bluuebunny/crossref_metadata_2025 huggingface dataset:
Can We Predict Isolated Fasting Hyperglycemia in Patients With GDM? [ID: 1368593]
Authors: Strauss Tirtza Spiegel , Al-Ibraheemi Zainab , Brustman Lois , Grubman Olivia , Owens Thomas , Scarpelli-Shchur Sophia
Published: May 2023

INTRODUCTION:

One-third of patients with gestational diabetes mellitus (GDM) require hypoglycemic agents. There is a subset of patients who control their postprandial values with diet, yet they have persistent fasting hyperglycemia requiring bedtime hypoglycemic agents (GDMHS). As fasting hyperglycemia is an independent risk factor for adverse pregnancy outcomes, we aimed to identify risk factors to predict (and subsequently counsel) GDM patients with a risk of isolated fasting hyperglycemia requiring treatment with bedtime hypoglycemic agents.

METHODS:

This was an IRB-approved retrospective cohort study of patients diagnosed with GDM after 24 weeks from 2016 to 2020. Patients monitored glucose four times daily (fasting and 2 hours postprandial); fasting hyperglycemia was defined as more than 50% fasting values greater than 90 mg/dL. Patients completely controlled with diet (GDMA1) were compared to those with GDMHS. A multivariate analysis assessed whether age, body mass index (BMI), fasting glucose tolerance test (GTT) value, HbA1c at diagnosis, history of polycystic ovarian syndrome or previous GDM, Asian race, or family history of diabetes predicted isolated fasting hyperglycemia.

RESULTS:

Four hundred five patients had GDM. 57% had GDMA1, and 28% had GDMHS. Compared to GDMA1, patients with GDMHS were older, had higher BMI, higher fasting GTT value, higher HbA1c, and higher incidence of previous GDM or family history of diabetes. After adjusting for confounders, higher HbA1c at GDM diagnosis (odds ratio [OR] 3.55), older age (OR 1.08), and higher fasting GTT value (OR 1.06) were significantly associated with an increased probability of persistent fasting hyperglycemia. Asian race was associated with decreased probability of fasting hyperglycemia but was confounded by lower fasting GTT and lower BMI.

CONCLUSION:

Our data suggest that elevated HbA1c, higher fasting GTT value, and older age may predict persistent isolated fasting hyperglycemia in GDM patients who are otherwise controlled with diet. These data can be used to educate and counsel patients to alleviate frustration encountered with persistent fasting hyperglycemia despite postprandial diet control.
Delivery Outcomes in Pregnant Women With Third-Trimester Vaginal Bleeding [ID: 1376165]
Authors: Kalyanpur Nisha , Byrne John , Cheng CeCe , Neuhoff Barbara , Rowley Justin , Sundjaja Claire
Published: May 2023

INTRODUCTION:

We sought to determine delivery-related morbidity outcomes in patients presenting with third-trimester vaginal bleeding in the absence of placenta previa or placenta accreta spectrum (PAS).

METHODS:

A retrospective cohort study was conducted among women presenting with third-trimester vaginal bleeding at our tertiary center from July 2020 to June 2022 with exclusion of placenta previa or PAS. Bleeding was categorized by amount documented on provider examination as follows: “light,” less than 50 mL; “heavy,” 50 mL or more. The primary outcome was postpartum hemorrhage (PPH; ≥1,000 mL). Secondary outcomes included relevant maternal and neonatal morbidity measures.

RESULTS:

Among 6,584 singleton pregnancies, 76 (1.2%) presented with third-trimester vaginal bleeding without evidence of placenta previa or PAS; 68 of patients had light and 8 had heavy bleeding. Bleeding was frequently accompanied by contractions (62%) and cervical change (74%). Bleeding on admission was not associated with increased risk of PPH (light: relative risk [RR] 0.7, 95% CI [0.3, 1.4], P=.14; heavy: RR 1.7, 95% CI [0.5, 5.5], P=.2) or need for blood transfusion. Cesarean delivery (CD), general anesthesia, preterm birth (PTB), and neonatal intensive care unit admissions were more common in patients with heavy bleeding (all P<.05). Light bleeding did not increase the risk of PTB or CD and was associated with a higher rate of spontaneous vaginal delivery (RR 1.24, 95% CI [1.1, 1.4], P=.0003). No patients with bleeding required intensive care unit admission, hysterectomy, or had neonatal demise. Seventy-five percent of patients with heavy bleeding (n=8) and 16% of patients with light bleeding (n=11) had clinical or pathological evidence of abruption.

CONCLUSION:

Third-trimester vaginal bleeding, without placenta previa or PAS, is not associated with increased risk for PPH. Heavy bleeding, however, is associated with increased risk of preterm delivery and cesarean section, with abruption evident in 75% of these patients. Light bleeding on admission is usually not associated with an abruption or an increase in adverse maternal or neonatal outcomes.
Differences in Ultrasonographic Predictors of Fetal and Maternal Morbidity and Mortality Between Gestational and Pregestational Diabetics [ID: 1376398]
Authors: Kucirka Lauren , Boggess Kim , Kraus Alexandria
Published: May 2023

INTRODUCTION:

We sought to estimate the association between polyhydramnios and/or large for gestational age (LGA) and perinatal outcomes in pregestational (PreDM) compared to gestational diabetic (GDM) patients.

METHODS:

This was a secondary analysis of an observational study at a large academic center between 2014 and 2021, excluding congenital anomalies. Using modified Poisson regression, we measured the relationship between polyhydramnios (mild or moderate/severe) and/or LGA, and risk of stillbirth, neonatal intensive care unit (NICU) admission, cesarean delivery, and postpartum hemorrhage. We adjusted for potential confounders and stratified by diabetes group (PreDM versus GDM). We also created a model including interaction terms between diabetes type and presence of 1) polyhydramnios or 2) LGA, to test for interactions on outcomes.

