bluuebunny/crossref_metadata_2025 huggingface dataset:
Impact of Lactation Consultation on Breastfeeding Rates in Women With Gestational Diabetes [14D]
Authors: Griffin Laurie , Kole Martha Brown , Ding Jia Jennifer , Lord Megan , Has Phinnara , Werner Erika
Published: April 2020

INTRODUCTION:

For women with gestational diabetes (GDM), breastfeeding can decrease type II diabetes risk; however they often face barriers to breastfeeding success, which may be addressed by lactation consultations. We sought to determine if lactation consultation during postpartum hospitalization was associated with breastfeeding success at three months post-partum in women with GDM.

METHODS:

Six hundred patients diagnosed with GDM by either the Carpenter-Coustan criteria or a 1-hour glucose challenge result over 200 mg/dl were prospectively enrolled. Patients completed surveys about infant feeding during their delivery hospitalization and at 3 months post-partum. For this secondary analysis, data regarding lactation consultations were extracted from the electronic medical record. Demographics and self-reported breastfeeding rates were compared between women with GDM who did and did not receive lactation consultations during their postpartum hospitalization.

RESULTS:

Complete data were available for 575 (96%) pregnancies of the cohort. Inpatient lactation consultations were completed for 444 (77%). Women who received lactation consults were more likely to report any breastfeeding attempts post-partum (82.2% vs 69.5%, P=.002) or exclusive breastfeeding at hospital discharge (37.7% vs 21.4%, P=.001) compared to women who did not receive lactation consultation. At the three months post-partum lactation consultation was associated with continued breastfeeding (87.8% vs 78.2%, P=.01) and exclusive breastfeeding (22.5 vs 13.5%, P=.03) among women who at least attempted breast feeding in the hospital.

CONCLUSION:

Among women with GDM, inpatient lactation consultations during the immediate postpartum period are associated with improved rates of breastfeeding and therefore may be a useful tool to decrease DM risk in this high-risk population.
Weight Retention and Risk of Pregnancy-Associated Hypertension in Subsequent Pregnancy [40D]
Authors: Franco Stephanie , Kawakita Tetsuya , Ghofranian Atoosa , Thomas Alexandra , Downs Sarah
Published: April 2020

INTRODUCTION:

We sought to examine the rate of pregnancy-associated hypertension according to weight gain between pregnancies among obese women.

METHODS:

This was a retrospective cohort study of all women who had at least two pregnancies at 23 weeks' gestation or greater at a single academic institution. Women with prepregnancy body mass index (BMI kg/m2) less than 30 kg/m2 in the first pregnancy, a history of chronic hypertension, or pregestational diabetes in the first pregnancy were excluded. Women were stratified based on weight change between pregnancies. Our primary outcome was the rate of pregnancy-associated hypertension (gestational hypertension or preeclampsia). A multivariable logistic regression analysis was performed to calculate adjusted odds ratios (OR) and 95% confidence intervals (95% CI), controlling for predefined covariates.

RESULTS:

Of 1,046 women, 248 (23.7%), 453 (43.3%), and 345 (33.0%) had weight loss (BMI>2 kg/m2), stable weight (BMI change -2 to +2 kg/m2), and weight gain (BMI>2 kg/m2), respectively. Women with weight gain compared to those with stable weight were more likely to have pregnancy-associated hypertension (14.5% vs. 7.1%; adjusted OR 1.96 [95% CI 1.20–3.22]). Women with weight loss compared to those with stable weight had a similar rate of pregnancy-associated hypertension (2.1% vs. 7.1%; adjusted OR 0.96 [95% CI 0.52–1.78]).

CONCLUSION:

In our cohort of obese multiparous women, weight gain was associated with increased odds of pregnancy-associated hypertension compared to a stable weight.
Implications of Decreasing Insulin Requirements for Diabetes in Pregnancy: A Systematic Review [15D]
Authors: Prior Alexandra , Jain Venu
Published: April 2020

INTRODUCTION:

Increased insulin resistance is a known physiologic change of pregnancy. For patients with gestational or preexisting diabetes being treated with insulin therapy, insulin requirements are expected to steadily increase throughout pregnancy. In a small subset of patients, insulin requirements decrease in the third trimester. It is felt by some practitioners that this clinical change is indicative of placental insufficiency, although current evidence is limited and conflicting.

METHODS:

A search strategy was developed to identify studies that compared maternal and neonatal outcomes in women with insulin-dependent diabetes who experienced a decrease in insulin requirement against those with insulin requirements that did not decrease in the third trimester. A systematic review was then carried out using MEDLINE, EMBASE, Cochrane Library, EBSCOHost CINAHL, Scopus, WOS Core Citation Indexes, Biosis Citation Index and Proquest Dissertations & Thesis Global databases.

RESULTS:

1514 studies were identified using the search strategy, and 21 were selected for full-text review. Data extraction from these studies is ongoing.

CONCLUSION:

There are currently no guidelines to inform management of insulin-dependent diabetes in pregnancy when insulin requirements drop. However, this clinical scenario is often considered to be an indication for increased surveillance and/or delivery. This review will help clarify whether the additional surveillance of such patients is warranted, and may aid in the development of future guidelines regarding the management of such patients.
Incidence of Abnormal Glucose Values Following Delivery in Women With Gestational Diabetes [18D]
Authors: Swor Erin C. , Armijo Gabrielle , Ramos Gladys A. , LaCoursiere D. Yvette
Published: April 2020

INTRODUCTION:

Limited evidence guides the immediate postpartum (PP) management of gestational diabetes (GDM). Protocols vary from universal, selective, or not screening glucose levels after delivery. We assessed the incidence of PP hyperglycemia, treatment, and risk factors for diabetes medications at discharge.

