bluuebunny/crossref_metadata_2025 huggingface dataset:
Racial Disparities in Total Abdominal Hysterectomy Postoperative Outcomes: Analysis Including American Indian or Alaska Natives and Native Hawaiian or Pacific Islanders [ID: 1377744]
Authors: Shirriff Ashley , Abella Maveric , Collins Robert , Manayan Olivia , Pawar Deepraj
Published: May 2023

INTRODUCTION:

Racial disparities in total abdominal hysterectomy outcomes among individuals in Black and Hispanic populations are well described in the literature. However, disparities in such outcomes for American Indians or Alaskan Natives (AI/AN) and Native Hawaiians or Pacific Islanders (NH/PI) remain understudied. Thus, the aim of our study is to assess total abdominal hysterectomy outcomes in Black, Hispanic, Asian, AI/AN, and NH/PI populations.

METHODS:

The National Surgical Quality Improvement Program was queried to identify all total abdominal hysterectomy procedures in the 2011 to 2020 National Surgical Quality Improvement Project (n=81,655). Multivariable regression models were used to investigate the effect of race and ethnicity on 30-day postoperative complications, readmission, and mortality.

RESULTS:

Compared to non-Hispanic White patients, Black patients had 0.7% higher odds of readmission (adjusted odds ratio [AOR] 1.007, 95% CI 1.003–1.011) and 2.3% higher odds of postoperative complications (AOR 1.023, 95% CI 1.016–1.030). Hispanic patients had 1.3% higher odds of a postoperative complication (AOR 1.013, 95% CI 1.004–1.021). AI/AN patients had 5.6% higher odds of a postoperative complication (AOR 1.056, 95% CI 1.020–1.093). NH/PI patients had the highest odds of a postoperative complication, 9.1% higher odds compared to non-Hispanic White patients (AOR 1.091, 95% CI 1.056–1.126), and were the only minority group associated with higher odds of mortality (AOR 1.007, 95% CI 1.004–1.010).

CONCLUSION:

AI/AN and NH/PI, which have been underrepresented in past research, experienced the highest rates of postoperative complications in total abdominal hysterectomy, highlighting the importance of including these patients in the discussion of policy and hysterectomy research studies.
Standard Opioid Prescribing in Pediatric and Adolescent Gynecology [ID: 1381154]
Authors: Fowler Kylie , Miller Rachel , O’Flynn O’Brien Kate , Reimche Paige
Published: May 2023

INTRODUCTION:

Enhanced Recovery After Surgery principles reduce opioid use postoperatively. There are no recommendations for optimal opioid dose prescribing for postoperative pain. The aim of this quality improvement project was to assess postoperative opioid use after pediatric gynecologic surgeries and establish standard opioid prescriptions across all surgeons based on procedural type.

METHODS:

Counseling on postoperative care including pain management was provided preoperatively and postoperatively. At the 2-week postoperative visit, patients were asked the number of opioid doses used and their pain control satisfaction. Baseline data were collected for 6 months with surgeons prescribing opioid doses via personal preference. After reviewing the prescribing practices and number of doses used, standard opioid doses were established with 10 doses provided for laparotomy with incision greater than or equal to 5 cm, 5 doses for laparoscopy or mini-laparotomy with incision(s) 4 cm or less, 5 doses for combined laparoscopic/vaginal approach, and 0 doses for vaginal cases. Data collection was repeated after implementation of standard opioid dose prescriptions.

RESULTS:

Complete data were recorded for 30 cases prior to implementation and 29 cases after implementation. Standard opioid dosing resulted in 30% decrease in total opioid doses (252–176 doses; P=.014) and 15% reduction in unused doses (162–137 doses). Forty-three percent of patients used no opioid doses. There was no significant difference in patient satisfaction (P=.014) in pain control.

CONCLUSION:

Application of standard opioid dose prescribing is feasible for common pediatric gynecologic surgeries without affecting patient satisfaction. This quality improvement project suggests further reduction in standard dose prescriptions is possible.
Delays in Diagnosis and Treatment of Appendicitis in Females [ID: 1375790]
Authors: Dosaj Ankita , Class Quetzal A. , George Jessica
Published: May 2023

INTRODUCTION:

Sex disparities in a perioperative emergency warrant investigation to improve equitable patient care. We investigated whether differences exist in care of appendicitis across patient sex.

METHODS:

We performed a retrospective cohort study of patients with appendicitis between 2011 and 2020 at an inner-city academic hospital. We collected demographic data and time records of key milestones in clinic care. We used chi-square, paired t test, ANOVA, and Cox proportional hazard analyses to examine differences between sex and other factors.

RESULTS:

A total of 385 patients were included, 182 (47.3%) females and 203 (52.7%) males. Patients were similar across sex, age, race, reason for visit, and number of emergency room visits. The time to admission for females was longer as compared to males (t(304)=–2.82, P<.05). Cox proportional hazard analysis predicting time to admission based on sex while controlling for age and race showed that females have a longer time to admission (HR 0.73 [95% CI 0.58–0.92]), youngest patients (<15 years) were admitted faster than older-aged patients (HR 2.13 [95% CI 1.45–3.13]), and as compared with Black patients, White patients were admitted faster (HR 1.56 [95% CI 1.06–2.29]).