RESULTS:

Among 2,533 pregnancies, 2,298 (91%) had GDM and 235 (9%) had PreDM. Four hundred seventy-two (18.6%) had LGA and 41 (1.6%) had moderate/severe polyhydramnios, and both were more common in PreDM versus GDM (34% versus 17%, P<.001, and 3.8% versus 1.4%, P<.05, respectively). LGA was associated with a significantly increased risk for cesarean section and NICU admission in both groups; however, moderate/severe polyhydramnios was associated with higher risk of stillbirth in PreDM (RR 14.7 [95% CI 1.3–163], P<.05), but not GDM. In those with moderate/severe polyhydramnios, PreDM had a significantly greater risk of stillbirth compared to GDM (P<.05). There was no statistically significant interaction between diabetes type, LGA, and risk of stillbirth.

CONCLUSION:

Moderate/severe polyhydramnios portends a higher risk of stillbirth in PreDM versus GDM. The presence of moderate/severe polyhydramnios should be considered in determining antenatal surveillance and delivery timing in patients with PreDM.
Hypertensive Disorders of Pregnancy and the Risk of Developing Hypertension Outside of Pregnancy Based on Updated Hypertension Guidelines [ID: 1377015]
Authors: Tucker Tonya , Branche-James Lauren , Cooper Shontreal , Kuo Chia-Ling , Shields Andrea
Published: May 2023

INTRODUCTION:

The purpose of this study is to determine whether hypertensive disorders of pregnancy (HDP) affect the development of chronic hypertension (HTN) within 5 years postdelivery based on updated guidelines by the American Heart Association (AHA).

METHODS:

This IRB-approved study evaluated women who delivered at one hospital from 2014 to 2016. Participants were determined to be normotensive or with HDP. Inclusion criteria for the HDP group was diagnosis of gestational HTN or preeclampsia at 20 weeks of gestation or greater. Exclusion criteria were previous diagnosis of HTN and age over 40. Women were followed up to 5 years postdelivery to assess development of chronic HTN, defined by the 2017 AHA guidelines as systolic greater than 130 mm Hg or diastolic greater than 80 mm Hg.

RESULTS:

Sixty-four participants (30.9%) developed chronic HTN within 5 years of delivery. Of these participants, 6.25% were from the normotensive pregnancy group, while 84.4% were from the preeclampsia with severe features group, with adjusted odds ratio of 11.38 (CI 4.67–22.46). Compared to the 5-year normotensive group, the 5-year chronic HTN group was associated with higher maternal body mass index (BMI) (P=.0146), preterm delivery (P=.0231), and neonatal intensive care unit (NICU) admission (P=.04).

CONCLUSION:

The rate of chronic HTN development 5 years postdelivery was significantly higher in participants with HDP, notably preeclampsia with severe features. Participants with development of chronic HTN had increased BMI during pregnancy, preterm delivery, and NICU admission rates as compared to participants with 5-year normotensive pressures. Awareness of the prevalence and risk factors for development of chronic hypertension provides areas of focus for future investigations.
Investigating the Relationship Between Maternal Obesity and Disorders of Amniotic Fluid [ID: 1377151]
Authors: Yan Xiteng , Bentley Beth , Dinglas Cheryl , El-Kady Dina , Rosner Jonathan , Schmidt-Swartz Jordana
Published: May 2023

INTRODUCTION:

Prior studies show conflicting evidence as to whether obesity in the absence of other medical or pregnancy-related conditions contributes to amniotic fluid disorders. The purpose of this study is to determine the association between late-pregnancy obesity with oligohydramnios (amniotic fluid index [AFI]<5 or maximum vertical pocket [MVP]<2) and/or polyhydramnios (AFI>24 or MVP>8).

METHODS:

This is a retrospective cohort study of 966 women with singleton gestations who had one or more obstetrical ultrasounds at Mount Sinai South Nassau at 36 0/7 weeks of gestation or beyond between August 1, 2015, and May 1, 2020. Patients were included if they had valid pregnancy dating and a documented AFI and/or MVP. Patients were categorized based on body mass index (BMI) (eg, normal, overweight, class I obesity, class II obesity, or class III obesity). Chi-square analyses were performed to evaluate whether there was a relationship between BMI and AFI. A logistic regression analysis was then performed for any confounding variables.

RESULTS:

There was no significant association between oligohydramnios and increasing BMI, whether patients had overweight (P=.17), class I (P=.46), class II (P=.49), or class III obesity (P=.99). The same was true for polyhydramnios and increasing BMI, whether patients had overweight (P=.68), class I (P=.74), class II (P=.94), or class III obesity (P=.99).

CONCLUSION:

Elevated maternal BMI was not significantly associated with disorders of amniotic fluid, regardless of the severity of obesity.
The Role of Fetal MRI in Management of Polyhydramnios: Findings From a Fetal Care Center [ID: 1378023]
Authors: Bank Rachel , Cass Darrell , Hopkins Maeve , Kalan Amanda , Kalan Amanda , Robertson Jason , Wang Sarah
Published: May 2023

INTRODUCTION:

Polyhydramnios, affecting 1–2% of pregnancies, is frequently associated with congenital anomalies. Prenatal ultrasound may identify potential etiologies for polyhydramnios and associated anomalies but has limitations particularly with regard to gastrointestinal imaging. There are no guidelines for use of fetal MRI (fMRI) in the setting of polyhydramnios.

