bluuebunny/crossref_metadata_2025 huggingface dataset:
The Clock gene regulates kainic acid-induced seizures through inhibiting ferroptosis in mice
Authors: Wang Fei , Guo Lianxia , Wu Zhengping , Zhang Tianpeng , Dong Dong , Wu Baojian
Published: June 2022

Objectives

Temporal lobe epilepsy (TLE) is a common and intractable form of epilepsy. There is a strong need to better understand molecular events underlying TLE and to find novel therapeutic agents. Here we aimed to investigate the role of Clock and ferroptosis in regulating TLE.

Methods

TLE model was established by treating mice with kainic acid (KA). Regulatory effects of the Clock gene on KA-induced seizures and ferroptosis were evaluated using Clock knockout (Clock−/−) mice. mRNA and protein levels were determined by quantitative real-time PCR and western blotting, respectively. Ferroptosis was assessed by measuring the levels of iron, GSH and ROS. Transcriptional regulation was studied using a combination of luciferase reporter, mobility shift and chromatin immunoprecipitation (ChIP) assays.

Key findings

We found that Clock ablation exacerbated KA-induced seizures in mice, accompanied by enhanced ferroptosis in the hippocampus. Clock ablation reduced the hippocampal expression of GPX4 and PPAR-γ, two ferroptosis-inhibitory factors, in mice and in N2a cells. Moreover, Clock regulates diurnal expression of GPX4 and PPAR-γ in mouse hippocampus and rhythmicity in KA-induced seizures. Consistent with this finding, Clock overexpression up-regulated GPX4 and PPAR-γ and protected against ferroptosis in N2a cells. In addition, luciferase reporter, mobility shift and ChIP assays showed that CLOCK trans-activated Gpx4 and Ppar-γ through direct binding to the E-box elements in the gene promoters.

Conclusion

CLOCK protects against KA-induced seizures through increased expression of GPX4 and PPAR-γ and inhibition of ferroptosis.
Probing plasma physics and elemental composition of a leonid meteor by fitting complex plasma radiation model parameters
Authors: Kubelík P , Koukal J , Lenža L , Srba J , Laitl V , Křížová R , Křivková A , Civiš S , Chernov V E , Ferus M
Published: June 2022

A numerical simulation model was developed and employed in elemental composition determination and characterization of meteor plasma physical parameters, particularly the plasma excitation temperature and electron density, by fitting the model parameters to the emission spectrum of a bright Leonid bolide recorded in the visible spectral range. Novel model introduced in this study involves self-absorption and enables parallel optimization of tens of the parameters. We also discuss that the observed bolide spectrum is strongly dependent on observation geometry.
3D elemental abundances of stars at formation across the histories of Milky Way-mass galaxies in the FIRE simulations
Authors: Bellardini Matthew A , Wetzel Andrew , Loebman Sarah R , Bailin Jeremy
Published: June 2022

We characterize the 3D spatial variations of [Fe/H], [Mg/H], and [Mg/Fe] in stars at the time of their formation, across 11 simulated Milky Way (MW)- and M31-mass galaxies in the FIRE-2 simulations, to inform initial conditions for chemical tagging. The overall scatter in [Fe/H] within a galaxy decreased with time until $\approx 7 \, \rm {Gyr}$ ago, after which it increased to today: this arises from a competition between a reduction of azimuthal scatter and a steepening of the radial gradient in abundance over time. The radial gradient is generally negative, and it steepened over time from an initially flat gradient $\gtrsim 12 \, \rm {Gyr}$ ago. The strength of the present-day abundance gradient does not correlate with when the disc ‘settled’; instead, it best correlates with the radial velocity dispersion within the galaxy. The strength of azimuthal variation is nearly independent of radius, and the 360 deg scatter decreased over time, from $\lesssim 0.17 \, \rm {dex}$ at $t_{\rm lb} = 11.6 \, \rm {Gyr}$ to $\sim 0.04 \, \rm {dex}$ at present-day. Consequently, stars at $t_{\rm lb} \gtrsim 8 \, \rm {Gyr}$ formed in a disc with primarily azimuthal scatter in abundances. All stars formed in a vertically homogeneous disc, Δ[Fe/H]$\le 0.02 \, \rm {dex}$ within $1 \, \rm {kpc}$ of the galactic mid-plane, with the exception of the young stars in the inner $\approx 4 \, \rm {kpc}$ at z ∼ 0. These results generally agree with our previous analysis of gas-phase elemental abundances, which reinforces the importance of cosmological disc evolution and azimuthal scatter in the context of stellar chemical tagging. We provide analytic fits to our results for use in chemical-tagging analyses.
Initial periods and magnetic fields of neutron stars
Authors: Igoshev Andrei P , Frantsuzova Anastasia , Gourgouliatos Konstantinos N , Tsichli Savina , Konstantinou Lydia , Popov Sergei B
Published: June 2022

Initial distributions of pulsar periods and magnetic fields are essential components of multiple modern astrophysical models. Not enough work has been done to properly constrain these distributions using direct measurements. Here, we aim to fill this gap by rigorously analysing the properties of young neutron stars (NSs) associated to supernova remnants (SNRs). In order to perform this task, we compile a catalogue of 56 NSs uniquely paired to SNRs with known age estimate. Further, we analyse this catalogue using multiple statistical techniques. We found that distribution of magnetic fields and periods for radio pulsars are both well described using the lognormal distribution. The mean magnetic field is log10[B/G] = 12.44 and standard deviation is σB = 0.44. Magnetars and central compact objects do not follow the same distribution. The mean initial period is $\log _{10} P_0 [P / \mathrm{s}] = -1.04_{-0.2}^{+0.15}$ and standard deviation is $\sigma _{\rm p} = 0.53_{-0.08}^{+0.12}$. We show that the normal distribution does not describe the initial periods of NSs sufficiently well. Parameters of the initial period distribution are not sensitive to the exact value of the braking index.
Rethinking the international tax transparency framework
Authors: Pfister Roland A
Published: June 2022