METHODS:

An IRB-approved retrospective cohort study of all women with GDM delivering at a large academic medical center that employs universal PP screening between Jan 2015-Nov 2017 was conducted to assess PP blood glucose (BG) levels and treatment.

RESULTS:

1039 women were included (GDMA1 n=509, GDMA2 n=503, GDMA2 vs T2DM n=27). Only 14% of women had 1 or more episodes of PP hyperglycemia (BG greater than 180 mg/dl). PP hyperglycemia increased with intensity of antepartum glucose management (1 or more elevated values: 11% diet, 17% oral medications, 22% insulin; p 0.01). Total daily insulin dose at admission was associated with increasing PP hyperglycemia (P=.015). Hyperglycemia was associated with non-white race (OR 1.53, 95% CI 1.0–2.3) and diabetes severity (GDMA2 OR 1.59, 95% CI 1.1–2.3; GDMA2 vs T2DM OR 11.14, 95% CI 4.8–25.9) and inversely associated with Cesarean delivery (OR 0.44, 95% CI 0.3–0.7) 20 women (1-GDMA1, 13 -GDMA2, 6-GDMA2 vs T2DM) were discharged on hypoglycemic medications.

CONCLUSION:

Only 1 in 7 women with GDM had immediate PP hyperglycemia. Universal PP screening resulted in evaluating over 1000 women to identify very few who were ultimately discharged on medications. GDM type and total insulin dose are strong predictors of those at risk. These findings should inform in-hospital screening protocols for postpartum GDM management.
Geographic Distribution of Medicaid-Claimant OB-GYNs Approved to Prescribe Buprenorphine for Opioid Use Disorder [15E]
Authors: Nguemeni Tiako Max Jordan , Culhane Jennifer , Meisel Zachary F.
Published: April 2020

INTRODUCTION:

High incidences of opioid use disorder (OUD) during pregnancy and neonatal abstinence syndrome (NAS) are manifestations of the U.S. opioid epidemic. Buprenorphine is an effective treatment for OUD, but with restricted access due to prescribing barriers. Neonates with in-utero buprenorphine exposure have milder NAS symptoms and shorter hospital stays. We sought to describe the geographic distribution of buprenorphine-approved obstetrician-gynecologists (ob-gyns).

METHODS:

To identify buprenorphine-waiver status and geographic location, we linked the Drug Addiction Treatment Act buprenorphine-waived provider list to the Centers for Medicare & Medicaid Services Physician Compare dataset, and extracted all physicians of the specialty “obstetrics and gynecology.” We obtained state NAS data from state agencies' reports, and classified counties based on rural-urban continuum codes.

RESULTS:

Out of 31,211 obgyns who treat patients with Medicaid insurance, only 1.8% (560) can prescribe buprenorphine. Only 292 out of 3220 counties have at least 1 buprenorphine-approved ob-gyn. Among the 292, 76.4% (223) are metropolitan, 23.6% (69) are non-metropolitan. All 10 states with the highest opioid overdose deaths rates have at least 1 buprenorphine-approved ob-gyn (2 to 48). West-Virginia and Maine, however, have the highest NAS rates (50.6 and 80 per 1000 births respectively, compared to 8 nationally), but each have only 4 buprenorphine-approved ob-gyns.

CONCLUSION:

Buprenorphine is a mainstay and guideline-recommended treatment for OUD in pregnancy. The geographic distribution of buprenorphine-approved ob-gyns in the US is variable and does not reflect the incidence of NAS. Policy and educational interventions could improve buprenorphine access during pregnancy to limit the opioid epidemic's impact on maternal-fetal outcomes.
Antepartum Edinburgh Depression Score: Implications for Postpartum Care [04E]
Authors: Zornberg Giselle Z. , Lyall Melinda , Ramos Gladys A. , Herrero Tiffany , LaCoursiere D. Yvette
Published: April 2020

INTRODUCTION:

Depression is a common complication that impacts perinatal outcomes. There is a paucity of literature investigating associations between an elevated Edinburgh Depression Score (EDS) 10 or greater and treatment (pharmacologic and behavioral) on postpartum visit adherence and contraception.

METHODS:

A retrospective cohort study of women with a singleton liveborn delivery who were screened antenatally using the EDS between 2010 and 2016 was performed. Primary outcomes were postpartum visit attendance within 12 weeks and contraception use. Secondary outcomes included contraceptive choice and effect of treatment on outcomes. Institutional Review Board approval was obtained for this study.

RESULTS:

1,730 patients underwent antenatal EDS screening, and 619 (36%) had an elevated EDS. Women with an elevated EDS were more likely to be black, have higher parity, have a history of depression, or a history of drug or tobacco use. After controlling for potential confounders, women with an elevated EDS had decreased postpartum visit attendance (adjusted OR (aOR) 0.75, 95% CI 0.57–0.98, P=.03) and increased contraception use (aOR 1.37, 95% CI 1.01–1.86, P=.04), specifically with higher sterilization rates (aOR 2.13, 95% CI 1.38–3.27, P=.001). The magnitude of both postpartum visit nonattendance and sterilization rates increased with increasing EDS. Psychotherapy, but not antidepressant use, was associated with improved postpartum visit attendance, especially among those without prior diagnosis of depression (71.5% vs 92.9%, P=.03).

