bluuebunny/crossref_metadata_2025 huggingface dataset:
Prevalence of Alcohol Use, Screening, and Counseling Among Postpartum Persons: Six U.S. States, 2019 [A290]
Authors: Board Amy , Park Youngjoo , Denny Clark H. , Salveson von Essen Beatriz , Miele Kathryn , D'Angelo Denise V.
Published: June 2022

INTRODUCTION:

The postpartum period presents an opportunity to engage patients in discussions on alcohol use and associated risks for the mother and infant. This study examined the prevalence of postpartum alcohol use, screening, and counseling.

METHODS:

We analyzed 2019 data from a telephone follow-up survey (10 months postpartum) among individuals with a recent live birth who responded to the Pregnancy Risk Assessment Monitoring System in six U.S. states with high rates of opioid overdose. Weighted prevalence estimates were calculated for alcohol use, screening, and counseling since birth, overall and among subgroups at risk of future alcohol-exposed pregnancies.

RESULTS:

Among 1,790 respondents (response rate=67.1%), 51.5% reported consuming alcohol and 15.6% reported binge drinking. Among those who drank postpartum, 70.5% reported being asked about alcohol use by a health care provider; prevalence was lower for those trying to get pregnant (55.2%) and those not using birth control (60.8%) at the time of the survey. Approximately 1 in 4 respondents who drank alcohol postpartum reported being advised about risky alcohol levels by a health care provider during the postpartum period. Of individuals who drank alcohol postpartum and were currently pregnant, 11% had been advised to reduce or quit drinking. Only 1.6% of individuals who drank alcohol postpartum and were trying to get pregnant were advised to reduce or quit drinking.

CONCLUSION:

Postpartum alcohol screening and counseling was lower among individuals not currently using birth control and respondents trying to get pregnant who drank postpartum, indicating missed opportunities to promote patient health and reduce alcohol-exposed pregnancies.
Attitudes and Perceptions of Prenatal Aneuploidy Screening Among Hispanic Women [A291]
Authors: Hoeppner Catherine G. , Durojaye Oluwaseun T. , Petersen Scott
Published: June 2022

INTRODUCTION:

Universal prenatal aneuploidy screening should be offered in pregnancy; however, patients may encounter various barriers. The goal of the study is to better understand the attitudes and perceptions of aneuploidy screening among Hispanic patients at an uninsured community clinic.

METHODS:

This survey was IRB-exempt. Patients who were>18 year old, <23 weeks pregnant, and identified as Hispanic were offered the survey in English or Spanish. The survey included demographics, baseline genetic testing knowledge, and reasons for accepting or declining screening. Data were added to a secure research database (REDCap). All statistical analyses, including Fisher's exact test, were performed with a P value<.05.

RESULTS:

A total of 55 patients completed the survey. The majority were 25–35 year old (58%), 49% had less than a high school education, and 61% were unemployed. The majority did not know what genetic conditions would be tested (55%), nor did they know options available if testing was abnormal (71%). Overall, 77% stated they would undergo genetic screening. Patients from Guatemala were statistically less likely to get screening (44% vs. 85%, P<.02). Decision to accept screening was influenced by “none of the above” (40%) followed by health care providers (24%), whereas those who declined were influenced by religion (41%).

CONCLUSION:

Although patients may be unfamiliar with aneuploidy testing, this survey highlights what influences patients regarding prenatal genetic screening, particularly health care providers and religion in this specific patient population. Targeting baseline knowledge, attitudes, and perceptions of unique patient populations may shift the acceptance rates of those offered genetic testing.
The Advent of Home-Based STI Testing: A Scoping Review to Assess if Programs Address Barriers to STI Testing for Youth [A117]
Authors: Sao Saumya , Wang Runzhi , Coleman Jenell
Published: June 2022

INTRODUCTION:

Barriers to sexually transmitted infection (STI) testing for youth include a lack of privacy and confidentiality, limited access to affordable testing, and discomfort with providers. Home-STI testing has high acceptability in the U.S., particularly for youth who are at highest risk for STIs. This review sought to identify home-based STI programs that could overcome barriers to testing for youth.

METHODS:

A scoping review of home-based STI testing programs was conducted. Data on STI test validation, cost, age restrictions, and provider access were collected.

RESULTS:

Seventeen home-based STI testing programs were identified: 16 were restricted to age ≥18 years, three accepted insurance, four included clinician fees in test cost, and one included medication costs in test cost. Validated self-collected samples (urine, vaginal swab, dried blood spot) were offered for Chlamydia trachomatis, Neisseria gonorrhoeae, Trichomonas vaginalis, syphilis, hepatitis B, and HIV. Only one program had free testing; the remaining programs charged $45–178 for chlamydia/gonorrhea tests alone and charged more to add other STIs/HIV. Additionally, five did not connect users to providers. No information was documented on prompts to improve test-kit return rates.

CONCLUSION:

Home-STI testing programs did not address the barriers to STI testing for youth. None were tailored to youth, and the majority had age restrictions. There were expensive out-of-pocket costs, and some programs did not link users who test positive to providers. Home-based STI testing at significantly subsidized costs and home-testing programs customized for youth are needed to help reduce their increasing STI incidence rates and decrease long-term risks of STI-related morbidity.
Perceptions and Acceptance of COVID-19 Vaccine in Pregnancy Using a Health Belief Model in an Inner-City Population [A127]
Authors: Knypinski Julia , Doulaveris Georgios , Rabin-Havt Sara , Igel Catherine , Dar Peer , Klugman Susan
Published: June 2022

INTRODUCTION:

COVID-19 vaccination is safe in pregnancy and has been recommended to reduce severe maternal and fetal morbidity; however, hesitancy still exists. We sought to investigate perceptions and acceptance of vaccination among pregnant patients.