The purpose of this article is to analyze whether the current Tax Transparency framework around the world has now become an overly complex, inefficient, and unmethodical system. The general expectation seems to be that Tax Transparency enables countries to better apply their domestic tax laws since they have the necessary information to assess taxpayers who used to be out of the radar of tax authorities. However, this conception is unlikely to be that simple. Overlapping regulations, voluminous information, differences between the tax authorities’ capabilities and interests to approach the matter, pose the question on whether the current international Tax Transparency framework remains consistent and realistic.
VIIIRenaissance Drama: Excluding Shakespeare
Authors: Bull Steve , Balakrishnan Lakshmi , Ragni Cristiano , Enjo Yuri
Published: June 2022

This chapter has three sections: 1. Editions and Textual Matters; 2. Theatre History; 3. Criticism. Section 1 is by Steve Bull; section 2 is by Lakshmi Balakrishnan; section 3(a) is by Cristiano Ragni; section 3(b) is by Yuri Enjo.
Wheat Curl Mite: A New Source of the Eriophyoid Mite in Wheat Fields Identified
Authors: Obasa Ken , Alabi Olufemi J. , Sétamou Mamoudou
Published: June 2022

Wheat curl mites (WCMs; Aceria tosichella) are an important global pest of cultivated wheat. Their feeding activities on epidermal cells of wheat leaves result in characteristic leaf curl symptoms that prevent the unfurling of affected leaves and impair the proper emergence of heads from the boot stage. The most significant economic impact of WCM infestation, however, is their ability to vector and transmit four important viruses of wheat, specifically, wheat streak mosaic virus, Triticum mosaic virus, High Plains wheat mosaic emaravirus, and brome streak mosaic virus. Being wingless, WCMs are almost completely dependent on air currents for their dispersal. In addition, because of their obligate lifestyle, wheat field infestations are thought to originate from sources such as volunteer wheat. Corn and other cultivated and noncultivated Poaceae hosts are also known to act as green bridges between successive wheat crops. Consequently, management practices mostly target these off-season host plants but also the use of resistant varieties and other cultural control methods. Here we report the discovery of seed-borne WCM eggs, a previously unknown method of their dispersal, as a possible source of new infestations in wheat fields. This discovery expands our understanding of the biology of WCMs, with potential implications for the development of more holistic and effective management strategies for this economic pest and virus vector.

[Formula: see text] Copyright © 2022 The Author(s). This is an open access article distributed under the CC BY 4.0 International license .
Entacapone alleviates acute kidney injury by inhibiting ferroptosis
Authors: Yang Jiahong , Sun Xiaolin , Huang Ning , Li Peng , He Jiaqi , Jiang Lan , Zhang Xuemei , Han Shu , Xin Hong
Published: June 2022

Acute kidney injury (AKI) is a common clinical problem and an efficacious treatment is lacking. Ferroptosis, a newly discovered type of programmed cell death, has been reported to alleviate renal tubular injury in ischemia/reperfusion‐induced acute kidney injury (I/R‐AKI). Entacapone is a specific inhibitor of catechol‐O‐methyltransferase, which is used as an adjuvant drug against Parkinson's disease. We demonstrated that entacapone prevents renal I/R injury by inhibiting ferroptosis. Compared with a sham group, entacapone treatment mitigated I/R‐induced pathological alterations, improved renal function, and inhibited ferroptosis. In HK‐2 cells, entacapone treatment significantly reduced the lipid peroxidation and iron accumulation induced by the ferroptosis inducers erastin and RSL3, and significantly regulated expression of ferroptosis‐related proteins. Entacapone upregulates p62 expression and affects the p62‐KEAP1‐NRF2 pathway, thereby upregulating nuclear translocation of NRF2. This action results in increased expression of the downstream SLC7A11, and significant suppression of oxidative stress and ferroptosis. Our results identify entacapone as a ferroptosis inhibitor that enhances antioxidant capacity. Entacapone may serve as a novel strategy to improve treatment of, and recovery from, I/R‐AKI.
Constructing a Pregnancy Loss Cohort From Electronic Health Records [A331]
Authors: Callahan Alison , Leonard Stephanie , Druzin Maurice , Lathi Ruth B. , Murugappan Gayathree
Published: June 2022

INTRODUCTION:

Pregnancy loss (PL) affects 20% of pregnancies but remains understudied due to imprecise coding and under-capture of PL events in administrative datasets. We sought to develop a method to identify PL from electronic health records (EHR).

METHODS:

We analyzed EHRs using a novel common data model, collected at a single U.S. institution from 2016-2021. Among female patients age 18-45 years with at least one pregnancy, we identified PL events, gravidity, parity, and gestational age (GA) at the time of loss using diagnosis and procedure codes, demographics, and clinical notes.

RESULTS:

Among 53,999 patients, 6,976 (13%) had a record of at least one PL event, for a total of 8,415 PL events. 1,142 (2%) of patients had two or more PL events. 5,947 PL events (71%) had over 1 year of follow-up. A total of 3,119 events (37%) had at least one record of GA at the time of loss. Among these events, 2,317 (74%) occurred at less than 12 weeks GA, 622 (20%) occurred between 12-23 weeks GA, 68 occurred between 24-35 weeks GA (2%), and 112 (4%) occurred after 36 weeks GA. We were able to extract parity information for 1,823 patients; 463 (25%) had additional PL events not captured from diagnosis or procedure codes.

