bluuebunny/crossref_metadata_2025 huggingface dataset:
Investigating the Association Between Metabolic Syndrome and Adenomyosis [24B]
Authors: Hanson Frances K. , Kishan Raina , MacLeay Katelyn , de Riese Cornelia
Published: April 2020

INTRODUCTION:

Adenomyosis is characterized by endometrial tissue dispersed in the myometrium of the uterus, causing heavy menses and dysmenorrhea. As of today, there is no confirmed etiology, although associations with obesity have been documented. The objective of this study is to identify additional factors such as metabolic syndrome and to determine if there is an association with adenomyosis.

METHODS:

We performed a retrospective electronic chart review of pelvic ultrasounds and clinical charts to extract surrogate markers suggestive of metabolic syndrome such as weight, BMI, HbA1c, and serum lipid profile.

RESULTS:

Preliminary data analysis of 200 patient charts, with 100 patients in each of the control (CON) and adenomyosis (AM) groups, was performed. This analysis showed that there was a statistically significant difference in weight between the two groups, with the AM group having a BMI 3.62kg/m2 higher than those in the CON group. Prior pregnancy also presented as a statistically significant difference, with the AM group (85.9%) being more likely to have been previously pregnant compared to the CON group (60%). Our data did not show statistically significant differences between the two groups among the other markers of metabolic syndrome.

CONCLUSION:

Limitations to this study include sample size, retrospective nature of the study, and the impact of medications used to treat hypertension, hyperlipidemia, and/or diabetes on the development of adenomyosis. Additional analysis is currently being performed to exclude patients who are taking medication for comorbidities relating to metabolic syndrome in order to better understand the association between metabolic syndrome and adenomyosis.
National Trends and Outcomes of Obesity and Morbid Obesity Complicating Benign Hysterectomy [28B]
Authors: Mandelbaum Rachel S. , Matsuzaki Shinya , Klar Maximilian , Roman Lynda , Wright Jason , Matsuo Koji
Published: April 2020

INTRODUCTION:

Nearly 40% of women in the United States are obese, presenting unique challenges and considerations for gynecologic surgeons. We sought to examine trends and outcomes of benign hysterectomy in obese women.

METHODS:

A population-based retrospective study utilizing the National Inpatient Sample was conducted including benign total hysterectomies from 2001–2015 (N=2,680,788). Temporal trends of obesity, perioperative complications, and mortality rates were assessed with piecewise linear regression with log transformation. Pairwise propensity score inverse probability of treatment weighting with a generalized estimating equation was then used to estimate risk of perioperative complications and mortality.

RESULTS:

Of all women who underwent hysterectomy, 172,517 (6.4%) had Class I-II obesity and 83,513 (3.1%) had Class III (morbid) obesity. During the study period, Class III obesity increased from 0.6% to 6.4% (11.1-fold increase) and Class I-II obesity increased from 1.8% to 11.4% (6.5-fold increase) (both, P<.001). Compared to non-obese women, women with Class I-II (13.2% versus 11.0%, odds ratio [OR] 1.22, 95% confidence interval [CI] 1.18–1.27) and Class III (17.0% versus 11.0%, OR 1.40, 95% CI 1.34–1.47) obesity had significantly increased risk of perioperative complications. Mortality was increased two-fold in women with Class III obesity compared to non-obese women (0.06% versus 0.02%, OR 2.01, 95% CI 1.06–3.81). Over the study period, hysterectomy complication rates increased from 7.4% to 17.0% (2.3-fold increase, P<.001), and there was statistically non-significant increase in surgical mortality (0.01% to 0.03%, 2.4-fold increase, P=.052).

CONCLUSION:

Obesity, particularly morbid obesity, complicating benign hysterectomy has significantly increased in the United States and is associated with increased perioperative morbidity and mortality.
Quality of Life Results After 52 Weeks of Treatment With Linzagolix for Endometriosis-Associated Pain [30B]
Authors: Bestel Elke , Gotteland Jean-Pierre , Donnez Jacques , Taylor Robert N. , Garner Elizabeth I.
Published: April 2020

INTRODUCTION:

Linzagolix is a new investigational, non-peptide, oral GnRH receptor antagonist being developed to treat endometriosis-associated pain (EAP). The EDELWEISS trial was a Phase 2b, double-blind, randomized, placebo-controlled, multicenter, dose-ranging trial in USA and Europe evaluating once daily oral doses of 50, 75, 100 and 200 mg taken for up to 52 weeks. Subjects randomized to placebo were crossed over to 100 mg after 12 weeks and those randomized to 200 mg were crossed over to 100 mg after 24 weeks.

METHODS:

IRB approval was obtained. Participants were women with surgically confirmed endometriosis and moderate to severe EAP. Assessment of EAP included dyspareunia, non-menstrual pelvic pain, dyspareunia and dyschezia symptoms. Quality of life endpoints included the difficulty of doing daily activities, Patient Global Impression of Change/Severity (PGIC/S) and Endometriosis Health Profile-30 (EHP-30).

RESULTS:

327 patients were randomized and treated. Mean age was 32 years and mean BMI was 26. In the treatment groups receiving linzagolix 75 mg and above there were significant improvements compared to placebo in EAP symptoms as well as the EHP-30 domain scores, PGIC and difficulty of doing daily activities at 12 weeks. These improvements were maintained or increased after 52 weeks of treatment.

