bluuebunny/crossref_metadata_2025 huggingface dataset:
Effect of Residency Training in Treating Maternal Opioid Use Disorder [ID: 1376984]
Authors: Herbosa Christina , Dickison Shelby , Kelly Jeannie , Lawlor Megan , Russell Sharman , Strand Eric
Published: May 2023

INTRODUCTION:

Buprenorphine treatment for opioid use disorder (OUD) remains substantially underutilized, reflecting a systemic deficit in medical education. Our study assesses the effect of residency training in a prenatal OUD-specific clinic (CARE) on postgraduate ob-gyn physician attitudes, self-perceived competence, and treatment of maternal OUD.

METHODS:

2013–2022 graduates from a single obstetrics and gynecology residency program were invited to participate in an online anonymous survey, which collected information on demographics, attitudes, self-perceived competency, and current practice. Answers from participants who graduated before the establishment of CARE in 2018 were compared to those who trained after the establishment of CARE using Fisher's exact, χ2, and Student t tests. A value of P<.05 was considered statistically significant.

RESULTS:

55/86 (64%) physicians completed the survey. Compared to graduates without CARE experience (N=30), those with residency experience in CARE (N=25) were significantly more likely to be actively prescribing buprenorphine (24% versus 3%, P=.02) or planning to obtain an X-waiver (24% versus 3%, P=.03). The majority with CARE experience reported feeling comfortable prescribing buprenorphine during pregnancy (92.0% versus 13.3%, P<.001), confident to treat maternal OUD (84% versus 26.7%, P<.001), and able to manage buprenorphine treatment during pregnancy (88% versus 30%, P<.001). Those with experience in CARE reported that residency provided sufficient training to manage maternal OUD without additional X-waiver training (84% versus 10%, P<.001). Institutional review board approval was obtained.

CONCLUSION:

Prenatal OUD-specific clinics are known to be associated with improved patient outcomes, and may also significantly expand the ability of ob-gyn residents to treat maternal OUD after graduation.
Racial Differences in Activity Restriction Recommendations in Pregnancy [ID: 1379637]
Authors: Ha Laura , Bairey Merz C. Noel , Bello Natalie , Hirsch Anna , Kilpatrick Sarah , Naqvi Mariam
Published: May 2023

INTRODUCTION:

Activity restriction (AR) is commonly recommended to pregnant patients despite lack of evidence demonstrating benefit to this practice. We describe AR recommendation patterns and identify factors associated with a higher likelihood of recommendation for AR.

METHODS:

This was a secondary analysis of the Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-Be (nuMoM2b) prospective cohort. Data were collected on nulliparous singletons at eight sites from September 2010 to September 2013. Patients were surveyed about AR recommendations at 22 weeks 0 days–29 weeks 6 days and delivery. We excluded patients missing data on AR and age. Patients were grouped by history of AR in pregnancy. We assessed characteristics between groups using χ2 and Wilcoxon rank sum tests. Associations between AR and demographic and clinical factors were examined with univariable and multivariable logistic regression.

RESULTS:

Of 9,312 women, 1,386 (14.9%) were recommended AR. In unadjusted analysis, prevalence of race and ethnicity, obesity, chronic hypertension, renal disease, and short cervix were significantly different between groups. After adjustment for covariates, Black and Hispanic patients were less likely to be placed on AR when compared to White patients (adjusted odds ratio [aOR] 0.81 [95% CI 0.68–0.98], and aOR 0.73 [95% CI 0.61–0.87], respectively).

CONCLUSION:

Activity restriction was more likely to be recommended in patients with obesity, chronic medical conditions, and short cervix. After adjustment for baseline differences, Black and Hispanic patients were significantly less likely to be recommended AR compared to White patients. While AR is not an evidence-based practice, these findings suggest implicit bias may affect which patients receive advice to limit activity in pregnancy.
Prenatal Care Utilization Among Pregnant Women With Substance Use Disorder: A Drug-Free Moms and Babies Project Study [ID: 1377131]
Authors: Dawley Denise , Breyel Janine , Lilly Christa , Umer Amna
Published: May 2023

INTRODUCTION:

Pregnant people with substance use disorder (SUD) are more likely to have inadequate prenatal care quality/utilization. The rate of stimulants and opioids use continues to increase nationwide with significantly higher rates observed in rural and socioeconomically disadvantaged pregnant populations. The objective of this study was to quantify the association between substance use and the quality of prenatal care in the rural Appalachian pregnant population of West Virginia.

METHODS:

Drug-Free Moms and Babies Project is a multicenter program in West Virginia that offers coordinated care for pregnant and postpartum individuals with SUD. Secondary data analysis for this study (2018–2022) was limited to only those patients who entered the program during pregnancy (N=1,555). Kessner Index was used to categorize prenatal care quality as inadequate, intermediate, and adequate. Substance use included stimulants alone, opioids/narcotics alone, opioids/narcotics and stimulants concurrent use, and all other substances but not opioid/narcotic or stimulant use.

RESULTS:

Pregnant people with opioids use alone (odds ratio [OR] 2.11 [1.43–3.12]), stimulants use alone (OR, 3.27 [1.69–6.32]), and concurrent use of opioids and stimulants (OR 4.69 [2.52–8.73]) were more likely to have inadequate versus adequate prenatal care compared to those who used only other substances after adjusting for maternal income, education, medical conditions, prior children, planned/unplanned pregnancy, alcohol use, or smoking during pregnancy.