CONCLUSION:

PL can be identified from EHR data and further characterized using variables that are not captured in administrative datasets. Our methods are feasible, scalable, and easily applied across institutions to improve our understanding of PL. Future directions include optimizing our algorithm to increase capture of PL events.
Implementation of Simulation Training to Reduce Perinatal Morbidity and Mortality: A Statewide Experience [A340]
Authors: Tate Danielle , Graves Cornelia , Barker Brenda , Miller Bonnie , Scott Patti , Scott Theresa A.
Published: June 2022

INTRODUCTION:

The Joint Commission (JC) recently established guidelines to reduce maternal morbidity and mortality. The aim of this project was to form a state-wide joint obstetrical/neonatal simulation program to address common emergencies and build technical skills for all maternity centers throughout Tennessee.

METHODS:

Birthing facilities attended a 6-hour workshop. Training included didactics on benefits of simulation, JC standards, and debriefing after simulation. Combined maternal/neonatal simulations were performed around hypertension and hemorrhage. Centers received a simulation tool kit including a maternal and infant simulator and instructions on incorporation of simulation training locally.

RESULTS:

A total of 89% of facilities participated in the training, 80% of which were level 1 or 2 and 20% were level 3 or 4. Eighty-three of the 141 participants completed evaluations, with 95% ranking the training as excellent and 99% stating increased confidence in the ability to incorporate simulation training into their facility. Sixty-one percent (n=30) of participating hospitals responded to a post-training survey. There was 27.6% increase in maternal simulation training (72.4% vs. 100%) and 36.7% increase in neonatal simulation training (63.3% vs. 100%, P=.03). Responding hospitals reported positive impact on clinical practice, with 83.3% reporting moderate or major impact. Sixty-nine percent (n=20) reported real-life cases occurring in the quarter following training, with 75% (n=15) moderate-major impact on assessment, 70% (n=14) moderate-major impact on response/management, and 70% (n=14) moderate-major impact on teamwork.

CONCLUSION:

By combining uniformed, evidence-based training with a modifiable approach to suit individual hospital needs, we are confident the implementation of a statewide simulation training program will aid in reducing perinatal morbidity and mortality in Tennessee.
COVID-19 and Its Effect on the Prevalence of Postpartum Anxiety [A306]
Authors: McCracken Johanna , Vozzola Amanda , Vozzola David E. , Roussos-Ross Dikea (Kay)
Published: June 2022

INTRODUCTION:

Early studies have shown that the prevalence of anxiety-related disorders in pregnant and postpartum women has increased since the onset of COVID-19. Reasons include fear related to the effects of COVID-19 on pregnancy and the newborn as well as concern about undergoing delivery without loved ones present. The purpose of this study was to determine if there was a difference in the rates of postpartum anxiety pre– and post–COVID-19 as demonstrated by the EPDS-3A, a modified standardized measure of postpartum anxiety.

METHODS:

A retrospective chart review of 916 randomly selected women who completed a postpartum visit and an Edinburgh Postnatal Depression Scale (EPDS)-3A) screening from April 2019–February 2020 (pre–COVID-19 cohort) and April 2020–February 2021 (post–COVID-19 cohort) was conducted with institutional review board approval. Presence of anxiety-related symptoms was evaluated using the EPDS-3A. Data including EPDS-3A score, demographic information, and medical history were queried. The data from the cohorts were compared using one-way analysis of variance (ANOVA).

RESULTS:

ANOVA showed a significant increase in the EPDS-3A scores for patients in the post– compared to pre–COVID-19 cohort (F (1, 908.06)=23.89, P< .001, η2 = .025). A score of 4 on the EPDS-3A indicated clinically significant anxiety. A greater number of patients scored>4 on the EPDS-3A in the post–COVID-19 cohort (34.8%) compared to the pre–COVID-19 cohort (18.8%).

CONCLUSION:

Postpartum anxiety as identified via the EPDS-3A was significantly more prevalent in the post–COVID-19 cohort. These findings emphasize the importance of screening for postpartum anxiety in addition to postpartum depression, especially in the post–COVID-19 era.
Is COVID-19 Associated With an Increase in Edinburgh Postpartum Depression Scale Scores Among Postpartum Women? [A307]
Authors: Vozzola Amanda , McCracken Johanna , Vozzola David E. , Roussos-Ross Dikea (Kay)
Published: June 2022

INTRODUCTION:

Postpartum depression affects approximately 10% to 20% of pregnancies. Recent studies suggest an increased incidence of postpartum depression during the COVID-19 pandemic. The purpose of this study was to investigate the incidence of postpartum depression in a cohort of patients cared for within a tertiary care center before and after the COVID-19 pandemic using the Edinburgh Postpartum Depression Scale (EPDS).

METHODS:

A retrospective chart review of randomly selected patients seen for postpartum care and who completed an EPDS between April 2019–February 2020 (pre–COVID-19 cohort, 448 patients) and April 2020–February 2021 (post–COVID-19 cohort, 468 patients) was conducted with Institutional review board approval. The EPDS scores categorized four levels: <9, 9–11, 12–14, and ≥15, corresponding to negative, mild, moderate, and severe total scores. One-way analysis of variance (ANOVA) compared these associations.

RESULTS:

Percentages of pre–COVID-19 cohort patients within each EPDS category above were 64.9%, 17%, 11.6%, and 6.5%, respectively, and for the post–COVID-19 cohort were 36.8%, 31.8%, 18.6%, and 12.8%, respectively. In the post–COVID-19 cohort, ANOVA showed a significant increase in the number of patients with positive total EPDS scores (F(1,895.22)=30.66, P<.001, η2=0.032), in mild EPDS levels (F(1,843.65)=12.24, P<.001, η2=0.013) and severe EPDS levels, (F(1,860.72)=12.26, P<.001, η2=0.013). ANOVA showed no significant difference in the number of patients with moderate EPDS levels.