CONCLUSION:

Linzagolix doses of 75 to 200 mg taken once daily for 52 weeks significantly decreased EAP and improved quality of life in women with moderate to severe endometriosis-associated pain.
Relugolix Combination Therapy Reduced Uterine Fibroid-Associated Pain in Two Phase 3 LIBERTY Studies [32B]
Authors: Stewart Elizabeth A. , Lukes Andrea S. , Venturella Roberta , Li Yulan , Hunsche Elke , Al-Hendy Ayman
Published: April 2020

INTRODUCTION:

Currently, pain (menstrual and non-menstrual), is poorly studied in women with uterine fibroids (UF). Relugolix combination therapy (Relugolix-CT; once-daily relugolix 40 mg, estradiol 1.0 mg, and norethindrone acetate 0.5 mg) significantly improved UF-associated heavy menstrual bleeding in the two LIBERTY randomized phase 3 trials.

METHODS:

In the LIBERTY 1 and 2 Institutional Review Board-approved studies, a key secondary endpoint was the proportion of women with no/minimal pain (maximal pain score ≤1 on the 0–10 numerical rating scale [NRS] during the last 35 days of treatment) in the pain-evaluable population (women with maximum pain NRS ≥4 during the 35 days prior to randomization). Pain was also evaluated on menstrual bleeding and on non-menstrual days during the last 35 days of treatment. Treatment comparisons were performed in both studies and the pooled dataset using the Cochran–Mantel–Haenszel test stratified by baseline menstrual blood loss volume.

RESULTS:

After 24 weeks of treatment, a significantly greater proportion of pain-evaluable patients in the Relugolix-CT groups (43.1% and 47.1% in LIBERTY 1 and 2, respectively) had no/minimum UF-associated pain during the last 35 days of treatment compared with placebo (10.1% and 17.1%, respectively; P<.0001). The proportions of women with no/minimum dysmenorrhea and non-menstrual pain were significantly higher with Relugolix-CT (pooled data: 65.0% and 44.6%, respectively) vs placebo (19.3% and 21.6%, respectively).

CONCLUSION:

Over 24 weeks, once-daily Relugolix-CT reduced UF-associated pain, with a more pronounced effect on menstrual vs non-menstrual pain. Thus, Relugolix-CT improved two common symptoms (menstrual bleeding and pain) associated with UF.
State Level Treatment Differences in Heavy Menstrual Bleeding and Uterine Fibroids: Claims Analysis [33B]
Authors: Wang Alice , Wang Siting , Vora Jamie , Diamond Michael
Published: April 2020

INTRODUCTION:

Heavy menstrual bleeding (HMB) is one of the most common and bothersome symptoms among women with uterine fibroids (UF). There is no published data to illustrate treatment differences by state and diagnosis of UF and/or HMB.

METHODS:

Retrospective study based on Truven MarketScan® Commercial Claims Database over the period 2007–2017. Women age 18–51 years were grouped into three cohorts upon diagnosis: a. UF only (ICD-9 218.x or ICD-10 D25.x); b. HMB only (ICD-9 626.2 or 627.0, ICD-10 N92.0, N92.1 or N92.4); c. UF and HMB. Treatment type (medical, surgical, no treatment) in the 12 months post-diagnosis was examined descriptively for each cohort and state.

RESULTS:

Study population included over one million women diagnosed with UF and/or HMB. During the 12 months post-diagnosis, about one-third of women with both UF and HMB were untreated. National surgery rate among diagnosed patients was 52% in those with UF and HMB, 20% in HMB only and 18% in UF only. At state level, surgery rate among UF and HMB diagnosed women ranged 31% - 79%; the five states with the highest surgery rates were all in the West/Midwest, and four out of the five states with the lowest surgery rates were in the Northeast. Hysterectomies represented 67% of all surgeries nationally in UF and HMB; 31 states had hysterectomy rates higher than the national average, 35% of them were in the South.

CONCLUSION:

Surgery rates were the highest among women with UF and HMB. Treatment differences among the states were substantial.
The Use of Indocyanine Green to Identify Endometriosis Intraoperatively [34B]
Authors: Meram Mary , Bealer Anne Baker , Tam Teresa
Published: April 2020

INTRODUCTION:

The gold standard for diagnosis of endometriosis is a tissue biopsy. Endometriosis can be a debilitating cause of pelvic pain. Since symptoms can be nonspecific, presumptive diagnosis without tissue biopsy may be difficult. Recently, indocyanine green (ICG), a fluorescent dye that identifies vascular areas, has been used to help identify the vascular lesions of endometriosis, specifically the “clear” lesions that can easily be missed during surgery.

METHODS:

A retrospective chart review and data analysis was performed on patients upon whom ICG was used from July 2014 to January 2019. Preoperative symptoms, including abnormal uterine bleeding, pelvic pain, dyspareunia, and fibroids were analyzed using Fisher exact test. identification of “clear” lesions with ICG was analyzed using Fisher exact test.

RESULTS:

Of 56 patients who underwent laparoscopic excision of endometriosis with ICG, 46 with positive fluorescence had pathology-confirmed endometriosis; 10 had negative pathology with no ICG fluorescence and 10 had fluorescence but no endometriosis. This indicates a positive predictive value of 82% and a sensitivity of 100%. There was no statistically significant difference with preoperative symptoms. Clear lesions were identified using ICG in 100% of patients with endometriosis; however, there was no statistically significant difference when compared to patients without endometriosis.