CONCLUSION:

Opioids/narcotics and stimulants use is associated with inadequate prenatal care utilization that becomes more pronounced with polysubstance use. Improving quality of prenatal care is critical for this population to improve the health of parent and child.
Psychological Trauma of COVID-19 in Pregnancy: Diagnosis, Treatment, and Recovery [ID: 1378016]
Authors: Drexler Kathleen , Tully Kristin , Young Omar
Published: May 2023

INTRODUCTION:

The objective of this study was to delineate birthing persons' accounts of COVID-19 diagnosis, inpatient treatment, and recovery from infection and the effect on mental health.

METHODS:

This is a prospective qualitative study of English-speaking birthing people hospitalized for treatment of COVID-19 during pregnancy at a single quaternary care center from August 2021 to March 2022. Semistructured interviews were conducted to examine emotional reactions to developing COVID-19 during pregnancy, experiences with hospital admission and inpatient care, and effect on mental health after recovery. All interviews were audio-recorded, professionally transcribed, and iteratively coded for inductive narrative analysis.

RESULTS:

Eight birthing people participated in interviews. Universally, participants experienced feelings of fear, panic, and frustration with the diagnosis of COVID-19 infection and their need to be hospitalized. Inpatient care engendered feelings of isolation and disconnection due to separation from family and limited interaction with health care team members. Compared to non-Hispanic White participants, non-Hispanic Black participants were more likely to express feelings of discrimination and disrespectful care. After discharge, participants described intentionally avoiding people to minimize risk of reinfection, further increasing fears of anxiety and isolation even months after diagnosis. Postdischarge recovery also included ongoing recovery from physical symptoms, including breathing and activities of daily living.

CONCLUSION:

Birthing people reported significant psychological trauma after their diagnosis, treatment, and recovery from COVID-19 infection in pregnancy. These experiences highlight the importance of focusing on mental health as part of recovery and outline opportunities to improve the provision of respectful, equitable care.
Maternal Adverse Childhood Experiences (ACEs) Increase Opioid Use During Pregnancy [ID: 1368263]
Authors: Jacobs Benjamin , Ganson Kyle , Jackson Dylan , Nagata Jason , Testa Alexander , Zhang Lixia
Published: May 2023

INTRODUCTION:

Adverse childhood experiences (ACEs) are linked with a myriad of adverse health outcomes and problematic health behaviors including depression, tobacco use, alcohol use, and illicit drug use. Although studies have drawn a connection between ACEs and substance use in adulthood, there is limited research on whether ACEs are associated with prescription opioids during pregnancy. The current study examines the relationship between ACEs and prescription opioid use during pregnancy using representative data from live births from two states.

METHODS:

This study uses data on 2,999 individuals from the 2019 and 2020 Pregnancy Risk Assessment Monitoring System (PRAMS) from North Dakota and South Dakota. Multiple logistic regression is used to assess the relationship between ACEs and prescription opioid use during pregnancy.

RESULTS:

The prevalence of prescription opioid use increases alongside accumulating ACEs. Compared to those with no ACEs, recent mothers with three or more ACEs have approximately a 2.4 greater odds of prescription opioid use during pregnancy (adjusted odds ratio 2.437, 95% CI: 1.319, 4.503).

CONCLUSION:

Given the potential harms of prescription opioid use during pregnancy, the findings suggest the need for additional research to better understand the mechanisms that link ACEs and prescription opioid use during pregnancy, as well as how to best support those with ACEs exposure in a trauma-informed manner to reduce the risk of substance use.
Evaluation of Patient Cost Savings in Tailored Prenatal Pathways [ID: 1375747]
Authors: Tang Michael , Cohn Amy , Fendrick Mark , Ghrayeb Leena , Peahl Alex
Published: May 2023

INTRODUCTION:

The Plan for Appropriate Tailored Healthcare in pregnancy (PATH) recommends tailoring prenatal visit schedules and modality (eg, telemedicine visits) to patients' risk factors and preferences. We simulated PATH recommendations to explore financial implications from the patient perspective.

METHODS:

In this IRB-exempt study, a dataset of 4,992 patients from a single academic health system was used to establish key assumptions for financial modeling. The model was constructed using several key parameters: patient risk, travel, and employment variables. We report patient-perspective cost and time savings across three models: traditional care (all patients seen for 12–14 in-person visits), tailored prenatal care (visit number tailored to patient risk), and hybrid tailored care (tailored care with telemedicine and in-person visits).

RESULTS:

Implementation of tailored care resulted in substantial cost and time savings. In the traditional model, average travel time was 26 hours and average total cost per patient was $1,374 (time off cost, $1,310; travel cost, $64). In the tailored model, patients saved on average 5 hours of travel time and $172 (total cost, $1,201; time off cost, $1,145; travel cost, $56). In the hybrid tailored model, patients saved on average 18 hours of travel and $792 (total cost, $581; time-off cost, $525; travel cost, $21; at-home supplies, $35). Extrapolated across all patients who sought prenatal care in 2020, estimated national cost savings range from approximately $0.5B and $2B annually for the in-person tailored and hybrid tailored model, respectively.

CONCLUSION:

Tailored prenatal care delivery policies, particularly those that include telemedicine, result in significant time and cost savings for patients.
Virtual Prenatal Care: The Effect of Telemedicine and Home-Ultrasound on Maternal Anxiety and Attachment During Pregnancy in Women With a History of Pregnancy Loss [ID: 1375930]
Authors: Weiner Eran , Cartun Zachary , Kleiner Ilia , Levy Michal , Marom Or , Tamayev Liliya
Published: May 2023

INTRODUCTION:

We aimed to study the effects of twice-a-week telemedicine visits on maternal anxiety and antenatal attachment in women with a history of previous pregnancy loss by complementing routine prenatal care with home ultrasound.