METHODS:

Pregnant patients were recruited during telehealth visits in a prospective, cross-sectional manner. Participants received an online survey using a health belief model framework to understand factors that predict COVID-19 vaccination acceptance in pregnancy. Perceptions of barriers to and benefits of vaccination as well as susceptibility to and severity of COVID-19 disease during pregnancy were sought. The primary outcome was vaccine acceptance rate pre- and post-recommendations from the American College of Obstetricians (ACOG) and Gynecologists and Society for Maternal–Fetal Medicine (SMFM). Secondary outcomes were perceptions of barriers to and benefits of vaccination.

RESULTS:

We received 238 responses out of 1,291 (18.4%) from May to November 2021. Among unvaccinated patients, 92.5% stated they would not accept vaccination during pregnancy. There was no difference when ACOG/SMFM recommendations were considered (94.1% pre versus 89.1% post, P=.4). During this period, more patients were fully vaccinated prior to pregnancy post recommendations (46.7% versus 18.8%, P<.01). Post recommendations, study participants had more confidence in the personal and fetal protective effects of vaccination (personal, 53.5% versus 33.7%, P<.01; fetal, 46.5% versus 23.5%, P<.01). However, there was no change in perception of vaccine harm to the pregnancy (30.7% versus 39.8%, P=.1).

CONCLUSION:

COVID-19 vaccination acceptance rates remained unchanged among unvaccinated pregnant patients following national recommendations. Approximately one third of patients consider the vaccine harmful to their pregnancy. Counseling regarding vaccine safety prior to and during pregnancy is crucial to improve acceptance rates.
Predictors of COVID-19 Vaccine Hesitancy and Top Concerns in Pregnant Women at a South Texas Clinic [A128]
Authors: Sutanto Michelle , Hosek Meredith G. , Stumpff Sierra , Ramsey Patrick S. , Boyd Angela , Neuhoff Barbara K.
Published: June 2022

INTRODUCTION:

COVID-19 vaccination rates among pregnant women remain low, despite increased risk of COVID-19-related illness and death and demonstrated vaccine safety and efficacy in this population. Continued research is needed to better understand and characterize the vaccine-hesitant pregnant population.

METHODS:

Following institutional review board approval, a cross-sectional cohort study was conducted from August to September 2021 surveying pregnant women at an urban South Texas clinic to identify predictors of COVID-19 vaccine hesitancy. Variables collected included: demographics, COVID-19 beliefs, Tdap/influenza vaccine hesitancy, and primary vaccine concerns. Fisher’s exact test and Mann-Whitney U test were used to identify variables predicting vaccine hesitancy. A multinomial logistic regression model was used to analyze sub-cohorts of unvaccinated participants.

RESULTS:

A total of 109 participants completed the survey, 35 vaccinated and 74 unvaccinated, with a response rate of 91.6%. Patients in the vaccine-hesitant cohort had greater odds of being younger (28.0 versus 31.0 years; OR, 0.90; P<.004) and further along in pregnancy (210 versus 140 days; OR, 1.01; P=.001). They also were more likely to report vaccine hesitancy for influenza (OR, 0.1, P<.001; OR, 0.11, P<.001) and Tdap (OR, 0.13, P<.001; OR, 0.29, P<.03). Furthermore, they had greater odds of believing they did not have enough information to confidently make their decision (OR, 0.15, P<.01; OR, 0.23, P<.01). Primary concerns with COVID-19 vaccines included short- and long-term side effects on the pregnancy, personal long-term side effects, and harmful ingredients in the vaccine.

CONCLUSION:

Results suggest that public health strategies aimed at increasing COVID-19 vaccine acceptance in pregnant women should focus on younger women, addressing broader hesitancy with vaccines in general and COVID-19 vaccine safety concerns.
Improving Provision of Expedited Partner Therapy in the Obstetrics and Gynecology Office [A131]
Authors: Vasudeva Isha , Hartnett Janice M. , Bondi Laura , Newmark Alexis , Lindsay Sarah
Published: June 2022

INTRODUCTION:

Expedited partner therapy (EPT) provides an opportunity to treat partners of patients diagnosed with gonorrhea or chlamydia without an examination, a practice supported by the American College of Obstetricians and Gynecologists and the Centers for Disease Control and Prevention (CDC), to decrease the risk of reinfection. However, EPT is not consistently offered by all providers. We performed a quality improvement project to increase the rate at which EPT is offered and prescribed at our clinic in line with Department of Public Health (DPH) regulations.

METHODS:

We completed quality improvement interventions at the Women’s Ambulatory Health Services, an urban hospital-based outpatient clinic in Hartford, CT, to improve appropriate provision of EPT to 70% of eligible patients. We defined appropriate provision of EPT by infection type (gonorrhea or chlamydia only, per CDC guidelines) and method of EPT prescription per DPH regulations (paper prescription or in-clinic dispensing to a patient for EPT). Interventions included education sessions regarding state EPT policies, implementation of a standard clinic workflow, and pre-completed written prescriptions. We gathered data from the electronic health record over 18 months to assess our quality improvement outcome.

RESULTS:

Rates of appropriate provision of EPT improved with our interventions (22% versus 75%). We found an unexpected decrease in EPT acceptance by patients after initiation of our interventions (81% versus 50%).