CONCLUSION:

ICG dye utilization offered a diagnosis of endometriosis in 46 of 56 patients. ICG is safe, inexpensive, and may help physicians diagnose endometriosis. Additional patients should be recruited to add power to the data. A future research study could analyze the possible differences in uptake of ICG in different stages of endometriosis.
A Comprehensive Approach to Maternal Mortality and Disparate Racial Outcomes [02C]
Authors: Wilcox Wendy C. , James-Conterelli Sascha
Published: April 2020

INTRODUCTION:

New York State ranks 30th in the nation for maternal mortality despite over a decade of statewide efforts to address the crisis. Although there has been a decrease in overall maternal mortality, the disparity between black, non-Latina women and white women have dramatically increased. Black women are 3–4 times more likely to die relative to their white counterparts in New York State and 12–14 times more likely to die in New York City. In April 2018 Governor Cuomo's Task Force was convened to address the issues of maternal mortality and racial disparities. This multidisciplinary task force consisted of a diverse group of stakeholders with Wendy Wilcox, MD, MBA, MPH, FACOG and Sascha James-Conterelli, DNP, CNM, FACNM as co-chairs.

METHODS:

Global, national and statewide data on maternal mortality data was reviewed using published data from the Centers for Disease Control, New York State and New York City Department of Health. We examined early statewide efforts to decrease maternal mortality which focused solely on addressing clinical issues. We convened community Listening Sessions across New York State in the summer of 2018, as well as a Symposium on Implicit Bias and Racial Disparities in Obstetrical Care.

RESULTS:

A comprehensive approach was adopted to address pervasive issue of maternal mortality which remains high in New York State, as well as the increasing rate of racial disparity.

CONCLUSION:

The Maternal Mortality Task force crafted recommendations to focus on more inclusivity between physicians and midwives, including the voice of the patient and addressing racial and discrimination.
Abdominopelvic Compression for Obstetric Hemorrhage in Resource-Limited Locations [04C]
Authors: Kerr Nancy L. , Hauswald Mark , Tamrakar Suman R.
Published: April 2020

INTRODUCTION:

This quality improvement project evaluated obstetric hemorrhage patient outcomes following adoption of low cost simple pneumatic circumferential abdominopelvic compression devices.

METHODS:

Two resource-limited locations added low cost inflatable compression devices to their standard protocols for obstetric hemorrhage. Providers in small medical facilities in rural Nepal and Papua New Guinea used devices that incorporated either a bicycle tube or soccer ball to provide abdominopelvic pressure after all available routine treatments had failed. Data collected included obstetric event, etiology of bleeding, need for surgery, transfusion, transport, length of transports, maternal survival and complications.

RESULTS:

The device was used a total of 106 times: the soccer ball “Ball and Binder” device was used thirty-eight times; the prototype bicycle tube device was used sixty-eight times. Devices were used primarily after vaginal birth with atony, but also for obstetrical lacerations, miscarriages and post-abortion bleeding. In all cases the bleeding stopped promptly after inflation of the device. All 106 women survived, none required hysterectomy or abdominal surgery, and no complications were reported from device use. Only fifteen patients were transported to a referral hospital, primarily for blood transfusion.

CONCLUSION:

Obstetric hemorrhage was controlled after an abdominopelvic circumferential pressure device was applied after usual care had failed. This device provided an additional method for treatment in resource-limited settings with limitations in surgical, transfusion and transport capability.
Access and Barriers to Oral Health Care in Pregnancy [05C]
Authors: LaPorte Amanda , Roussos-Ross Kay , Villanueva Kara Mia , Goodin Amie
Published: April 2020

INTRODUCTION:

Despite ACOG recommendations regarding oral health and pregnancy, many women do not receive recommended oral health care during pregnancy. This study, conducted in conjunction with ACOG DXII Committee for the Healthcare of Underserved Women, evaluated barriers to access and use of oral health care services in pregnant women.

METHODS:

IRB approval was obtained. Between May and July 2019, consenting women admitted to the postpartum unit at UF Health were offered a survey about oral health care utilization during pregnancy. Enrollment occurred on a rolling basis. Descriptive statistics were calculated for all responses, with chi square analysis compared by insurer.

RESULTS:

Two hundred women participated. The majority were insured by Medicaid (54% Medicaid, 39% private, 3% government, 2% none, 2% no response). Most women (68%) reported that their insurance covered dental care. 50% of women reported seeing a dentist within the last year. 36% of women with Medicaid saw a dentist within the last year compared to 71% of women with private insurance (P<.001). The most common reasons for not receiving dental care within the last year were cost and only going when acute problems arise. Most women (75%) responded that seeing a dentist during pregnancy was “important.” 20% of women reported that their prenatal care provider made a recommendation regarding dental care.

CONCLUSION:

Many women are not receiving adequate oral health care during pregnancy and disparities exist among women by payer status. Increasing access to care and improving patient education regarding oral health is necessary to improve oral health care for pregnant women.
Adverse Maternal and Neonatal Outcomes in a Hispanic Population With Excessive Gestational Weight Gain [06C]
Authors: Robles Brittany N. , Ramirez-Barbieri Giovanna , Faustin Daniel
Published: April 2020

INTRODUCTION:

Women who are classified as severely obese at conception have increased risks of infant and maternal mortality, hypertensive disorders of pregnancy, gestational diabetes, large for gestational age infants, and cesarean delivery than non-obese women at conception.