METHODS:

This was a randomized controlled trial. Women with history of pregnancy loss (>20 weeks) were recruited and randomized 1:1 in the treatment arms early in their subsequent pregnancy in our high-risk clinic. The control group received routine prenatal high-risk care per protocol, while the study group received additional twice-a-week telemedicine visits with a maternal–fetal medicine specialist, which included a home ultrasound scan (for fetal heart rate, movement, and amniotic fluid) for reassurance. The scan was performed by the patient using a home ultrasound device (Pulsenmore ES) with physician authorization and guidance. Maternal anxiety was evaluated by the validated State-Trait Anxiety Inventory Scale (STAI-S) and maternal attachment was evaluated by the validated Maternal Antenatal Attachment Scale (MAAS-2) at four time points throughout pregnancy. The primary outcome was the STAI-S score at the last prenatal visit. Power analysis required 40 patients to demonstrate a 20% difference in the primary outcome. The study was approved by the local IRB, and all patients signed an informed consent upon randomization.

RESULTS:

To date, 32 patients completed follow-up, with 16 per arm. There were no differences in demographics or pregnancy outcomes between groups. The study group demonstrated lower anxiety levels at the last prenatal visit (STAI 42.2±4.7 versus 49.6±5.8, P<.001), higher differences between STAI scores at the first versus last visit (−9.9±2.7 versus −7.1±3.1, P=.011), and higher MAAS-2 scores (50.4±3.9 versus 47.2±4.5, P=.039) at last visit.

CONCLUSION:

Routine prenatal telemedicine visits with home ultrasound can lower maternal anxiety and improve attachment in women with previous pregnancy loss.
A Pilot Randomized Control Trial of Topical Capsaicin as Adjunctive Therapy for Nausea and Vomiting of Pregnancy [ID: 1376219]
Authors: Murphy Lauren , Griffin Laurie , Hamel Maureen , Smith Megan , Whelan Anna
Published: May 2023

INTRODUCTION:

Nausea and vomiting is one of the most common complications of pregnancy affecting 50–80% of pregnant persons and despite its prevalence remains a challenging condition to treat. Therapy often involves oral and IV medications with potential side effects, particularly when taken in combination. Capsaicin cream is proven to decrease nausea and vomiting in cyclic vomiting syndrome, however has not been well studied among pregnant patients. We conducted a pilot randomized controlled trial (RCT) to test the acceptability and feasibility of the off-label use of capsaicin for treatment of nausea and vomiting in pregnancy.

METHODS:

Patients were recruited during triage evaluation for nausea and vomiting. Institutional review board approval was obtained prior to enrollment. Consenting participants were randomized to abdominal application of topical capsaicin versus placebo. All participants received intravenous hydration and metoclopramide. The primary outcome, total treatment time, was recorded for all participants. Additionally, symptom severity was assessed every 30 minutes using a visual analogue scale.

RESULTS:

Of the 38 eligible individuals approached, 30 were randomized. There was a trend towards decreased mean treatment time in the capsaicin group compared to placebo (79.9 versus 97.3 minutes, P=.1). There were no significant differences in VAS scores at any time point between groups. Furthermore, capsaicin was well tolerated, with only one individual requesting the medication be removed.

CONCLUSION:

This study demonstrates that capsaicin is an acceptable treatment for nausea and vomiting in pregnancy and additional explorations of its use as therapy are feasible. A larger RCT is needed to determine the efficacy of capsaicin in this population.
Effect of U.S. Region on the Incidence of In-Hospital Pregnancy Terminations Over Two Decades [ID: 1376691]
Authors: Desposorio Jonathan , Ramsey Patrick , Seifi Ali
Published: May 2023

INTRODUCTION:

The overturning of Roe v Wade will result in a patchwork of abortion laws that vary based on where a person lives; however, the current association between geographical region in the United States and abortion is poorly understood. Our objective was to define the effect geographic location has on the incidence of in-hospital pregnancy terminations in the United States.

METHODS:

The U.S. Nationwide Inpatient Sample (NIS) database was queried for all patients who underwent an in-hospital abortion (termination of pregnancy) from 1997 to 2014. The cohort was divided based on what region in the United States the procedure was performed: Northeast, Midwest, South, and West. ANOVA statistical analysis was used to compare the four groups across the study period.

RESULTS:

We identified a total of 37,600 patients who underwent an in-hospital pregnancy termination with a significant decrease from 4,113 abortions in 1997 to 1,059 in 2014 (P<.001). Compared to the rest of the United States, the Northeast region experienced a significantly higher incidence of abortions (P<.01), with a mean of 878 abortions per year, and the Midwest experienced a significantly lower incidence of abortions (P<.01), with a mean of 261 abortions per year.

CONCLUSION:

Our study found that the Northeast and Midwest regions of the United States experience the highest and lowest rates of abortion, respectively. With Roe v Wade overturned, an even higher discrepancy between abortion rate and U.S. region might ensue; however, further study is needed to investigate the etiology of these differences.
Fetal Monitoring mHealth Apps: A Mixed-Methods Study of Users' Perceptions of App Effects [ID: 1377502]
Authors: Baker Elizabeth , Bedia Enrique , Buckingham-Schutt Lyndi , Duffy Pamela , Ferguson Emma
Published: May 2023

INTRODUCTION:

Little is known about users' perceptions of fetal monitoring mHealth apps (FMAs). mHealth guidelines for developing behavior change interventions, like FMAs, recommend consistent evaluation of these apps to examine users' perceptions of app effects and to identify unintended consequences or harms to app users. The objective of this secondary, mixed-methods study was to explore app users' perceptions of the interventions' effects.