CONCLUSION:

Our quality improvement intervention increased appropriate provision of EPT. However future work should investigate potential barriers to EPT acceptance, including the impact of DPH regulation of prescribing options and standard workflow in patient counseling.
Real-World Treatment for Menopausal Symptoms in the U.S. by Practitioner Type [A133]
Authors: DePree Barbara , Houghton Katherine , Shiozawa Aki , Esterberg Elizabeth , Kim Janet , Mancuso Shayna
Published: June 2022

INTRODUCTION:

Vasomotor symptoms are the most common menopausal symptoms for which women seek treatment. We describe current treatment use by practitioner type (gynecologists versus primary care providers [PCPs]) and U.S. geographic region.

METHODS:

This subgroup analysis of a noninterventional, observational study used a convenience sample of 283 practitioners (131 gynecologists, 152 PCPs) who abstracted data on menopause-specific therapy from medical records of women aged 40‒60 years who initially presented with menopausal symptoms between January 1, 2016, and December 31, 2019. Data were summarized descriptively.

RESULTS:

Practitioners provided data for 1,016 women (from gynecologists: 512; PCPs: 504). About half the women overall experienced symptoms for ≥6 months before consultation. Patients of gynecologists had more vaginal and sexual symptoms recorded than patients of PCPs. Gynecologists’ patients more commonly had prescription medications (63% versus 57%) but less commonly had nonprescription therapies/interventions (59% versus 66%) documented than PCPs’ patients. They more often received hormone therapy (HT; 76% versus 64% of patients with any prescription) and compounded HT (17% versus 7%) and less often received selective serotonin reuptake inhibitors (SSRIs; 11% versus 19%) and serotonin-norepinephrine reuptake inhibitors (2% versus 12%) than PCPs’ patients. Black cohosh was the most frequently documented nonprescription therapy by gynecologists (24%) and PCPs (35%); gynecologists more commonly documented Estroven (16% versus 10%). Compounded HT use was more common in the U.S. Southeast and Southwest (∼20%), and SSRI use was more common in the Northeast (22%) than other regions.

CONCLUSION:

Prescribing patterns for menopausal symptoms vary by practitioner type and U.S. region.
Perceived Maternal Discrimination and Adverse Perinatal Outcomes Among Black Women [A136]
Authors: Adeyeye Adeola , Ard Quantrilla , Da Cunha Godoy Lucas , Shields Andrea , Campbell Winston , Cooper Shontreal
Published: June 2022

INTRODUCTION:

The purpose of this study is to determine if perceived maternal discrimination among Black women with varying levels of education impacts adverse perinatal outcomes such as preterm delivery and low birth weight.

METHODS:

We surveyed a cohort of 400 Black women between January and April 2019 who delivered an infant in the United States within the last 5 years after institutional review board approval. Participants were recruited through advertisements on social media. Inclusion criteria were participants who self-identified as a Black female, 18 years or older, and fluent in English. The validated Jackson, Hogue, Phillips Contextualized Stress Measure Survey was used. Scores were obtained from the sum of the responses. Scores were divided into tertiles to denote low, moderate, and high stress levels. Data was analyzed using Fisher’s exact test and pairwise comparison if the Fisher’s test was statistically significant. A P value <0.05 was considered statistically significant.

RESULTS:

From the 400 Black women surveyed, 107 completed surveys were returned and analyzed. The mean age of the respondents was 38 (26–49). The majority of respondents had either a college (42.9%) or professional degree (48.5%). Approximately 58% reported household incomes greater than $90,000. Of women with moderate to high levels of perceived racism, 13.51% and 15.79% had a preterm delivery, P=.02.

CONCLUSION:

Perceived racism and indicators of general stress were associated with preterm delivery and low birth weight. These findings provide further evidence that psychosocial factors may play an important role in birth outcome disparities among Black women.
The Association of Endometriosis and Placenta Previa During Pregnancy [A137]
Authors: Lee Misooja , Shibata Michiko , Matsuzaki Shinya , Matsuzaki Satoko , Sakaguchi Hitomi , Hisa Tsuyoshi , Kamiura Shoji
Published: June 2022

INTRODUCTION:

Endometriosis is a common gynecological disease characterized by chronic inflammation, with an estimated prevalence of approximately 5% to 15%. The prevalence of endometriosis has been increasing in reproductive-aged women, but recent developments in assisted reproductive technologies have improved pregnancy rates among women with endometriosis.

METHODS:

This study aimed to assess the relationship between placenta previa and endometriosis. In compliance with the Preferred Reporting Items for Systematic Reviews guidelines, a systematic review of the literature was conducted through June 30, 2021, using PubMed, Scopus, and the Cochrane Library.

RESULTS:

Twenty-three studies in which 99,773 pregnancies with endometriosis and 7,184,426 pregnancies without endometriosis were systematically reviewed. Using an adjusted-pooled random effects analysis, we found that endometriosis was associated with an increased incidence of placenta previa (adjusted odds ratio [aOR], 3.17; 95% CI, 2.58–3.89) compared to those without endometriosis. We also performed an unadjusted analysis using a fixed effects model and found that severe endometriosis was associated with an increased prevalence of placenta previa (OR, 11.86; 95% CI, 4.32–32.57), whereas non-severe endometriosis was not (OR, 2.16; 95% CI, 0.95–4.89). Notably, one study showed that placenta previa with endometriosis was associated with increased intraoperative bleeding (1,515 mL versus 870 mL, P<.01) compared to those without endometriosis.