CONCLUSION:

This study demonstrates a statistically significant increase in EPDS scores in postpartum patients during the COVID-19 pandemic. Further research should be conducted to determine which factors impacted the increase in EPDS scores after the onset of the COVID-19 pandemic.
Gynecologic Oncology Patients in Rural Areas Less Likely to Utilize Telemedicine During the COVID-19 Pandemic [A318]
Authors: Kuan-Celarier Anna , Wilkerson Marielle , Ali Samira , Maxwell John B. , Holman Laura
Published: June 2022

INTRODUCTION:

The COVID-19 pandemic has resulted in shifts in clinical care delivery to incorporate more telemedicine services. However, there are concerns regarding limitations of its use with regard to access to and ability to use requisite technology. The purpose of this study was to characterize gynecologic oncology patients who utilized telemedicine in their cancer care in order to determine potential barriers to telemedicine use.

METHODS:

A single institution retrospective chart review of patients who participated in a telemedicine visit from March 1, 2020 to September 30, 2020 at a National Cancer Institute–designated cancer center was completed. institutional review board approval was obtained for the study. Demographic factors were compared between telemedicine users and nonusers using Fisher’s exact test for categorical values and Wilcoxon rank sum test for continuous variables.

RESULTS:

Out of 2,238 patients, 193 patients participated in telemedicine visits. There were no significant differences in age, race, primary language, or insurance status. 8.9% of patients with private insurance or Medicaid/Medicare utilized telehealth services, compared to 4.1% of all other patients (P=.0462). The odds of using telemedicine for patients in rural zip codes was 34.6% less than for patients in non-rural zip codes (Odds Ratio 0.654, 95% CI 0.473–0.906).

CONCLUSION:

Telemedicine provides an opportunity to reduce unnecessary patient exposure to healthcare settings and patient financial burden. While 37% of patients seen lived in rural areas, a significantly smaller proportion of telemedicine users lived in rural areas, compared to nonusers (P=.0101). This highlights the importance of identifying barriers to utilizing telemedicine services and developing strategies to improve access.
Systematic Scoping Literature Review of Disparities in Stage of Endometrial Cancer [A321]
Authors: Najor Anna , Melson Valerie , Lyu Junrui , Bakkum-Gamez Jamie , Sherman Mark E. , Destephano Christopher
Published: June 2022

INTRODUCTION:

Endometrial cancer (EC) in the United States is twice as lethal for Black than White people with a uterus (PWU), partly due to disparities in stage at diagnosis. This systematic scoping review utilizes the Pathway to Treatment framework to identify actionable care and evidence gaps.

METHODS:

The complete protocol was previously published (DOI 10.1186/s13643-021-01649-x). Structured searches of PubMed, EMBASE, Scopus, and Cochrane Central Register of Controlled Trials were performed. Two reviewers screened abstracts and then full articles for eligibility. Data meeting quality criteria were qualitatively synthesized.

RESULTS:

Out of 2,171 records, 24 were included, with 9 reporting on appraisal, 4 on help seeking, 5 on diagnostic, and 10 on pre-treatment intervals. Study quality ratings were heterogenous, between 3 and 9 per Newcastle-Ottawa, with a median score of 7.0. Based on 2,059 PWU from four studies, no disparities in EC-relevant health literacy were identified. Based on 2,991 PWU from one study, willingness of Black PWU to seek care for EC symptoms was either the same or greater than White PWU. Based on 3,006 PWU from two studies, the physician not disclosing concern for cancer may prolong the diagnostic interval. Based on 743,139 PWU from five studies, the pre-treatment interval is significantly (all P values<.05) longer for Black and Hispanic PWU, those with less insurance coverage, and those with lower socioeconomic status.

CONCLUSION:

The Pathway to Treatment framework operationalized the evidence, revealing when disparities in timeliness occur. Interventions to reduce delays in the diagnostic and pre-treatment Intervals are particularly promising for addressing EC stage disparities.
Type 1 Diabetes Mellitus and Thromboembolism in Pregnancy [A275]
Authors: Thomas Jacob , Brewerton Charles , Holmgren Calla , Harrison Rachel
Published: June 2022

INTRODUCTION:

Type 1 diabetes mellitus (T1DM) is associated with vascular disease. The risk for thromboembolism in pregnancy is uncertain. We hypothesize that T1DM is associated with higher rates of thrombotic events in pregnancy.

METHODS:

This is a retrospective cohort study utilizing the National Inpatient Sample database from the Healthcare Cost and Utilization Project for all of 2018. Pregnant patients with a history of T1DM were compared to those without. The primary outcome was diagnosis of any thrombotic disease (pulmonary embolism [PE], deep vein thrombosis [DVT], cerebral vascular thrombosis [CVT], or other thromboses). Secondary outcomes included diagnosis of each individual type of thrombo-embolic event. Groups were compared via Student's test, Chi-square, and logistic regression analyses, controlling for confounders including age, race, obesity, tobacco use, chronic hypertension, asthma, anemia, and cesarean section.

RESULTS:

A total of 754,721 subjects met criteria. Patients with T1DM encompassed 0.4% of subjects (N=3,307). T1DM subjects were more likely to be younger, non-Hispanic White, obese, tobacco users, chronic hypertensive, and asthmatic and have a history of cesarean delivery (P<.05 for all). They were less likely to be privately insured or in the top income quartile. Thromboembolic events occurred more frequently in those with T1DM (0.5% vs. 0.2%, P<.001). DVT was the most common event (0.3%). After controlling for confounders, T1DM remained associated with any thromboembolic event in pregnancy (adjusted odds ratio [aOR] 3.39, 95% CI 1.81–6.35), DVT (aOR 4.84, 95% CI 2.15–10.92), PE (aOR 4.87, 95% CI 1.19–19.88), and CVT (aOR 4.30, 95%CI 1.59–11.63).