METHODS:

A convenience sample of 806 pregnant individuals aged 18+ who voluntarily downloaded a free, proprietary FMA completed a survey, including open- and closed-ended items in four survey sections: app engagement, perceived efficacy of the app raising awareness of fetal movements, health behaviors and diagnoses, and pregnancy and birth outcomes. We conducted a thematic analysis of the responses of the 299 participants who answered open-ended questions and triangulated themes with app user data (DMU IRB-2021-17).

RESULTS:

Four major app effects were reported by users: reduced prenatal anxiety and increased parent/family–fetal bonding, awareness of fetal movement, and health-seeking behavior in the presence of decreased fetal movement. Moreover, app user data suggested that these benefits were amplified by more consistent app use.

CONCLUSION:

Collectively, FMA users in this study associated app use with clinically significant prenatal outcomes and did not report that app use led to consequences or harm. From an institutional perspective, these findings may support health systems and prenatal providers who are investigating whether and how to integrate digital patient support modalities into prenatal care and are seeking evidence to support decision-making.
The Natural History of Fetal Triploidy in an Era of Limited Abortion Access: A Case Series [ID: 1380133]
Authors: Moustafa Ahmed Zaki , Araji Sarah , Clericuzio Natalie , Frieson Danielle , Hendon Laura
Published: May 2023

INTRODUCTION:

Triploidy is a chromosomal abnormality that occurs in 1–3% of all conceptions and often results in early spontaneous miscarriage. It is exceedingly rare for a triploid fetus to survive to birth. Neonates usually die within hours to days after delivery. After the Dobbs v Jackson Women's Health Organization ruling in July 2022, access to abortion is becoming increasingly limited, and therefore providers should consider the adverse maternal health outcomes that can be associated with triploidy.

METHODS:

In this case series, we describe three cases of confirmed fetal triploidy that we encountered in our center within 1 year (2021–2022). All three cases were referred to us after House Bill 1259 was passed on July 1, 2020, in Mississippi banning termination of pregnancy based on race, sex, or genetic abnormality.

RESULTS:

Our first case is a 21-year-old patient referred at 19 weeks 2 days for abnormal second-trimester serum screen. Ultrasound showed an enlarged multicystic placenta and multiple fetal anomalies. Amniocentesis showed a 69,XXY karyotype. Patient was managed expectantly. At 21 week 5 days, patient was diagnosed with superimposed preeclampsia with severe features. Patient underwent medical termination of pregnancy. The second case is a 25-year-old referred at 30 weeks 0 days for concerns of fetal anomalies. Ultrasound confirmed multiple fetal anomalies. Amniocentesis showed a 69,XXY karyotype. Patient was diagnosed with preeclampsia and pulmonary edema and was delivered at 30 weeks 1 day. The neonate passed away at 22 days of life. Our third case is a 20-year-old referred at 24 weeks 0 days for abnormal aneuploidy screening. Ultrasound showed a major cardiac defect and severe fetal growth restriction. Amniocentesis showed a 69,XXY karyotype. Patient was managed expectantly. At 29 weeks 0 days, intrauterine fetal demise was diagnosed. Patient was diagnosed with peripartum depression.

CONCLUSION:

Women with pregnancies affected by fetal triploidy are at risk of developing preeclampsia. Restricting access to abortion will lead to increased maternal morbidity and mortality rates.
Stigma, Confidentiality, and Blame: Qualitative Focus Groups of Ghanaian Obstetric Providers After Maternal and Perinatal Losses [ID: 1377293]
Authors: Russell Colin , Beyuo Titus , Lawrence Emma , Oppong Samuel , Owusu-Antwi Ruth
Published: May 2023

INTRODUCTION:

Despite maternal and perinatal mortality disproportionately occurring in low- and middle-income countries, there are limited data on the emotional toll these losses have on obstetric providers. In a series of focus groups discussions (FGDs), this study delves into the experiences of physicians and midwives in Ghana after maternal and perinatal losses.

METHODS:

Participants were obstetrician/gynecologists and midwives at the two largest tertiary hospitals in Ghana. Five FGDs were conducted by a trained facilitator, using a semi-structured guide. Questions explored experiences after patient deaths and perspectives on supportive interventions for providers. FGDs were audio-recorded and transcribed verbatim. Using an iteratively developed codebook, transcripts were thematically analyzed with NVivo. Written informed consent and IRB approvals were obtained.

RESULTS:

Twenty obstetricians and 32 midwives participated in five FGDs in Accra and Kumasi, Ghana. Most providers (84%) had completed training, and almost half (46%) had been in practice for above 10 years. Three major themes emerged: 1) pervasive stigma about seeking mental health services, especially from psychiatrists, rooted in cultural norms; 2) skepticism about departmental and peer confidentiality if providers seek support after poor outcomes; 3) profound sense of blame, both from self and peers, that resulted in poor mortality audit attendance and effects on workplace performance. Despite numerous barriers, providers expressed a strong need for improved departmental and institutional support systems.