CONCLUSION:

Reproductive-aged females had significantly longer times to admission than male peers with the same indication, and White patients were admitted more expeditiously than Black patients. There was a trend of slower surgical consult and admission for females with gynecological disorders. This study suggests that sex biases exist within our system. This highlights that an active effort must be taken to rule out differentials that are not sex based.
Novel Anti-Ovarian Epithelial Adenocarcinoma Agent: HM-10/10 HDL-Mimetic Peptide—Pharmacokinetic and Pharmacodynamic Characterization [ID: 1377510]
Authors: Wells Brittney , Doe Emily , Farias-Eisner Robin , Taylor Mitchell
Published: May 2023

INTRODUCTION:

Epithelial adenocarcinoma of the ovary (EOC) is the second most common cancer affecting the female reproductive system and is associated with the fifth highest rate of cancer-related deaths in women. With many women presenting in late stages, the estimated chance of survival for 2, 5, and 10 years were 65%, 44%, and 36%, respectively. In recent literature, the role of HDL-associated apolipoproteins has been shown to be effective in the treatment of proinflammatory diseases, including cancer. Previously we developed a novel 20-amino acid mimetic peptide, HM-10/10, which was able to inhibit tumor development and growth in EOC models in vitro and in vivo. These findings prompted our decision to further our research by performing characterization to advance HM-10/10 as our apolipoprotein mimetic peptide candidate of choice for use as a novel therapeutic agent against EOC. The aim of this study was to report the pharmacokinetic (PK) and pharmacodynamic (PD) properties of HM-10/10 relative to its stability in vitro.

METHODS:

To evaluate PK/PD, multiple procedures were performed in vitro.

RESULTS:

The results demonstrated PK/PD good stability in plasma and the gastric environment. However, under conditions modeling the small intestine, HM-10/10 demonstrated significant degradation, likely because of the diverse array of peptidases encountered therein.

CONCLUSION:

These data highlight the PK/PD of HM-10/10 and demonstrate its potential as an effective therapeutic for treating EOC. The preferred route of delivery of HM-10/10 is oral, and toward that end, HM-10/10 demonstrated remarkable stability over a broad physiologic pH range; however, its stability was significantly degraded by conditions simulating the small intestine.
Comparison of Obstetric Outcomes Between Unassisted Pregnancies and Non-IVF Fertility Treatment Pregnancies in Infertile Patients [ID: 1365555]
Authors: Qin Jennifer , Adeleye Amanda , Cedars Marcelle , Huang David , Rinaudo Paolo , Zablotska Lydia
Published: May 2023

INTRODUCTION:

Prior studies suggest that pregnancies conceived with non-IVF fertility treatment (NIFT) have an increased risk of adverse obstetric outcomes compared to unassisted pregnancies. However, recent population-based studies suggest that infertility independently contributes to elevated perinatal risks. It is unclear whether underlying infertility or NIFT itself contributes to obstetric risks. To understand the effects of NIFT on pregnancy, we compare obstetric outcomes between NIFT and unassisted pregnancies in infertile patients.

METHODS:

The Developmental Epidemiological Study of Children Born Through Reproductive Technology (DESCRT) recruited an IRB-approved prospective cohort of women with infertility who delivered between 2018 and 2022 (funded under R01-HD084380). We compared maternal serum analyte levels and obstetric outcomes between infertile patients who conceived spontaneously and those who utilized NIFT (ovulation induction, superovulation, and/or intrauterine insemination). Serum analytes were compared using the Mann-Whitney test. Obstetric outcomes regarding placental insufficiency were reviewed by two ob-gyns and compared using χ2 tests.

RESULTS:

We analyzed 101 unassisted pregnancies and 141 NIFT pregnancies. There were no significant differences in mean maternal age (36.6 and 35.6, P=.08). There were no significant differences in maternal serum analytes or in adverse obstetric outcomes, including hypertensive disorders of pregnancy (P=.35), fetal growth restriction (P=.12), abnormal placentation (P=.79), spontaneous preterm birth (P=.97), and gestational diabetes (P=.30).

CONCLUSION:

Among infertile patients, there were no significant differences in maternal serum analytes or adverse obstetric outcomes between unassisted and NIFT pregnancies. This suggests that the previously demonstrated risk of adverse pregnancy outcomes associated with NIFT could be attributed to underlying infertility rather than the utilization of NIFT.
A Randomized Controlled Trial to Assess the Effectiveness of a Specially Formulated Food Supplement and Pelvic Floor Muscle Training in Women With Stress-Predominant Urinary Incontinence [ID: 1372768]
Authors: Takacs Peter , Koroknai Erzsebet , Kozma Bence , Krasznai Zoard , Pakozdy Krisztina
Published: May 2023

INTRODUCTION:

The objective of this study was to assess the effectiveness of a creatine-leucine-based food supplement and standardized pelvic floor muscle training (PFMT) in women with stress-predominant urinary incontinence (SUI).

METHODS:

Women with SUI were randomized to receive daily oral supplementation for 6 weeks with either a supplement or placebo. Both groups were instructed to perform daily PFMT at an intensity of at least 75% of one repetition maximum of 45 pelvic floor muscle contractions per day. The primary outcome was the Urogenital Distress Inventory Short Form (UDI-6) score. Secondary outcomes were the Incontinence Impact Questionnaire (IIQ-7) score, Biomechanical Integrity (BI) score measured by Vaginal Tactile Imager. To have a power of 80% and a significance level of 5%, a sample size of 32 was needed. The trial was IRB approved.