CONCLUSION:

There is a strong association between endometriosis and an increased rate of placenta previa, and endometriosis may be associated with adverse surgical outcomes during cesarean delivery. Therefore, the development of novel therapeutic agents or methods are warranted to prevent placenta previa in women with endometriosis.
Perinatal Outcomes of High-Risk Patients Delivered by Resident Versus Private Practice Physicians [A138]
Authors: Gould Alexander J. , Recabo Olivia , Has Phinnara , Ayala Nina , Savitz David A. , Lewkowitz Adam K.
Published: June 2022

INTRODUCTION:

This study compared perinatal outcomes of deliveries performed by resident and private practice physicians.

METHODS:

This is a secondary analysis of a large institutional review board‒approved, National Institutes of Health–funded retrospective cohort study of pregnant patients with chronic hypertension, diabetes, and/or fetal growth restriction who delivered singletons at a tertiary-care maternity hospital from January 2002 to March 2013. Maternal and neonatal outcomes of deliveries by resident physicians were compared to those of private practice physicians. The primary outcome was mode of delivery.

RESULTS:

The cohort included 9,744 deliveries: 1,928 resident and 7,816 private. Compared to private patients, resident patients were younger; more likely to be non-White, multiparous, or cigarette-smoking; and more likely to have public or no insurance, low BMI, or chronic hypertension. Private practice patients were more likely to have fetal macrosomia and diabetes. After adjusting for these factors, resident patients had 18% lower risk of cesarean delivery (CD) overall (aRR, 0.82; 95% CI, 0.76–0.88), driven by a 45% reduction in elective CD (aRR, 0.55; 95% CI, 0.43–0.70). Resident patients also had lower rates of episiotomy (aRR, 0.71; 95% CI, 0.58–0.88), but higher rates of endometritis (aRR, 1.93; 95% CI, 1.49–2.49) and NICU admission (aRR, 1.19; 95% CI, 1.04–1.36).

CONCLUSION:

In this cohort of high-risk pregnant patients, delivery by resident physicians was associated with a reduction in CD, particularly elective CD, and episiotomy. A focus on understanding the choice of private practice patients to undergo elective cesarean delivery and their providers to perform elective cesarean delivery may help reduce preventable morbidity.
Initial Clinical Experience With Brexanolone for Postpartum Depression: Why Aren’t More Patients Using It? [A140]
Authors: Silver David F. , Sholley Kristy , Silver Nazanin E. , Getz Virginia L.
Published: June 2022

INTRODUCTION:

Postpartum depression (PPD) occurs after 15% of live births. Brexanolone (BRX, Zulresso) demonstrated 60–70% rapid and durable response rates in randomized clinical trials (RCT) with 5% risk of excessive sedation or altered consciousness (LOC). We examined the outcomes of our first 20 patients treated with BRX for moderate-to-severe PPD.

METHODS:

PPD diagnosis and severity were based on 90-minute psychiatric evaluations (PE) and Hamilton Depression scores (HAM-D) greater than 20. Depressive episodes started in the third trimester or within 4 weeks postpartum (PP). Patients were consented and enrolled in the FDA Risk Evaluation Mitigation Strategy (REMS) and treated/monitored per REMS protocol. Edinburgh Postpartum Depression Scales (EPDS) and PE were obtained pre-infusion and daily until discharge. Follow-up included 2-week, 4-week, and 3-month post-treatment PE. EPDS, PE, and side effects were prospectively recorded.

RESULTS:

BRX was offered to 78 patients and provided to 20 (26%) patients from September 2019 through September 2021. All 20 remained on stable doses of pretreatment SSRI or SNRI. All 20 completed BRX without interruption or dose reduction. No patients had sedation or LOC. Overall response rate was 85% (17/20). Twelve of 17 patients responded by Day 3. The remaining five responded by Day 10. Sixteen of 17 responses were durable for 3 months of follow-up. One patient relapsed between 3 and 4 weeks post-treatment. She was subsequently diagnosed with bipolar 1 disorder requiring lithium. Of three nonresponders, two had migraines during treatment and one had preexisting untreated OCD. Eleven of 20 patients breastfed during treatment.

CONCLUSION:

Of 20 patients, 60% responded to BRX on Day 3, consistent with RCTs. A further 25% responded between Days 3 and 10 (total response=85%).
Accuracy of Blood Loss Assessments During Cesarean Deliveries [A144]
Authors: Zermeno Yuri , Kram Jessica J. , Dickson Elizabeth , Salvo Nicole
Published: June 2022

INTRODUCTION:

Traditionally, during deliveries blood loss was estimated visually (Estimated Blood Loss; EBL). More recently, Quantitative Blood Loss (QBL) has been implemented to increase blood loss assessment accuracy. Our quality improvement study aimed to identify if QBL is superior to EBL in quantifying blood loss in comparison to Calculated Blood Loss (CBL).

METHODS:

We retrospectively reviewed all women with a cesarean delivery in one urban hospital between December 1, 2018, and December 1, 2019, who had EBL and QBL recorded. CBL, our gold standard for identifying postpartum hemorrhage, was calculated using maternal height, weight, pre- and post-delivery hematocrit. Hemorrhage was defined as blood loss ≥1,000 mL. Basic descriptive and inferential statistics were conducted.