METHODS:

The medical records of all patients referred to Cleveland Clinic’s Fetal Care Center between 2015 and 2021 were reviewed. Singleton pregnancies with amniotic fluid index (AFI)≥24 cm who underwent fMRI were included. Prenatal diagnoses made by ultrasound and fMRI were compared to postnatal diagnosis and potential etiologies for polyhydramnios.

RESULTS:

Fifty-eight patients with polyhydramnios received an fMRI, of which 26.6% (16/58) had a new diagnosis not detected by prior prenatal ultrasounds. Among cases where fMRI resulted in a new diagnosis, the majority were neurological 25% (4/16) or genitourinary anomalies 25% (4/16); 12.5% (2/16) were considered causative of polyhydramnios. Among patients with a new diagnosis on fMRI, 25% (4/16) had no abnormalities identified by prenatal ultrasound. Fetal MRI confirmed ultrasound diagnoses in 76.2% (32/42) of cases. There was no difference in average AFI between patients who were and were not found to have a new diagnosis on fMRI (33.1 versus 33.0, P=.47).

CONCLUSION:

In patients presenting to a fetal care center with polyhydramnios, addition of fMRI to prenatal ultrasound identified new anomalies in 26.6% of cases. Fetal MRI should be considered an adjunct to prenatal ultrasound in evaluation of pregnancies complicated by polyhydramnios to improve prenatal diagnosis of structural anomalies, prenatal counseling, and perinatal management.
Likelihood of Subsequent Type 2 Diabetes Diagnosis Among Patients Diagnosed With Gestational Diabetes and a 50-Gram 1-Hour Glucose Test Value of 200 mg/dL or Greater [ID: 1379006]
Authors: Harrison Rachel , Neuburg Blake , Palatnik Anna
Published: May 2023

INTRODUCTION:

Patients with gestational diabetes mellitus (GDM) are at increased risk for lifelong type 2 diabetes mellitus (T2DM). We sought to identify whether a 1-hour 50-g glucose result of 200 mg/dL or greater increased likelihood of T2DM among individuals with GDM.

METHODS:

This was a retrospective cohort study at a single tertiary care site from 2011 to 2019. Participants were included if diagnosed and treated for GDM during pregnancy, at least 18 years of age, and had singleton pregnancy. Exclusion criteria were significant fetal anomalies or incomplete records. Participants with values of 200 mg/dL or greater were then grouped and compared to participants with a value less than 200 mg/dL. Primary outcome was diagnosis of T2DM within 5 or less years of pregnancy. T tests, χ2, Fisher’s exact, and logistic regression were utilized for statistical analyses.

RESULTS:

Seven hundred eight participants met inclusion criteria. Among these, 100 (14.1%) had a value of 200 mg/dL or greater on the 1-hour 50-g glucose test. Groups were similar, with the exception that those with a very elevated 1-hour glucose result were more likely to be publicly insured (32.0% versus 17.1%, P=.009), identify as non-Hispanic Black (19% versus 14.6%, P=.036), and likely to be married (28.0% versus 25.8%, P=.039). Of the 708 participants, 31 (31.0%) were found to have T2DM among those with 1 hour of 200 mg/dL or greater versus 93 (15.3%) of those with lower 1-hour glucose results (P<.001). After controlling for confounders, T2DM remained independently associated with 1-hour glucose of 200 mg/dL or greater (adjusted odds ratio 2.14, 95% CI 1.22–3.74).

CONCLUSION:

Elevated screening results (≥200 mg/dL) on the 1-hour 50-g glucose test predicts an increased likelihood for T2DM.
Second-Trimester Screening for Placenta Accreta in Those With Prior Cesarean Delivery [ID: 1380253]
Authors: Chasen Stephen , Suner Talia
Published: May 2023

INTRODUCTION:

Our objective was to determine whether placental evaluation in the second trimester is sufficient to look for evidence of placenta accreta in those with prior cesarean delivery (CS).

METHODS:

Those with prior CS who underwent routine ultrasound (US) at 18–22 weeks in 2021 and delivered in our hospital were identified. Records were reviewed for history and US findings, and delivery records were reviewed to identify those with clinical or pathological evidence of accreta. Fisher’s exact test and Mann-Whitney U were used for statistical comparison.

RESULTS:

Eight hundred seventy-one patients were included, including 145 (17%) with multiple CS. There were 11 with confirmed accreta (1.3%): 7 requiring hysterectomy and 4 with myometrial fibers on placental pathology. Of 11 cases of accreta, only 4 (36%) had US findings in the second trimester, representing 57% of cases requiring hysterectomy. Cases without suspicious second-trimester findings all had other major risk factors, such as previa (n=3) or additional uterine scars such as prior B-Lynch suture (2), “T” incision (1), and Asherman syndrome (1). Overall, second-trimester US was accurate in 99.1% of cases. Of 8 inaccurate cases (7 false negative, 1 false positive) previa was noted in 4 (50%), versus 7.4% with accurate assessment (P=.002). There was no relationship between age, body mass index, or number of prior CS and accuracy of second-trimester US.

CONCLUSION:

Ultrasound findings were not identified in the second trimester in the majority of cases with accreta, although findings were noted in the majority requiring hysterectomy. All cases without second-trimester findings had previa or additional risk factors for scarring. Third-trimester US to screen for placenta accreta may not be necessary in all those with prior CS if second-trimester US is normal. Those at highest risk should undergo third-trimester imaging. If there is a selective approach to third-trimester US, a detailed history is important in identifying those with risk factors.
Intrahepatic Cholestasis of Pregnancy Complicated by COVID-19 Infection [ID: 1381429]
Authors: Gogia Soumya , Johnson Andrea , Patel Soha , Pham Amelie
Published: May 2023

INTRODUCTION:

Recent studies show that COVID has been associated with liver injury. Our study presents a case series of pregnant patients with intrahepatic cholestasis of pregnancy (ICP) complicated by prior COVID infection.