CONCLUSION:

This study uncovers key barriers for providers to access mental health care and support after experiencing maternal and perinatal mortalities. Findings should inform interventions to better support struggling providers.
Initiation of Oral Agents Versus Insulin as First-Line Therapy for Gestational Diabetes Mellitus [ID: 1360154]
Authors: Edwards Kayla , DeFranco Emily , Griffith Taylor , Masters Heather
Published: May 2023

INTRODUCTION:

Although the American College of Obstetricians and Gynecologists recommends insulin as first-line pharmacologic treatment for gestational diabetes mellitus (GDM) since 2017, use of oral agents as first-line remains common. This study aims to identify patient-level factors associated with choice of initial pharmacologic treatment of GDM with oral agents compared to insulin.

METHODS:

Case–control study of 617 patients with White's class A2 GDM treated at a single academic center in a comprehensive GDM treatment program, 2011–2018. Pregestational diabetes and GDM not requiring medication (A1 GDM) were excluded. Case group was GDM pregnancies treated with any oral agent first-line and control group was treated with insulin as first-line treatment. Logistic regression was performed to identify patient factors associated with oral agents as first-line pharmacologic treatment. Receiver-operator characteristic (ROC) curve estimated the ability of these factors to predict initial medication choice.

RESULTS:

Among those with GDMA2, 80% were started on an oral agent and 20% were started on insulin. Those started initially on oral agents were more likely to be Hispanic or non-Hispanic White, be non-English speakers, have private insurance, and have normal body mass index (BMI). Factors strongly associated with starting on an oral agent rather than insulin were Hispanic ethnicity, treatment initiated later in pregnancy (>28 weeks), normal BMI, and 1-hour glucose challenge test (GCT) greater than 200. The ROC derived from the adjusted logistic regression model found a predictive value of these variables for initiating oral agents of 79% (area under the curve 0.79).

CONCLUSION:

Patient-level factors are predictive of pharmacological agent chosen for first-line treatment of GDM. Factors that are typically associated with more difficult to control GDM, such as obesity, high values on the GCT screening test and earlier gestational age at diagnosis are more common in patients treated initially with insulin. However, some demographic factors such as Hispanic ethnicity and non-English primary language are more common among patients initiated on oral agents for treatment of GDM.
Timing of Fetal Growth Restriction Development in Patients With Preeclampsia [ID: 1363469]
Authors: Francis Matilda , Kawakita Tetsuya , Martins Juliana
Published: May 2023

INTRODUCTION:

Preeclampsia (PEC) and fetal growth restriction (FGR) share common pathophysiology of placental insufficiency. In pregnancies complicated by PEC, the incidence of FGR increases significantly. We sought to examine the timing of FGR development in patients with PEC.

METHODS:

This was a retrospective cohort study of patients with PEC and singleton pregnancy who delivered at 23 weeks or greater. Patients who had been diagnosed with FGR prior to PEC diagnosis, those who were diagnosed with FGR at the same time as PEC, and those who delivered immediately after PEC diagnosis were excluded. Demographics were compared between patients with FGR and those without FGR. We plotted Kaplan-Meier curves for the interval from the diagnosis of PEC to the development of FGR. A Cox proportional hazards model was used to estimate the adjusted hazard ratios (HRs) for FGR. Our IRB approved this analysis.

RESULTS:

Of 392 patients with PEC, 31 (7.9%) developed FGR. Compared to patients who did not develop FGR, patients who developed FGR were more likely to have early-onset PEC and lower maternal weight and were less likely to have gestational diabetes (P<.05). The incidence rate of FGR increased by 11.6% each week from the PEC diagnosis. Compared to patients with late-onset PEC, those with early-onset PEC had a significantly higher cumulative incidence of FGR (P<.01). The Cox proportional hazards model showed that early-onset PEC was associated with FGR (adjusted HR 4.12, 95% CI 1.19–14.33) compared to late-onset PEC.

CONCLUSION:

Patients with early-onset PEC had a significantly higher incidence of FGR compared to those with late-onset PEC. There was a high cumulative incidence rate of FGR in patients with early-onset PEC. Patients with PEC should be followed by serial fetal growth ultrasound.
Adverse Pregnancy Outcomes of Cervical Cerclage According to the Indications [ID: 1363547]
Authors: Kawakita Tetsuya , Nehme Lea
Published: May 2023

INTRODUCTION:

The objective of this study was to examine pregnancy outcomes of patients who underwent cervical cerclage according to cerclage indications.

METHODS:

This was a retrospective cohort study of patients with a singleton pregnancy who underwent cervical cerclage from 2014 to 2020 at a single academic institution. Patients were categorized according to cervical cerclage indications (history-indicated, ultrasound-indicated [cervical length 1–2.4 cm versus less than 1 cm], and physical exam indicated cerclage). Our primary outcome was spontaneous preterm delivery before 37 weeks of gestation. Outcomes were compared according to cervical cerclage indications. Multivariable logistic regression models were used to calculate adjusted odds ratios (aORs) and 95% CI, adjusting for a history of preterm delivery. Our IRB approved this analysis.

RESULTS:

Of 501 patients, 240 (47.9%), 115 (23.0%), 50 (10.0%), and 96 (19.2%) had a history-indicated, ultrasound-indicated (1–2.4 cm), ultrasound-indicated (<1 cm), and physical exam-indicated cerclage, respectively. Rates of preterm delivery were statistically different according to the indications. Compared to history-indicated cerclage, physical exam-indicated cerclage was associated with spontaneous preterm delivery (adjusted odds ratio [aOR] 3.97, 95% CI 2.27–6.97), preterm delivery (aOR 3.48, 95% CI 2.23–5.96), spontaneous preterm delivery less than 34 weeks (aOR 5.60, 95% CI 2.92–10.74), and neonatal demise or stillbirth (aOR 3.18, 95% CI 1.35–7.50). Compared to history-indicated cerclage, ultrasound-indicated cerclage (1–2.4 cm) was associated with preterm delivery (aOR 1.70, 95% CI 1.07–2.72) and neonatal intensive care unit (NICU) admission (aOR 1.81, 95% CI 1.11–2.96). Compared to history-indicated cerclage, ultrasound-indicated cerclage (<1 cm) was associated with spontaneous preterm delivery less than 34 weeks (aOR 2.46, 95% CI 1.02–5.94) and NICU admission (aOR 2.51, 95% CI 1.23–3.36).