CONCLUSION:

Antenatal depressive symptomatology is associated with postpartum visit nonattendance and higher sterilization rates, with effect sizes modulated by symptom severity. Treatment with psychotherapy may improve postpartum visit attendance among women with depressive symptoms.
Assessment of Anxiety and Depression During Prolonged Antepartum Admission [05E]
Authors: Peterson Jessica , Koelper Nathanael , Srinivas Sindhu
Published: April 2020

INTRODUCTION:

To determine the prevalence of depression and anxiety on the inpatient antepartum unit, the impact of length of stay, and provider screening patterns.

METHODS:

Prospective cohort of women admitted to the antepartum inpatient unit for >1 week. The Patient Health Questionnaire (PHQ2) and The Hospital Anxiety and Depression Scale (HADS) were given at admission and weekly. Patients also took a survey about perceived screening patterns.

RESULTS:

36 patients were screened from 12/2018 to 4/2019. 13 were admitted to the antepartum unit for >1 week. 46.7% and 7.7% initially screened positive on the HADS and the PHQ2 respectively. After one week, 6/7 that initially screened positive on the HADS continued to screen positive and 30.8% of patients screened positive on the PHQ2. 47% of patients reported they were assessed for mood disorders daily. After discharge, 9 patients (64%) attended their postpartum visit, 6 were screened for mood disorders (66.7%) and 2 endorsed depressive symptoms (33.3%). Of the 2 patients who endorsed depressive symptoms, 1 screened negative while admitted and 1 had screened positive. 25 providers took a survey about their screening habits. 32% of providers reported screening weekly, an equal proportion reported never screening.

CONCLUSION:

Nearly half of the women screened had a positive initial screen on the HADS and continued to screen positive. Inpatient screening patterns varied widely and most patients did not have close interval follow-up. A standardized screening method and short interval follow-up is needed to better treat these women who are at high risk for mood disorders.
The Impact of Maternal BMI on Adverse Perinatal Outcomes in Shoulder Dystocia [36D]
Authors: Thayer Sydney Marie , Owens Sarah N. , Garg Bharti , Caughey Aaron B.
Published: April 2020

INTRODUCTION:

Increasing BMI is associated with higher risk of shoulder dystocia (SD), but is it associated with other adverse perinatal outcomes (APOs) in the setting of SD? We sought to investigate this association.

METHODS:

This is a retrospective cohort study of singleton, non-anomalous, term vaginal deliveries complicated by SD between 2007–2011 using linked vital statistics and ICD-9 data. Neonatal outcomes included brachial plexus injury (BPI), clavicular fracture (CVF), 5-min-APGAR <7, neonatal intensive care unit admission (NICUa), and composite of severe neonatal outcomes (neonatal seizure, APGAR score ≤3, neonatal death). Maternal outcomes included postpartum hemorrhage (PPH), 3rd/4th-degree perineal lacerations (PLs), and maternal blood transfusion (MBT). Chi-square tests were used to compare rates of APOs among BMI categories. Multivariable logistic regression was used to control for diabetes status, race/ethnicity, age, education, insurance status, parity, and prenatal care.

RESULTS:

In a cohort of 21,489 births complicated by SD, we found statistically significant increasing rates of BPIs, CVFs, 5-min-APGAR <7, NICUa, and composite severe neonatal outcomes with rising maternal BMI. Incidence of PLs decreased significantly with increasing maternal BMI. Rates of PPH and MBT were not significantly different between groups. After controlling for confounders, there remained a statistically significant increase in odds of BPI, CVF, and NICUa (aOR 2.35, 1.59, and 1.26 respectively) and decreased odds of PLs (aOR 0.69, 95% CI 0.56–0.84) in obese women.

CONCLUSION:

Higher maternal BMI increases risk of complications in the setting of SD. Providers should exercise heightened awareness of the effect maternal BMI has on these potential outcomes when managing pregnancies complicated by SD.
Effect of a Health System Sponsored Mobile App on Perinatal Health Behaviors [13E]
Authors: Vartanian Keri , Rinaldi J.B. , Pieper Kevin , Jellison Trina
Published: April 2020

INTRODUCTION:

The increasing popularity of pregnancy mobile applications raises the need for prenatal apps to include evidence-based content. We aimed to assess the potential for a health system-sponsored mobile app to improve health outcomes and increase healthy behaviors by providing personalized and reliable health information on pregnancy, postpartum recovery, and infant care.

METHODS:

The study took place over 18 months at the Providence St. Joseph Health system in Portland, Oregon. Our sample included women who received prenatal care at a Providence clinic and had a live birth at a Providence hospital. We compared a treatment group (app users) and a control group (non-app users) using a self-reported health behavior survey and outcomes data from electronic medical records. Providence Health and Services IRB approved this study.

RESULTS:

We enrolled 167 women in the treatment group and 400 in the control group. Compared to non-app users, app users had greater odds of breastfeeding beyond 6 months postpartum and of exercising three or more times per week during pregnancy. They also had lower odds of missed prenatal appointments. There was no significant impact of app use on nutritional measures or clinical outcomes, including premature births, low birth weight babies, and neonatal intensive care unit stays.

CONCLUSION:

The use of a prenatal mobile app and access to personalized, evidence-based health information was associated with an increase in certain healthy behaviors, while there was no impact on clinical health outcomes. More research is needed to determine the impact of mobile prenatal apps on pregnancy and infant outcomes.
Vitamin Deficiency After Bariatric Surgery and Pregnancy Outcomes [39D]
Authors: Harrison Rachel K. , Braun Emilie , Semons-Booker Kia , Lak Kathleen , Cruz Meredith , Wlodarczyk Katarzyna
Published: April 2020

INTRODUCTION:

Women after bariatric surgery are frequently vitamin deficient. We sought to identify how vitamin deficiencies impact pregnancy outcomes in women with a history of bariatric surgery.