METHODS:

A retrospective review of singleton pregnancies delivered in an academic center between January 2020 and April 2022 identified patients with ICP (bile acids [BA]>10 mmol/L) with prior COVID infection in pregnancy. Maternal demographics, clinical/laboratory findings, medication use, and perinatal outcomes were collected. Secondary outcomes included BA greater than 40 mmol/L, BA trends in pregnancy, use of ursodiol, and rate of adverse perinatal outcomes (maternal/neonatal death). Institutional review board approval was exempted for this study.

RESULTS:

Of 138 cases of ICP and 743 cases of COVID during our study period, 14 patients were evaluated, 9 of whom met inclusion criteria. All cases of COVID resolved prior to delivery except one. Most cases (77.8%, 7/9) used ursodiol for treatment of ICP with mean duration of 6.9 weeks (±4.7). Six cases (66.7%) had BA greater than 40 mmol/L. One reported BA as high as 153 mmol/L at 23.5 weeks after COVID was diagnosed at 23.2 weeks. In this case, BA levels resolved by 26 weeks to less than 10 mmol/L and remained normal until delivery at 37 weeks. No adverse perinatal outcomes were reported.

CONCLUSION:

ICP cases in the setting of prior COVID in pregnancy are rare, but liver injury related to COVID may increase BA levels in pregnancy. Further studies are needed to evaluate possible associations between elevated BA due to COVID-19 and adverse perinatal outcomes.
Outcomes of Diabetic Intervention With One Abnormal Value on the 3-Hour 100-Gram Glucose Tolerance Test [ID: 1381570]
Authors: Foy Melissa , O’Reilly Geralyn
Published: May 2023

INTRODUCTION:

Recent studies identified an increased risk of adverse perinatal outcomes in women who have one abnormal value on the 3-hour 100-g glucose tolerance test (GTT) compared to women without gestational diabetes (GDM). Limited data are available on the benefit of diabetic intervention with these patients. We examined outcomes of pregnancies diagnosed and managed with GDM based on one abnormal value compared to those receiving routine care.

METHODS:

We performed a retrospective cohort study of all women with one abnormal value, comparing outcomes for those patients who received routine prenatal care (January 2016 to February 2018) versus those treated for gestational diabetes (March 2018 to July 2021). The primary outcome was birth weight greater than 4,000 g. Secondary outcomes included large for gestational age and cesarean delivery secondary to labor dystocia. Nonparametric tests were used to compare outcomes between groups. Study was IRB exempt.

RESULTS:

One hundred twenty-six women had one abnormal value on the 3-hour GTT. 76 (55.88%) were diagnosed with GDM and managed accordingly, while 50 (36.76%) were followed with routine care. Of the women diagnosed with GDM, 27 (35.52%) required pharmacologic treatment. Diagnosis of GDM and intervention were associated with a significant reduction in birth weight greater than 4,000 g (5.26% versus 20%, odds ratio 0.22, 95% CI 0.07–0.75). There were no significant differences for secondary outcomes.

CONCLUSION:

Pregnancies with one abnormal value on 3-hour GTT who received diabetic intervention were less likely to have birth weights greater than 4,000 g. Although further studies with larger cohorts are needed, this supports the use of one abnormal value for the diagnosis of GDM.
The Contribution of Neighborhood Context to the Association of Race With Anemia [ID: 1369542]
Authors: Hacker Francis , Lemon Lara , Phillips Jaclyn , Simhan Hyagriv , Simhan Jayanthi , Simhan Uma
Published: May 2023

INTRODUCTION:

Anemia on delivery admission is a risk factor for severe maternal morbidity (SMM). SMM occurs more often in racial minorities and those of socioeconomic disadvantage. We sought to explore the relationship between anemia on delivery admission, race, and a composite measure of neighborhood socioeconomic disadvantage.

METHODS:

We performed an IRB-approved retrospective cohort analysis of delivery admissions in a single health care network from 2015 to 2020. Area deprivation index (ADI) was used to represent neighborhood socioeconomic disadvantage and is a composite index of neighborhood that spans income, education, household characteristics, and housing. The index ranges from 1 to 100 with higher values indicating higher disadvantage. Anemia was defined as hemoglobin less than 11.0 mg/dL. Multivariable binomial regression models were used to estimate the effect that ADI has on the relationship between race and anemia.

RESULTS:

People in disadvantaged neighborhoods and those of Black race had the highest unadjusted incidence of anemia (23% and 29%, respectively). Across all ADI values, people of Black race had higher rates of anemia than all other races. In the multivariable model, Black race had a 2.7 times odds anemia when compared to White race (95% CI 2.6–2.9). This relationship persisted in an adjusted model (adjusted odds ratio 1.9, 95% CI 1.8–2.0). The relationship between ADI and anemia did not depend upon or vary by race.

CONCLUSION:

Rates of anemia increase as neighborhood disadvantage increases, but this relationship does not depend on or vary by race. Exploration of specific factors in the built environment that contribute to anemia deserves future study for possible remediation.
Effect of Race and Insurance on Outcomes in Women With Placenta Accreta Spectrum [ID: 1374697]
Authors: Parikh Bijal , Garretto Diana , Heiselman Cassandra , Herrera Kimberly , Kohli Harmehar , Korgaonkar-Cherala Chaitali
Published: May 2023

INTRODUCTION:

We evaluated whether maternal race and insurance status affect outcomes in pregnancies diagnosed with placenta accreta spectrum (PAS).