RESULTS:

Within-group analysis showed that UDI-6 and IIQ-7 scores improved significantly from baseline to 6 weeks in the treatment group but not in the control group (UDI-6 score [mean±SD], 45±21 versus 29±21, P=.02; 43±18 versus 33±26, P=.22) (IIQ-7 score [mean±SD], 50±30 versus 30±21, P=.01; 48±23 versus 40±28, P=.36). Out of the 52 examined VTI parameters, significantly more parameters improved in the treatment group compared to the control group (11/52 versus 3/52, P=.04). BI-score, on average, improved significantly in the treatment and control group as well (SD unit, mean, from −1.06 to −0.58, P=.001; from −0.66 to −0.42, P=.04).

CONCLUSION:

Women with SUI receiving a specially formulated supplement in addition to daily PFMT for 6 weeks had improved urinary symptoms (significant decrease in UDI-6 and IIQ-7 scores) and better BI score compared to baseline.
Predicting Miscarriage and Stillbirth Using Weighted Ensemble Machine Learning [ID: 1338167]
Authors: Lokhande Anagha , Gimovsky Alexis , Sarkar Indra
Published: May 2023

INTRODUCTION:

Prediction of miscarriage and stillbirth remains a clinical challenge. Prior efforts to use machine learning tools have not used an ensemble weighted machine learning approach, called “super learner,” which offers the opportunity to improve prediction performance by aggregating the outputs of constituent machine learning models and preferentially weighting the highest-performing models.

METHODS:

Data were obtained from hospital-wide electronic health records from a large academic institution. The sample comprised 13,337 patients who delivered between 2008 and 2019, 6,932 of whom experienced a miscarriage or stillbirth. Phecodes for ICD-9-CM and ICD-10-CM were used to define miscarriage and stillbirth and create comorbidity categories. The constituent models of the super learner were XGBoost, random forest, a regularized generalized linear model (both lasso and ridge regressions), and a support vector machine. The objective of this study was to develop a super learner algorithm to predict miscarriage and stillbirth.

RESULTS:

The super learner model predicted miscarriage and stillbirth classification with an area under the receiver operating characteristic curve of 0.94 and an accuracy of 92%. It used two models: random forest, weighted at 73%, and SVM, weighted at 27%. The most highly weighted predictors were amniotic cavity abnormalities, pelvic soft tissue abnormalities, and preeclampsia.

CONCLUSION:

A super learner performs comparably to other models in the literature. External validation is warranted. The promising results suggest that a super learner model can be used as a clinical decision support tool, supplementing clinical judgement in predicting miscarriage and stillbirth.
Mobile Assessments to Improve Screening and Novel Patient Engagement to Diagnose and Manage Maternal Mental Health (MIND) Study Midpoint Analysis: Compliance Rate of Antenatal Screening [ID: 1363058]
Authors: Lucas Kathryn , Hoeppner Catherine , Marko Kathryn , Sebastian Anish , Sheth Sheetal , Tung Bonnie
Published: May 2023

INTRODUCTION:

One in five to seven birthing people are affected by perinatal mood disorders. While screening for gestational diabetes is well defined, the efficacy of standardized assessment of mood disorders is less understood. Between 2018 and 2020, screening at an academic center was highly variable, demonstrating need for improvement. Remote surveillance using novel integrated technology was used to improve patient participation in routine antenatal screening.

METHODS:

A prospective observational cohort of 81 patients from two clinical sites in the Babyscripts (BRx) Maternal Mental Health Module received digital Edinburgh Postnatal Depression Scale (EPDS) screening at 12 and 28 weeks of gestation. The control group consisted of 81 randomly selected patients who received in-person standardized screening from 2018 to 2020. In a midpoint analysis, EPDS completion was assessed at weeks 12 and 28 in the intervention group and compared to the control group using χ2 analysis. The study was reviewed and exempted by the George Washington University IRB.

RESULTS:

The BRx treatment group totaled 45 patients enrolled prior to week 14 and 74 patients enrolled prior to week 30. At week 14, 38% of BRx patients (17/45) had completed an EPDS survey, compared with 10% of patients in the control group (8/81). At week 30, 36% of BRx patients (27/74) had completed an EPDS survey, compared with 21% of control (17/81). Improved EPDS response rates of the BRx cohort were statistically significant at both assessments (P<.01 and P=.03).

CONCLUSION:

Remote mood screening resulted in significantly higher rates of adherence in the first and second trimesters as compared to standard methods. In the next phase of analysis, we plan to assess adherence of screening through 12 months postpartum. Future analysis is planned to determine noninferiority as compared to in-office methods among a larger cohort. We hypothesize that novel telehealth mood screenings will help to sustain engagement with providers and reduce time to intervention.
The Effect of Trimester of COVID-19 Infection on Pregnancy Outcomes After Recovery [ID: 1365996]
Authors: Seif Karl , Desai Andrea , Mangione Mary , Tadbiri Hooman , Turan Shifa , Wolfe Alexa
Published: May 2023

INTRODUCTION:

Many physiological, immune, and respiratory adaptations occur during pregnancy. Data have emerged that COVID-19 infection affects placental function, raising concerns about obstetric morbidity. It is not currently known how timing of COVID-19 infection affects pregnancy. We hypothesize that maternal and neonatal outcomes are different if COVID-19 infection occurs in different trimesters of pregnancy.

METHODS:

This IRB-approved retrospective cohort study was conducted at a single center from March 2020 to June 2022. Pregnant patients with a positive COVID-19 infection more than 10 days before delivery (COVID-recovered) were identified and grouped by trimester of infection. Demographics and maternal infection, obstetric, and neonatal outcomes were collected. Wilcoxon rank-sum and Fisher’s exact tests were used to compare continuous and categorical data, respectively. To account for multiple comparisons, a significant P value was set at .01.