METHODS:

IRB approval was obtained. Clinical, demographic, and pregnancy information was collected on 158 women with a prior bariatric surgical procedure. Pregnancies were stratified by presence or absence of vitamin deficiency as per their medical record. Maternal and neonatal outcomes were analyzed via univariable and multivariable analyses.

RESULTS:

Among 158 women who met inclusion criteria, 102 (64.6%) were identified as vitamin deficient. There was no difference in maternal age, race/ethnicity, nulliparity, or pre-bariatric surgery weight when comparing women with and without vitamin deficiency. Vitamin deficient women had lower early pregnancy body mass index (BMI) (34.2±7.4 vs 37.0±8.0 kg/m2, P=.033), had a history of primarily malabsorptive procedure (86.7% vs 58.9%, P=.001), took supplements plus prenatal vitamins (85.3% vs 57.5%, P=.001), and had anemia at the time of delivery (59.4% vs 38.2%, P=.012). In univariable analysis, there were no differences in rates of preterm delivery, cesarean delivery, gestational diabetes, pregnancy-related hypertension, a composite maternal outcome, birth weight, large-for-gestational age, small-for-gestational age, or a composite neonatal outcome. These findings persisted in multivariable analysis after controlling for confounding factors.

CONCLUSION:

Pregnant women with vitamin deficiency after bariatric surgery were more likely to have undergone a primarily malabsorptive procedure, had lower BMI in pregnancy, and had higher rates of anemia at the time of delivery. They otherwise did not have worse maternal or neonatal outcomes compared to women without a vitamin deficiency.
Comparison of Preterm Birth Rates in Patients Treated With Methadone or Buprenorphine for Opioid Use Disorder [09E]
Authors: Gonzalez-Brown Veronica M. , Battin Megan , Walker Erin , Danzo Megan , Brown Morgan , Rood Kara M.
Published: April 2020

INTRODUCTION:

Standard therapy for opioid use disorder (OUD) has been medication assisted treatment (MAT) using Methadone (MMT) or buprenorphine. Several studies have noted an increased risk of preterm birth (PTB) in women on methadone versus buprenorphine, but do not separate spontaneous or provider-initiated preterm birth. We aim to compare rates and types of PTB among pregnancies in women with OUD on MAT at our institution.

METHODS:

This is a retrospective cohort analysis of mother–neonate dyads with OUD on MAT who received prenatal care and delivered at a single academic institution from July 2013 to June 2018. All women in this study either received buprenorphine/naloxone (SUB) or MMT therapy during their antepartum and intrapartum care. Preterm birth was defined as delivery <37 weeks gestation. Frequencies were compared using chi-square. Multivariable analysis was used to control for possible confounders.

RESULTS:

We identified 718 mother–singleton neonate dyads, 22% of the cohort were treated with methadone and 78% with SUB. Overall preterm birth rate was 21.7% (156/718). MMT group had higher rates of PTB compared to SUB group (30.4% vs 19.2%, P=.003), that remained significant after controlling for smoking and history of prior preterm birth (aOR 1.84; 95% CI 1.24–2.74). However, there was no difference between rates of spontaneous PTB.

CONCLUSION:

In our cohort of OUD pregnant patients on MAT, the risk of overall PTB was increased in patients receiving MMT in pregnancy. However, our data suggests that this difference is only significant in provider-initiated PTB and that spontaneous PTB rates are similar between MMT and SUB.
Opioid Use After Cesarean Delivery in a Community Hospital Setting [25E]
Authors: Curro Valerie , Pardanani Setul
Published: April 2020

INTRODUCTION:

The opioid epidemic is a serious public health concern that currently affects approximately 2 million Americans. Since cesarean sections are one of the most common surgeries performed in the United States, there have been many studies looking at opioid prescription practices. Prescribing patterns of opioids after cesarean vary widely and there is little information regarding normative patterns of practitioners. This study aims to assess our opioid prescribing practices after cesarean delivery at our hospital.

METHODS:

This is a prospective cohort study including women between the ages of 18–50 years old who underwent cesarean section. Data was collected through chart review and phone call follow-up after hospital discharge to determine the amount of opioid and oral NSAID medication used during both inpatient stay and after discharge, the number of narcotic pills leftover if applicable, pain score and activity level.

RESULTS:

59 patients were included, 13 were lost to follow-up, and 1 declined participation. 50% of participants had leftover pills, 38% percent never filled a prescription, and 12% percent consumed all pills. One patient required an additional narcotic prescription. Of the six different OB GYN practices, the number of narcotic pills prescribed ranged from 6 to 30 tablets.

CONCLUSION:

Narcotic use in the hospital can predict narcotic use at home in the first one to two weeks postoperatively. Most patients had unused narcotic pills. Prescribing practices at Stamford Hospital are highly varied among practitioners. Data from our study will help to standardize prescriptions for postoperative pain management after cesarean delivery.
Association Between Maternal Obesity Class, Adherence to Labor Guidelines and Perinatal Outcomes [04D]
Authors: Stafford Irene A. , Moustafa Ahmed S. Z. , Berra Alexandra , Spoo Lauren , Burgess Angela
Published: April 2020

INTRODUCTION:

Although there is evidence to suggest that obese women with a BMI ≥40 experience increased rates of perinatal complications, there is limited data concerning rates of these complications compared to women with other BMI classes when guidelines for the safe prevention of the primary cesarean delivery are applied. The aims of this study were to determine labor guideline adherence by BMI class and to compare perinatal outcomes across BMI classes with guideline adherent labor management.

