy (10/2015–09/2019; n=191). Receipt of ACOG recommended standard of care treatment of patients with diabetes in pregnancy (assessed by: receipt of diabetes education, Maternal Fetal Medicine consultation, growth ultrasounds, weekly fetal monitoring, postpartum glucose testing, and attendance to prenatal appointments) was evaluated before (n=148) or after (n=43) implementation of the LSU-DNS using Fisher exact and Wilcoxon Signed-rank tests.

RESULTS:

In our cohort, 60 (31%) patients had preexisting diabetes (n=15 Type 1 DM; n=45 Type 2 DM) and 131 (69%) had gestational diabetes. Patients were on average 31±6 years old with a mean body mass index of 37.0±8.7 kg/m2. 49.7% were African American and 90.0% used government-assisted health insurance. Overall adherence to standard of care was significantly improved with the LSU-DNS (before LSU-DNS 78±15% compliance vs. after LSU-DNS 86±13% compliance; P=.0002), and all individual metrics significantly improved except for prenatal appointment attendance.

CONCLUSION:

A clinical navigation system for management of diabetes in pregnancy improves adherence to standard of care guidelines.
Survey of Antepartum Women to Assess Barriers to Sequential Compression Device Compliance [30C]
Authors: Reinhard Megan , Flynn Kathryn , Palatnik Anna
Published: April 2020

INTRODUCTION:

Sequential compression device (SCD) is recommended for antepartum venous thromboembolism (VTE) prophylaxis. Based on a prior study by our group, women's compliance with SCD on antepartum floor is low. The objective of this study was to design and pilot test a patient survey to identify barriers to SCD use.

METHODS:

SCD survey was designed and assessed for validity and interpretation of each question by face-to-face cognitive interviews with providers and patients admitted to the antepartum floor and prescribed SCD. The survey was then administered to 50 pregnant women admitted to antepartum floor. Patient-reported understanding of SCD purpose, bother, and reasons for non-compliance were included in the survey.

RESULTS:

All women reported they understood the purpose of SCD. Across 12 categories of bothersome aspects of SCD, the average total bother score was 30 (range 12–60). The most common reasons women identified as why SCDs were not worn at all times were: 1) discomfort; 2) too hot/sweaty; and 3) they wake me up. The most common responses to what women believe would make SCD easier to use were to have a wireless/cordless device, lighter weight/cooler material, and to have a better availability of nurses to assist with SCD placement.

CONCLUSION:

In this pilot study we validated and pilot-tested a survey to identify self-reported barriers to SCD use among antepartum pregnant women. Self-identified barriers to use centered around discomfort and restrictive nature of the device. Women identified fixing these barriers as well as needing more assistance with the device as important in increasing its use.
Necessity of Glycemic Agents in Patients With Hypothyroidism and GDM Versus Patients With GDM Alone [26D]
Authors: Feldman Kristina M. , Hussain Farrah N. , Schneider Emily , Chu Lam Melissa T. , Rosenn Barak , Brustman Lois
Published: April 2020

INTRODUCTION:

Diabetes and hypothyroidism are frequent endocrine pathologies seen in pregnancy. The relationship between medication requirements in patients with concurrent hypothyroidism and GDM is not well established. Our hypothesis was that patients with concurrent hypothyroidism and GDM would be more likely to require hypoglycemic agents during their pregnancy.

METHODS:

This is a retrospective case-control study of 160 singleton pregnancies between August 2015 and August 2019. Patients with concurrent GDM and hypothyroidism were compared to BMI-matched controls with GDM alone. The primary endpoint was a descriptive composite of patients who required either a hypoglycemic agent (glyburide and insulin) or diet alone. Continuous measures were compared with t-tests or Wilcoxon rank-sum tests and categorical measures were compared using Chi-squared tests.

RESULTS:

80 patients with concurrent GDM and hypothyroidism were compared with 160 patients with GDM. The demographics amongst the two groups were similar including age and average BMI. There was a statistically significant difference in the percent of patients with concurrent GDM and hypothyroidism versus those with GDM alone with the use of medication for glycemic control (60% versus 47.1%, P<0.0001). Of the patients with concurrent GDM and hypothyroidism, 41.2% of patients required insulin therapy, versus 16.1% of patients with GDM alone (P<.0001).

CONCLUSION:

Our study suggests that patients with concurrent hypothyroidism and GDM had a greater need for hypoglycemic agents than those with GDM alone.
Improving Maternal and Neonatal Outcomes for Patients With Diabetes by Clinical Navigation [16D]
Authors: LeMoine Felicia , Odisho Roumta , Chapple Andrew , Sutton Elizabeth , Boggs Karli Mizell
Published: April 2020

INTRODUCTION:

The Louisiana State University Obstetric Clinic (LSU-OBGYN Clinic) developed a navigation system to guide patients with diabetes through their prenatal care. We aimed to determine whether participation in the LSU-Diabetes Navigation System (LSU-DNS) could improve adverse maternal and neonatal outcomes associated with diabetes in pregnancy.