RESULTS:

Overall, 486 patients had EBL, QBL, and CBL values. The median values for EBL (600.0; IQR, 500.0–800.0) and QBL (547.5; IQR, 347.0–808.0), were significantly lower (both P<.001) than CBL (896.2; IQR, 512.4–1,323.4). When compared to CBL, EBL had low sensitivity (12.0%; 95% CI, 7.7–16.3%) and high specificity (89.7%; 95% CI, 78.6–100.0%). QBL also demonstrated low sensitivity (22.6%; 95% CI, 17.0–28.1%) and high specificity (94.4%; 95% CI, 91.7–97.2%). The negative predictive value for EBL (58.2%; 95% CI, 53.7–62.7%) and QBL (60.2%; 95% CI, 55.5–64.9%) was low. The positive predictive value for EBL (89.7%; 95% CI, 78.6–100.0%) was greater than QBL (76.6%; 95% CI, 66.2–87.0%). Ultimately, only six additional hemorrhages were detected by QBL (35 versus 29 for EBL); on the other hand, CBL detected 153.

CONCLUSION:

Given the time and resources necessary to calculate QBL, this study questions its utilization and/or superiority to EBL in the detection of postpartum hemorrhage.
Implementation of Nursing Protocol to Decrease Admission-to-Induction Timeline [A154]
Authors: Livergood M Christine , Kessel Johanna , Uner Ismet Joan , Ford Jordanne , Tsaih Shirng-Wern , Peterson Erika
Published: June 2022

INTRODUCTION:

A quality initiative of nurse training in ultrasound and vaginal misoprostol placement was performed. The study objective was to determine if that initiative decreased admission to induction times for term inductions of labor.

METHODS:

Retrospective pre-intervention data was collected for 6 months. Following the intervention, there was a wash-out period and then 6 months of data was collected. Inclusion criteria were planned term inductions of labor. Clinical characteristics were collected. Univariable and graphical analyses were performed.

RESULTS:

A total of 368 pre-intervention and 430 post-intervention inductions were analyzed. The inductions did not differ in multiparity, gestational age, starting cervical dilation, induction medication, or cesarean delivery rate. The average time from admission to administration of induction medication did not differ from pre-intervention to post-intervention (90.8 min versus 87.3 min, P=.37). The post-intervention group had a nearly significant decreased time to delivery compared to pre-intervention (21.5 hours versus 22.7 hours, P=.07). The post-intervention group had fewer inductions that took>60 mins to start (67.2% versus 73.9%, P=.04). On graphical analysis, there appeared to be a trend toward decreased time from admission to induction as the months progressed after the intervention.

CONCLUSION:

While the intervention did not decrease the time from admission to induction, there was a trend toward decreasing times. There was a decrease in number of inductions that took greater than 60 minutes to begin. We believe the intervention to be a viable quality initiative; however, further work needs to be done on optimizing induction and admission processes.
The Effect of Co-Existing Maternal Obesity and Chronic Hypertension on Neonatal Birth Weight [A156]
Authors: Pinkerton Elizabeth , Siff Lauren
Published: June 2022

INTRODUCTION:

While the individual effects of maternal obesity and chronic hypertension on neonatal birth weight are well known, there is little data when these factors are co-existing. The goal of this study was to investigate the effect of these co-existing factors on neonatal birth weight.

METHODS:

This retrospective cohort study utilized the 2018 Natality Database from the Centers for Disease Control and Prevention. Institutional review board approval was obtained. Live birth records at 37, 38, and 39 weeks with recorded birth weight and maternal BMI greater than 18.4 were isolated. Exclusion criteria included maternal pregestational or gestational diabetes, gestational hypertension, preeclampsia, eclampsia, maternal tobacco use, multi-gestational pregnancies, suspected or confirmed chromosome disorder, or fetal anomaly.

RESULTS:

Univariate analysis of the primary objective revealed that neonates born from mothers with obesity and chronic hypertension weighed more than mothers without by 17 g, 28 g, and 18 g at 37, 38, and 39 weeks respectively. The secondary objective compared birth weights at varying obesity levels. At the same maternal BMI, neonates born from mothers with hypertension weighed less than those without. Compared to normotensive, normal-BMI mothers, neonates born from mothers with hypertension weighed less when maternal BMI was less than 30; weighed most similar at BMI 30–34.9; and weighed more as BMI increased over 35.

CONCLUSION:

While statistically significant differences in birth weight were noted between neonates from normotensive, normal-BMI mothers and those with chronic hypertension and obesity, these differences of less than 50 g are unlikely to be clinically significant. The opposing weight effects of obesity and hypertension balanced at BMI 30–34.9. Neonatal outcomes from mothers with co-existing risk factors should be investigated.
Effect of Postoperative Intravenous Ketorolac Administration on Postoperative Urine Output After Cesarean Delivery [A169]
Authors: Collins Ana M. , Moncada Kea , Ali Munira , Spierer Gary , LaPorta Christopher , Fruhman Gary
Published: June 2022

INTRODUCTION:

To determine if intravenous ketorolac administration has an effect on the postoperative urine output after cesarean delivery.

METHODS:

We conducted a retrospective cohort study of women who delivered at Staten Island University Hospital from January 1 to June 30, 2021. During this timeframe, there were 236 cesarean deliveries. Exclusion criteria included intrauterine fetal demise (IUFD) and gestational age at delivery. Operative records and PACU records were utilized to determine intraoperative urine output, intraoperative estimated blood loss (EBL), intraoperative intravenous fluid (IVF) administration, postoperative urine output, and whether or not ketorolac was administered (dependent on surgeon preference). All patients received IVF postoperatively at 125 mL/hour. Urine output was measured for the first three hours postoperatively and was considered adequate if >0.5 mL/kg/hour. We conducted analyses using multiple linear regressions and chi-square tests, where P<.05 was considered statistically significant. The study was institutional review board‒-approved.

RESULTS:

After controlling for potential cofounders (operative EBL, amount of Pitocin, and intraoperative IVF), a linear regression showed the effect of IV ketorolac was significant (P<.001), with a mean decreased postoperative urine output of 53 mL/hour compared to patients who did not receive ketorolac.

