bluuebunny/crossref_metadata_2025 huggingface dataset:
A Systematic Review Investigating Disparities in Maternal Mortality in Latin American Countries [ID: 1376589]
Authors: Ernst Rebecka , Acoff Eboni , Hsu Albert
Published: May 2023

INTRODUCTION:

The goal of this review is to investigate maternal mortality rates (MMRs) in Latin American countries. While there are clear disparities in maternal mortality rates in Black versus non-Hispanic White women, the rate of maternal mortality rates in Hispanic women has not been well characterized. This study specifically addresses disparities in maternal mortality rates in Latin American countries. It also explores factors contributing to high MMR including socioeconomic status, age, comorbidities, ethnicity, and access to health care.

METHODS:

Four bibliographic databases were searched for keywords, including “maternal mortality,” “ethnic groups,” and “racial disparities.” Inclusion criteria were manuscripts that discussed Latin American countries; exclusion criteria included “wrong outcome” and studies only discussing maternal morbidity. Quality assessments for each study were completed.

RESULTS:

Bolivia (650/100,000), Mexico (413.5/100,000), and Ecuador (321.1/100,000) have the highest average MMR. Caribbean countries tend to have the lowest recorded MMR, whereas countries in Central and South America have the highest MMRs in Latin America. The most common factor associated with mortality was hypertensive disorders. Low socioeconomic status (SES) and extremes of maternal age were correlated with higher mortality rates.

CONCLUSION:

Many comorbidities contribute to mortality among pregnant women throughout Latin America, including human immunodeficiency virus, SES, extremes of maternal age, and access to care. This study shows a need for further research to help identify disparities in MMR across different Latin American countries.
Effect of Insurance Status on the Length of Time to Readmission for Postpartum Preeclampsia [ID: 1377910]
Authors: Jiang Judy , Benito Carlos , Casademont Catherine , Sigdel Manisha
Published: May 2023

INTRODUCTION:

Maternal statistics show us that the majority of maternal morbidity and mortality occur postpartum, with a higher rate of morbidity and mortality in those without private insurance. Hypertensive disorders of pregnancy remain a significant cause of pregnancy-related death, and preeclampsia was found to account for 82% of the readmissions at our community-based hospital. Timely diagnosis of preeclampsia can prevent further morbidity and mortality. A retrospective cohort study was conducted to determine whether insurance status has an effect on length of time until diagnosis of preeclampsia requiring postpartum readmission.

METHODS:

All patients with deliveries and postpartum readmissions from January 1, 2018 to December 31, 2020, were included in the study at Saint Peters University Hospital in New Brunswick, New Jersey, with IRB approval. Data were obtained from the Paragon Electronic Medical Record, including the patient insurance status (private or service-Medicaid, Medicaid HMO, self-pay), race, ethnicity, age, length of admission and readmission, as well as length of time between the delivery admission to readmission. Institutional board review committee approval was obtained for this study.

RESULTS:

A total of 15,509 patients were delivered between 2018 and 2020 with 149 (0.96%; 149/15,509) patients readmitted for hypertensive disorders of pregnancy. The study showed that patients with private insurance were readmitted on average in 4.54+3.42 days after their delivery admission, whereas those without private insurance were admitted on average 6.30+4.91 days after delivery admission (P=.010).

CONCLUSION:

In this community-based hospital, patients with private insurance who were readmitted for preeclampsia were diagnosed and readmitted for treatment in a shorter period of time than those without private insurance.
Implementation of a Severe Maternal Morbidity Quality Review Process at a Level IV Public Hospital [ID: 1377992]
Authors: Stanteen Samantha Mendoza , Fomina Yevgenia , Gilbert Juanmekia , Nelson David , Pruszynski Jessica , Spong Catherine
Published: May 2023

INTRODUCTION:

Severe maternal morbidity (SMM) is tracked by national organizations offering opportunities to evaluate, monitor, and address in near real time. Using a multidisciplinary case review committee to analyze all cases of SMM at a level IV inner-city hospital, we hypothesized that case reviews will identify opportunities for improvement in obstetric practices.

METHODS:

A case review was triggered for any delivery with an SMM ICD-10 code, transfusion of greater than 4 units, readmission within 48 hours of discharge, a patient safety concern by staff, or a severe adverse neonatal outcome. This cohort study included all of the case reviews of cases between 2019 and 2022. Severe maternal morbidity outcomes, demographics, and obstetric practices were analyzed.

RESULTS:

Of 36,671 deliveries, 296 (0.8%) met criteria and were reviewed. Of these, 80 (27%) had two or more concurrent SMM events. Postpartum hemorrhage was the most common (37%), followed by intensive care unit admission (13%) and hysterectomy (12%). After review, practices done well included interdisciplinary communication and prompt decision-making. Opportunities for improvement included inadequate access to peripartum care due to socioeconomic barriers, communication, and lack of role clarity.

CONCLUSION:

Social barriers, inadequate communication, and lack of role clarity were identified as the most common areas of improvement in SMM cases. These findings led to the development of an escalation of care pathway for massive transfusion protocol and vital signs thresholds at which to contact anesthesia. The implementation of a standardized SMM surveillance system results in systematic improvements in obstetric practices.
Effect of Suture Material in History-Indicated Cerclage on Spontaneous Preterm Delivery Risk [ID: 1370506]
Authors: Sweeney Heather , Ghadiali Tejal , Hong Christian , Lee Richard , Nguyen Michelle , Sriprasert Intira
Published: May 2023

INTRODUCTION:

This study aimed to determine whether suture material in history-indicated cerclage is associated with spontaneous preterm delivery (sPTD).