CONCLUSION:

Compared to history-indicated cerclage, other cerclage indications were associated with increased odds of adverse pregnancy outcomes.
Neonatal Outcomes Associated With Personalized Text Messages for Diabetes Self-Management in Pregnancy [ID: 1373396]
Authors: Lester Lauren , Boerrigter Ashley , Gavard Jeffrey , Mostello Dorothea , Sakach Julia
Published: May 2023

INTRODUCTION:

The objective was to determine whether providing individualized text messages regarding diabetes management improved compliance with care and pregnancy outcomes.

METHODS:

Institutional review board committee approval was obtained for the study. Pregnant women with type 2 (T2) and gestational diabetes (GDM) were randomized into two groups. The “contact-control” group was enrolled in the Text4baby program, which provides nonpersonalized educational text messages throughout pregnancy. The intervention group (Text4diabetes) received individualized text messages regarding upcoming appointments, current insulin regimen, and encouragement to keep and submit glucose logs for review. The primary outcome is compliance (data not yet analyzed). This analysis assesses neonatal outcomes, including perinatal loss (>24 weeks), delivery gestational age (GA), arterial cord pH less than 7.1, 5-minute Apgar less than 7, large-for-gestational-age (LGA) status, need for glucose supplementation, intubation, and surfactant administration.

RESULTS:

One hundred forty-four women with T2 or GDM were randomized. Both groups had similar numbers of women with T2 diabetes (33% and 31%) and history of GDM in prior pregnancy (21% and 19%). The Text4diabetes group had fewer deliveries less than 35 weeks, fewer LGA infants, and fewer surfactant administrations. A composite of adverse neonatal outcomes, including LGA status, delivery less than 35 weeks GA, arterial cord pH less than 7.1, and need for surfactant administration, showed fewer adverse outcomes in the Text4diabetes group. No findings, however, reached statistical significance.

CONCLUSION:

Text messages aimed at improving compliance with diabetes care in pregnancy did not significantly affect neonatal outcomes. Correlation with compliance results is needed to see whether improved compliance improved neonatal outcomes.
Effect of the New Diagnostic Criteria of Fetal Growth Restriction on Obstetric and Neonatal Outcomes [ID: 1376466]
Authors: Ibirogba Eniola , Romero Vivian , Tsimis Michael , Wizner Casey
Published: May 2023

INTRODUCTION:

The diagnostic criteria of fetal growth restriction (FGR) was modified by the Society of Maternal-Fetal Medicine in 2020 to include both an abdominal circumference (AC) and estimated fetal weight (EFW) less than the 10th percentile as opposed to previous definition using only the EFW. We sought to evaluate the outcomes of this criteria modification.

METHODS:

This retrospective study compared the incidence, obstetrical and neonatal outcomes before (group 1, 2020) and after (group 2, 2021) the implementation of the modified diagnostic criteria at a single institution. This is an IRB-approved study.

RESULTS:

Of the 459 pregnancies with FGR included in this study, 100 were diagnosed in 2020 (group 1) and 359, in 2021 (group 2). An increase in the incidence of FGR was noted after the modification, 1.5% versus 5.3% (P<.05). Median gestational age (weeks) at delivery decreased from 38.1 (Q1, 37.1; Q3, 39.1) in 2020 to 37.4 (Q1, 36.1; Q3, 38.3) in 2021 (P<.05). There were no statistically significant differences in obstetrical outcomes. An increase in the frequency of respiratory distress syndrome was observed, 6 (6%) versus 51 (14.2%), P<.05, and median length of neonatal stay 2.0 (Q1, 1.0; Q3, 3.0) and 2.0 (Q1, 2.0; Q3, 12.0) in group 1 compared to group 2 (P<.05).

CONCLUSION:

The new diagnostic criteria for FGR is associated with increased incidence of diagnosis, neonatal respiratory distress, longer neonatal hospital admissions, and lower gestational age of delivery with no difference in obstetrical outcomes. It remains uncertain whether this modification will translate to improved outcomes, and larger multicenter prospective studies are needed.
Effect of Fetal Surgery on Maternal Mental Health [ID: 1376946]
Authors: Larish Alyssa , Betcher Hannah , Liseth Olivia , Moore Katherine , Schenone Mauro , Weng Jessica
Published: May 2023

INTRODUCTION:

Perinatal mental illness imparts a significant health burden. A multitude of factors are hypothesized to increase the incidence of perinatal mood and anxiety disorders (PMADs) in the fetal surgical population, including uncertain fetal prognosis and the inherent risks of surgery and preterm delivery. We sought to determine the disease course of PMADs in the fetal surgery population.

METHODS:

A retrospective chart review was conducted of fetal surgery patients from 2017 to 2021 at a tertiary care center. Demographics, surgical, obstetric, and psychiatric diagnoses were recorded. Standard descriptive analyses were performed.