METHODS:

This study included low risk women with a singleton, term pregnancy admitted in active labor or undergoing induction between May 2014 and April 2017 after the prevention of the primary cesarean delivery guidelines were implemented at our center. Patients were identified using an institutional IRB approved database. All demographic and perinatal outcomes were recorded. Women with prior hysterotomy and cesarean for non-reassuring fetal status were excluded.

RESULTS:

13,029 women met criteria. Guideline adherence decreased with increasing BMI, with 96% adherence among women of normal weight (BMI>18.5–25) compared to 81% for class III obese women (P<.05 adjusted for race, parity, neonatal weight and age). When guidelines were followed, there was no difference in rates of infectious morbidity or a maternal composite outcome including blood transfusion (P=.96, .48, .84 respectively). Although newborns of women with class III obesity had higher rates of meconium (P<.05), a composite of neonatal outcomes was not different with increasing maternal BMI (P=.60).

CONCLUSION:

With guideline adherence, there were no differences in adverse perinatal outcomes with increasing BMI.
Using Tailored Opioid Prescribing to Reduce the Number of Opioid Tablets Prescribed Following Cesarean Delivery [39E]
Authors: Dayaa Joseph , Straube Lacey , Webster Carolyn , Stuebe Alison , McKenzie Christine
Published: April 2020

INTRODUCTION:

Our project aim was to evaluate the effect of a tailored opioid prescribing (TLP) algorithm on the number of opioid tablets prescribed at hospital discharge after cesarean delivery.

METHODS:

The number of tablets to prescribe was determined by multiplying the number of opioid tablets used in the 24 hours before discharge by 5. If no opioids were used, up to 5 tablets were recommended. TLP was introduced through a series of PDSA cycles between November 2018 and April 2019. Outcome measures included opioid tablets prescribed, opioid use in the 24 hours prior to discharge, and patient satisfaction. Outcome data were compared from August to October 2018 (pre-implementation) and June to August 2019 (post-implementation). IRB approval was waived.

RESULTS:

During the pre-implementation (N=342) and post-implementation (N=305) periods, the median prescription tablets at discharge was 20 (IQR 20, 30) and 5 (0, 15) (P<.0001), respectively. The median opioid use 24 hours prior to discharge was 10 (0, 25) and 0 (0, 15) mg of oxycodone (P<.0001), respectively. The proportion of patients who did not use opioids in the 24 hours before discharge was 36.5% and 50.8% (P<.0001), respectively. The proportion of patients who were not prescribed opioids at discharge was 7.9% and 34.8% (P<.0001), respectively. Inpatient pain scores and patient satisfaction did not differ.

CONCLUSION:

TLP reduced the number of opioid tablets prescribed and increased the number of patients who were discharged without an opioid prescription. A tailored prescribing algorithm based on inpatient opioid use is an effective strategy to reduce excess opioid prescribing.
Differences in Birthweight With Gestational Diabetes and Thyroid Disease, Compared to Gestational Diabetes Alone [08D]
Authors: Hussain Farrah N. , Schneider Emily , Feldman Kristina M. , Chu Lam Melissa T. , Rosenn Barak , Brustman Lois
Published: April 2020

INTRODUCTION:

Diabetes and thyroid disease are the most frequent endocrine pathologies seen in pregnancy. The metabolic stresses of pregnancy and associated carbohydrate intolerance places patients with hypothyroidism at additional risk of developing GDM. There is no data on how concurrent thyroid disease and GDM can affect neonatal birthweight. Our hypothesis was that women with concurrent GDM and hypothyroidism would have larger birthweight neonates.

METHODS:

IRB approved retrospective case-control study of 240 singleton pregnancies between August 2015 and August 2019. Patients with GDM and hypothyroidism were compared to BMI-matched controls with GDM alone in a 1:2 ratio. Baseline characteristics were similar. The primary endpoint was comparison of birthweight. T-tests, Wilcoxon rank-sum tests, and Chi-squared tests were used as appropriate.

RESULTS:

There were 80 patients with GDM and hypothyroidism compared to 160 patients with GDM only. In third trimester, patients were euthyroid with no additional titration of thyroxine, and GDM was treated with a goal average glucose of <105 mg/dL. Mean birthweight in the GDM with hypothyroidism group was 3316.2 g (SD 446.4 g), compared with 3229.4 g (SD 486.8 g) in the GDM alone group. This difference was not statistically significant (P<.2).

CONCLUSION:

There was no significant difference in neonatal birthweight between patients with GDM and hypothyroidism versus GDM alone. Although not statistically significant, there was an absolute difference of 86.8 g in the mean birthweight of neonates between these groups. Further prospective study with larger sample sizes and varying glycemic and metabolic control is warranted.
An Elevated Fasting GTT Doesn't Increase Adverse Outcomes Compared With Other GTT Elevations [03D]
Authors: Satti Mohamed A. , Mackeen A. Dhanya , Young Amanda J. , Paglia Michael J.
Published: April 2020

INTRODUCTION:

To determine if an isolated elevated fasting blood sugar (FBS) has an increased risk for adverse maternal and neonatal outcomes compared to isolated elevated values at 1, 2, or 3 hours on the glucose tolerance test (GTT).

METHODS:

A retrospective cohort study of pregnant women who completed a GTT between 23–32 weeks, had an isolated elevation of one of the GTT results and delivered from 7/12–6/18 was performed. The composite primary maternal outcome included preeclampsia, cesarean, operative vaginal delivery, and perineal lacerations. Composite neonatal outcome was calculated as a secondary outcome. Sensitivity analyses of obese patients were performed.