CONCLUSION:

T1DM is associated with an increased risk of thrombo-embolic events in pregnancy.
Current Knowledge and Use of Mifepristone for Miscarriage in Utah and the Impact of An Educational Video On Future Use [A292]
Authors: Kaiser Jennifer E. , Kurtz Theresa , Glasser Annabah , Brintz Ben , Turok David , Sanders Jessica
Published: June 2022

INTRODUCTION:

We aimed to 1) describe current use of mifepristone for miscarriage management in Utah, 2) identify predictors of knowledge pre- and post-educational video, and 3) explore post-video impacts on the likelihood to use mifepristone.

METHODS:

Between September 2020 and March 2021 we surveyed Utah clinicians from six specialties offering miscarriage management, recruited through professional organization and hospital listservs. Participants completed a pre-video questionnaire, viewed a 3.5-minute educational video on mifepristone for miscarriage, and completed a post-video questionnaire. We evaluated predictors of high pre-video and improved post-video knowledge using random forest regression conditional importance measures and partial dependency plots. We describe current mifepristone use and post-video effects on likelihood to use mifepristone.

RESULTS:

Of 530 participants, most specialize in emergency medicine (34%) and practice in private settings (51%). Most had heard of mifepristone for any indication (69%), but fewer than half knew of its use for miscarriage (42%). Of the 38% desiring mifepristone use for miscarriage, only 59% reported successful use. Baseline knowledge scores were low (mean=4.81/13 [37%] correct). Important predictors of high pre-video knowledge include prescription or attempted prescription of mifepristone, having heard of mifepristone, providing medication or expectant miscarriage management, and specialty type. Mean post-video knowledge scores improved by 67%. Low pre-video knowledge score and prior prescription or attempted prescription of mifepristone were predictive of improvement. Post-video, 64% stated they are much more or somewhat more likely to use mifepristone.

CONCLUSION:

Among Utah providers, baseline mifepristone knowledge and use are low. An educational video improved knowledge and likelihood of use.
Five-Year Real-World Audit Data for Adjunctive Spectroscopic Colposcopy [A293]
Authors: Brady Jullien
Published: June 2022

INTRODUCTION:

Spectroscopic colposcopy is National Institute for Health and Care Excellence–recommended in the United Kingdom for its increased detection rate of high-grade cervical intraepithelial neoplasia (CIN) compared to traditional colposcopy. The author's institution adopted the technology in 2015, and it is used as the sole method of colposcopy. Over 1,500 examinations have been conducted.

METHODS:

This is a 5-year retrospective audit of practice, using the U.K.-mandated colposcopy data set where applicable to review change in detection rate of high-grade CIN in a low-grade referral population following introduction of the technology. Biopsies suitable for histology analysis (standard 90%).LEEPS removed a single specimen (standard 80%)LEEPS meeting the depth of excision requirements (standard minimum depth of 7 mm in 95%)Rate of change of colposcopy opinion following presentation of adjunctive map.

RESULTS:

The high-grade CIN detection rate reflects and improves upon the published data. It confirms a significant improvement following introduction of the technology of 30–70%. The U.K. standards were exceeded in biopsies suitable for histology analysis (actual, 99%; standard, 90%). LEEPS removed a single specimen (actual, 96%; standard, 80%), meeting the depth of excision requirements (actual, 96%; standard minimum depth of 7 mm in 95%). Rate of change of colposcopy opinion following presentation of the map was 5%.

CONCLUSION:

These real-world data confirm an improvement in the detection of high-grade CIN following the introduction of spectroscopic colposcopy technology. Coloscopy procedures performed when using the technology exceed the requirements of the U.K.-mandated standards. Spectroscopic colposcopy should be considered by all physicians performing colposcopy.
Heavy Menstrual Bleeding Treatment With a Levonorgestrel 52-mg IUS [A116]
Authors: Creinin Mitchell D. , Barnhart Kurt , Gawron Lori M. , Eisenberg David , Mabey R. Garn , Jensen Jeffrey T.
Published: June 2022

INTRODUCTION:

Prior levonorgestrel 52-mg intrauterine system (IUS) studies for heavy menstrual bleeding (HMB) limited body mass index (BMI) and included only parous women. We evaluated outcomes in a population without BMI or parity restrictions.

METHODS:

We performed an institutional review board‒approved, Phase 3 study of Liletta for HMB. Participants had up to three screening cycles with collection of study-specific sanitary products for alkaline hematin blood loss measurement. We enrolled those with two menses ≥80 mL (values averaged for baseline blood loss) and placed the IUS. Participants collected sanitary products used during months 3 and 6 post-placement for blood loss measurement if any bleeding occurred. We evaluated median absolute change in blood loss in participants with at least one follow-up assessment and compared BMI and parity outcomes using Wilcoxon rank sum tests.

RESULTS:

Of the 105 enrolled participants, 68 (65%) were White, 25 (24%) were Black, 47 (45%) were obese (BMI ≥30), and 29 (28%) were nulliparous. Baseline mean blood loss ranged from 73 mL to 520 mL (median, 143 mL; interquartile range [IQR], 112–196 mL), with median 3-month (n=86) and 6-month (n=81) values of 9.5 mL (IQR, 2.5–22.9 mL) and 3.8 mL (IQR, 0–10.1 mL), respectively. The median percentage decreases per participant were 93% (IQR, 82–98%) and 97% (IQR, 90–100%), respectively. At six months, median decreases in non-obese (n=46) and obese (n=35) participants did not differ (97% [IQR, 90–100%] and 97% [IQR, 89–100%], respectively; P=.73) with similar findings for nulliparous (n=25) and parous (n=56) participants (97% [IQR, 92–99%] and 97.5% [IQR, 89–100%], respectively; P=.74). Discontinuations included 4 (4%) expulsions, 6 (6%) removals for bleeding/cramping, and 12 (11%) participant choice/lost to follow-up/consent withdrawal.