METHODS:

This was an IRB-approved retrospective cohort study including women diagnosed with PAS from January 2013 to December 2021 at a single academic institution. Women were grouped based on race and insurance status. Primary outcome was intraoperative complications including PPH, uterine rupture, cystotomy, and ureteral injury. Secondary outcomes included total blood products, length of stay, and postdischarge complications (readmission, infection, disseminated intravascular coagulation, and venous thromboembolism). Statistical analysis was performed using χ2 tests, Student t tests, and logistic regression modeling, with statistical significance defined as P<.05.

RESULTS:

A total of 72 pregnancies with PAS were included. The majority of patients were Caucasian (69.0%), followed by Hispanic (14.1%), African American (11.3%), Asian/Pacific Islander (2.8%), and other (2.8%). 27 women (37.5%) had government-assisted insurance. There was no association between race and preoperative multidisciplinary planning (P=.223), planned hysterectomy (P=.926), or composite of any intraoperative complications (P=.141). Race did not predict receiving greater than five blood products (P=.623), ICU admission (P=.447), or composite of any postdischarge complication (P=.103). Similarly, there was no association with the above outcomes based on insurance status. Government-assisted insurance did predict length of stay greater than 7 days (85.7% versus 14.3%, P=.010).

CONCLUSION:

At our institution, maternal race and health insurance status did not affect preoperative planning, perioperative resuscitation, and delivery outcomes in women with PAS.
Association of Gestational Diabetes Mellitus Recurrence With Race and Ethnicity [ID: 1375479]
Authors: Hersh Alyssa , Caughey Aaron , Doshi Uma , Garg Bharti
Published: May 2023

INTRODUCTION:

To assess whether there is an association between race and ethnicity with recurrence of gestational diabetes mellitus (GDM) among pregnant persons with a history of GDM in a prior pregnancy.

METHODS:

This was a retrospective cohort study of births between 2000 and 2012 to pregnant persons in California with a history of GDM in a prior pregnancy. We included singleton, nonanomalous births at gestational ages 23–42 weeks and excluded those who developed preexisting diabetes mellitus between pregnancies or with missing data for race and ethnicity. We adjusted for body mass index, age, educational attainment, and insurance type. Statistical analyses were performed using chi-square and multivariable logistic regression with a P value of .05.

RESULTS:

We included 26,903 births in this analysis. There were significant differences for all sociodemographic characteristics by recurrence of GDM. The highest proportion of pregnant persons with GDM recurrence were non-Hispanic Asian (55%), followed by Hispanic (51%). We found that the adjusted odds of GDM recurrence was higher among Hispanic (odds ratio [OR] 1.24, 95% CI 1.14–1.35) and non-Hispanic Asian (OR 1.93, 95% CI 1.76–2.11) individuals than the referent, while there was no difference in the adjusted odds of GDM recurrence for non-Hispanic Black (OR 0.99, 95% CI 0.83–1.18) or non-Hispanic American Native (OR 0.99, 95% CI 0.58–1.69) individuals.

CONCLUSION:

We found that among pregnant persons with a history of GDM, there was a higher adjusted odds of GDM recurrence among certain racial and ethnic groups. Future studies should assess this disparity with targeted interventions to mitigate this increased risk among these specific populations.
Mental Health Care Disparities After Implementation of a Perinatal Depression Intervention [ID: 1377829]
Authors: Spalding Hannah , Byatt Nancy , Leung Katherine , Simas Tiffany Moore , Yeboah Tracy
Published: May 2023

INTRODUCTION:

Perinatal depression affects upward of 1:7 childbearing individuals and is associated with significant negative intergenerational outcomes, especially when unrecognized and untreated. Our study examined provider perinatal depression screening, assessment, treatment, and follow-up by race and ethnicity, as a proxy for implicit bias or systemic racism, after a perinatal depression intervention was implemented.

METHODS:

The Program In Support of Moms (PRISM), an obstetric practice intervention, was implemented in November 2017 at the UMass ob-gyn resident clinic. PRISM aims to improve the detection, assessment, treatment, and follow-up of patients with perinatal depression. With IRB approval, we abstracted data from charts of patients having one or greater prenatal or postpartum visits with an Edinburgh Postnatal Depression Screen (EPDS) score equal to or greater than 10 between October 2017 and May 2020. Descriptive statistics were used for comparisons.

RESULTS:

Seven hundred ninety individuals were included (White n=369, Black n=84, Hispanic n=264, other n=73). There were significant differences by race and ethnicity in the assessment of prior mental health history, interest in treatment engagement, therapy referrals, and medication treatment offered (all P≤.001) with White patients having significantly higher rates than patients who were Black or another race. There were no differences by race and ethnicity in provider positive screen acknowledgement, provision of psychoeducation, or repeat screening after a positive screen.

CONCLUSION:

Racial disparities in assessment, referral, and medication treatment offerings exist after a perinatal depression intervention. Implementation of PRISM intervention with an anti-racist lens is needed to improve equitable access to mental health care for those marginalized by racism.
Racial Disparities in Cervical Length Surveillance in Patients With a History of Spontaneous Preterm Birth [ID: 1378309]
Authors: Chornock Rebecca , Alzamora Maria , Anders Jacqueline , Kumnick Allison , Mokhtari Neggin
Published: May 2023

INTRODUCTION:

Racial disparities in preterm birth are well established. We sought to identify racial disparities in cervical length surveillance in patients with a history of spontaneous preterm birth.

METHODS:

This was a subgroup analysis performed on data collected from a multi-institutional retrospective cohort study of pregnant patients with a history of early (<34 weeks) and late (≥34 weeks) spontaneous preterm birth (PTB) that underwent transvaginal cervical length surveillance between November 2016 and March 2022. MedStar Health Research Institute IRB approval was obtained. Twin pregnancies were excluded. Data was compared between Black patients and non-Black patients using χ2 tests, t tests, and ANOVA analyses, as appropriate (α=0.05).