RESULTS:

Nine hundred and nine women met inclusion criteria: 252 had an elevated FBS and 657 had a non-fasting isolated GTT elevation. There were clinically non-significant differences in race, age, BMI and nulliparity between the groups; outcomes were adjusted for these variables. The primary outcome did not differ between groups. APGAR <7 was higher with an elevated FBS (9.1% vs 2.6%, P<.01); there were no differences in other neonatal outcomes. In obese patients, there were no differences in composite maternal or neonatal outcomes. APGAR <7 was higher in those with an elevated FBS (13.4% vs 3.3%, P<.01) as was neonatal hyperbilirubinemia (10.6% vs 5.6%, P=.01).

CONCLUSION:

There are no significant differences in maternal/neonatal composite outcomes between isolated abnormal FBS on GTT compared to other isolated elevations, regardless of obesity status. In obese women, there was a higher incidence of APGAR <7 and neonatal hyperbilirubinemia in the group with elevated FBS on GTT.
Diagnosis of Postpartum Depression in Women With Prolonged Antenatal Admission [11E]
Authors: Berra Alexandra , Palmer Grace , Davis Beth R. , Sangi-Haghpeykar Haleh , Stafford Irene A.
Published: April 2020

INTRODUCTION:

The prevalence of postpartum depression is approximately 10%. Antepartum depression has been associated with greater maternal stress during the postpartum period. There is a paucity of research concerning length of antenatal admission, reason for admission and subsequent postpartum depression scores as measured by the Edinburgh Postnatal Depression Score (EPDS) screening tool.

METHODS:

After Institutional Review Board approval, all pregnant women who were admitted to the antepartum unit from September 2017 to August 2018 at our center were identified and corresponding obstetric and demographic variables and EPDS scores were recorded. Women with postpartum EPDS scores greater than or equal to 10 were identified as having postpartum depression. Number and length of antepartum admissions, and reason for admission were compared among women with and without postpartum depression. Chi square testing was used for analysis.

RESULTS:

Of the 239 women with antenatal admissions, 50 met criteria for the diagnosis of postpartum depression (20.9%). This is a statistically significant difference when compared to the national average as reported by the CDC (10%; p less than 0.0001). There was no significant difference among depressed women with respect to length of antepartum admission (P=.79) or reason for antepartum admission (P=.71).

CONCLUSION:

Women with any antepartum admission are at increased risk of postpartum depression. It is important that all women with an admission prior to delivery are screened in the early postpartum period for signs and symptoms of depression. Women who are admitted to the antepartum unit may benefit from psychologic assessment at the time of admission.
Pregnancy Outcomes Among Class 3 Obese Women With Normal Early Glucola [31D]
Authors: Mitchell Courtney , Dillon Jacquelyn , Ellet Tressa , Siegel Anne , Dotters-Katz Sarah K. , Denoble Annalies
Published: April 2020

INTRODUCTION:

ACOG recommends early screening for glucose intolerance in obese women, who are at increased risk of insulin resistance. We aimed to assess the risk of developing GDM based on the value of a normal early 50g oral glucose challenge test (GCT).

METHODS:

Retrospective cohort of non-anomalous singleton pregnancies with maternal BMI ≥40 at one institution, 2013–2017. Pregnancies with multiple gestation, late entry to care, type 1 or 2 diabetes, and missing diabetes-screening information are excluded. Primary outcome was development of GDM. Secondary outcomes include fetal growth restriction, fetal macrosomia, gestational age at delivery, large for gestational age, delivery BMI, total pregnancy weight gain, labor induction, shoulder dystocia, and cesarean delivery. Bivariate statistics compare demographics, pregnancy complications and delivery characteristics of women with early GCT >100 and women who with early GCT 101–134. Regression models used to estimate odds of primary outcome.

RESULTS:

Of 169 women, 66 (39%) had an early GCT <100, and 103 (61%) had an early GCT of 101–134. Women with low normal eGCT were more likely to use recreational drugs (P=.03). Other baseline demographics did not differ. The rate of GDM was low in this population (5.3%), with no difference in the rate of GDM between women with a low normal eGCT and high normal eGCT (P=.9). The median neonatal birthweight was higher in the normal GCT group as compared to the low GCT (P=.03).

CONCLUSION:

Among women with class 3 obesity, the specific value of an early normal GCT was not predictive of developing GDM by the third trimester.
Pregnancy Outcomes for Patients With Excessive Gestational Weight Gain Stratified by Class of Obesity [33D]
Authors: Oliva Mariana , Sipe Bradley , Odibo Linda , Odibo Anthony O.
Published: April 2020

INTRODUCTION:

Excessive gestational weight gain (EWG) increases risk of large for gestational age (LGA) neonates, hypertensive disorders of pregnancy and cesarean delivery. There is limited data on EWG in the obese population. We aim to compare pregnancy outcomes among obesity classes in women with EWG.

METHODS:

This is a secondary analysis from a prospective study of pregnant women undergoing fetal growth assessment. Obese participants were sorted into cohorts of adequate gestational weight gain (AWG) and EWG as defined by the Institute of Medicine guidelines. The groups were further stratified by class 1, class 2, and class 3 obesity (BMI 30–34.9, 35–39.9, >40 respectively). The primary outcome was LGA neonates. Secondary outcomes included: hypertensive disorders of pregnancy, gestational diabetes (GDM), preterm delivery (PTD), composite adverse neonatal outcomes (CANO, including neonatal ICU admission, neonatal death, seizures, intraventricular hemorrhage, respiratory distress syndrome, necrotizing enterocolitis, and pH <7.10) and small for gestational age (SGA) neonates. Chi-square tests were used to compare outcomes between the cohorts when stratified by class of obesity.