CONCLUSION:

Levonorgestrel 52-mg IUS reduces blood loss more than 90% for most users with HMB regardless of BMI and parity.
Uptake of Influenza, Tdap, and COVID-19 Vaccines in Pregnancy [A126]
Authors: Agasse Eva , Rodriguez Gabriella , Vilarino Valerie , Galli Johnny , Duthely Lunthita M. , Potter JoNell
Published: June 2022

INTRODUCTION:

Immunization plays an essential role in protecting the mother and child dyad from serious illnesses. Despite current recommendations from the American College of Obstetricians and Gynecologist, Advisory Committee on Immunization Practices, and Centers for Disease Control and Prevention, vaccination rates in the U.S. are significantly below 100%. The aim of this study is to assess uptake of influenza, Tdap, and COVID-19 vaccination in pregnancy among a culturally diverse population in South Florida.

METHODS:

An institutional review board‒approved cross-sectional survey was administered among inpatient postpartum persons between July and September 2021. The 359 enrolled participants completed a survey assessing basic demographics and vaccination history. Chi-square tests, set at a significance level of P<.05, compared uptake of each vaccine by ethnicity and U.S.-born status.

RESULTS:

Of the 359 participants, 67.7% self-identified as White, 67.4% reported Hispanic ethnicity, and 68.5% were non-U.S.-born. Compared to the 2019–2020 national average, Tdap vaccine uptake in this cohort was higher (74.7% versus 56.6%) and influenza vaccine uptake was lower (45.1% versus 61.2%). COVID-19 vaccine uptake during the study period mirrored the national average (18.1% versus 18.9%). Generally, there was higher vaccination uptake among Hispanics and non-U.S.-born individuals. However, a significant difference was only observed for uptake in influenza vaccine between U.S.-born and non-U.S.-born persons (chi-square=11.54, P=.0007).

CONCLUSION:

The suboptimal rates of influenza, Tdap, and COVID-19 vaccination seen in this cohort demonstrate the necessity for interventions to improve education about the safety and effectiveness of vaccination in pregnancy. Furthermore, increased efforts to maximize availability and access to vaccines during prenatal care are also needed. Together, these strategies may increase vaccine uptake in pregnancy, especially across diverse populations.
Uterine Prolapse in Pregnancy: National Trends, Risk Factors, and Obstetric Outcomes [A141]
Authors: Paterson David S. , Badeghiesh Ahmad , Baghlaf Haitham , Debay Anthony , Alturki Faisal , Dahan Michael H.
Published: June 2022

INTRODUCTION:

The uterus can prolapse acutely during pregnancy. We report national trends, characteristics, and obstetric outcomes of women with uterine prolapse (UP).

METHODS:

Retrospective cohort study using the HCUP-NIS database. Our study cohort included women admitted for delivery between 2004 and 2014 inclusively and had a diagnosis of UP. Multivariate logistic regression analyses compared obstetric outcomes among pregnancies complicated by UP versus those without, while adjusting for confounding variables.

RESULTS:

Among the 9,096,788 deliveries during our study period, 713 received a diagnosis of UP. The incidence of UP increased over time (P≤0.0001). Women with UP were likelier to be older, multigravida, smokers, have endometriosis, or fibroids (P≤0.002, all). They were less likely to have had a previous cesarean delivery (CD) (P<.0001), or multiple gestation (P=.03). Women with UP had lower odds of pregnancy-induced hypertension (aOR, 0.38; 95% CI, 0.25–0.58), preeclampsia (aOR, 0.27; 95% CI, 0.13–0.57), operative vaginal delivery (aOR, 0.41; 95% CI, 0.26–0.64), and CD (aOR, 0.30; 95% CI, 0.23–0.39). They had higher odds of having a spontaneous vaginal delivery (aOR, 3.46; 95% CI, 2.73–4.39), para-delivery hysterectomy (aOR, 21.5; 95% CI, 11.78–29.25), postpartum hemorrhage (aOR, 2.12; 95% CI, 1.56–2.87), wound complications (aOR, 2.72; 95% CI, 1.22–6.09), blood transfusion (aOR, 2.39; 95% CI, 1.43–3.10) or birth of neonates with major congenital abnormalities (aOR, 2.48; 95% CI, 1.18–5.22).

CONCLUSION:

Women with UP are at higher risk of obstetric complications and neonatal morbidity. These findings elucidate risk factors that may improve prenatal counseling, perinatal surgical management, and clinical practice and policy guidelines.
Patterns in Preconception Expanded Carrier Screening: Race, Wealth, and Marriage [A142]
Authors: Spiegel Strauss Tirtza N. , Schneider Emily , Boniferro Emily , Johnson Anna , Brockhoff Erika , Brustman Lois
Published: June 2022

INTRODUCTION:

Genetic carrier screening is ideally performed before pregnancy to provide patients with a full range of reproductive options. In 2018, our academic medical center began offering expanded carrier screening (ECS), which was universally reimbursed. The aim of this study was to compare the demographics of women who obtained ECS preconception to women who obtained ECS during pregnancy.

METHODS:

This was a descriptive retrospective cohort study. From 2018 to 2021, ECS was ordered by genetic counselors, residents, fellows, and attendings. Demographics were reviewed to evaluate age, race, ethnicity, insurance payer, marital status, and language spoken by patient. Chi-square tests were performed as appropriate.

RESULTS:

During our study, 98 women underwent ECS preconception and 1,090 women obtained ECS during pregnancy. The majority of patients obtaining preconception ECS were White (58%), non-Hispanic (84.7%), married (66.3%), English-speaking (86.7%), and had commercial insurance (77.6%). Ordering providers were predominantly genetic counselors (89%). White women were more likely than Black women to obtain ECS preconception (P<.0001), as were women with commercial insurance compared to those with public insurance (P<.0001). There was a nonsignificant trend toward married women being more likely to obtain ECS preconception than unmarried women (P=.06).