METHODS:

We conducted a retrospective cohort study of patients with singleton pregnancies who underwent history-indicated transvaginal cerclage at a tertiary care center from June 2015 to January 2022. The primary outcome was sPTD before 24 weeks of gestation. Secondary outcomes included sPTD at less than 26, 28, 32, and 34 weeks of gestation, chorioamnionitis, days in neonatal intensive care unit, and various adverse neonatal outcomes. Baseline characteristics and outcomes were compared using chi-square and Fisher’s exact tests according to type of suture material: 5-mm braided polyester fiber (Mersilene tape) versus monofilament suture (Prolene). Odds ratios (ORs) for sPTD were estimated using multivariable logistic regression.

RESULTS:

A total of 64 patients were included in the study, with 50 (78%) patients receiving Mersilene and 14 (22%) receiving Prolene. Mersilene, compared to Prolene, was associated with significantly lower rates of sPTD at less than 24 weeks (6% versus 29%, P=.02) and less than 26 weeks (8% versus 29%, P=.04). At more advanced gestational ages, Mersilene still resulted in lower rates of sPTD compared to Prolene, but statistical significance was lost. After adjusting for race and ethnicity, body mass index, use of postoperative progesterone, and gestational age at cerclage placement, patients with Prolene had increased odds of delivery less than 24 weeks (OR 7.69, 95% CI 1.04–56.6). Secondary outcomes were similar between the two groups.

CONCLUSION:

In patients undergoing history-indicated cerclage, Mersilene compared to Prolene was associated with a significantly lower risk of previable pregnancy loss.
The Effect of Implementing a Colorimetric Quantitative Blood Loss System for Identification of Postpartum Hemorrhage [ID: 1377803]
Authors: Gallo Mary , Caliendo Martin , Lardy Meghan , Nims Sarah
Published: May 2023

INTRODUCTION:

Maternal mortality rates have increased to 23.8 per 100,000 live births in 2020, with the rate for non-Hispanic Black patients 2.9 times greater than non-Hispanic White patients in 2020. Postpartum hemorrhage (PPH) is responsible for approximately half of maternal morbidity. Many PPHs are preventable, and are due to delay in recognition. Disparities in health care outcomes are related to systemic racism, and implicit bias. Improvement requires developing and implementing standardized protocols. The California Maternal Quality Care Collaborative (CMQCC) developed a hemorrhage tool kit, featuring accurate quantitative assessment of blood loss (QBL) as a cornerstone to address these issues. Our main objective was whether implementation of a colorimetric-based QBL would identify PPH at earlier stages and improve maternal outcomes.

METHODS:

This is a retrospective case–control study comparing incidence of PPH, stage of PPH, maternal morbidity and length of stay, stratified by race and ethnicity, 1 year before and after implementation of a colorimetric-based QBL system.

RESULTS:

There was a 178% increase in overall identification of PPH from 5.1% to 14.2%. There was an increase in identification of stage I PPH, and decrease in stage II and stage III PPH. Total intensive care unit (ICU) admissions decreased from nine to zero. In non-Hispanic Black patients, PPH increased from 3.6% to 13.8%, with increased identification of stage I PPH.

CONCLUSION:

An unbiased colorimetric-based system for QBL during delivery and postpartum leads to earlier identification of postpartum hemorrhage in all patients regardless of ethnicity or race, a decrease in total ICU admissions, and shorter length of stay, overall increasing maternal outcomes.
The Effect of Implementation of a Standardized Multidisciplinary Placenta Accreta Spectrum Team: A Quality Improvement Initiative [ID: 1377806]
Authors: Lardy Meghan , Caliendo Martin , Gallo Mary , Nims Sarah
Published: May 2023

INTRODUCTION:

Placenta accreta spectrum (PAS) is associated with significant morbidity and mortality. A multidisciplinary team and standardized protocol for identified PAS cases were created to provide a clear preoperative plan for mitigation of intraoperative blood loss, and surgical and postoperative complications.

METHODS:

This is an ongoing quality improvement study. The PAS team was implemented January 2021. All cases of PAS resulting in cesarean hysterectomy from January 2018 through August 2022 at a single regional perinatal center were included. Estimated blood loss (EBL), number of blood products (packed red cells, platelets, fresh frozen plasma), whether surgical complication was incurred, intensive care unit (ICU) length of stay (LOS), and hospital LOS were compared. T tests and χ2 were used to calculate significance.

RESULTS:

Thirty-eight cases were reviewed, 18 cases before implementation of the PAS team, 20 after. Average EBL was 3,800 mL pre-team, 3,191 mL post-team (P=.522). Pre-team average units of packed red cells were 4.67, 3.55 post-team (P=.199); platelets 1.72 versus 1.35 units (P=.424); fresh frozen plasma 0.67 versus 0.55 units (P=.581). Average ICU LOS and hospital LOS pre-team were 0.67 and 3.56 days, 0.30 (P=.121) and 3.35 (P=.434) days, respectively, post-team.

CONCLUSION:

Estimated blood loss, total blood products, occurrence of surgical complication, ICU LOS, and hospital LOS were decreased after implementation of a PAS multidisciplinary team. Statistical insignificance in all parameters was attributable to small sample size necessitating further future analysis with additional cases. A standardized multidisciplinary approach to PAS may demonstrate morbidity reduction.
Provider Adherence to Aspirin Prophylaxis Recommendations in Pregnancy at a Single Military Treatment Facility [ID: 1380223]
Authors: Chatfield Lindsay , Elmezzi Kristen , Owens Amanda
Published: May 2023

INTRODUCTION:

Preeclampsia complicates 2–8% of pregnancies and is a major contributor to maternal and perinatal morbidity and mortality. Aspirin (ASA) is known to decrease rates of preeclampsia in patients at risk for developing the disease. We examined provider compliance with the U.S. Preventive Services Task Force risk-based aspirin prophylaxis guidelines at our institution and identified a need for improvement.