METHODS:

We conducted a cross-sectional study, women with a singleton gestation, delivered at Wyckoff Hospital Medical Center from January 1 to December 31, 2017. BMI was categorized at their first prenatal visit. Gestational weight gain (GWG) were categorized as appropriate and excessive based on IOM guidelines. All mothers underwent a 1hr 50g glucose challenge test (GCT) at 28 weeks, if the GCT was abnormal (greater than 130 mg/dL), they were referred for a 3 hr 100g glucose tolerance test (GTT).

RESULTS:

Among 831 women, normal weight (n=269), overweight (n=263), and obese (n=299) mothers were found. Mothers were stratified by BMI, appropriate GWG were 25–35lbs for normal-weight (27.9%), 15–25 lbs for overweight (34.5%), and 11–20lbs for obese (24.5%). The prevalence of excessive GWG was 23.1%, 35.8% and 37.5% respectively for normal weight, overweight, and obese women. 61% of obese women with excessive GWG and 38% of obese women with normal weight gain were noted to have chronic hypertension (OR 1.1, 95% CI 0.3–4.2). A significant association were found between excessive GWG and an elevated 1 hr GCT in obese mothers (OR 0.4, 95% CI 0.16–1.016) and between obese mothers with excessive GWG and LGA birth weight (OR 2.3, 95% CI 1.15–4.97).

CONCLUSION:

Women with an abnormal initial pregnancy BMI that have an excessive GWG are at risk for adverse maternal and neonatal outcomes.
Examining Joint Effect of Race and Neighborhood Socioeconomic Disadvantage on Adverse Obstetric Outcomes [09C]
Authors: Hoppe Kara Kjersten , Harl Felicity , Lowry Alexa , Evans Linnea
Published: April 2020

INTRODUCTION:

The Area Deprivation Index (ADI) is a neighborhood-level index derived from census data to capture spatial socioeconomic status (SES). The primary objective was to assess the joint relationship between race/ethnicity and neighborhood disadvantage on obstetric outcomes at a single Midwestern- academic institution, situated in a city with high economic-segregation.

METHODS:

A retrospective cohort study of births at a single academic institution from 2016–2018 (n=10,442). Birth record data (preterm & low birth weight), and ICD-10 codes (hypertensive-disorders) were geocoded and linked to census-block group ADI. The relationship between race/ethnicity, ADI and outcomes were evaluated using multivariate logistic regression models.

RESULTS:

In models interacting race/ethnicity and ADI, racial/ethnic gaps vary greatly. At the lowest deprivation levels, compared to white women, black (OR 3.68, P<.001) and Asian women (OR 1.86, P<.05) were at greater risk for LBW, whereas at the highest levels of deprivation the differences were not significant, and Latinx women exhibited some advantage. Similar patterns are observed for PTB, with black women experiencing greater risk (OR 1.9, P<.10) at the lowest ADI, yet no increased risk at high ADI. Hypertensive disorders were greater among black and white women at all levels of ADI, compared to Asian and Latinx women (odds ratios range across low to high ADI for black women OR 2.41- 8.0, P<.01 and white women OR 1.90–6.0, P<.001).

CONCLUSION:

Racial/ethnic disparities in health are context dependent and should be examined in relation to neighborhood characteristics, perhaps allowing for better-tailored and targeted interventions.
Impact of Minority Races on Clinical Trials on Latency Antibiotics [12C]
Authors: Bailey Josianne , Davis-Nelson Shareece , Martin Courtney , Mason Danielle , Yao Ruofan , Chan Elena
Published: April 2020

INTRODUCTION:

Racial variations in response to therapy exist in many areas of medicine, as it must in obstetric practice. The objective of this study was to determine if the study populations in published literature on latency antibiotics (LA) in the treatment of preterm premature rupture of membrane (PPROM) were diverse enough to demonstrate a benefit for minority races.

METHODS:

This was a meta-analysis of literature published between 1995 and 2018 by searching PubMed using the keywords: antibiotics, preterm and ruptured membranes. Included studies were randomized clinical trials that identified the racial composition and delivery within 48 hours as an outcome of interest. Population level modeling was performed on the pooled result by recalculating the rate of outcome for each study if the rate of outcome of a particular race was the same between intervention and placebo arms. Pooled results that remain statistically significant after race specific adjustments suggest minimal influence from that particular race.

RESULTS:

There were 495 studies identified, 64 of which were clinical trials. Three studies reported racial composition of the study population and were included in the analysis. LA decreased risk of delivery within 24hrs (RR 0.80, 95% CI [0.67–0.94]). Race adjusted pooled result remained significant for white (RR 0.82, 95% CI [0.70–0.97]), black (RR 0.80, 95% CI [0.67–0.94]), Hispanic (RR 0.81, 95% CI [0.69–0.96]) and Asian (RR 0.79, 95% CI [0.67–0.93]).

CONCLUSION:

In studies on latency antibiotic use in PPROM, no individual race had a major influence on the pooled result based on studies that published population racial composition.
Impact of Minority Races on Clinical Trials on Magnesium for Neuroprotection [13C]
Authors: Chan Elena , Bailey Josianne , Davis-Nelson Shareece , Martin Courtney , Mason Danielle , Yao Ruofan
Published: April 2020

INTRODUCTION:

It is unclear if clinical trial populations are adequately diverse to address racial variations in response to therapy. The objective of this study was to determine if study populations in published literature on magnesium for neuroprotection were diverse enough to demonstrate a benefit for minority races.