RESULTS:

405 obese women were identified, of which 256 experienced EWG and 68 experienced AWG. Among all obese women, EWG was not associated with LGA (P=.35), GDM (P=.12), CANO (P=.75), gestational hypertension (0.87), preeclampsia (P=.68), PTD (P=.91), or SGA (0.21). When stratified by class of obesity there were no differences in the primary or secondary outcomes.

CONCLUSION:

EWG among obese women was not associated with increased risk of LGA, CANO, GDM, PTD, hypertensive disorders of pregnancy and SGA regardless of obesity class.
Reducing Outpatient Opiate Utilization in the Postpartum Period [32E]
Authors: Conroy Meredith , Altman Alan , Marcotte Michael Paul , Mincarelli Delores , Holbert Michael , Crisp Catrina C.
Published: April 2020

INTRODUCTION:

The United States is experiencing an epidemic of opiate-related deaths with rates continuing to rise. The majority of postpartum women use only half of opioid tablets prescribed at discharge, and 95% of women do not dispose of excess medication by the postpartum visit. This offers an opportunity to modify physician prescribing habits during the postpartum period.

METHODS:

This is an IRB approved retrospective study at a single, high-volume tertiary healthcare system over four years from January 1, 2015, to December 31, 2018. Women were excluded if they received methadone or buprenorphine during the inpatient postpartum period. The primary outcome was morphine milligram equivalents (MME) prescribed at discharge and within 21 days of discharge.

RESULTS:

Among vaginal deliveries, there was a significant reduction in prescribed MME from 109.4 mg in 2015 to 5.5 mg in 2018 (P<.0001), with an increase in the percentage of patients with no opioids prescribed at discharge or in the immediate postpartum period from 29.5% in 2015 to 93.1% in 2018 (P<.0001, OR 32.3 CI 22.2–41.0). Among cesarean deliveries, there was a reduction in prescribed MME from 235.8 mg in 2015 to 152.6 mg in 2018 (P<.0001), with a decrease in the percentage of patients with no opioids prescribed at discharge or in the immediate postpartum period from 20.0% to 15.5% (P=<.02, OR 0.73 CI 0.57–0.96).

CONCLUSION:

A change in physician prescribing habits can significantly reduce opiate utilization in the postpartum period.
A Retrospective Study of the Associations of Body Weight, BMI and Hypertension With Preeclampsia [01D]
Authors: Power Michael L. , Schulkin Jay
Published: April 2020

INTRODUCTION:

Preeclampsia is a leading cause of morbidity and mortality for mothers and neonates. We examined births between 2009 and 2018 in the University of Washington medical system (UW) to assess the associations between maternal body weight, body mass index (BMI), blood pressure prior to and early in pregnancy and preeclampsia.

METHODS:

Retrospective data-pull of births at UW. Analysis of variance and Chi Square were used to compare pregnancies with and without preeclampsia for maternal pre-pregnancy weight, BMI, pre- and early pregnancy blood pressure, and birth weight.

RESULTS:

Of the 5,972 births, 1024 (17.1%) were complicated with preeclampsia. Women with preeclampsia were twice as likely to deliver preterm (28.0% versus 13.2%; P<.001); 30.5% of preterm births were complicated with preeclampsia. Women who experienced preeclampsia were heavier (81.6±1.5 kg versus 70.5±0.5 kg) with higher BMI (30.25±0.52 versus 26.22±0.18; P<.001 for both). Obese women were twice as likely to develop preeclampsia (27.5% versus 11.4% for non-obese women). Blood pressure was higher in women who developed preeclampsia at 6–9 months preconception, 0–6 months preconception, and within the first and second trimesters (P<.001 for all). Among women diagnosed with pre-existing hypertension (1,290; 21.6%), 77.3% developed preeclampsia compared to 0.6% in women without pre-existing hypertension (P<.001). The high proportion of preeclamptic pregnancies that were preterm resulted in lower mean birthweight, but term infants did not differ.

CONCLUSION:

Obesity and elevated blood pressure as long as 9 months preconception and during early pregnancy were associated with preeclampsia. A diagnosis of hypertension pre-pregnancy is strongly associated with preeclampsia.
Hemoglobin A1c to Determine the Prevalence of Undiagnosed Carbohydrate Intolerance in Pregnancy [13D]
Authors: Dinglas Cheryl , Cochrane Elizabeth , Umesh Vaibhavi , Bernasko James
Published: April 2020

INTRODUCTION:

Our objective was to evaluate an antepartum diagnostic approach to differentiate between women who had pre-pregnancy carbohydrate intolerance (pre-diabetes or overt diabetes) versus those who had pre-pregnancy normal carbohydrate tolerance using hemoglobin A1c (HbA1c).

METHODS:

An IRB approved retrospective observational study was conducted with women who had HbA1c measured at the initiation of prenatal care between July 2015 and June 2016. Patients with known pre-pregnancy diabetes, or condition affecting HbA1c (ie, hemoglobinopathy) were excluded. The prevalence of undiagnosed overt diabetes (HbA1c>6.5%), pre-diabetes (HbA1c of 5.7- 6.4%) and normal carbohydrate tolerance (HbA1c≤5.6%) was determined. Among those with HbA1c <6.5%, rates of “true gestational diabetes mellitus (GDM)” and their postpartum follow up testing results were evaluated. Maternal characteristics were also extracted.