RESULTS:

Of 324 patients, 231 (71.3%) were Black and 93 (28.7%) were non-Black. When comparing patients who had early PTB to late PTB, Black patients were more likely than non-Black patients to have early PTB (76.3 versus 61.3%, P=.005). Average gestational age at time of last spontaneous PTB was significantly earlier in Black patients compared to non-Black patients (28 weeks 3 days versus 30 weeks 4 days, P=.008). Black patients were further along in current gestation at the time of cerclage placement than non-Black patients (16 weeks 6 days versus 14 weeks 1 day, P=.041).

CONCLUSION:

Black patients are more likely to have later cerclage placement compared to non-Black patients despite a predisposition to earlier gestational age at time of prior preterm birth.
Use of an NTSV Checklist to Identify the Cause of Racial Disparities in Cesarean Birth Rates [ID: 1380461]
Authors: Vandyck Rhoda , Hayes Natalie , Jones Monica , Karpman Mitchell , Suess Jennifer
Published: May 2023

INTRODUCTION:

Despite reductions in our overall nulliparous, term, singleton, vertex (NTSV) cesarean birth rates with targeted initiatives, nationally recognized racial disparities also exist at our institution. Implementation of an NTSV checklist in February 2022 enabled evaluation for racial disparities in NTSV care implementation.

METHODS:

In this IRB-approved, single-institution, retrospective cohort study of NTSV deliveries between July 2021 and June 2022, data were abstracted using EMR reports, customized queries, and manual chart reviews. We analyzed the effect of race, comorbidities, and use of specified interventions on delivery method. The primary aim was to assess for racial disparities in implementation of institutional NTSV initiatives. Secondary aims were to assess the effect of comorbidities and checklist implementation on NTSV cesarean birth rates.

RESULTS:

Before February 2022, Black NTSV patients were 76% more likely than White counterparts to have cesarean births (odds ratio [OR] 1.76, CI 1.28–2.41). Post-intervention, Black NTSV patients were 6% more likely to have cesarean births (OR 1.06, CI 0.70–1.60). Comparing Black NTSV patients with completed checklists to White counterparts showed no statistically significant difference in likelihood of cesarean birth (OR 1.36, CI 0.49–3.74) or having no NTSV intervention utilized (OR 1.10, CI 0.30–4.03). Black NTSV patients were more likely than White counterparts to have gestational hypertension (OR 1.47, CI 1.05–2.06) or intrauterine growth restriction (OR 2.3, CI 1.24–4.27).

CONCLUSION:

The NTSV checklist did not reveal statistically significant racial disparities in use of institutional initiatives. NTSV checklist implementation may have contributed to a decreased racial disparity in NTSV cesarean birth rates. A larger sample size would strengthen analysis of the effect of comorbidities, institutional initiatives, and checklist implementation on delivery mode.
Effect of Anemia on Adverse Perinatal Outcomes Is Greater in Black Women at Varying Hemoglobin Concentrations [ID: 1380962]
Authors: Ladella Subhashini , Gomes Cintia , Shaver Amber
Published: May 2023

INTRODUCTION:

Maternal anemia affects 40% of pregnancies worldwide. It is associated with adverse birth outcomes, including preterm birth (PTB), which disproportionally affects Black women. We compared adverse perinatal outcomes and anemia as defined by World Health Organization/Centers for Disease Control and Prevention (hemoglobin [Hb]<11 g/dL) and institutional guidelines (Hb<12 g/dL), among Black women.

METHODS:

Institutional review board-approved retrospective cohort study was performed on patients delivered at Community Regional Medical Center, Fresno, California, from 2015 to 2016. Data abstraction included gestational age, first- and third-trimester Hb, race and ethnicity, parity, maternal age, mode of delivery, and neonatal outcomes. Exclusion criteria included hemoglobinopathies, tobacco use, uterine abnormalities, multiple gestation, and prior PTB or cervical surgery.

RESULTS:

Birth outcomes of 1,305 term and 990 PTB were analyzed for anemia at Hb less than 11 g/dL and less than 12 g/dL. Black women with PTB (83.8%) had significantly higher rates of anemia compared to term (68.8%) at Hb less than 12 g/dL (P<.05) versus Hb less than 11 g/dL (P>.05). Compared with other ethnicities (n=2,104), Black women (n=193) showed significantly higher rate of first- (47.60% versus 24.3%; P<.01) and third-trimester anemia (75.10% versus 59.50%, P<.01), low birth weight (LBW) neonates (38.70% versus 26.20% not-AA, P<.1), and lower 1- and 5-minute Apgar scores (32.30% and 15.30% versus 22.90% and 8.70% not-AA, respectively; P<.05) at Hb less than 12 g/dL.

CONCLUSION:

Significant association of anemia with PTB, LBW, and lower Apgar scores was noted in Black women at HB less than 12 g/dL. Further studies with larger sample sizes are needed to evaluate the need for redefining anemia Hb concentration for Black women, which may help initiate early treatment and prevent adverse perinatal outcomes.
Maternal Morbidity Rates Relative to Length of Labor in a Multiethnic Patient Population [ID: 1337798]
Authors: Lee Daniel , Kwan Lorna , Nguyen Emily , Pluym Ilina , Tandel Megha
Published: May 2023

INTRODUCTION:

Prolonged induction of labor is associated with increased morbid maternal outcomes. Induction of labor length varies by institution and labor management. The objective of this study was to determine the risk of morbid outcomes increasing hours of labor induction in a multiethnic tertiary care center.