METHODS:

This was a meta-analysis of randomized control trials found on PubMed using the search terms: “magnesium,” “neuroprotection,” and “cerebral palsy.” Trials that identified racial composition and risk of cerebral palsy as an outcome were included. Population-level modeling was performed on the pooled result by recalculating the rate of outcome for each study if the rate of outcome of a particular race was the same between intervention and placebo arms. Pooled results that remain statistically significant after race-specific adjustments suggest minimal influence from that particular race; a non-significant result suggests stronger influence from that race.

RESULTS:

There were 62 clinical trials identified. Review of these abstracts showed four studies that met the inclusion criteria. Magnesium decreased risk of cerebral palsy (RR 0.68, 95% CI [0.52–0.89]). Race adjusted pooled result remained statistically significant for Hispanic (RR 0.72, 95% CI [0.56–0.94]) and Asian (RR 0.68, 95% CI [0.52–0.88]), but not statistically significant for white (RR 0.91, 95% CI [0.71–1.16]), or black (RR 0.89, 95% CI [0.69–1.14]).

CONCLUSION:

In studies on magnesium for the neuroprotection, Hispanic and Asian races were underrepresented, whereas white and black races were major contributors.
Influence of Socioeconomic Status on Adverse Outcomes in Pregnancy [15C]
Authors: Pawar Deepraj , Sarker Minhazur , Caughey Aaron B. , Valent Amy M.
Published: April 2020

INTRODUCTION:

Lower socioeconomic status (SES) has been associated with adverse pregnancy outcomes. We determined whether ZIP-code level-based SES indicator was associated with adverse pregnancy outcomes.

METHODS:

Retrospective study of OHSU births from 2009–2014 compared adverse pregnancy outcomes among women living in 88 Portland metro-area ZIP-codes stratified into 3 median household income groups: Low (below 10th percentile), medium (10th-90th percentile), and high (above 90th percentile) socioeconomic status (SES). Perinatal outcomes were compared by univariate analysis; multivariable logistical regression determined strength of association of low and high SES with adverse outcomes (medium SES=reference group), adjusting for significant variables.

RESULTS:

Of 8,118 deliveries included, 1,654 (20%) were in low SES, 5,856 (72%) were in medium SES, and 608 (8%) were in high SES. Women in low SES were more likely to be younger, have higher BMI and tobacco use, and have less private insurance. Lower SES was associated with higher rates of preeclampsia (PEC) (9.02% vs 7.48% vs 5.93%, P<.028) and small for gestational age (SGA) (10.7% vs 9.34% v 6.61%, P<.012), and lower birth weights (mean 3,280 g vs 3,340 g vs 3,592 g, P<.001). High SES was associated with lower gestational diabetes mellitus (GDM) rates (10.8% vs 11.0% vs 7.58%, P<.036), even after adjusting for confounders (aRR high SES 0.710, 95% CI 0.507–0.995).

CONCLUSION:

In the Portland metro-area, low SES is associated with higher rates of PEC and SGA. High SES is associated with lower rates of GDM. ZIP-code level SES indicator detects perinatal outcome differences and may be useful for identifying healthcare disparities.
Patient Risk Factors for Postpartum Re-presentation for Evaluation [17C]
Authors: Smithson Sarah , Greene Naomi , Esakoff Tania
Published: April 2020

INTRODUCTION:

The objective of our study was to identify risk factors for postpartum readmission. We hypothesized that patients who re-present for evaluation have identifiable demographic and obstetric risk factors.

METHODS:

This retrospective cohort study was conducted at a large urban US medical center. Demographic and pregnancy data were extracted for all patients who delivered within the study window (2012–2018). Data was compared between patients who re-presented to the emergency department (ED) for evaluation within the first 30 days following discharge from their delivery admission versus those that delivered within the study window but did not re-present for reevaluation.

RESULTS:

A total of 45, 342 women delivered within the study window. 1089 women re-presented for reevaluation (2.4%). Results from univariate analyses offer support for the idea that women who re-presented were more likely to be black or Latina, obese, have public insurance, prefer a language other than English, require an interpreter, and less likely to have a partner. They were also more likely to be primiparous, deliver preterm, by cesarean, and with admission to the NICU. A longer length of stay was significantly associated with re-evaluation, even when broken down by delivery type. Race, delivery method, gestational age, BMI, parity, and length of stay remained significant after adjusting for all other factors in a multivariable analysis.

CONCLUSION:

There are several identifiable demographic and obstetric risk factors for re-presentation following discharge after delivery. This has implications as to how we may optimize postpartum counseling and follow up to decrease readmission rates in groups at higher risk.
Racial and Ethnic Disparities in Perinatal Process Measures [20C]
Authors: Dwyer Erin , Souter Vivienne , Sitcov Kristin , Painter Ian
Published: April 2020

INTRODUCTION:

Racial disparities in obstetric outcome measures have been demonstrated in numerous studies. Disparities in process measures have yet to be subject to the same observation. This study aims to assess the magnitude of racial and ethnic disparities in perinatal process measures in a U.S. birth cohort.

METHODS:

A retrospective cohort study was conducted involving 58,280 singleton births (01/2017–3/2019) at 17 hospitals in the Northwest US. Process measures included antenatal steroids for births <34 weeks, late-preterm steroid administration for late preterm (34+0–36+6 weeks) births, timely treatment of severe hypertension, episiotomy, and prophylactic antibiotics for 3rd/4th degree laceration. Unadjusted odds ratios and 95% CIs were calculated by race or ethnicity, using white as the reference group.