METHODS:

For quality improvement, we implemented provider education, updated patient history forms, and an embedded ASA checklist within our note template. We retrospectively reviewed demographics, medical/obstetric history, and candidacy/prescription placement for two patient groups at their first prenatal visit. The first was the preintervention group (January 1 to June 30, 2019; N=434) and the second was the postintervention group (July 1 to September 30, 2021; N=284). Preintervention and postintervention data were then compared to determine whether rates of compliance with ASA prophylaxis guidelines improved.

RESULTS:

A similar proportion of patients met criteria for ASA prophylaxis preintervention (43.1%, 95% CI 38.5–47.8%) and postintervention (46.8%, 95% CI 41.1–52.6%, P=.36), with similar proportions of patients who qualified with one high risk factor versus multiple moderate risk factors. There were significantly more patients who qualified for aspirin and were not identified in the preintervention group (67.9%, 95% CI 60.9–74.2%) than in the postintervention group (18.8%, 95% CI 13.0–26.3%, P<.0001). This improvement was even more pronounced in patients who only qualified by moderate risk factors (preintervention [79.7%, 95% CI 72.5–85.5%] versus postintervention [21.2%, 95% CI 14.7–29.7%]).

CONCLUSION:

The implementation of provider education, updated patient history forms, and an ASA checklist significantly improved provider adherence to ASA prophylaxis recommendations.
MomHEART: Utilization of a Web-Based Postpartum Hypertension Platform [ID: 1371438]
Authors: Winsten Mary Taylor , Gold Stacey , Overcash Rachael
Published: May 2023

INTRODUCTION:

Maternal complications of hypertensive disorders of pregnancy (HDP) extend to the postpartum period. Remote blood pressure (BP) monitoring and online educational platforms may improve a patient's knowledge, accessibility, and adherence to BP monitoring allowing for earlier identification of complications. We sought to compare differences in postpartum hypertension platform utilization based on severity of HDP.

METHODS:

We performed a single-center, prospective implementation study of women enrolled in a web-based postpartum hypertension platform called MomHEART. Through MomHEART, women received educational information about BP monitoring, text message reminders or calls from virtual nurses to log their BP daily for 14 days. Primary outcome was utilization defined as logging a BP, viewing educational information, and/or interacting with a virtual nurse. Descriptive statistics were used to analyze our data. A Fisher exact test was used to compare program utilization based on hypertensive severity.

RESULTS:

Sixty-four patients were enrolled from April to July 2022. The mean gestational age at delivery was 37.1 weeks. Participants were more likely to be Black, single, have insurance, and delivery vaginally. Thirty-two participants (50%) had HDP with severe features, and 32 (50%) had HDP without severe features. Forty-nine (76.6%) participants interacted with MomHEART. We found no difference in platform utilization by severity of hypertensive diagnosis.

CONCLUSION:

Utilization of MomHEART did not vary based on hypertension severity. Overall, utilization was high, indicating participants found MomHEART valuable. This is a small pilot study on the utilization of the MomHEART program. Additional analysis will be performed to assess the efficacy of identifying maternal hypertensive complications in the postpartum period.
Improvement in HAMD-17 Subscale Scores With 14-Day Treatment Course of Zuranolone in Postpartum Depression: Results From the SKYLARK Study [ID: 1372313]
Authors: Deligiannidis Kristina , Bullock Amy , Kotecha Mona , Li Sigui , Maximos Bassem , Vera Theresa
Published: May 2023

INTRODUCTION:

Postpartum depression (PPD) is a serious perinatal complication. SKYLARK (phase 3, randomized, double-blind, placebo-controlled trial [NCT04442503]) evaluated zuranolone, an investigational, neuroactive steroid positive allosteric modulator of both synaptic and extrasynaptic GABA(A) receptors, in adult patients with PPD. The primary endpoint, change from baseline (CFB) in HAMD-17 total score at day 15, was met. Zuranolone was generally well tolerated. The HAMD-17 can be divided into subscales that group specific items from the HAMD-17 scale that measure different aspects of depression presentation. Here, we present HAMD-17 subscale data from SKYLARK.

METHODS:

Patients aged 18–45 years with severe PPD (HAMD 17 total score ≥26) were randomized 1:1 to oral, once-daily zuranolone 50 mg or placebo for 14 days. The secondary endpoint was day 15 CFB in HAMD-17 subscale (Core Depression, Anxiety, Bech-6, Maier) scores. Subscales were analyzed separately by a mixed-effects model for repeated measures. Institutional review board approval was obtained.

RESULTS:

One hundred ninety-five patients (zuranolone, 98; placebo, 97) were randomized, received study drug, and had valid baseline and one or more post-baseline efficacy assessments. At day 15, patients receiving a 14-day treatment course of zuranolone showed nominally significant improvements across all HAMD-17 subscales versus placebo (least squares mean [SE] CFB treatment difference: Core Depression, −5.9 [2.4], P=.0151; Anxiety, −5.7 [2.3], P=.0123; Bech-6, −8.6 [3.0], P=.0040; Maier, −7.6 [2.6], P=.0041). Improvement in all subscales was observed starting at day 3.