CONCLUSION:

Our data suggests race and insurance payer were different in patients who obtained ECS preconception compared to those who obtained ECS during pregnancy. In order to provide complete reproductive autonomy, it is important that ECS be offered to all women of reproductive age prior to pregnancy. Future directions include assessing patient comprehension of ECS, and access to screening and care.
Mode of Delivery of Stillbirths in the United States 2014–2018 [A145]
Authors: Pearson Hattie , Schumaker Brianna , Berman Susan
Published: June 2022

INTRODUCTION:

In recent years there has been a movement to decrease the cesarean delivery rate. In cases of stillbirths, the American College of Obstetricians and Gynecologists (ACOG) recommends cesarean delivery only in unusual cases. This study examines the most recent data for rates of cesarean delivery in women with intrauterine fetal demises.

METHODS:

Fetal deaths from 2014 to 2018 were analyzed from the Center for Disease Control’s National Vital Statistics Report. Institutional review board approval was waived. We examined the overall rates of cesarean delivery as well as the rates in several subpopulations. We used a Cox proportional-hazard model to adjust for contributing factors and determine risk factors for cesarean delivery.

RESULTS:

From 2014 to 2018, 16.1% of all fetal deaths in the United States were delivered by cesarean. In gestations over 28 weeks, 32% of stillbirths were delivered by cesarean. Multiple gestations and history of cesarean delivery were most strongly associated with risk of cesarean delivery. Preexisting maternal conditions, pregnancy, and delivery complications increased the risk of cesarean delivery.

CONCLUSION:

Despite ACOG's recommendation to reserve cesarean delivery of stillbirths for exceptional cases, cesarean delivery remains a commonly performed procedure in this population. We found a small increase in the overall rate of cesarean delivery compared to prior studies. When examining data for gestations over 28 weeks, the rate of cesarean delivery approached that of live births. Our study identified several factors associated with cesarean delivery of stillbirths that can help obstetricians understand indications for surgical delivery and prevent unnecessary interventions.
Maternal Race and Clinical Vigilance in Obstetric Hemorrhage Management [A147]
Authors: Wang Michelle J. , Alexander Megan , Srivastava Akanksha , Tummala Swetha P. , Comfort Ashley , Yarrington Christina
Published: June 2022

INTRODUCTION:

Non-White maternal race has been associated with an increased risk for severe morbidity from obstetric hemorrhage (OBH). In the present study, we investigate the hypothesis that such disparities could be secondary to delay in the administration of standard third stage oxytocin or decreased use of additional hemorrhage interventions for pregnant patients of color compared to White patients.

METHODS:

We performed a retrospective cohort of all deliveries from 2018 to 2019 at our institution. The two groups compared were 1) Hispanic White or non-White race (HW/NWR) pregnant people and 2) non-Hispanic White (NHW) pregnant people. The primary outcome was time from delivery to first dose of postpartum oxytocin; secondary outcome was the frequency of additional hemorrhage interventions. Groups were compared using t test and chi-square or Fisher’s exact tests.

RESULTS:

Of 3,832 patients who delivered a live infant between January 1, 2018, and December 31, 2019, with self-identified race and ethnicity recorded in their patient record, 644 patients identified as NHW and 3,188 patients identified as HW/NWR. There was no difference in time to first dose of postpartum oxytocin (P=.51). There was also no difference in frequency of administration of any individual uterotonics, tranexamic acid, transfusion, uterine artery embolization, or hemorrhage-related surgical techniques.

CONCLUSION:

There was no delay in the administration of postpartum oxytocin when comparing non-White and Hispanic White patients to non-Hispanic White patients. Additional research is needed to continue to explore systemic causes of and solutions for racial disparities in obstetric hemorrhage.
Preconception Immunosuppression Regimens and Perinatal Outcomes in Renal Transplant Recipients [A158]
Authors: Mulhall Joseph C. , Nguyen Lynsa , Pham Amelie , Langone Anthony , Thompson Jennifer L.
Published: June 2022

INTRODUCTION:

Renal transplant recipients are frequently transitioned to new immunosuppression regimens (ISR) in anticipation of pregnancy to reduce teratogenic risks. The consequent effects on perinatal outcomes and renal allograft condition are not known. We evaluated the risks of transitioning to a new ISR in the preconception period on perinatal outcomes and allograft condition in renal transplant recipients.

METHODS:

Institutional review board approval was obtained for the study. A retrospective cohort study at a single tertiary-care center included all pregnancies with a history of renal transplant between January 1995 and 2021. Patients who did not have a pregnancy following their transplant or who were still pregnant at the time of data analysis were excluded. Study groups included patients who transitioned to a new ISR prior to pregnancy versus patients who continued on their established ISR.

RESULTS:

Of 93 pregnancies identified, 27 patients, with a total of 30 pregnancies, met inclusion criteria. Preconception ISR transition occurred in 13 pregnancies (48.1%). There were no significant differences in maternal characteristics between groups. Preconception ISR transition was associated with a significantly later gestational age at delivery (36.0 versus 30.9, P=.02) and a non-statistically-significant higher live birth rate (84.6% versus 52.9%, P=.07). Overall, maternal and fetal composite adverse outcomes and acute renal injury in pregnancy did not differ between groups.

CONCLUSION:

Transitioning patients to a new ISR in the preconception period did not significantly affect perinatal outcomes or allograft condition in pregnancy; however, women may deliver at a later gestational age. Additional studies are needed to further investigate this association.
Reconsidering Absolute Diagnostic Thresholds in Intrahepatic Cholestasis of Pregnancy [A159]
Authors: Tamzali Ines , Pirics Michael L. , Burwick Richard M.
Published: June 2022

INTRODUCTION:

Practice guidelines utilize absolute bile acid levels to diagnose intrahepatic cholestasis of pregnancy (ICP) or to determine its severity, but the normal reference range varies by laboratory. We sought to evaluate variation in total bile acid assays by laboratory, testing method, and fasting state.