RESULTS:

Compared to white women, Hispanic women were less likely to receive late preterm steroids if they delivered at 34–36 weeks (OR 0.56; 95% CI 0.44–0.71) and antibiotics for a 3rd/4th degree laceration (OR 0.48; 95% CI 0.25–0.92). Hispanic and African-American women were more likely to receive timely treatment for severe hypertension (OR 1.64; 95% CI 1.24–2.19 and OR 1.51; 95% CI 1.01–2.26, respectively). Nulliparous vaginal births in Asian/Pacific Islander women were more likely to have an episiotomy (OR 1.51; 95% CI 1.27–1.81). Antenatal steroid administration for births <34 weeks was similar across racial groups.

CONCLUSION:

This study demonstrates that disparities exist in obstetric process measures. A better understanding of why these disparities exist and their relation to outcome disparities is needed.
Racial Differences in Substance Use During Pregnancy and Neonatal Birth Measurements [22C]
Authors: Gottula Jessica , Thomas Megan , Devaiah Ganga , Lambers Donna , Dhanraj Dave
Published: April 2020

INTRODUCTION:

Illicit drug use during pregnancy causes changes in neonatal growth parameters that are associated with neurodevelopmental outcomes and childhood chronic diseases. This study aims to describe racial differences in substance use and birth measurement outcomes.

METHODS:

A retrospective study of singleton births from August 2013 through December 2014 was conducted using urine drugs screen collected universally at the initiation of prenatal care. Excluded were multiple gestations and preterm deliveries. Reported are substance use patterns and race (Caucasian, African American, and Asian) as well as mean neonatal birth measurements (head circumference, birth length, and birthweight).

RESULTS:

2,270 patients met study criteria. There was a significant difference in birthweight between Caucasians, Asians and African Americans at baseline without substance use (3,386 g, 3,338 g and 3,181 g respectively, P<.001). However those with substance use had no significant difference in birth measurements seen between races. Infants of Caucasian mothers with substance use were noted to have significantly smaller birthweights compared with Caucasian nonusers (3,386 g vs 3,191 g, P<.001). Whereas infant birthweights of African American mothers with substance use were not different from African American nonusers (3,181 g vs 3,170 g, P=.738). Of the 117 Asians screened in the study, there were no substance users.

CONCLUSION:

Our study addresses the racial differences of drug use during pregnancy and its effect on neonatal growth measurements at birth. Substance use impacts overall birthweight in Caucasian substance users but not African Americans. Efforts should be taken to describe substance use patterns by race and its effect on neonatal growth outcomes long term.
Racial Disparities in Postpartum Hemorrhage in a Community Hospital: A Retrospective Cohort Analysis [24C]
Authors: Sabato Emily , Gobern Joseph , Meske Sam , Buckley Meghan
Published: April 2020

INTRODUCTION:

Nationwide Inpatient Sample data from 2012–2014 shows significantly higher risks for postpartum hemorrhage (PPH) for black women. As accumulating evidence raises the question about racial disparities in obstetric outcomes, we aimed to assess disparities in the prevalence of PPH at our community healthcare system.

METHODS:

This retrospective cohort study included deliveries at one of Main Line Health System's four acute care hospitals between May 1st, 2018 and May 1st, 2019. PPH was defined as a cumulative estimated blood loss (EBL) of greater than or equal to 1,000 milliliters. The primary outcome was incidence of PPH among racial groups (white, black, Asian, other). Multivariable logistic regression was used to assess the relationship between race and PPH, while controlling for age, ethnicity, gestational age, multiple gestations, gravidity, parity, obesity complicating pregnancy, chronic and pregnancy-related hypertensive disorders, and gestational diabetes.

RESULTS:

6,517 deliveries from 6,390 mothers were analyzed. 74% of mothers identified as white, 15% black, 8% Asian, and 3% other. Compared to white and Asian mothers, black mothers were significantly younger and had higher rates of obesity complicating pregnancy, chronic hypertension, and having a cesarean section. The rate of PPH was significantly higher in black mothers (9.7%) compared to white (6.2%) and Asian (4.4%) mothers (P<.001). After controlling for delivery characteristics, the odds of black mother's having PPH was 1.96 and 2.46 times greater than white and Asian mothers, respectively.

CONCLUSION:

Even after controlling for risk factors associated with PPH, black mothers at our community hospital are nearly 2 times more likely to experience hemorrhage.
Racial Disparities in the Risk for Preterm Birth as a Function of Maternal Age [25C]
Authors: Gulersen Moti , Grunebaum Amos , Bornstein Eran , Chervenak Frank
Published: April 2020

INTRODUCTION:

We sought to investigate the impact of maternal age on the risk for preterm birth (PTB) and whether it is affected by maternal race.

METHODS:

This retrospective cohort study utilized the US Live Birth database from the CDC for the years 2016–2017. Nulliparous women with in-hospital, singleton PTBs between 22–37 weeks of gestation were eligible for analysis. Exclusion criteria included fetal anomalies and maternal hypertension and/or diabetes complicating pregnancy. Maternal race was characterized as non-Hispanic white (NHW), non-Hispanic black (NHB), Hispanic and Asian. The rate of PTB was calculated among each racial group across all maternal ages. Chi-squared analysis was used to compare the prevalence of PTB per maternal age across the different racial groups.

RESULTS:

The cohort included 199,643 PTBs. Of those, 102,815 (51.5%) were NHW, 37,844 (19%) were NHB, 44,472 (22.3%) were Hispanic and 14,512 (7.2%) were Asian. Across all racial groups, the rate of PTB is higher at the extremes of maternal age, with the highest risk occurring in women >35 years old (P<.05). The difference in PTB rates between NHB and all other racial groups increased as a function of age (P<.05).