METHODS:

We conducted a retrospective cohort study on patients undergoing scheduled induction of labor from June 2020 to May 2021 at a tertiary care center. Nulliparous singleton term pregnancies with intact membranes who had an initial cervical dilation less than 3 were included. Length of labor induction was defined as first intervention to birth. Morbid outcomes included suspected intraamniotic infection (IAI), postpartum hemorrhage (PPH), and cesarean birth. Multivariable logistic regressions were performed relative to the length of labor.

RESULTS:

Two hundred sixty-seven patients were included in our study, with 18.0% Asian American/Pacific Islander, 6.4% Black/non-Hispanic, 20.2% Hispanic, 32.6% White/non-Hispanic, 17.6% multiracial/other, and 5.2% unknown. The median labor length was 28.5 hours (interquartile range 21.2–38.5). The rates of IAI was 22%, PPH 12%, and cesarean birth 22%. For every hour of labor, there was 1.04 increased odds of IAI, 1.08 odds of cesarean birth, and 1.05 odds of PPH after adjusting for confounders (P<.01). When comparing White versus non-White patients, there were no differences in labor length (28.4 hours versus 28.6 hours, P=.46) and no differences in IAI, PPH, and cesarean.

CONCLUSION:

For each hour of labor, the risk of IAI, PPH, and cesarean birth increased by 4%, 8%, and 5%, respectively. Characteristics contributing to this association may be multifactorial and suggest labor management should aim for an expedient birth.
Approach to Intrapartum Fever During the COVID-19 Pandemic: A New York City Hospital Experience [ID: 1377237]
Authors: Parow Aimee , Cron Julia , Nagy Szilvia , Saiman Lisa , Uppal Nikhil
Published: May 2023

INTRODUCTION:

At the start of the COVID-19 pandemic, repeat testing for SARS-CoV-2 was added to the management of intrapartum fever. Mother–newborn isolation and separation were implemented until repeat results were available and negative. As few data exist to support or refute repeat testing in this setting, we assessed the yield of repeat testing for intrapartum fever.

METHODS:

We performed a retrospective, IRB-exempt, study from October 2020 to June 2022 of patients who had a negative SARS-CoV-2 test at admission and developed intrapartum fever without an alternative explanation for the fever. Maternal and newborn demographic and clinical variables were extracted from electronic medical records.

RESULTS:

During the study period, among 3,236 deliveries, 151 (4.7%) patients (median age, 34 years) had intrapartum fever; 43%, 11%, and 37% were Asian, Black, and White: 17% were Hispanic. All delivered live newborns (median gestational age, 39 weeks). The median time to fever after admission was 19 hours (range, 0.17–46.17 hours), the median fever was 38.3°C, and median time to repeat test result was 2.07 hours (range, 0.42–12.70 hours). On repeat testing, one (0.7%) patient was positive for SARS-CoV-2 and two had other respiratory viruses detected. Less than 1% had COVID symptoms other than fever. Nine percent of newborns needed transient respiratory support. Two newborns were tested for SARS-CoV-2; both were negative.

CONCLUSION:

Repeat SARS-CoV-2 testing for intrapartum fever management resulted in one additional case, suggesting that routine repeat testing in patients with intrapartum fever and no other symptoms is generally not needed. Additionally, in this setting, mother–newborn isolation and separation are not warranted.
TeamBirth to Enhance Communication and Inpatient Maternity Care Experiences in English and Non-English-Speaking Patients [ID: 1380450]
Authors: Lacroix Tiffany , Ireland Luu , Leung Katherine , Moore-Simas Tiffany , Weiseth Amber , Yeboah Tracy
Published: May 2023

INTRODUCTION:

Communication affects obstetric experiences. Limited data exist on the effect of speaking a language other than English on birthing persons’ experiences. Few scalable solutions exist to improve communication and mitigate potential poor clinical care experiences. We aimed to understand UMass Memorial Medical Center’s TeamBirth initiative on experiences with health care teams between English and non-English-speaking obstetric patients.

METHODS:

The TeamBirth quality improvement initiative was implemented May 2021. TeamBirth includes structured communication approaches using storyboarding and “huddles” throughout inpatient maternity care. During postpartum stay (May 3, 2021 to May 31, 2022), patients were given an opportunity to complete surveys including validated tools. Data analyses compared experiences between English- and non-English-speaking patients.

RESULTS:

Of 886 respondents, 785 were English-speaking (89%), and 101 were non-English-speaking (11%). English as compared to non-English-speaking patients reported having greater than or equal to 1 huddle in labor (75.1% versus 65.7%, P=.052). Sharing preferences was perceived as making a difference (yes somewhat or definitely) in care (82.0% English- versus 80.9% non-English-speaking, P=.64). There were no statistically significant differences between English- and non-English-speaking patients regarding questions about clinical teams helping patients understand all information (P=.85), providers using words patients did not understand (P=.62), providers talking too fast (P=.29), and providers ignoring what was shared (P=.36). Overall, regardless of preferred language, patients felt their providers were trustworthy (P=.64).

CONCLUSION:

TeamBirth may play a role in improving disparities within clinical care experiences between English and non-English speakers through enhanced communication. Ultimately, this may result in improved health outcomes and a more equitable experience for marginalized obstetric patients.
Advanced Maternal Age Associated With Significantly Increased Cervical Ripening Times and Decreased Vaginal Delivery Rates [ID: 1367634]
Authors: Birchall Courtney , Burns Jamie , Dickinson Taylor , Leftwich Heidi , Nguyen Linh , Taylor Rachel
Published: May 2023

INTRODUCTION:

With increasing numbers of advanced maternal age (AMA) gravidas, labor characteristics specific to this population are important to understand. The objective of this study was to examine patterns in cervical ripening times and vaginal delivery rates for patients with AMA.