RESULTS:

Two hundred ninety-eight COVID-recovered pregnant patients were identified. Of those, 48 (16%) were infected in the first trimester, 123 (41%) in the second trimester, and 127 (43%) in the third trimester. There were no significant demographic differences between the study groups. Vaccination status was similar. Hospital admission rate and the need for oxygen therapy while infected were significantly higher in patients with second- or third-trimester infection (18% and 20% versus 2% and 13% and 14% versus 0%, respectively). Rates of preterm birth (PTB) less than 37 weeks (33% versus 19% and 12%, P=.006) and extreme PTB (19% versus 5%, P<.001) were higher in the first-trimester infection group. Infants born to mothers infected in the second trimester had more neonatal sepsis workups (22% versus 12% and 7%, P=.008). Other maternal, obstetric, and neonatal outcomes were similar between groups.

CONCLUSION:

First-trimester COVID-recovered patients were more likely to have preterm birth despite having lower rates of hospital admission and oxygen supplementation while infected than patients who recovered from a second- or third-trimester infection.
Cervical Length Surveillance in Patients With a History of Early Versus Late Preterm Birth [ID: 1378074]
Authors: Alzamora Maria , Anders Jacqueline , Chornock Rebecca , Kumnick Allison , Mokhtari Neggin
Published: May 2023

INTRODUCTION:

The American College of Obstetricians and Gynecologists recommends patients with a history of a preterm birth (PTB) be monitored with serial cervical length (CL) measurements for short cervix. We sought to evaluate the utility of serial CL surveillance in patients based on gestational age at the time of their prior PTB.

METHODS:

This was a multi-institutional retrospective study of pregnant patients with a history of spontaneous PTB between 23 weeks 0 days and 36 weeks 6 days that underwent a transvaginal CL between January 2017 and December 2021. Multiple gestation pregnancies were excluded. Data were compared between patients with a history of late PTB (>34 weeks) and patients with a history of early PTB (<34 weeks) using χ2 tests, t tests, and ANOVA analyses, as appropriate (α=0.05). Institutional review board approval was obtained for the study.

RESULTS:

Of 321 patients with a history of spontaneous PTB, 106 (33%) had a late PTB and 215 (67%) had an early PTB. Patients with a prior late PTB were less likely to be on 17-OHP (42.5% versus 54.5%, P=.04) and have a cerclage placed (4% versus 19.5%, P=.0002) compared to patients with an early PTB. Patients with a prior late PTB had their first CL performed at later gestations (18 weeks 0 days versus 17 weeks 2 days, P=.016) and fewer CL measurements (3.2 versus 3.5, P=.034). There was no difference in the gestational age that the shortest CL was detected (21 weeks 0 days versus 21 weeks 0 days, P=.98).

CONCLUSION:

In patients with either a history of early or late spontaneous PTB, universal CL surveillance at the time of the anatomy (18–20 weeks) may be sufficient to identify patients for intervention.
Role of Environmental Discrimination on Birth Weight: A Systematic Examination in a Sample of Black, Latina, and White Women in the Phoenix Metropolitan Area [ID: 1341491]
Authors: Mickelson Kristin , Chambers Claudia , Doehrman Pooja , Kaneris Marianna , Stewart Chelsea , Sullivan Shea
Published: May 2023

INTRODUCTION:

Health inequities begin before birth, with Black women being more likely to have low-birth-weight babies than White and Latina women. The purpose of this study is to examine the relationship of discrimination (environmental, vicarious, and daily) on birth weight in Black, Latina, and White women.

METHODS:

This study utilized medical records and face-to-face interviews to examine the role of discrimination on birth weight (controlling for gestational age and assigned sex). Data analysis involved multiple linear regression. The spatial relationship between environmental discrimination and mean birth weights from neighborhoods in Phoenix was examined using heat maps that layer environmental discrimination onto geographic locations. Institutional review board approval was obtained from St. Joseph Medical Center.

RESULTS:

In this sample of 329 patients, Black women reported the lowest birth weight (M 3,268.25, SE 65.61), with Latina (M 3,313.99, SE 33.91) and White (M 3,327.98, SE 39.23) women reporting similar birth weights. Only environmental discrimination emerged as a significant predictor of baby’s birth weight (b=−67.57, SE 25.99, P=.01), such that greater perceived environmental discrimination was related to lower birth weight. Environmental discrimination was compared to geographic areas in the Phoenix metropolitan area using zip code data and a comparison of these regions showed statistically significant differences in experiences of environmental discrimination based on geographic location (P=.010).

CONCLUSION:

Women experiencing high rates of environmental discrimination had lower birth weight babies. These experiences were localized to geographic areas within the Phoenix metropolitan area. These findings may help better target resources to specific centers to overcome the issues that influence how people experience their environment.
Experiences of Discrimination and Treatment Outcomes Among Pregnant and Postpartum People With Opioid Use Disorder [ID: 1376917]
Authors: Xu Joyce , DeFranco Emily , Murnan Aaron , Nidey Nichole , Terplan Mishka , Wilder Christine
Published: May 2023

INTRODUCTION:

Experiences of discrimination among pregnant and postpartum people with opioid use disorder (OUD) are common and likely affect utilization of medication for OUD (MOUD), which is associated with reduced risk of overdose and death. We aimed to examine experiences of discrimination by prenatal care (PNC) and substance use disorder (SUD) treatment settings and estimate its effect on the risk of various MOUD utilization outcomes.