CONCLUSION:

The rate of PTB is higher in the extremes of maternal age for all races. At each maternal age interval, a racial disparity in PTB rates exists and increases as maternal age increases. Clinicians should be aware of this disparity in the risk of PTB and the impact of extremes of the maternal age when counseling patients during pregnancy.
Risk Factors Affecting Rising Rate of No Prenatal Care in US Births Between 2012–2016 [27C]
Authors: Gregory Emily J. , DeFranco Emily
Published: April 2020

INTRODUCTION:

To describe changes in rate of no prenatal care (PNC) in US between the years 2012–2016, and identify patient demographic and maternal medical risk factors for receiving no PNC.

METHODS:

Case-control study of US live births between 20–42 weeks gestation using vital statistics birth records. We analyzed maternal sociodemographic factors and medical characteristics as risk factors. Logistic regression estimated the influence of factors on outcome of no PNC, as indicated on the US birth certificate. No prenatal care was defined by having 0 visits prior to delivery.

RESULTS:

The frequency of births to mothers with no PNC increased each year during the study period, from 1.36% to 1.58%, P<.001. The rate of no PNC was highest among mothers with low maternal education level, Medicaid insurance and maternal hepatitis C (rates 2–5% and adjusted odds >2.2). Maternal black race, unmarried, and tobacco use were also significant risk factors (adjusted odds ratio >1.4).

CONCLUSION:

The rate of no PNC in the US has risen in recent years, 2012–2016. Women with factors that are associated with increased risk for adverse pregnancy outcome are those most likely to have no PNC. Public health initiatives should focus educational efforts on the importance of prenatal care to minimize risk of adverse pregnancy outcomes. Programs aimed to increase access to prenatal care in at-risk pregnancies should be developed to address the increase in no PNC in the US.
Cervical High-Grade Precancer Standard of Care Effectiveness and Safety Outcomes—A US Retrospective Cohort Study [40E]
Authors: Hughes Katherine Carlson , Herring Timothy A. , Twyman Mark , Bhuyan Prakash K.
Published: April 2020

INTRODUCTION:

Clinical management of cervical high-grade squamous intraepithelial lesions (HSIL) has lowered cervical cancer incidence rates. However, cervical HSIL surgical treatment is associated with lesion recurrence and adverse outcomes, including pre-term birth. This population-based study reports cervical HSIL standard care effectiveness and safety outcomes.

METHODS:

From a health insurance claims database of 4% of the US population, we derived a retrospective study cohort of women aged 18+ years with claims for biopsy-confirmed cervical HSIL from 2008 to 2018. The cohort was divided into those initially managed with treatment (TX), watchful waiting (WW), and who began WW but were subsequently treated (ie, delayed-treatment, DTX). Women with available data were classified as HPV-16/18 positive vs. negative.

RESULTS:

Sixty five thousand five hundred twenty-seven women with cervical HSIL comprised the cohort. Among those, 72% received TX initially, while 28% were managed by WW. Among those managed with WW, 22% had DTX. Consistent with guidelines, women in WW tended to be younger than treated women (mean age 32.2 versus 34.5 years) and were more likely to have pregnancy history within six months preceding diagnosis (6% versus 3%). HPV-16/18 status is available for 2% of the cohort—among such women who also had WW, 35% of HPV-16/18 positive and 18% of HPV-16/18 negative received DTX.

CONCLUSION:

This large cohort will add beneficial information to enable assessment of effectiveness and safety outcomes associated with cervical HSIL standard care management. Ongoing analyses will assess several outcomes, including cervical HSIL recurrence, HPV clearance, pre-term birth, and perinatal mortality, comparing management and HPV genotypes.
Pregnancy Outcomes and Anxiety in Nulliparous Women [30E]
Authors: Gimbel Lauren A. , Blue Nathan R. , Allshouse Amanda A. , Gimbel Bruce , Silver Robert R.
Published: April 2020

INTRODUCTION:

Maternal anxiety affects 20–35% of pregnancies. Both untreated anxiety and its medical therapy are associated with adverse pregnancy outcomes; however, data are mixed and limited. We examined pregnancy outcomes in women with treated and untreated anxiety in a well-characterized cohort.

METHODS:

An IRB approved secondary analysis of the NuMoM2b study, a prospective multi-center cohort of nulliparous women that included study visits each trimester and postpartum. Anxiety was assessed at 6w0d-13w6d using the State Trait Anxiety Inventory (STAI-T). Women were divided into three groups: anxiety and medical treatment, anxiety and no medical treatment, and no anxiety (controls). The primary outcome was a composite of preterm birth, abruption, hypertensive disorders of pregnancy, and small for gestational age. Potential confounders were adjusted for using multivariable logistic regression.

RESULTS:

Among 8,292 eligible women, 23.9% (n=1983) had anxiety; 311 were treated medically. The composite outcome occurred more often in women with untreated anxiety than controls (28.6% vs 25.9%, P=.02), with no difference between treated anxiety and controls (27.7% vs 25.9%, P=.5). The primary outcome increased across STAI-T score deciles (P<.009). After adjustments for confounders there were no differences in the primary outcome among groups, although untreated anxiety was associated with more neonatal intensive care unit stays >48 hours.