METHODS:

This was an IRB-approved retrospective cohort study conducted at a single academic center. Data were collected by retrospective chart review of deliveries from 2020 to 2021. We included nulliparous patients aged 18 or older with singleton pregnancies, pre-pregnancy body mass index of 18.5 or greater, and gestational age of 37.0 or greater. Patients with pregestational diabetes and lethal fetal anomalies were excluded.

RESULTS:

One thousand twenty-two patients met inclusion and exclusion criteria, 17.7% of whom were AMA. Lower gestational age and less Hispanic ethnicity were noted in the AMA group. Among AMA patients, there was an increase in cervical ripening time as compared to patients aged older than 35 with an average difference of 3.14 hours (CI 1.26–5.01, P=.001). Compared to participants younger than 35, those that are AMA were 36% less likely to have a vaginal delivery (CI 0.46–0.89, P=.008). Median cervical ripening time to vaginal delivery was 15.0 hours for non-AMA and 19.9 hours for AMA patients. At any point of cervical dilation, AMA patients had a 28% less chance to have a vaginal delivery than non-AMA (P<.001).

CONCLUSION:

Patients who were AMA experienced increased cervical ripening times and decreased rates of vaginal deliveries compared to patients younger than 35. Knowing labor characteristics specific to the AMA population is important for counseling and clinical decision-making.
Effect of Prior Cesarean Section Delivery on Intrapartum Cesarean Section Outcomes [ID: 1372249]
Authors: Goodman Bree , Carbonell Katherine , Carter Ebony , Kelly Jeannie , Raghuraman Nandini , Simpson Lucy
Published: May 2023

INTRODUCTION:

Intrapartum cesarean deliveries (CDs) are associated with higher rates of maternal and neonatal morbidity than scheduled CDs. In patients undergoing trial of labor after cesarean (TOLAC), perceived added difficulty of intrapartum CD may influence provider decisions on labor management. We sought to evaluate the effect of prior CD on operative times and maternal/neonatal outcomes among those undergoing intrapartum CD.

METHODS:

This is a retrospective cohort study of all singleton, nonanomalous fetuses delivered by intrapartum CD at a tertiary care center from June 2018 to April 2019. CD was categorized as intrapartum if it occurred after the patient was admitted in spontaneous labor or received an induction agent. The primary outcome was time from skin incision to delivery. Secondary outcomes were composite measures of maternal (postpartum hemorrhage, bowel or bladder injury, transfusion, endomyometritis, intensive care unit admission, readmission, wound complications) and neonatal (neonatal intensive care unit admission, respiratory support, therapeutic hypothermia, neonatal mortality, and fetal acidemia) morbidity. We compared these outcomes between women with and without history of prior CD. Multivariable logistic regression was used to control for potential confounders.

RESULTS:

Of 374 intrapartum CDs, 270 (72%) were in patients without prior cesarean section and 104 (28%) were in patients undergoing TOLAC. Operative times were significantly longer in women with a prior CD including time from skin incision to delivery (9 [interquartile range (IQR) 7–13] versus 6 minutes [IQR 3–8], P<.001) and total procedure time (63 [IQR 52–79] versus 55 minutes [IQR 45–65], P<.001). Composite maternal (adjusted relative risk [aRR] 1.04, 95% CI 0.62–1.74) and neonatal (aRR 1.01, 95% CI 0.63–1.64) morbidity did not differ between groups.

CONCLUSION:

Although associated with longer operative times, history of a prior CD does not significantly increase maternal or neonatal morbidity among women undergoing intrapartum CD. Therefore, the threshold to perform an intrapartum CD in those undergoing TOLAC should be similar to those without a prior CD.
Rates of Vaginal Delivery With Increasing Cervical Dilation After Cervical Ripening and Advanced Maternal Age [ID: 1372406]
Authors: Loke Rohini , Burns Jamie , Dickinson Taylor , Leftwich Heidi , Nguyen Linh , Taylor Rachel
Published: May 2023

INTRODUCTION:

Pregnant patients of advanced maternal age (AMA) are at an increased risk for cesarean delivery. Our primary objective was to determine the association between cervical dilation after cervical ripening and vaginal delivery rates for AMA versus non-AMA patients.

METHODS:

This was an IRB-approved, retrospective cohort study conducted at a single tertiary care center, which included nulliparous, term deliveries that required cervical ripening from January 2020 to January 2022. We excluded patients with multifetal gestation, pregestational diabetes, lethal fetal anomalies, prior cesarean delivery, and prisoner status.

RESULTS:

Altogether, 964 patients met inclusion/exclusion criteria, of whom 17.7% were AMA. Increasing cervical dilation at the end of cervical ripening was associated with higher rates of vaginal delivery, with a mean of 3.7 cm for patients who underwent vaginal delivery and 3.2 cm for those who delivered via cesarean (P<.001). A logistic regression examined the interaction between AMA status with cervical dilation after ripening and vaginal delivery rates, which was not significant (P=.38). After adjusting for AMA status, the odds of having a vaginal delivery increased by 22% for every 1-unit increase in end cervical dilation after ripening (CI 1.12–1.33, P<.001). Compared to non-AMA, after adjusting for end dilation after ripening, AMA patients were 35% less likely to have a vaginal delivery (CI 0.46–0.91, P=.013).

CONCLUSION:

Advancing cervical dilation after ripening was associated with a higher rate of vaginal delivery overall. However, AMA patients had significantly fewer vaginal deliveries even when controlling for this end cervical dilation.