METHODS:

Patient-stakeholders co-designed survey questions to measure self-reported outcomes related to MOUD treatment utilization, return to substance use, and overdose. First, we examined the proportion of participants who endorsed items on a modified Healthcare Discrimination Scale and summed the total scores. Next, we quantified the effect of discrimination experienced by health care setting on postpartum MOUD utilization, return to use, and overdose using log-binomial models to calculate relative risk (RR) and 95% CIs.

RESULTS:

Among the 100 participants enrolled in the study, 57 reported experiencing discrimination, 56 within PNC and 33 within SUD treatment settings. Discrimination within PNC (RR 2.6, CI 1.06–6.40) and SUD treatment (RR 3.26, CI 1.59–6.70) were associated with increased risk of not using MOUD as prescribed. Discrimination within SUD treatment settings correlated with an increased risk of MOUD discontinuation (RR 2.56, CI 1.19–5.54) and return to use (RR 2.36, CI 1.18–4.73).

CONCLUSION:

Experiences of discrimination were common, especially within prenatal care settings, and discrimination was associated with poor MOUD treatment outcomes and risk of return to use. Interventions to address discrimination within health care settings can improve outcomes for pregnant and postpartum people with OUD.
Increased Risk of Preterm Birth in a Native American Population Concurrent With the COVID-19 Pandemic [ID: 1377321]
Authors: Baranco Nicholas , Mastrogiannis Alexander , Mastrogiannis Dimitrios , Thompson Brian
Published: May 2023

INTRODUCTION:

The objective of this study was to evaluate changes in obstetric outcomes in a Native American population compared with other racial groups.

METHODS:

An electronic birth certificate based system was used to obtain data for all singleton births in the Central New York region from January 2012 to June 2022 after IRB exemption. Race was self-identified and categorized as White, Black, Native American, or other. We compared delivery before or after January 2020. The primary outcome was premature birth. Secondary outcomes included prenatal care adequacy, fetal growth restriction, neonatal outcome, diabetes, hypertension, and obesity. Analysis was preformed using χ2 and logistic regression including body mass index (BMI), smoking, hypertension, and diabetes.

RESULTS:

Out of 178,420 singleton births, 2,647 (1.4%) identified as Native American, 143,743 (77.7%) as White, and 15,476 (8.4%) as Black. Compared to patients before 2020, no racial group had a higher rate of inadequate or late prenatal care, and all groups had increased obesity (BMI >30) and decreased smoking. Preterm birth increased in the Native American population before 37, 34, and 28 weeks of gestation: adjusted odds ratio (95% CI) 1.42 (1.02–1.99), 1.81 (1.02–3.22), and 3.68 (1.39–9.77). No other population had increased preterm birth before 34 or 28 weeks of gestation.

CONCLUSION:

There was a significant increase in all categories of preterm birth in the Native American population during the COVID-19 pandemic without a differential increase in known risk factors compared to other racial groups. This highlights the need for more research on the causes of adverse outcomes in Native American populations.
Geospatial Analysis of Access to Evidence-Based Early Pregnancy Loss Management in New Mexico [ID: 1377363]
Authors: Krashin Jamie , Black Patricia , Brannen Eric , Gard Charlotte , Lin Yan , Schreiber Courtney
Published: May 2023

INTRODUCTION:

Little is known about availability of evidence-based early pregnancy loss (EPL) treatment in emergency departments (EDs), where patients often first seek care. We evaluated geographic access to mifepristone/misoprostol and uterine aspiration in New Mexican hospitals.

METHODS:

We used an enhanced two-step floating catchment area method to model accessibility from census block groups’ population-weighted centroids to hospitals. Our primary outcome was access to mifepristone/misoprostol and uterine aspiration in EDs; our secondary outcome was access to in-hospital aspiration, both outcomes defined as less than a 60-minute commute. We surveyed all EDs in New Mexico and used public databases to compute census block groups’ demographic, transportation, rurality, and area deprivation data. We used logistic regression to evaluate the associations between access and race and ethnicity, area deprivation, and rural location. The University of New Mexico IRB approved this study.

RESULTS:

Thirty-five (83%) of 42 hospitals responded. Two (6%) provided in-ED treatment, and 24 (69%) in-hospital aspiration. Half of reproductive-aged women had access to in-ED treatment, and 90% to in-hospital aspiration. Census block groups with higher quartile proportions of American Indian/Native Alaskan reproductive-aged women had higher adjusted odds ratios of accessing in-ED treatment (2.5–7.3, P<.05). Rural areas and higher area deprivation quartiles had lower in-ED access adjusted odds ratios (0.03–0.07 [P<.05] and 0.3–0.4 [P<.05], respectively) compared with urban and lower area deprivation quartiles. In-hospital aspiration results were similar to in-ED treatment results across all categories.

CONCLUSION:

By prioritizing rural areas and areas with higher socioeconomic deprivation, EPL treatment implementation efforts can improve equitable care access and equity for patients.
Decentralized Clinical Trials: A Flexible and Efficient Adjunct to Accelerate Pregnancy Complication Research [ID: 1377487]
Authors: Cowan Alison , Brundage Tiffany , Greenberg Rebecca , MacDonald Reece , Moe Alison , Reddy Mitsu
Published: May 2023

INTRODUCTION:

This study sought to determine whether a decentralized, mobile-friendly, virtual model could achieve appropriate enrollment for a pregnancy health study after COVID-19 closed most clinical research. Preterm birth continues to be a significant and growing issue with 2021 rates exceeding 10%. There is urgent need for new research and technology to improve the ability to predict, prevent, and personalize treatment for complications such as preterm birth, preeclampsia, and gestational diabetes.