CONCLUSION:

As postoperative ketorolac administration after cesarean delivery is associated with clinically significant decreased urine output and is contraindicated in patients who are at high risk of bleeding, alternative modalities for postoperative pain management should be considered.
Periviable Delivery Management and Outcomes in a Largely Native Hawaiian, Pacific Islander, and Asian Population [A170]
Authors: Maykin Melanie , Mercer Elizabeth , George Kandie , Yamasato Kelly
Published: June 2022

INTRODUCTION:

Racial disparities among Native Hawaiian, Pacific Islanders, and select Asian subgroups have been reported in obstetric outcomes. We describe periviable delivery management and outcomes by maternal race at the highest-volume labor and delivery unit in Hawai‘i.

METHODS:

This was a retrospective cohort study of births from 2017 to 2019 between 22 and 24 weeks of gestation at our institution. Maternal and neonatal outcomes were stratified by self-reported race and analyzed with Fisher’s exact tests. A P value <.05 was considered significant.

RESULTS:

A total of 74 neonates were born of 63 gravidas (53 singleton, nine twins, one triplets). Of these, 13 were born at 22 weeks, 22 at 23 weeks, and 32 at 24 weeks. In all, 65 neonates received some form of resuscitation. Native Hawaiians comprised 38% of periviable births, followed by Asians (19%) and White individuals (15%). The racial composition of periviable deliveries was similar to that of the overall State of Hawai‘i live birth rate. Among maternal outcomes, the cesarean delivery rate was 54%, of which 90% were classical hysterotomies. Neonatal survival among those who received resuscitation was 14% at 22 weeks, 41% at 23 weeks, and 63% at 24 weeks. Survival at 22 and 23 weeks did not vary by race, but at 24 weeks this trended toward significance (P=.056).

CONCLUSION:

Survival rates between 22 and 24 weeks of gestation at our institution were comparable to other published cohorts, without obvious racial disparities. Neonatal resuscitation and cesarean delivery were common among all racial groups. These data provide background for future studies examining periviable outcomes in this uniquely diverse and understudied population.
The Cost of Loss: A Secret-Shopper Survey of Mortuary Disposition of Fetal Remains [A182]
Authors: Burns Roshan , Henkel Andrea , Cahill Erica
Published: June 2022

INTRODUCTION:

While only a minority of patients facing a pregnancy termination or loss seek burial or cremation of fetal remains, there is little information or awareness around the cost of these services. With an increasing number of states introducing mandatory fetal cremation/burial laws, we investigated the availability and cost of these services.

METHODS:

This was a cross-sectional “secret shopper” telephone survey of all mortuaries in five Northern California counties identified by the California Cemetery and Funeral Bureau. Two “secret shoppers” presented as clinicians assessing the availability and cost of cremating and/or burying fetal remains for loss in the second trimester.

RESULTS:

Of the 60 funeral homes contacted, 21% did not accept fetal remains. No mortuaries that accepted fetal remains had policies excluding remains from abortion procedures. The total cost of cremation ranged from USD $0 to $1,800, with a mean of $596.98. This was significantly less than the cost of burial services, mean $853.67 (P=.01), which were also often accompanied by additional cemetery fees and plot expenses up to $3,000.

CONCLUSION:

Private disposition of fetal remains after an abortion or pregnancy loss is expensive and not available in all mortuary settings. When discussing options for disposition of remains with families, providers must be mindful of the associated costs as a limitation for many families. Legislation requiring private or clinic disposition of fetal remains would add significant cost and financial burden to those seeking or providing abortion care.
Hypertensive and Diabetic Disorders of Pregnancy in Women in Same-Sex Versus Different-Sex Marriages [A188]
Authors: Rubin Elizabeth , Snowden Jonathan , Sandström Anna , Paula Amato , Jae Downing
Published: June 2022

INTRODUCTION:

Sexual-minority women may have higher rates of adverse perinatal outcomes; however, population level maternal morbidity has not been studied in this group.

METHODS:

We conducted a cross-sectional study of birth certificates from Massachusetts (2012–2018) and Ohio (2016–2018). Within each state, women giving birth in same-sex marriages were compared to those in different-sex marriages. Outcomes included gestational hypertension or preeclampsia (GHTN/PEC), chronic hypertension, pregestational diabetes, and gestational diabetes. Chi-square tests were used for comparisons. Multivariable logistic regression was performed to control for age, parity, race, and socioeconomic status.

RESULTS:

Of the 315,432 and 323,841 birth records from married individuals in Massachusetts and Ohio, respectively, 1,997 (0.6%) and 1,677 (0.2%) were from those in same-sex marriages. In both states, women giving birth in same-sex marriages had higher rates of nulliparity, age over 35, obesity, and tobacco use. In Ohio they were more likely to be of Black race, lower education level, and utilizing WIC, but in Massachusetts they were more likely to be of White race, higher educational level, and not utilizing WIC. In both states, this population had higher rates of GHTN (3.5% versus 2.3%), PEC (11.8% versus 8.8%), and, in Massachusetts, chronic hypertension (3% versus 1.7%) (all P<.001). In the multivariable logistic regression models, the adjusted odds ratios of GHTN/PEC, chronic hypertension, pregestational diabetes, or gestational diabetes were similar between women in same-sex and different-sex marriages.