CONCLUSION:

In SKYLARK, zuranolone was associated with rapid improvement in depressive and anxiety symptoms in patients with PPD across multiple domains, supporting its development as a potential oral, rapid-acting treatment option for PPD.
Should Severe Preeclampsia Be Considered a Risk Factor for Postpartum Depression and Anxiety? [ID: 1376999]
Authors: Broome Sidney , Dallas Madison , Kinzer Carly , Lowtan Tiffany , Roussos-Ross Dikea , Razavi Mehrsa Sadat
Published: May 2023

INTRODUCTION:

Postpartum mood disorders are common and seen in approximately 20% of women. It is important to understand risk factors associated with this diagnosis so that earlier interventions can be initiated. To date, the effect of preeclampsia on postpartum mood disorders has not been thoroughly investigated. The purpose of this study was to investigate whether severe preeclampsia (SPE) acts as a risk factor for postpartum depression (PPD) or postpartum anxiety (PPA).

METHODS:

A retrospective chart review of participants who delivered between January 1, 2015, and April 1, 2022, was conducted after IRB approval. Inclusion criteria required: 1) at least one prenatal visit, 2) a postpartum visit, 3) an Edinburgh Postnatal Depression Scale (EPDS) score, 4) a SPE diagnosis, and 5) no other significant perinatal complications. Control records met #1–3 and #5 criteria. Data analysis was conducted using an independent-samples t test.

RESULTS:

Of 216 SPE participants and 253 control participants queried, 150 and 200 participants respectively met inclusion criteria. An independent-samples t test comparing EPDS scores of SPE and control participants found no significant difference, t(299)=0.40, P=.693. Comparing EPDS anxiety scores (EPDS-3A) likewise found no significant difference between the two groups, t(240)=.85, P=.397.

CONCLUSION:

Results indicate that SPE is not a risk factor for PPD or PPA diagnosis. Despite null findings, those with and without preeclampsia must be screened for PPD because of its prevalence and detrimental effect if left untreated. Future studies should examine PPD and PPA diagnoses within 12 months postpartum instead of the immediate postpartum period.
Healing at Home: Impacting Postpartum Outcomes Utilizing Clinical Practice Changes and Augmented Intelligence [ID: 1379350]
Authors: Leitner Kirstin , Christ Lori , Cutri-French Clare , Levine Lisa , McCabe Meaghan , Scalise Laura
Published: May 2023

INTRODUCTION:

The fourth trimester is a time of great physical and emotional challenge. To help patients navigate this period, we created the Healing at Home (H@H) program, which combined expedited discharge with a 24/7 bidirectional postpartum support chatbot.

METHODS:

Clinical outcomes, abstracted from medical record and patient report via text message, were evaluated for patients enrolled in H@H (March 2020 to September 2021) compared to patients delivering prior to program implementation (July to December 2019). Enrolled patients had a full-term singleton vaginal delivery of a non-small-for-gestational-age infant without postpartum hemorrhage (>1,000 cc), a low-risk sepsis risk score, a low- to intermediate-risk bilirubin, and lack of significant maternal comorbidities (eg, preeclampsia, preexisting diabetes). Institutional review board waiver for this quality improvement study was obtained.

RESULTS:

There were 490 patients enrolled in H@H versus 309 in preintervention group. The groups were similar in parity, race, ethnicity, and insurance status. There was no difference in the primary outcome, postpartum visit attendance (76.9% versus 76.1%, P=.77). H@H patients had a shorter postpartum length of stay (33.3 versus 46.7 hours, P<.001), higher rates of exclusive breastfeeding at 1 week (59.2% versus 57.0%, P=.02), and a higher rate of contraceptive use (55% versus 44%, P=.01), with no difference in maternal unscheduled visits or hospital readmissions.

CONCLUSION:

This innovative postpartum program was associated with a shorter length of stay and improvement in contraceptive acceptance and breastfeeding without increasing unscheduled visits. Future studies should evaluate the cost-effectiveness of this program and expansion to higher-risk patients including those with cesarean delivery and medical comorbidities.
Do Clinicians Appropriately Screen for Thyroid Disease in Pregnancy Using Targeted Screening Guidelines? A Real-World Retrospective Study [ID: 1368322]
Authors: Dong Allan , Lott Melisa
Published: May 2023

INTRODUCTION:

Universal screening for thyroid disease in pregnancy is not currently recommended. Guidelines support targeted screening of high-risk individuals. Prior studies have provided some evidence to the cost-effectiveness of universal screening. We aim to evaluate adherence to targeted screening criteria as well as outcome differences between screened and unscreened patients.

METHODS:

All patients presenting for new obstetrical visits in 2020 were reviewed. Institutional review board approval was obtained for this study. Risk factors meeting thyroid screening criteria based on American Thyroid Association (ATA) and/or American College of Obstetricians and Gynecologists (ACOG) guidelines, and pregnancy outcomes were extracted. Pregnancy outcomes were compared between patients meeting ATA and/or ACOG criteria who did or did not receive screening via thyroid function testing (TFT).

RESULTS:

One thousand twenty-five records were included. 87/198 patients meeting ACOG criteria for screening (43.9%) and 108/826 patients meeting ATA criteria (13.1%) had TFT. Patients meeting ATA criteria who underwent TFT had higher live-birth rates and lower miscarriage rates compared to unscreened patients meeting ATA criteria, 92.6% versus 83.26% (P=.006) and 4.63% versus 12.41% (P=.009), respectively. No difference was found between patients meeting ACOG criteria who did or did not receive TFT. No differences were observed in preterm delivery rates.