CONCLUSION:

Anxiety occurred in almost a quarter of nulliparas. Although untreated anxiety is associated with increased perinatal morbidity, other factors likely contribute. Treated anxiety was not associated with a change in perinatal outcomes. Given the frequency, the relationship between anxiety, associated factors, treatment and perinatal outcomes warrants further research.
Sociodemographic, Psychiatric, and Obstetric Predictors of Breastfeeding [35E]
Authors: Reed Caroline M. , Michopoulos Vasiliki , Joyner Andrea B.
Published: April 2020

INTRODUCTION:

Despite having been linked to numerous benefits for both mother and child, many women do not initiate breastfeeding postpartum. The current study aims to identify sociodemographic, psychiatric, and obstetric predictors of self-reported breastfeeding at the postpartum visit.

METHODS:

Pregnant women of all gestational ages (n=238) were recruited at Grady Memorial Hospital in Atlanta, GA, through the Grady Trauma Project. IRB approval was obtained for the study. Trauma exposure, depression, and PTSD symptoms were assessed. Data were abstracted from the medical record regarding prenatal care, delivery outcomes, perinatal complications, and breastfeeding.

RESULTS:

In the current sample, 32.4% reported breastfeeding and 67.6% reported bottle-feeding (formula). African American women (P=.021) and women with less education (P=.024) were less likely to breastfeed. Increased breastfeeding was associated with increased gravidity (P=.003), prior preterm births (P=.004), prior abortions (p less than 0.001), APGAR score at 5 minutes (p less than 0.001), NICU admission (p less than 0.001), estimated blood loss at delivery (p less than 0.001), delivery complications (p less than 0.001), number of triage visits (P=.013), and admissions from triage (P=.019).

CONCLUSION:

Our results indicate that more adverse perinatal and prenatal factors are predictive of greater breastfeeding. This may be due to increased interaction with providers in a hospital setting, or increased confidence in breastfeeding ability due to success in prior pregnancies. However, the rate of women who breastfeed was significantly below the national average (83.2%) and standards set for Healthy People 2020 breastfeeding goals. Provider education may be key to improving likelihood of successful breastfeeding initiation.
Using Machine Learning and Electronic Health Records to Predict Postpartum Depression [38E]
Authors: Zhang Yiye , Joly Rochelle , Hermann Alison , Pathak Jyotishman
Published: April 2020

INTRODUCTION:

Postpartum depression (PPD) affects 1 in 7 women with devastating effects when untreated. To improve compliance with screening recommendations, we used data from patient electronic health records (EHRs) and developed machine learning (ML) algorithms to identify women at high risk of developing PPD who can be preemptively screened.

METHODS:

We performed a retrospective study using the EHR data from an academic medical center in New York City (NYC) between January 2015 and June 2018. ML algorithms were applied to calculate the risk for PPD at 12, 18, 24, and 30 weeks of pregnancy gestation, and to compare with real life development of PPD. The algorithms were further validated using the EHR data from the NYC Clinical Data Research Network (NYC-CDRN) between 2004–2017.

RESULTS:

Mental Health history and active symptoms, marital status, race, use of beta blockers and antihistamines, and the number of ED visits were among the most predictive features. A total of 15,97 deliveries in the WCM and 53,92 deliveries in the NYC-CDRN were included. The highest area under the curve (AUC) was 0.93 with a sensitivity of 0.83 ad specificity of 0.96. The AUC computed using NYC-CDRN data was 0.853, with the sensitivity at 0.84 and 0.77.

CONCLUSION:

Our study validates ML algorithms to predict the risk of developing PPD based on information in the EHR. Our ongoing work is focused on using this approach to facilitate patient-provider communication and decision-making.
Marijuana Use in Pregnancy: Does the High Make You High Risk? [20E]
Authors: Chang Kristie , Guise David , Daggy Joanne , Haas David , Shanks Anthony L.
Published: April 2020

INTRODUCTION:

To identify adverse pregnancy outcomes associated with marijuana use during pregnancy.

METHODS:

We conducted a secondary analysis of the prospective cohort study, “Nulliparous Pregnancy Outcomes Study: monitoring mothers-to-be” (nuMoM2b), which recruited 10,038 nulliparous women with singleton pregnancies from eight U.S. medical centers. Information regarding marijuana use was obtained using direct questionnaires during in-person interview. The composite adverse outcome included stillbirth, hypertensive disorders of pregnancy, preterm birth, and small-for-gestational-age births. Secondary outcomes assessed neonatal morbidity, specifically examining neonatal intensive care unit admission, respiratory distress syndrome, neonatal sepsis, and neonatal death. Other secondary outcomes included mode of delivery and suspected intrauterine fetal growth restriction.

RESULTS:

Marijuana use during pregnancy was identified in 1.3% of the nulliparous women with singleton pregnancies. Marijuana users during pregnancy were found to have an increased risk of the composite adverse outcome compared to nonusers (27.6% vs 20.4%; P=.049) with an increase small-for-gestational-age births (16.6% vs 9.5%; P=.021). After adjustment for age, BMI, race, and chronic hypertension, marijuana use was not associated with the composite adverse pregnancy outcome (adjusted odds ratio 1.27; 95% CI 0.84–1.89).

CONCLUSION:

Maternal marijuana use is potentially associated with an increased risk of composite adverse pregnancy outcome of stillbirth, hypertensive disorders of pregnancy, preterm birth, and small-for-gestational-age births. However, the association was not significant when controlling for possible confounders. Future studies should focus on biologic evidence of marijuana consumption as compared to self-report.