CONCLUSION:

In two large populations, women in same-sex marriages were significantly more likely to have GHTN/SPEC, but not after controlling for known risk factors, all of which were higher in this population.
The Effect of Changes in Treatment Recommendations for Gestational Diabetes on Perinatal Morbidity [A191]
Authors: White Samantha , Gurram Padmalatha , Danhauser Sara , Tassone Lauren , Ngyuen Anh , Mover Kelly
Published: June 2022

INTRODUCTION:

Evidence about the lack of efficacy of glyburide prompted the American College of Obstetricians and Gynecologists (ACOG) to recommend insulin as first-line treatment and metformin as an alternative for treatment of gestational diabetes (GDMA2) in February 2018. This study compared the treatments and perinatal outcomes in women before and after the ACOG recommendations.

METHODS:

This was a retrospective study of patients treated for GDMA2. Patients were divided into two groups (group 1: February 2016 to January 2018; group 2: February 2018 to January 2020). The primary outcome was comparison of perinatal outcomes between the groups during those two periods. The secondary outcome was comparison of the effect of glyburide, metformin, and insulin on perinatal outcomes regardless of the time frame. Outcomes were also compared between insulin glargine and insulin NPH. Maternal outcomes included rates of primary cesarean delivery, preeclampsia, and ICU admission. Neonatal outcomes included large for gestational age, shoulder dystocia, NICU admission, hypoglycemia, hyperbilirubinemia, and stillbirth. Institutional review board approval was obtained.

RESULTS:

A total of 160 patients received medications. Baseline characteristics were similar. Insulin was the most common medication used in both groups (58%). In group 1, 21 patients received glyburide versus seven in group 2 (P=.01). There was no difference regarding insulin or metformin use between groups (P>.05). Perinatal outcomes were similar in both groups (P>.05). Regardless of time frame, NICU admissions (P=.01) and shoulder dystocia (P=.04) were higher with glyburide. Preeclampsia rates were lower in women receiving insulin NPH (P=.03).

CONCLUSION:

Glyburide use decreased after ACOG recommendations. Decline in use of glyburide is not accompanied by significant improvements in perinatal morbidity. Regardless of time frame, glyburide is associated with higher neonatal adverse outcomes and NPH with decrease in maternal adverse outcomes.
Validation of a New Calculator for Predicting Success of Vaginal Birth After Cesarean Delivery at a Tertiary Center [A194]
Authors: Nittur Nandini , Cansino Catherine , Reyes Carolyn , Ponzini Matthew D. , Wilson Machelle D. , Marshall Maya
Published: June 2022

INTRODUCTION:

Race as a variable in a predictive model for successful trial of labor after cesarean delivery (TOLAC) has been questioned as contributing to health inequities. The Society for Maternal–Fetal Medicine has just released a modified calculator removing race as a variable. To our knowledge, the new calculator has not been validated in any U.S. population outside the cohort from which it was derived.

METHODS:

We reviewed all patients who underwent a TOLAC in 2019–2020 at a tertiary academic center. Institutional review board approval was either obtained for the study. The probability of successful TOLAC was calculated for each patient using both predictive calculators and compared to birth outcomes. The area under the curve (AUC) was calculated for each model.

RESULTS:

From the cohort of 134 patients, 42% identified as African American (AA) or Hispanic. The success rate for vaginal birth after cesarean delivery was 80% for the entire population, and 82% among AA and/or Hispanic patients. The AUC of the original calculator was 0.715, compared to 0.748 for the new calculator. For AA and/or Hispanic patients, the average predicted success rates between the models rose from 62% to 71%.

CONCLUSION:

Our results suggest that AA and Hispanic patients were previously predicted to have a poorer chance of successful TOLAC based on the original calculator. The higher AUC associated with the new model implies improved predictability for AA and Hispanic populations. Informed by using the new calculator, AA and Hispanic patients may begin to have better birth experiences based on more accurate counseling of their success rates.
Tobacco and Marijuana Use and Effect on Gestational Weight Gain [A195]
Authors: Mirsky Elizabeth , Paudel Alissa M. , Maples Jill M. , Mastronardi Alicia , Young Megan Lacy , Zite Nikki
Published: June 2022

INTRODUCTION:

Previous work has addressed the effect of marijuana and tobacco use in pregnancy on infant birth weight; however, there is a paucity of data reporting the potential impact of marijuana and tobacco use on maternal gestational weight gain (GWG). This study sought to determine an association between marijuana and/or tobacco use and meeting GWG recommendations.

METHODS:

This retrospective study included patients who delivered at a single academic institution between January 2019 and June 2021. Institutional review board approval was obtained. Data collected included prepregnancy weight, BMI, and gestational weight gain (GWG), as well as tobacco and marijuana use. GWG was categorized according to Institute of Medicine and American College of Obstetricians and Gynecologists recommendations as adequate, inadequate, or excessive.

RESULTS:

A total of 7,653 patients were included in the study. Polysubstance use was excluded. Overall, 52% of patients experienced excessive GWG, 28% adequate GWG, and 19% inadequate GWG. Former tobacco users were more likely to have excessive GWG than non-smokers and current tobacco users (61% versus 51% and 51%; P<.001), while current tobacco users were more likely to have inadequate GWG than non-users and former tobacco users (24% versus 19% and 15%; P<.001). Marijuana users were more likely to have excessive GWG than non-users (57% versus 52%; P=.007). Marijuana use remained a significant predictor of excessive GWG, even when controlling for tobacco use (P<.035).