RESULTS:

One hundred nineteen eligible patients were identified. Fetal surgery was performed at a median gestational age of 23.0 (range 16.0–34.0) weeks. Laser ablation of placental anastomoses (n=51) and in utero myelomeningocele repair (n=22) were the most common procedures. 26.8% (32/119) had preexisting mood disorders, with 59.3% (19/32) and 53.1% (17/32) on a baseline medication for depression or anxiety, respectively, prior to surgery. 26.4% (23/87) of patients without a history of anxiety or depression had a new diagnosis of PMAD. Two patients experienced suicidal ideation. 6.7% (8/119) and 10.1% (12/119) initiated a new psychiatric medication during or post-pregnancy, respectively. 19.8% (21/113) received a therapy referral. Among patients with baseline anxiety or depression, 62.5% (20/32) experienced an exacerbation postpartum with 25.0% (8/32) referred for therapy, and 34.3% (11/32) changing dose or medication for anxiety and 37.5% (12/32) for depression.

CONCLUSION:

Among patients undergoing fetal surgery, a high incidence of PMAD was identified. Most patients with prepregnancy anxiety or depression experienced an exacerbation postpartum. Further research into effective supportive interventions is warranted.
Where Is Communication Breaking Down? Narrative Tensions in Obesity-in-Pregnancy Clinical Encounters [ID: 1377560]
Authors: Dadouch Rachel , D'Souza Rohan , Kingdom John , Maxwell Cynthia , Parsons Janet , Windrim Rory
Published: May 2023

INTRODUCTION:

Health care professionals (HCPs) often view obesity in pregnancy as a condition associated with numerous adverse clinical outcomes and procedural difficulties. In contrast, patients characterize their challenges encountered because of stigma, their desire for a normal pregnancy, and may feel weight is overemphasized. The study's objective was to explore stories of patients and HCPs in tandem, in order to understand communication challenges within obesity-in-pregnancy clinical encounters.

METHODS:

Employing narrative inquiry, we conducted in-depth interviews with 16 patients and 19 HCPs. Stigma theory informed our research approach. Dialogical narrative analysis of interview transcripts was conducted.

RESULTS:

We identified five narrative tensions that contributed to communication challenges during clinical encounters. The first three tensions related to contrasting views on obesity: 1) obesity as a detriment to health versus acceptance of obesity; 2) a result of personal choice versus a result of uncontrollable circumstances; and 3) a regular pregnancy versus a high-risk diagnosis. Two further tensions related to characterizations of communication within the clinical encounter: 4) typical and problem-free versus a tremendously difficult clinical encounter; and 5) talking openly about obesity versus sidestepping the topic. How participants positioned themselves relative to prevailing societal discourses regarding obesity and being a “good” HCP/patient influenced these tensions.

CONCLUSION:

This study identified five narrative tensions and revealed specific areas where communication in the obesity-in-pregnancy clinical encounter is vulnerable to breaking down, accounting for the complexities in this interactive space. These findings can inform clinical practice and education and may be applicable to other clinical contexts.
Outcomes in Gestational Diabetes Stratified by Treatment With Oral Agents Only, Insulin Transition From Oral Agents, and Insulin Only [ID: 1378229]
Authors: Griffith Taylor , DeFranco Emily , Edwards Kayla , Masters Heather
Published: May 2023

INTRODUCTION:

Patients with gestational diabetes (GDM) requiring insulin after inadequate glycemic control on oral agents have increased rates of fetal macrosomia and neonatal intensive care unit admission compared to patients with insulin-only treatment. Our objective was to stratify additional GDM outcomes by treatment type.

METHODS:

Single-center retrospective cohort study of 617 patients with GDM, 2011–2018, excluding pre- and diet-controlled GDM. We stratified by treatment: oral agents (referent), transition to insulin from oral agents, and insulin only. Generalized linear modeling adjusted for group differences and biologically plausible covariates.

RESULTS:

Most patients were treated with oral agents only (74.5%), 7.1% changed to insulin, and 19.7% insulin only. Patients on oral agents only were more likely to be Black, Asian, or Hispanic/Latina race and ethnicity, non-English-speaking, lower body mass index (BMI), and later diagnosis. Insulin addition was significantly associated with increased hyperglycemia admissions and gestational weight gain (GWG), after adjusting for BMI, treatment initiation gestational age (GA), race and ethnicity, language, and insurance. Insulin transition was also significantly associated with increased cesarean delivery (CD) rate, after adjusting for age, delivery GA, parity, BMI, chronic hypertension, race and ethnicity, and insurance. To examine abdominal circumference (AC90) and estimated fetal weight (EFW90) above the 90th percentile, we adjusted for age, weight gain, parity, and race and ethnicity. Insulin use after oral agents increased risk of AC90, while insulin only decreased risk of EFW90.

CONCLUSION:

Oral agent failure was associated with excess GWG, admission for hyperglycemia, CD rate, and AC90. Insulin-only treatment was associated with decreased risk of EFW90, perhaps indicating identification of patients likely to fail oral agents could improve outcomes.
Accuracy of Endometrial Biopsy in Diagnosing Endometrial Polyps [ID: 1343431]
Authors: King Nathan , Goldfeld Ester , Mansuria Suketu , Wang Li
Published: May 2023

INTRODUCTION:

Endometrial polyps are commonly reported on endometrial biopsies, but accuracy remains uncertain. The purpose of this study was to determine the positive predictive value (PPV) of endometrial polyp findings on endometrial biopsy.