METHODS:

We conducted a retrospective cohort study of LSU-OBGYN Clinic patients with diabetes in pregnancy (n=191, 10/2015–09/2019; approved and monitored by Woman's Hospital IRB). The primary outcome was occurrence of a maternal-neonatal composite compared in patients before (n=148) or after (n=43) implementation of the LSU-DNS using Fisher exact and Wilcoxon Signed-rank tests. Composite variables included: antepartum admission, preterm delivery, pregnancy-induced hypertension, shoulder dystocia, failure of postpartum glucose tolerance testing, fetal demise, NICU admission, NICU length of stay, neonatal birthweight, large for gestational age, and neonatal hypoglycemia.

RESULTS:

Since 2015, the maternal-neonatal composite occurred in 112 (58.6%) patients; 89 (60.1%) of patients before the LSU-DNS was implemented and 23 (53.5%) patients that participated in the LSU-DNS (P=.48). While the overall composite is not significantly decreased in LSU-DNS participants in this interim analysis (currently n=43 patients have completed LSU-DNS participation), incidence of several individual outcomes were decreased in LSU-DNS patients compared to pre-LSU-DNS patients including: preterm delivery (21.4% vs. 29.7% respectively, P=.33), pregnancy-induced hypertension (20.1% vs. 26.4%, P=.55), shoulder dystocia (0% vs. 4.1%, P=.33), and large for gestational age neonates (19.0% vs. 23.6%, P=.68).

CONCLUSION:

The LSU-DNS may improve maternal and neonatal outcomes in patients with diabetes in pregnancy, however more patients are needed to adequately assess its effectiveness.
Influence of Obesity on Maternal and Neonatal Outcomes in Advanced Maternal Age Women [22D]
Authors: Hanneman Nonda , Sarker Minhazur , Caughey Aaron B. , Valent Amy M.
Published: April 2020

INTRODUCTION:

Advanced maternal age (AMA) and obesity have been shown to independently influence maternal and neonatal outcomes. We sought to determine if obese AMA women had greater risk for adverse outcomes compared to non-obese AMA women.

METHODS:

A retrospective cohort study of non-anomalous, singleton AMA (age 35+) pregnancies at Oregon Health & Science University from 2009–2014 to assess if obesity (pre-pregnancy BMI 30+) impacted outcomes above AMA status alone. Maternal outcomes included gestational diabetes (GDM), pre-eclampsia (PET), and cesarean section (CS). Neonatal outcomes included NICU admission, SGA/LGA, preterm birth, and hypoglycemia. Univariate analyses were used to determine significant differences between groups (P<.05), and multivariate logistic regression adjusting for biologically plausible confounders was utilized to determine strength of association.

RESULTS:

Of the 7,953 deliveries during the study period, 1,712 were to AMA women with 459 obese (27%) and 1,253 non-obese (73%). Obese AMA women were associated with significantly increased rates of GDM (aOR 3.04, 95% CI 2.23–4.40), PEC (aOR 1.64, 95% CI 1.09–2.47), and CS (aOR 1.42, 95% CI 1.12–1.85). Neonates born to obese AMA women were associated with significantly increased rates of LGA (aOR 2.66, 95% CI 1.86–3.80) and hypoglycemia (aOR 1.98, 95% CI 1.10–3.58). There was no significant association between obesity in AMA women and SGA, preterm birth, or NICU admission.

CONCLUSION:

In AMA pregnancies, obesity is associated with significantly increased rates of GDM, PEC, CS, LGA neonates, and neonatal hypoglycemia. These results suggest that AMA pregnancies complicated by maternal obesity may benefit from earlier intervention and counseling.
Mode of First Delivery and Postpartum Weight Retention 1 Year After First Childbirth [25D]
Authors: Legro Nicole R. , Kjerulff Kristen H.
Published: April 2020

INTRODUCTION:

The prevalence of obesity in the US has increased markedly in women in their reproductive years over the past 3 decades, partially due to higher rates of excessive gestational weight gain (GWG) and postpartum weight retention. Few studies have considered mode of delivery as an independent risk factor for postpartum weight retention and long-term obesity.

METHODS:

This was an IRB-approved prospective cohort study of 2,747 first-time mothers, aged 18 to 35 with singleton pregnancies. Postpartum weight retention was measured at 1 year after delivery and was defined as weight at 1 year compared to weight just before becoming pregnant. Logistic regression models assessed the association between mode of first delivery and subsequent weight retention of 10 pounds or more, adjusting for key confounders including pre-pregnancy body mass index, GWG, age, education, poverty status, smoking, race/ethnicity, pregnancy complications, gestational age, breastfeeding, and exercise habits during pregnancy and the first year after delivery.

RESULTS:

At 12 months after delivery the women who had delivered by cesarean were more likely to have a postpartum weight retention of 10 pounds or more (28.3%), than those who had delivered vaginally (22.8%), unadjusted OR 1.34 (95% CI 1.11–1.61 P=.003). Even after controlling for confounding variables, mode of delivery remained significantly associated with postpartum weight retention of 10 pounds or more, adjusted OR 1.30 (95% CI 1.05–1.60 P=.015).

CONCLUSION:

Cesarean delivery at first childbirth is associated with increased risk of weight retention of 10 pounds or more at 1 year postpartum.