METHODS:

This was a prospective, observational study of a cell-free RNA platform utilizing direct-to-participant recruitment via targeted social media from July 2020 to December 2021. The IRB-approved study was open to patients aged 18–45 with a singleton pregnancy in the United States. Participants signed informed consent, provided record release forms, completed a short questionnaire, and scheduled mobile phlebotomy via a web-based platform.

RESULTS:

One thousand eight hundred ninety-four participants submitted samples in less than 18 months. Because of delays in shipping, insufficient volume, temperature stability, and hemolysis, 63 samples (3.3%) were not useable. Medical records were received for over 85% of participants. The cohort is geographically and ethnically diverse representing 1,220 zip codes across 30 states.

CONCLUSION:

This work demonstrates a decentralized, mobile-friendly, virtual study is feasible, efficient, scalable, and flexible, enabling clinical research during a global pandemic. The rate of medical records receipt is likely affected by the large quantity of unique providers and hospitals. This is a rapid, patient-accepted way to conduct clinical research as a supplement to traditional enrollment models.
Race Differences in Transfusion Thresholds in Patients Undergoing Cesarean Delivery [ID: 1377655]
Authors: Phillips Jaclyn , Hacker Francis , Lemon Lara , Simhan Hyagriv , Simhan Jayanthi , Simhan Uma
Published: May 2023

INTRODUCTION:

Transfusion is a major contributor to severe maternal morbidity (SMM) and is influenced by the presence of anemia on admission for delivery. As rates of SMM vary by race, we sought to describe transfusion thresholds by race and hemoglobin on admission for delivery.

METHODS:

This was an IRB-approved retrospective cohort analysis of deliveries in a single health care network from 2015 to 2020. Multivariable binomial regression models assessed the relationship between transfusion, hemoglobin on admission for delivery, and race. Patients with hemorrhage, abruption, or placenta abnormalities were excluded to control for events associated with transfusion. Models were adjusted for age, parity, insurance, marital status, and tobacco use and evaluated by mode of delivery. Anemia was defined as hemoglobin less than 11.0 mg/dL.

RESULTS:

Eighty-one thousand six hundred thirteen delivery admissions were included. People of Black race diagnosed with anemia had 1.4 times the odds of transfusion compared to White race (95% CI 1.1–1.8). In anemic patients undergoing cesarean, people of Black race had two times the odds of transfusion than people of White race (95% CI 1.4–2.7). For example, people of Black race undergoing cesarean with starting hemoglobin of 6.0 mg/dL had a 76% (95% CI 64–88%) predicted probability of transfusion compared to 27% (95% CI 17–37%) for people of White race at the same starting hemoglobin undergoing cesarean.

CONCLUSION:

Transfusion was more likely in people of Black race compared to White race regardless of starting hemoglobin value or underlying risk factors. This was most pronounced in patients undergoing cesarean. Exploration of specific factors contributing to this finding in the context of structural racism and inequitable care are warranted.
Main Street, USA Enrollment: Community Hospital Recruitment Strategies for Diverse and Equitable Selection of Pregnant Participants in a Prospective Cohort Study [ID: 1377833]
Authors: Sutton Elizabeth , Cowan Alison , Haverty Carrie , Jones Briasha , Moe Alison , Russell Donna
Published: May 2023

INTRODUCTION:

The same factors contributing to disproportionately worse health outcomes are also barriers to inclusion in research for Black, Hispanic, and Indigenous patients. In this subanalysis of a large, multisite prospective cohort study of maternal plasma mRNA signatures and adverse pregnancy outcomes (APOs), we sought to determine whether equitable representation was aided by the inclusion of a large community hospital as an enrollment site.

METHODS:

Pregnant persons between 18 and 45 year old with a singleton pregnancy eligible to enroll in this IRB-approved prospective cohort study at Woman’s Hospital (Baton Rouge, Louisiana). A hybrid of indirect and direct recruitment strategies, bolstered by text message communication and gift card compensation, were deployed to facilitate enrollment that mirrored the community’s diversity.

RESULTS:

Two thousand five hundred twenty-two participants have been enrolled over 22 months (18% of the hospital’s eligible patient population): 41% of participants are Black, 9% are of Hispanic origin, 50% are White, and 9% Other race. This identically mirrors the demographics of the hospital obstetric patient population (38% Black, 7% Hispanic, 49% White, and 13% Other).

CONCLUSION:

Participants overall mirrored the diverse population served. Inclusion of study sites outside of the traditional academic setting is an effective strategy for promoting equitable access to clinical research, combating barriers to inclusion in research faced by the populations that are disproportionately affected by APOs.
Racial Differences in Severe Maternal Morbidity Exist for Tricare Beneficiaries [ID: 1377133]
Authors: Lyon Emily , Gonzalez-Brown Veronica , Keyser Erin , Porter Katherine , Tindal Rachel
Published: May 2023

INTRODUCTION:

Maternal morbidity and mortality rates in the United States have increased in the last two decades with a disproportionate effect on women of color. Military Tricare coverage models universal health care access; however, in studies looking at births in military treatment facilities, disparities still exist for women of color. This study analyzes maternal delivery outcomes for all women with Tricare coverage including deliveries in the civilian sector.