CONCLUSION:

In a real-world study of obstetrical practice, less than 50% of patients were appropriately screened for thyroid disease in pregnancy. ATA criteria identified threefold more patients for screening compared to ACOG criteria. Those screened appropriately per ATA criteria had higher live-birth rates and lower miscarriage rates compared to unscreened patients meeting ATA criteria.
Low Optimism and Social Media Use Characteristics in Pregnancy [ID: 1375605]
Authors: Ayala Nina , Jarell Amelia , Lewkowitz Adam , Mette Makena , Schlichting Lauren , Whelan Anna
Published: May 2023

INTRODUCTION:

Dispositional optimism (DO) is a resilience factor associated with improved perinatal somatic and mental health outcomes. Low DO has been associated with lower perceived control over labor. Little is known about the relationship between DO and social media (SM) use characteristics, which might provide context for the differences in perceived labor control.

METHODS:

This is a cross-sectional descriptive study of patients from a single tertiary institution. Participants were approached during their postpartum hospitalization and completed a short series of questionnaires including DO (Life-Orientation Test-Revised), perceived labor control (Labour Agentry Scale), and SM use characteristics (frequency, time spent on SM, frequency of posting). Those with low DO (score ≤14) were compared to those with high DO using bivariable analyses. Institutional review board approval was obtained prior to enrollment initiation.

RESULTS:

Two hundred ninety-nine postpartum individuals took part in the study, and 97 (32.4%) had low DO. Those with low DO were younger, had lower education, and were more likely to self-identify as non-White. Overall frequency of SM use did not differ between groups; however, those with low DO were more likely to post information about their pregnancy online (P<.01). They also had nonsignificantly lower rates of posting pregnancy-related questions (37.1% versus 62.9%, P=.25). Lastly, they had lower perceived control over the labor process (47.1 versus 52.9, P<.01).

CONCLUSION:

Recently postpartum individuals with low versus high DO reported using SM differently during their pregnancy, which may have contributed to differences in perceived control over labor, an important predictor for postpartum psychopathology.
Adverse Maternal Outcomes Associated With Gestational Weight Gain in Women With Polycystic Ovarian Syndrome [ID: 1377702]
Authors: Rossi Jordan , Johnson Juliane , Park Bo , Yao Ruofan
Published: May 2023

INTRODUCTION:

The objective of this study was to investigate maternal complications associated with gestational weight gain (GWG) in women with a history of polycystic ovarian syndrome (PCOS).

METHODS:

This was a retrospective cohort analysis using data abstracted from the California Office of Statewide Health Planning and Development (OSHPD) Linked Birth File with hospital discharge International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnoses between 2007 and 2012. Pregnancies in women with a history of PCOS were stratified based on the Institute of Medicine 2009 recommendations for GWG as follows: appropriate weight gain, excessive weight gain, inadequate weight gain, or weight loss. The maternal outcomes of interest included preeclampsia, cesarean delivery, blood transfusion, and intensive care admission. Logistic regression analysis was performed to estimate the odd ratio of the outcomes of interest for each GWG stratum in pregnancies with and without PCOS, with adjustments for confounding variables.

RESULTS:

There were 3,161,821 pregnancies, with 4,233 women with history of PCOS. The risk of cesarean delivery for women in the excessive weight gain cohort without PCOS was 1.35% versus 1.68% in the PCOS group (P<.001, 95% CI [1.38–2.04]). There were no significant differences in cesarean delivery rate for women with PCOS in the inadequate weight gain or weight loss groups. There were no statistically significant differences for preeclampsia, blood transfusion, and intensive care admission in pregnancies with and without PCOS based on GWG.

CONCLUSION:

In pregnancies affected by PCOS, excessive weight gain is associated with increased risk of cesarean delivery compared to women without PCOS.
Obstetric and Allergy Providers' Attitudes Towards Penicillin Allergy Testing in Pregnancy: A Single Hospital System Survey Study [ID: 1378292]
Authors: Baird Rachael , Goje Oluwatosin , Kuder Margaret , Pien Lily
Published: May 2023

INTRODUCTION:

Penicillin (PCN) allergy affects 10% of the U.S. population. The American College of Obstetricians and Gynecologists recommends PCN allergy testing in pregnancy when available. The objective of this study is to explore obstetric and allergy providers' knowledge and attitudes toward penicillin allergy testing and identify current barriers.

METHODS:

Single hospital system survey-based study of all obstetric and allergy providers. All obstetric and allergy providers were emailed an anonymous survey of their knowledge, current practice pattern, and perceived barriers to PCN allergy testing. Institutional review board approval was obtained for this study.

RESULTS:

From January 1, 2021 to July 31, 2022, 2,795 of 20,500 initial prenatal visits (14%) had a listed beta-lactam allergy. Of these 2,795 patients, 300 (11%) were referred for allergy testing. Fifty-four obstetric providers completed surveys. Thirty-nine percent of obstetric providers had never referred a patient for PCN allergy evaluation. Twenty-seven percent of obstetric providers self-identified lack of provider knowledge in testing process as a complete barrier to testing, and one-third of providers perceived lack of time in clinic to discuss referral as a barrier. Twenty-one allergy providers completed the survey. All allergy provider responders were willing to perform allergy testing in pregnant women, with 63% performing a direct oral challenge to confirm results. Forty-one percent of allergy providers preferred to defer testing until the third trimester.

CONCLUSION:

Allergy providers are willing and able to perform penicillin allergy testing in pregnancy, but testing is limited by obstetric provider referrals. Current barriers include obstetric provider knowledge about testing and resources to allow efficient discussion of testing benefits in clinic.
Timing of COVID-19 Vaccination and Rates of Severe COVID-19 Infection [ID: 1377384]
Authors: Kucirka Lauren , Lessler Justin , Manuck Tracy
Published: May 2023

INTRODUCTION:

Optimal timing of COVID-19 vaccination in pregnancy is not established. We sought to characterize the relationship between vaccine timing and severe COVID-19 in pregnancy.