METHODS:

Using a search engine, we compiled a list of laboratories located within North America, the United Kingdom, and Australia. We obtained laboratory-specific information on bile acid assays, including testing method, reference range, and fasting requirements. Reference ranges were evaluated in relation to ICP severity thresholds (40 or 100 micromoles/L).

RESULTS:

We identified seven laboratories with total bile acid assays: four in the U.S., one in Canada, one in the U.K., and one in Australia. Three labs also offered a fractionated assay (ARUP, Lab Corp, Quest). Depending on the test employed, the upper limit of normal for total bile acids ranged from 6.8 to 19.0 micromoles/L. Assay methods included chromatography/mass spectrometry, quantitative enzymatic, and spectrophotometry. Fasting was preferred or required in 10 of 11 assays—either overnight, 8 hours, 12–14 hours, or duration unspecified. Utilizing ICP severity thresholds, a total bile acid level greater than 40 micromoles/L or 100 micromoles/L was 2–6 times or 5–15 times the upper limit of normal, respectively, depending on the assay used.

CONCLUSION:

Multiple bile acid assays are available, but the normal reference range varies due to assay methodology and fasting recommendations. Thus, caution is warranted if a definitive bile acid is utilized to define disease severity or perinatal risk.
Prenatal Phenotype in Nonimmune Hydrops Fetalis [A160]
Authors: Makhamreh Mona M. , Rice Stephanie , Critchlow Elizabeth , Araji Sarah , Berger Seth , Al-Kouatly Huda B.
Published: June 2022

INTRODUCTION:

Nonimmune hydrops fetalis (NIHF) is defined by fluid accumulation in ≥2 fetal compartments without alloimmunization. Structural anomalies on prenatal imaging should be assessed for genetic diagnosis. Our goal was to describe the prenatal phenotype of a NIHF cohort based on prenatal imaging, also determine the significance of prenatal imaging in the genetic workup.

METHODS:

The Hydrops-Yielding Diagnostic Results of Prenatal Sequencing (HYDROPS) study is an ongoing prospective series of NIHF with negative standard workup. Trio exome sequencing (ES) was performed and prenatal records were reviewed. The primary outcome was identifying major organ system abnormalities in NIHF. The secondary outcome was comparing major organ system abnormalities in NIHF in cases diagnosed or possibly diagnosed by ES to cases that remained undiagnosed.

RESULTS:

In 30 cases, major organ system abnormalities were: musculoskeletal (MSK) 9 (30%); central nervous system (CNS) 7 (23%); cardiac 6 (20%); and renal 2 (6.7%). Among 16 cases with major organ system abnormality on prenatal imaging, 15 (93.7%) were diagnosed or possibly diagnosed by ES, while 1 (6.3%) was undiagnosed. Of 14 cases with no major organ abnormalities, 6 (42.9%) were diagnosed or possibly diagnosed by ES while 8 (57.1%) were undiagnosed. The presence of major organ abnormalities in NIHF increased the diagnostic yield of ES. (P=.004).

CONCLUSION:

The most common major organ system abnormalities on prenatal imaging in NIHF were MSK, CNS and cardiac. Most NIHF cases with congenital abnormalities on prenatal imaging yielded a diagnostic or possibly diagnostic result on ES. Comprehensive prenatal phenotyping increases the diagnostic yield in NIHF.
Low Mortality and High Severe Maternal Morbidity in Pregnancy Among People With Sickle Cell Disease [A174]
Authors: Early Macy , Eke Ahizechukwu , Lanzkron Sophie , Pecker Lydia
Published: June 2022

INTRODUCTION:

Pregnancy in people with sickle cell disease (SCD), who are predominantly Black, is high-risk. This study’s purpose is to update risk estimates of severe pregnancy outcomes in SCD and define the excess risk attributable to SCD.

METHODS:

We analyzed pregnancy-related admissions in the 2012–2018 National Inpatient Sample (NIS) and compared rates of the Center for Disease Control and Prevention’s Severe Maternal Morbidity (SMM) Index in SCD to the general unaffected population (GP) and the unaffected Black population (UB). The composite SMM excluded transfusion and vaso-occlusive crisis. Multivariate logistic regression was used to calculate odds ratios and excess risk fractions, controlling for age, multiple gestation, socioeconomic variables, and hospital characteristics.

RESULTS:

There were 8,121,002 pregnancy-related admissions, 6,610 among people with SCD (87% Black). There were few maternal deaths in SCD pregnancies (<10). SCD pregnancies were over three times as likely to experience SMM than GP or UB pregnancies (GP: OR 4.63, 95% CI 4.16–5.16, P<.001; UB: OR 3.33, 95% CI 2.97–3.75, P<.001). SCD pregnancies had higher odds of hysterectomy (GP: OR 2.24, P=.002; UB: OR 1.68, P=.09), sepsis (GP: OR 6.72, P<.001; UB: OR 5.54, P<.001), venous thromboembolism (GP: OR 9.89, P<.001; UB: OR 6.24, P<.001), and cerebrovascular event (GP: OR 13.94, P<.001; UB: OR 10.90, P<.001). In SCD pregnancies, excess risk for composite SMM was attributable to SCD status (70%; 95% CI, 67–73%), Black race (31%; 95% CI, 30–32%), and public insurance (14%; 95% CI, 14–15%).

CONCLUSION:

Contemporary data identifies SMM-, race-, and insurance-based disparities in SCD pregnancies, highlighting the need for disease-specific, pharmacotherapeutic interventions during pregnancy, and requires further prospective validation.