METHODS:

Data from 6.2 million births in the Centers for Disease Control and Prevention WONDER Linked Birth/Infant Death Records for 2017–2019 were analyzed for all-cause morbidity (transfusions, perineal lacerations, uterine rupture, unplanned hysterectomy, and intensive care unit admissions), severe maternal morbidity (SMM) (excludes lacerations), and SMM excluding transfusion. Risk ratios were calculated comparing overall maternal morbidity rates between Tricare, Medicaid, self-pay, and private insurance. In addition, risk ratios were calculated between insurance types stratified by race.

RESULTS:

Compared to private insurance, Tricare insurance had significantly reduced risk of all-cause maternal morbidity. Compared to White women, Black women with Tricare and all other insurances had a decreased risk of all-cause morbidity, but a significantly increased risk of SMM and SMM without transfusion. Asian women had significant increased risk of all-cause, SMM and SMM without transfusion. There was no significant difference in the risk of morbidity for women of color with Tricare insurance compared to women of color with Medicaid, private, or self-pay insurance.

CONCLUSION:

The risk of severe maternal morbidity remains elevated for women of color despite access to Tricare health insurance.
Quantitative Fetal Fibronectin to Predict Prolonged Induction of Labor [ID: 1371638]
Authors: Novack Mallory , Herring Amy , Roloff Kristina , Ruma Michael , Valenzuela Guillermo , Varberg Nathan
Published: May 2023

INTRODUCTION:

Prolonged induction of labor is problematic for patients and providers alike, but we lack clinical tools to help predict time to delivery. We hypothesize quantitative fetal fibronectin may function as a tool to predict prolonged induction.

METHODS:

We performed a prospective observational study of low-risk patients undergoing induction of labor at 39 0/7 to 41 0/7 weeks. Prior to induction, fetal fibronectin (fFN) sampling (off-label use) and transvaginal cervix length were completed. Median fFN values were compared to time-to-delivery using 12-, 24-, and 36-hour thresholds. Delivery within these thresholds was modeled using logistic regression after controlling for parity, Bishop score, cervical length, and gestational age. Continuous log time-to-delivery was modeled using linear regression. Arrowhead Regional Medical Center IRB granted approval Protocol #21–29.

RESULTS:

Of 95 patients enrolled, 35 (37%), 70 (74%), and 80 (84%) patients delivered within 12, 24, and 36 hours. Unadjusted tests for differences in median fFN in these groups were nonsignificant. Cervical length and gestational age were removed from adjusted models because of nonsignificance. Regression models showed a significant relationship between fFN and delivery time within 24 hours, but not within 12 or 36 hours. Each 50 ng/mL increase in fFN was associated with 25% higher odds of delivering within 24 hours (adjusted odds ratio [aOR] 1.25, 95% CI 1.01–1.54, P=.04) with a 3.7% decrease in labor time (53-minute reduction in a 24-hour labor) (aOR 0.963, 95% CI 0.929–0.097, P=.04).

CONCLUSION:

Our findings suggest fFN maybe a useful tool to identify patients who will deliver within 24 hours of induction initiation.
Outpatient Cervical Ripening: A Multicentered Retrospective Cohort Study [ID: 1377444]
Authors: Alavifard Sepand , Ashraf Rizwana , Chamy Caroline , Dong Zi Yang (Susan) , D’Souza Rohan , Roberts Surain
Published: May 2023

INTRODUCTION:

This study aims to compare safety and effectiveness between different outpatient cervical ripening (CR) methods.

METHODS:

Seven community and academic hospitals in the Greater Toronto Area that performed outpatient CR participated. We reviewed eligible charts over 12–24 months based on predetermined criteria. Multivariable analyses were performed; covariates included nulliparity, cervical unfavourability, and maternal and gestational age. Binary outcomes were modeled using logistic regression, presented as adjusted odds ratio (OR) with 95% CI. Time-to-event outcomes were described using unadjusted Kaplan-Meier curves. Multivariable time-to-event analyses were performed using accelerated failure time models with effects presented as time ratios (TRs) with 95% CI.

RESULTS:

We identified 1,910 pregnancies that underwent outpatient CR using balloon catheters in 881 (46%), dinoprostone vaginal inserts (DVIs) in 553 (29%), and dinoprostone vaginal gel/tablets (DG/T) in 476 (25%) pregnancies. The choice of agent varied considerably per site; one site used balloon catheters in 95%, another used DG/T in 95%, and three sites used DVI in more than 74% of cases. There were no differences in cesarean deliveries or adverse events related to CR. Compared to balloon catheters, patients with pharmacological ripening more often needed a subsequent ripening agent (DVI adjusted odds ratio 2.32 [1.62, 2.81], DG/T 3.26 [2.44, 4.36]). CR-to-delivery time did not differ, but compared to balloon catheters, DG/T had a shorter admission-to-delivery (aTR 0.71 [0.59, 0.86]) interval.

CONCLUSION:

Balloon catheters, DVI, and DG/T for outpatient CR are comparable in terms of safety and effectiveness. When choosing between agents, consideration should be given to clinical findings, patient preference, and resource availability.
Outcomes in Low-Risk Patients Before and After an Institutional Policy Offering 39-Week Elective Inductions [ID: 1379269]
Authors: Cozzi Gabriella , Battarbee Ashley , Blanchard Christina , Oben Ayamo , Sinkey Rachel , Subramaniam Akila
Published: May 2023

INTRODUCTION:

We aimed to pragmatically analyze the effect of offering elective induction of labor (eIOL) in low-risk patients on perinatal outcomes.