METHODS:

This was a retrospective cohort study of pregnant patients at a tertiary health system December 15, 2020 to June 16, 2022. Severe COVID-19 infection was defined as requiring inpatient admission and remdesivir with or without monoclonals. We compared the rate of severe COVID-19 during pregnancy between patients who were 1) never vaccinated, or were vaccinated 2) before pregnancy, 3) in the first trimester, 4) in the second trimester, or 5) in the third trimester. Infections are reported per 1,000 person-years under observation to account for differences in follow-up and length of gestation. All analyses are descriptive given small numbers of severe infections.

RESULTS:

Among 17,540 patients, 13,226 (75.2%) were unvaccinated throughout pregnancy. 1,795 (10.2%) were vaccinated before pregnancy, 566 (3.2%) first trimester, 1,126 (6.4%) second trimester, and 825 (4.7%) third trimester. There were 33 cases of severe COVID (27 among unvaccinated patients). No cases occurred among patients vaccinated in the first or second trimester (0 per 1,000 person-years). There were 2 cases among patients vaccinated in the third trimester (3.4 per 1,000 person-years) and 4 cases among patients vaccinated prior to pregnancy (3.3 per 1,000 person-years). All 4 cases among patients vaccinated before pregnancy occurred during the Omicron wave.

CONCLUSION:

There were fewer severe COVID-19 cases among patients vaccinated early in pregnancy compared to those vaccinated before pregnancy or in the third trimester, suggesting that optimal timing for boosters may be in the first or second trimester, and delaying to the third trimester may increase maternal morbidity. Larger studies are needed to better characterize the relationship between vaccine timing and severe COVID-19.
Prior History of Cholestasis Is Not Associated With Worsening Outcomes in Subsequent Pregnancy With Cholestasis [ID: 1363296]
Authors: Sarker Minhazur , DeBolt Chelsea , Ferrara Lauren
Published: May 2023

INTRODUCTION:

Intrahepatic cholestasis of pregnancy (IHCP) is associated with adverse pregnancy outcomes including intrauterine fetal demise, spontaneous preterm labor, and meconium-stained amniotic fluid. Studies have yet to determine whether a prior pregnancy complicated by cholestasis is associated with more severe adverse outcomes in a subsequent pregnancy complicated by cholestasis.

METHODS:

This was a retrospective cohort study of multiparous, singleton, nonanomalous live gestations complicated by IHCP at Elmhurst Hospital Center from 2005 to 2019. We compared rates of adverse outcomes in multiparous pregnancies complicated by IHCP with or without history of prior IHCP. Our primary outcome of interest was rates of spontaneous preterm labor. Our secondary outcomes included rates of iatrogenic preterm birth, meconium-stained amniotic fluid, cesarean delivery (CD) for nonreassuring fetal heart tracing, umbilical artery pH less than 7.20, and neonatal intensive care unit (NICU) admission. Chi-square and multivariate regression tests were used to determine the strength of association. In all analyses, a P value less than 0.05 and 95% CI not crossing 1.00 indicated statistical significance. Mount Sinai Icahn School of Medicine IRB approval was obtained for this project.

RESULTS:

Of the 795 multiparous pregnancies complicated by IHCP, 618 (77.7%) had no prior history of IHCP and 177 (23.3%) had prior history of IHCP. Multiparous pregnancies with prior history of IHCP had higher rates of prior preterm birth, had earlier gestational age at diagnosis and delivery, and were more likely to receive ursodeoxycholic acid therapy. In subsequent pregnancies with IHCP, history of IHCP was associated with iatrogenic preterm birth and NICU admission. After adjusting for confounders, the association with iatrogenic preterm birth and NICU admission were no longer statistically significant. There was no significant association between history of prior IHCP and other adverse obstetric outcomes.

CONCLUSION:

Findings suggest that history of prior IHCP is not associated with worsening outcomes in subsequent pregnancies complicated by cholestasis.
Long-Term Developmental Outcomes of Infants With Neonatal Abstinence Syndrome [ID: 1375900]
Authors: Heiselman Cassandra , Abuzeid Omar , Garry David , Heiligenstein Mia , Parikh Bijal , Shinder Eliane
Published: May 2023

INTRODUCTION:

There is limited information on long-term developmental outcomes in infants with neonatal abstinence syndrome (NAS). We evaluated the infant outcomes of women with opioid use disorder based on newborn pharmacologic treatment of NAS after birth.

METHODS:

This retrospective cohort study identified opioid-exposed gestations presenting for delivery from January 2017 to July 2022. Infants were included if follow-up data was available and were divided based on pharmacologic treatment of NAS. Pregnancy information, newborn demographics, and infant care up to 4 years of age were collected. Assessments of infant outcomes included standardized developmental milestones along with any developmental delays. Statistical analysis included chi-square and Student t tests with significance levels of P<.05.

RESULTS:

There were 387 infants with 170 (44%) requiring pharmacologic treatment of NAS and 217 (56%) not requiring treatment. The gestational age at delivery, mode of delivery, birth weight, and rate of Plan of Safe Care (POSC) on discharge were similar between groups. Newborns receiving pharmacologic treatment were more likely to experience preterm birth (PTB) (22.4% versus 12.9%, P=.02), have a positive toxicology (83.4% versus 64.2%, P=.001), and a longer median length of stay with PTB removed (9.0 versus 7.0 days, P=.001). Developmental outcomes related to social-emotional delay, language-communication delay, cognitive delay, and physical-motor delay were similar between groups at 2–6 months (n=177), 9–18 months (n=138), and 2–4 years (n=94).