CONCLUSION:

It appears that tobacco and marijuana use may play a role in GWG. Further research is needed in order to fully understand and appropriately counsel on the potential effects of marijuana and tobacco use on GWG and pregnancy outcomes.
Investigating Below the County Level to Reveal Poverty-Related Disparity in Poor Birth Outcomes [A204]
Authors: Hall Jaclyn , Smith Erica , Wen Tony , Reeder Callie , Layton Claire , Lemas Dominick
Published: June 2022

INTRODUCTION:

Birth outcome disparity associated with communities of rurality and socioeconomic vulnerability within the state of Florida was examined. Specific challenges suffered by poor communities may be overlooked when reporting standards for health outcomes are at the county level. We hypothesized that birth outcome disparities are more related to neighborhood socioeconomic vulnerability than rurality.

METHODS:

Data for Florida births from 2013 to 2017 were obtained from FLHealthcharts.com. Maternal counties of residence were identified as rural or non-rural by the population density measure used by the Florida Department of Health. The Centers for Disease Control and Prevention’s index for socioeconomic status vulnerability (SEV) was incorporated for residential census tracts, which were divided into higher and lower vulnerability halves. The prevalence of preterm (PTB) and low-weight birth (LBW) was calculated for each outcome. Statistical significance of birth outcome disparity was tested using rate ratio statistical test.

RESULTS:

Residing in a rural area was associated with a significant disparity of 7% higher rate for PTB and 2% higher rate for LBW. Residing in a community with high SEV was associated with a larger disparity. High SEV is associated with 18% higher PTB and 28% higher LBW risk than residing in low SEV.

CONCLUSION:

The health burden related to socioeconomic vulnerability is higher than the disparity related to rurality. Public health studies involving social determinants of health, like birth outcomes, require statistical investigations below the county level. By moving beyond the county as the standard for public health reporting and reporting at the community level, we uncover the burden of health concerns as related to SEV.
Immediate Versus Delayed Admission in Early Labor [A214]
Authors: Iovino Nicole , Chappelle Joseph
Published: June 2022

INTRODUCTION:

There is no clear consensus on when to admit patients in early labor. The purpose of this study is to evaluate whether early labor admission increases rate of cesarean delivery compared to delayed admission, and additionally, to explore differences in neonatal outcomes and length of hospital stay among these groups.

METHODS:

A retrospective cohort study comparing immediate versus delayed admission in full-term patients presenting in early labor at a university-based tertiary-care center and found to be 1–4 cm dilated.

RESULTS:

Of 432 patients who presented to our hospital for labor evaluation, 131 were admitted on initial presentation and 301 experienced delayed admission. There was no statistically significant difference in rate of cesarean delivery in the immediate admission group versus delayed admission (6.1% versus 10.3%, P=.2), Apgar<7 (5.3% versus 4.9%, P=.811), meconium (26% versus 28.1%, P=.377), infection (5.3% versus 49.7%, P=.41) or NICU admissions (11.5% versus 16.4%, P=.187). Time from admission to delivery was statistically similar among these groups (10.9 versus 12.5 h, P=177).

CONCLUSION:

There was no evidence of increased risk of cesarean delivery or harm in patients who underwent immediate admission. Interestingly, both patients who were admitted initially and those who had their admission delayed had similar lengths of time until to delivery once they were admitted, suggesting that providers likely have a good clinical sense of when a patient should be admitted, or at a minimum are consistent. There is no clear answer on optimal timing for admissions; thus we should continue to use clinical judgment, talk to our patients, and make joint decisions.
Implementation of Guideline for Transthoracic Echocardiography Screening for Pregnant Women With Risk for Cardiac Disease [A221]
Authors: Abelman Sarah , Burd Julia , Muir Molly , Smith Jessica M. , McCurdy Rebekah J.
Published: June 2022

INTRODUCTION:

Adverse maternal outcomes from cardiac disease may be mitigated by pregnancy screening guidelines as proposed by the California Maternal Quality Care Collaborative.

METHODS:

Prior to guideline implementation (January 2020), provider discretion determined echocardiography recommendations. Post-guideline, echocardiography was recommended to pregnant women with ≥4 risk factors OR, history of cardiac disease. Risk factors included: age ≥40, BMI ≥35, Black race, chronic hypertension, prepregnancy diabetes, and substance use (opiates, cocaine, alcohol, or other substance). Underlying heart disease included history of endocarditis, congenital heart disease, cardiotoxic chemotherapy, or other cardiac disease. All outpatient maternal–fetal medicine consultations from December 2017 to August 2021 were reviewed, and patient demographics and echocardiography recommendations were recorded.

RESULTS:

Pre-guideline, 1,318 consultations (93 high-risk for cardiac disease) were completed. Post-guideline, 1,697 consultations (69 high-risk) were completed. Risk factors for the 162 high-risk patients included age (20.4%), race (60.5%), BMI (48.7%), diabetes (29.6%), hypertension (46.3%), opioids (5.6%), cocaine (1.2%), alcohol (1.2%), other substance use (5.6%), cardiotoxic chemotherapy (8.1%), endocarditis (3.1%), congenital heart disease (20.4%), and other cardiac disease (35.8%). Of the 162 high-risk patients, 100 (61.7%) received recommendations for echocardiography. Post-guideline, echocardiography was recommended for high-risk patients more often than pre-guideline (n=62 [89.9%] versus n=38 [40.9%], P<.001). When echocardiography was recommended, it was more likely to be completed (87.0%) than if not recommended (17.7%, P<.001). Delivery mode for 133 completed pregnancies was via cesarean delivery (51.9%), operative vaginal delivery (4.5%), and spontaneous vaginal delivery (43.6%).

CONCLUSION:

A standardized guideline prompted more recommendations for and subsequent completion of transthoracic echocardiography among pregnant patients at high risk for underlying cardiac disease.