METHODS:

This was a retrospective cohort study of low-risk nulliparous or multiparous patients delivering live, nonanomalous singletons at a single center at greater than or equal to 39 0/7 weeks’ gestational age (GA). Those with prior or planned cesarean delivery (CD), ruptured membranes, medical comorbidities, or contraindications to vaginal delivery were excluded. Patients were categorized as before (pre-eIOL; January 2012 to March 2014) or after (post-eIOL; March 2019 to December 2021) an institution-wide policy offering eIOL at 39 0/7 weeks. Births from April 2014 to December 2018 were considered to be during-eIOL given increased exposure to eIOL during the period of the ARRIVE trial at our center. The primary outcome was CD. Characteristics and outcomes were compared between the pre- and during-eIOL, and pre- and post-eIOL groups, and adjusted OR (aOR) (95% CI) was calculated using multivariable regression. Subgroup analysis by parity was planned.

RESULTS:

Of 10,966 patients analyzed, 2,611 (23.8%) were pre-eIOL, 5,486 (50.0%) during-eIOL, and 2,869 (26.2%) post-eIOL. Groups differed with respect to labor type, age, race and ethnicity, marital and payor status, and GA at care entry. Post-eIOL was associated with lower odds of CD compared to pre-eIOL (aOR 0.75 [95% CI 0.66–0.87]), which was consistent for both nulliparas (aOR 0.71 [0.59–0.85]) and multiparas (aOR 0.64 [0.52–0.79]). During-eIOL was also associated with lower odds of CD compared to pre-eIOL (aOR 0.73 [0.65–0.82]). Both during- and post-eIOL groups were associated with higher odds of chorioamnionitis, operative delivery, and hemorrhage compared to pre-eIOL. However, only among post-eIOL were there fewer neonatal birth weights greater than 4,000 g, large-for-GA infants, and hypoglycemia compared to pre-IOL.

CONCLUSION:

Institutional policy offering eIOL at 39 0/7 to low-risk patients was associated with a lower CD rate and lower birth weights, and an increased risk of chorioamnionitis and hemorrhage.
Variation in Severe Maternal Morbidity Among Black and White Medicaid Enrollees in 27 States [ID: 1368013]
Authors: Admon Lindsay , Auty Samantha , Daw Jamie , Declercq Eugene , Gordon Sarah , Kozhimannil Katy
Published: May 2023

INTRODUCTION:

Interventions designed to address high rates of severe maternal morbidity (SMM) and improve maternal health equity often lack comprehensive data on the relative burden of specific SMM indicators across populations. This study examines variation in indicators of delivery-related SMM among non-Hispanic Black compared with non-Hispanic White Medicaid beneficiaries in 27 states.

METHODS:

We conducted a pool, cross-sectional analysis of the 2016–2018 Transformed Medicaid Statistical Information System. Unadjusted estimates of indicator frequency were generated for 27 states with adequate quality data on non-Hispanic Black and non-Hispanic White race and ethnicity. We estimated rates for each indicator for each racial group overall and within each state. This study was approved by the IRB at Boston University.

RESULTS:

Among deliveries to the non-Hispanic Black population (n=629,774), six indicators occurred at overall rates greater than 25 per 10,000 deliveries: eclampsia (leading indicator in 15 states), pulmonary edema/heart failure (3 states), renal failure (1 state), adult respiratory distress syndrome (3 states), sepsis (2 states), and disseminated intravascular coagulation (2 states). Among deliveries to the non-Hispanic White population (n=1,051,459), indicators occurred in different rank-order and at rates typically less than half of those identified among the non-Hispanic Black population. Morbidity indicators among the non-Hispanic White population were distributed differently across states.

CONCLUSION:

These findings provide opportunities for interventions designed to reduce SMM and improve maternal health equity in Medicaid to be tailored to the leading causes of SMM, which differ among non-Hispanic Black and White populations across and within states.
Age-Related Disparities in National Maternal Mortality Trends in the United States From 2000 to 2019 [ID: 1376567]
Authors: Huang Ryan , Abenhaim Haim Arie
Published: May 2023

INTRODUCTION:

Over the past two decades, there has been a trend toward increasing maternal age in the United States. The study objective was to examine the association of maternal age with maternal mortality in the United States and examine temporal trends in mortality by maternal age.

METHODS:

A nationwide population-based cross-sectional study in the United States between 2000 and 2019 was conducted using data from the Centers for Disease Control and Prevention’s “Birth Data” and “Mortality Multiple Cause” data files. Annual incidence and period trends in maternal deaths were calculated using the annual maternal deaths over annual live births across age groups. Multivariate logistic regression models were used to estimate the association between maternal age and risk of maternal mortality and calculate temporal changes in risk of mortality over the study period.

RESULTS:

Between 2000 and 2019, 21,241 deaths were observed in women during pregnancy and childbirth for an average incidence of 26.3 maternal deaths/100,000 births (95% CI 21.8–31.2). Of all deaths, 6,870 (32.3%) were in women 35 years or older, while only 15.1% of live births were attributed to women 35 years or older. Compared with women 25–29 years of age, there was a significantly greater risk of maternal mortality among women 35–39 (odds ratio 1.60, 95% CI 1.53–1.67), 40–44 (3.78, 3.60–3.99), 45–49 (28.49, 26.49–30.65), and 50–54 (343.50, 319.44–369.37). Risk of mortality increased over time, with the greatest rise in women 35 years or older.

CONCLUSION:

In the United States, maternal mortality increased during the past two decades, especially in women 35 years or older. Given these findings, targeted strategies to reduce the increasing maternal mortality should become a priority.