CONCLUSION:

Infants from opioid-exposed gestations that experienced NAS have similar long-term outcomes regardless of pharmacologic treatment for NAS after birth.
Examination of Acupuncture and Acupressure as an Integrative Treatment for Preeclampsia With Severe Features [ID: 1354672]
Authors: Kocher Zena , Castro-Pearson Sandra , Colicchia Laura , Schulte Anna , Watson David , Wunderlich Whitney
Published: May 2023

INTRODUCTION:

This study assessed whether acupuncture (AQ) and acupressure (AP) in conjunction with routine care are associated with improved blood pressure control or obstetric outcomes in hospitalized preeclampsia patients.

METHODS:

This is a retrospective matched cohort study (2010–2020) of patients with preterm preeclampsia with severe features admitted for expectant management. Integrative medicine services including AQ or AP were offered to antepartum patients starting in 2010. Patients receiving AQ/AP were matched with controls who received only routine care. Matching criteria included gestational age on admission, maternal age, parity, multiple gestation, chronic hypertension, and other clinical features. Controls were eligible for matching if their pregnancy continued at least 12 hours after the matched case received their first AQ/AP treatment.

RESULTS:

Among 416 patients admitted for preeclampsia, 146 had AQ/AP treatment, of which 104 were matched to controls for a final sample of 208 patients. Mean gestational age at admission was 30.6 weeks. Mean latency period from admission to delivery was 9.6 days (±7.6) in the treatment group and 7.3 days (±7.5) in the control group (P=.006). Changes in mean arterial pressure (MAP) from 12, 8, and 6 hours before and after the first treatment were not significantly different between the matched pairs.

CONCLUSION:

Among patients hospitalized for preeclampsia with severe features, AQ/AP treatment was associated with significant prolongation of the latency period from admission to delivery, but was not associated with changes in MAP over the 12–24 hours surrounding the first treatment.
The Effect of Antibiotics on Latency When Given at the Time of Membrane Rupture Prior to Viability [ID: 1357946]
Authors: Lambert Katherine , Cate Jennifer , Dotters-Katz Sarah , Grace Matthew , Honart Anne West
Published: May 2023

INTRODUCTION:

Antibiotics administered when membranes rupture (ROM) after viability increase latency to delivery. This may also be true in previable prelabor preterm rupture of membranes (pPPROM). This study assesses the effect of prophylactic antibiotics on latency in individuals with pPPROM.

METHODS:

Retrospective cohort of pregnancies with pPPROM less than 23 weeks 0 days in a single health system (2013–2022). Patients opting for termination or with contraindication to expectant management were excluded. Prophylactic antibiotic administration (48 hours IV azithromycin/ampicillin followed by 5 days oral amoxicillin) was at clinician discretion. The primary outcome was latency (weeks) from diagnosed pPPROM to delivery. Secondary outcomes included maternal and neonatal morbidity and mortality. Bivariate statistics compared patients who did and did not receive antibiotics. Kaplan-Meier/Cox proportional hazards ratio using significant covariates (P<.1) in bivariate analysis models antibiotic effect on latency.

RESULTS:

Ninety-three patients had pPPROM; 46 (49%) met inclusion criteria. Thirty-four (74%) received prophylactic antibiotics. Median gestational age (GA) at ROM trended later among those who received antibiotics (22.0 weeks [20.6, 22.4] versus 20.9 weeks [19.6, 21.7], P=.09). Median latency (interquartile range) did not differ with antibiotic receipt (1 week [0.4, 2.6] versus 0.6 weeks [0.3, 0.9], P=.27). When adjusted for GA at ROM, antibiotics were not associated with longer latency (hazard ratio 1.33 [0.91, 1.93]). Antibiotic receipt was associated with lower rates of previable delivery (23.0 weeks [22.7, 24.0] versus 21.3 weeks [20.5, 23.1], P=.006). After controlling for GA at ROM, adjusted odds of previable delivery remained lower with receipt of antibiotics (adjusted odds ratio 0.20 [0.04, 0.90]).

CONCLUSION:

Antibiotics at the time of pPPROM were not associated with longer latency but, after controlling for confounders, did increase the odds of delivering after viability. Further study should address optimal antibiotics strategies for this unique population.
Up to Date in Pregnancy: Assessing Vaccination Status in Hepatitis C-Positive Pregnant Persons [ID: 1372896]
Authors: Angelides Mary , Murone Julie , Venkat Divya , Vij Ruchika
Published: May 2023

INTRODUCTION:

Hepatitis C virus (HCV) is the most commonly reported bloodborne infection in the United States. Over 65% of infections are among people of childbearing age leading to increased perinatal transmission. The American College of Obstetricians and Gynecologists recommends HCV screening for all pregnant persons. Prior to HCV treatment, the hepatitis B (HBV) vaccination series is recommended. Per recommendations from the Centers for Disease Control and Prevention, the HBV vaccination series should be given to unvaccinated pregnant persons. This study aims to assess the frequency of HCV-positive pregnant persons who are screened for HBV immunity.

METHODS:

A quality improvement project through retrospective chart review was performed at a single institution from October 2020 to October 2022. Patients identified as HCV positive in pregnancy were included. Data collected included patient demographics and infectious variables such as HCV viral load, HBV antigen/antibody testing, and whether patients underwent HCV treatment.

RESULTS:

From October 11, 2020, to October 11, 2022, 113 pregnant patients were noted to be HCV positive. Of this population, 95% were also screened with HBV antigen. Only 13 patients had a HBV surface antibody checked to assess vaccination or previous infection status, of whom 9 were previously immunized. In total, only 74% of patients had a HCV viral load checked, half of whom had a viral load present. Of the patients with a positive viral load, only 51% had planned or participated in HCV treatment.