RESULTS:

205 women were included. 5 (2.4%) had HbA1c >6.5%, 38 (18.5%) had HbA1c between 5.7–6.4%, and 162 (79%) had HbA1c ≤5.6%. Of the women with HbA1c <6.5%, 30 women (15%) were diagnosed with GDM based on IADSPG criteria. GDM was diagnosed in 18% of women with HbA1c between 5.7–6.4% and 14% of those who had HbA1c ≤5.6%. Further, only 8 (26.7%) completed the recommended 4–12 weeks postpartum GTT.

CONCLUSION:

Antepartum HbA1c testing can help identify women who had carbohydrate intolerance before pregnancy. Early identification may capture a high risk population during prenatal care and enable appropriate antepartum management and timely referrals. Pre-delivery identification of pre-existing carbohydrate intolerance proves superior to post-delivery identification because of the persistently poor completion rates of the latter.
The Impact of Peanut Birthing Ball on Cesarean Delivery Rates in the Obese Cohort [37D]
Authors: Staudenmaier Emily K. , White Samantha , Yassa Mark , Tisser Danielle , Vullo John , Gurram Padmalatha
Published: April 2020

INTRODUCTION:

Obese women are at an increased risk for cesarean delivery (CD) and postoperative complications such as surgical site infections and venous thromboembolism. Recent studies have shown that the Peanut Ball (PB) decreases rates of CD in women laboring with an epidural. The purpose of this study is to evaluate whether PB reduces CD rates in women with body mass index (BMI) greater than 30 compared to non-obese women (BMI<30).

METHODS:

This is a retrospective chart review of women delivered between 2015 to 2017. Women that delivered at term and received epidural anesthesia were included. Preterm deliveries, medically indicated deliveries and anomalies were excluded. Maternal characteristics, duration of labor, mode of delivery, birthweights and Apgar scores were studied. The primary outcome measure is CD rate. Outcomes of women who received PB intervention (PB) were compared to women without the use of PB (NPB). Women were stratified based on BMI and outcome measures were compared. IRB approval was obtained.

RESULTS:

328 PB and 417 NPB patients were included. Maternal age, race/ethnicity, parity and BMI were similar between the groups (P>.05). No difference in CD rates was noted between the PB and NPB groups (P=.225). Obese women were stratified into Class 1, Class 2 and Class 3 Obesity. No difference in CD rates were noted in any of the obesity classes.

CONCLUSION:

Obese women who utilized the PB during labor did not experience lower cesarean delivery rates.
Prediction of Neonatal Birth Weight in Obese Women by Presence of Diabetes [29D]
Authors: McCurdy Rebekah , Gleason Laura
Published: April 2020

INTRODUCTION:

To design a model that will predict neonatal birth weight within obese mothers by diabetic status.

METHODS:

A secondary data analysis of an RCT (NCT 02909582) was utilized to create a neonatal birth weight prediction model. Women (n=325) with a BMI >35 kg/m2 from a tertiary academic institution, 2016–2019, were included to estimate the risk of large for gestational age (LGA) infants and neonatal birth weight based on maternal pre-pregnancy BMI and diabetic status. LGA was defined as an infant birth weight >90th percentile. Analysis included Chi-square, t-test, multivariate logistic and linear regression.

RESULTS:

Mean birthweight did not differ in obese mothers based on diabetic status (P>.05). The frequency of large for gestational age infants was significantly greater for diabetic mothers (17% vs 7% without diabetes, P=.024). Total pregnancy weight gain (continuous, lbs) (OR 1.03; 95% CI 1.01, 1.05; P=.016) and pre-pregnancy BMI (continuous, OR 1.08; 95% CI 1.01, 1.15; P=.018) were associated with the risk of LGA infants when accounting for demographics (model R2=0.074). The presence of diabetes (RR 146; 95% CI 24, 268; P=.019), total weight gain (lbs) (RR 4; 95% CI 1, 7; P=.015), and gestational age (RR 197; 95% CI 175, 220; P<.001) were associated with neonatal birth weight when accounting for demographics (model R2=0.550).

CONCLUSION:

These models incorporate the joint effects of maternal obesity and diabetic status in predicting neonatal birthweight, thereby enabling clinicians to counsel their high-risk patients on risk for large for gestational age infants.
Leading Cause of Primary Cesarean Delivery in Diabetic Women Is Failed Induction [23D]
Authors: Roman Tania
Published: April 2020

INTRODUCTION:

To evaluate mode of delivery in diabetic women compared to non-diabetic pregnant women.

METHODS:

We conducted a retrospective cohort study of pregnant women at our center from 2013 to 2015. Women with singleton pregnancies, who initiated prenatal care at less than 20 weeks, and who completed their delivery at our institution were included. The diabetic cohort consisted of women with pre-gestational (PGDM) and gestational diabetes (GDM). The primary outcome was mode of delivery: cesarean (CD) or vaginal (VD). The secondary outcome was indication for the primary CD. Continuous variables were compared using student t-test and one-way ANOVA for group comparisons. Categorical variables were analyzed using Chi-square test. A P-value of <.05 was considered statistically significant.

RESULTS:

Out of 697 women who met the inclusion criteria, 64 (9.2%) had PGDM, 92 (13.2%) had GDM, and 541 (77.6%) were non-diabetic women. Overall, diabetic women were more likely to have a CD compared to non-diabetic women (58% vs. 41%, P=.0001). In both the diabetic and non-diabetic groups, more than half of the cesarean sections were repeat CD. Women with GDM had the highest rate of primary CD (43%). 50% of women in the PGDM group had primary CD for failed induction, as compared to 14% of the GDM women, and 8.3% of the non-diabetic women (P=.0010).

CONCLUSION:

Failed induction is the leading cause of primary CD in women with pre-gestational diabetes. Studies on induction techniques and assessment in this population are needed.