METHODS:

In this retrospective cohort study, we screened 1,403 patients with endometrial biopsies that indicated presence of endometrial polyp between 2010 and 2020. Patients with concurrent endometrial cancer were excluded. Of the remaining patients, 546 had a subsequent gold-standard (GS) procedure (440 with hysteroscopy and 106 with hysterectomy) and were enrolled. Pathology results of GS procedures were analyzed for confirmation of endometrial polyp, and hysteroscopy operative reports were reviewed to determine intraoperative polyp visualization.

RESULTS:

Of the 546 patients whose endometrial biopsy reported endometrial polyp, 391 had endometrial polyp confirmed on GS pathology for a PPV of 71.6% (95% CI 67.6–75.4). Of the 440 patients who had hysteroscopy, 351 had endometrial polyp on pathology for a PPV of 79.8% (95% CI 75.7–83.4). Only 292 of the 440 hysteroscopy patients, however, had a polyp visualized by the surgeon, for a PPV of 66.4% (95% CI 61.7–70.8) when based on operative findings. Patients with a polyp on GS pathology were more likely to be postmenopausal (P=.001), have obesity (body mass index >30) (P=<.001), diabetes (P=.015), and hypertension (P=.037). There was no difference based on patient race (P=.182), hormonal therapy use (P=.295), or tamoxifen use (P=.127). Patients with thicker endometrial linings on ultrasound were more likely to have a polyp on GS pathology (P=.002), but uterine cavity length did not affect the PPV (P=.415).

CONCLUSION:

Endometrial biopsy correctly predicted the diagnosis of endometrial polyp in 72% of cases based on subsequent GS procedures, with the remaining 28% being false positives. Endometrial biopsy was more likely to accurately diagnose endometrial polyps in patients who were postmenopausal, had certain comorbid conditions, and had thicker endometrial linings.
Determinants of Patient No-Shows in a Multisite Urogynecology Clinic [ID: 1376316]
Authors: Miranne Jeannine , Courtepatte Alexa , Minassian Vatche , Schatzman-Bone Stephanie
Published: May 2023

INTRODUCTION:

The objective of this study was to describe sociodemographic and clinical characteristics of patients who “no-show” urogynecology appointments and identify risk factors for “no-show” appointments.

METHODS:

We conducted an IRB-approved prospective chart review study of women aged 18 years or older scheduled for a urogynecology appointment at four outpatient clinical sites associated with an urban academic tertiary care referral center over 4 months. Patients were included in the no-show group if they did not show up for their appointment or cancelled their appointment the same day. For a comparison group, the patient immediately prior to or after the one who “no-showed” with the same visit type was included. Logistic regression was used to identify risk factors for “no-show” appointments.

RESULTS:

Four hundred twenty-six women were included, 213 in both the no-show and show groups. Women who “no-showed” were younger (median age 60 [interquartile range (IQR) 47–72] versus 69 [IQR 59–78], P<.001). More women in the no-show group were Hispanic (24.4% versus 13.1%) and non-Hispanic Black (7.51% versus 3.76%, P=.0093), had Medicaid (17.4% versus 6.57%, P=.0006), no-showed a previous appointment (24.9% versus 11.7% P=.0005), had to wait longer for an appointment (median 39 days [IQR 23.5–55.5] versus 30.5 days [IQR 12.8–47.0], P=.002), and made appointments for urinary incontinence (44.1% versus 26.8%, P=.0002). On multivariate logistic regression, women with Medicaid had significantly higher odds of “no-showing” their appointment (adjusted odds ratio, 2.11 [1.04–4.48], P=.0440).

CONCLUSION:

Women with Medicaid are particularly likely to “no-show” urogynecology appointments. Further research is needed to identify and address potential barriers this group faces when accessing care.
Improving Care After Sexual Assault: A Needs Assessment for a Standardized, Patient-Centered Educational Resource [ID: 1377465]
Authors: Lepore Christina , Bechtel Kirsten , Choi Jennie E. S. , Gawel Marcie , Griggs Susan , Pathy Shefali
Published: May 2023

INTRODUCTION:

Prompt medical and psychiatric follow-up improves outcomes among survivors of sexual assault (SSAs). The American College of Obstetricians and Gynecologists recommends clinical and psychological follow-up within 1–2 weeks, yet only one-third receive such care within 1 year. In the setting of acute trauma, SSAs are unlikely to retain much information and discharge paperwork should be provided, including follow-up resources and patient education. Lack of standardization may result in wide variation of these handouts and negatively affect follow-up rates.

METHODS:

A retrospective chart review of discharge paperwork was performed of SSA patients presenting to a tertiary care emergency department from May to October 2022. Per World Health Organization guidelines for sexual assault (SA) follow-up, the elements evaluated included 1) acute SA treatment (human immunodeficiency virus, sexually transmitted infection, and pregnancy prophylaxis), 2) clinical and psychological follow-up resources, and 3) community resources for SSA. Institutional review board approval was obtained.

RESULTS:

A total of 39 SA handouts were evaluated. Only two-thirds (27/39) contained instructions regarding post-SA medications, 82% (32/39) included medical follow-up information, a quarter (10/39) included mental health resources, and one-third (13/39) included community resources.

CONCLUSION:

Timely follow-up after SA reduces patient morbidity. This initial needs assessment demonstrated a wide variation in completeness of discharge paperwork for SSA. As a result, a standardized handout was created, including a timeline of acute and long-term follow-up objectives and a comprehensive list of patient resources, which was incorporated into the electronic medical record system. This model can empower SSA to obtain follow-up care, improve outcomes, and address potential disparities in care.