CONCLUSION:

Pregnancy offers a unique opportunity to complete complex vaccination series for previously unimmunized individuals who are positive for HCV. This quality improvement project indicates a lack of screening and assessment for further HBV immunization in a vulnerable population.
Comparative Risks of Electronic Versus Tobacco Cigarette Use During Pregnancy: Findings From a Low-Risk Sample [ID: 1374893]
Authors: Azar Michelle , Bailey Beth , Oatey Elena
Published: May 2023

INTRODUCTION:

Harms of tobacco use in pregnancy are well studied and include low birth weight, decreased newborn well-being, and need for medical interventions after birth. Less understood is the effect of noncombustible alternatives, including electronic cigarettes (ECs). We examined whether EC use during pregnancy also increases risk of adverse birth outcomes.

METHODS:

Data were from the Michigan Obstetrics Initiative (OBI), a quality improvement effort involving 75 maternity hospitals, focused on safely reducing cesarean delivery rates. Our participants were nulliparous, singleton pregnancy, term delivery, and vertex fetal positioning. Data were from medical records, entered locally, and compiled centrally by OBI.

RESULTS:

Participants delivered since January 1, 2021, with no known pregnancy alcohol and opioid use: controls (no EC/tobacco use [n=26,394], EC only [n=493], and tobacco only [n=2,126]). After control for confounding and comparison to controls, the EC group had significantly lower birth weight; the tobacco group had reduced birth weight, and greater rates of arterial cord pH less than 7.1, 5-minute Apgar scores less than 8, and neonatal intensive care unit admission.

CONCLUSION:

While EC use in pregnancy reduced birth weight, most newborn risks linked to tobacco exposure were not predicted by EC use. Additional study is needed, as nonsignificant trends toward poorer outcomes for EC users were evident, and potentially significant with larger samples or when amount/timing of EC exposure is considered. Further, given this sample was low risk, cases for whom EC use led to adverse outcomes were potentially eliminated. Growing evidence suggests pregnant patients should be counseled to avoid EC use.
Operational Effects of Implementing Hybrid Prenatal Care Models: A Retrospective Analysis [ID: 1374984]
Authors: Ghrayeb Leena , Bryan Timothy , Cohn Amy , Peahl Alex , Zhang Yuanbo
Published: May 2023

INTRODUCTION:

Telemedicine is promising for improving prenatal care access but may generate unscheduled prenatal care utilization including phone calls and portal messages. We describe differences in care utilization between pregnant people receiving in-person only versus hybrid (in-person and telemedicine) models of prenatal care.

METHODS:

In this IRB-exempt electronic health record-based study, we identified patients who received prenatal care and gave birth at our academic institution between March 1, 2021 and March 31, 2022. We classified patients into four groups based on medical and social risk factors: A) completely low risk; B) high social risk only; C) high medical risk only; and D) completely high risk. We compared visit number, portal messages, and phone calls between patients who received hybrid versus in-person only care. We report medians for all measures.

RESULTS:

Of the 4,992 included patients, 48% received hybrid care. Patients in all groups had one additional visit if they received hybrid versus in-person care (A: 9 versus 8; B: 8 versus 7; C: 9 versus 8; D: 9 versus 8). Patients receiving hybrid care used more portal messages than patients in the same group who received in-person care: A: 8 versus 6; B: 9 versus 5; C: 10 versus 9; D: 12 versus 8. There was no significant difference in phone call utilization between the in-person and hybrid patient groups.

CONCLUSION:

Patients who received hybrid prenatal care tended to utilize prenatal care including both planned and unplanned services more frequently than exclusively in-person patients.
Prenatal Sleep Linked to Postpartum Mental Health Outcomes [ID: 1375042]
Authors: Sinow Carolyn , Avalos Lyndsay , Beck Arne , Felder Jennifer , Stark Joanna , Sujan Ayesha
Published: May 2023

INTRODUCTION:

Sleep disturbances commonly occur in pregnancy; and the postpartum state confers elevated risk for mental health disorders. In nonpregnant populations, sleep problems have been linked to mental health problems. The scant research on the association between prenatal sleep disturbances and postpartum mental health has produced mixed results. The goal of this project was to evaluate the association between prenatal sleep and postpartum mental health.

METHODS:

This IRB-approved prospective cohort study included 336 individuals receiving prenatal care at a single institution between August 2020 and April 2021. Participants completed a baseline questionnaire upon recruitment, in the first or early second trimester, and a follow-up questionnaire at 4–8 weeks postpartum. Individuals completed surveys for sleep (Pittsburgh Sleep Quality Index [PSQI]), depression (Patient Health Questionnaire depression scale [PHQ-8]), and anxiety (General Anxiety Disorder scale [GAD-7]).

RESULTS:

After adjusting for baseline depression and potential confounders, prenatal global sleep quality (PSQI, >5) was associated with development of postpartum depression (PHQ-8, ≥10) (relative risk [RR] 1.12: 95% CI 1.01–1.25). Specifically, sleep quality (RR 2.18: 95% CI 1.22–3.91) and sleep latency (RR 1.52: 95% CI 1.06–2.17) were associated with postpartum depression. Prenatal sleep problems were associated with higher postpartum anxiety scores (RR 1.09: 95% CI 0.99–1.20), but findings did not reach statistical significance.

CONCLUSION:

Prenatal sleep problems are associated with the development of postpartum depression. Research suggests that treating prenatal insomnia may prevent postpartum depression. Screening for sleep disorders in pregnancy could potentially be used to target screening and prevention measures for postpartum depression.