bluuebunny/crossref_metadata_2025 huggingface dataset:
Testing the role of AGN on the star formation and metal enrichment of ‘twin galaxies’
Authors: Angthopo J , del Moral-Castro I , Ferreras I , García-Lorenzo B , Ramos Almeida C
Published: June 2022

We explore the effect of AGN activity on the star formation history of galaxies by analysing the stellar population properties of 10 pairs of nearby twin galaxies – selected as being visually similar except for the presence of an AGN. The selection of such twin samples represents a method to study AGN feedback, as recently proposed by del Moral Castro et al. We use integral field unit (IFU) data from CALIFA, stacked within three fixed apertures. AGN galaxies in a twin pair suggest more evolved stellar populations than their non-AGN counterpart 90 per cent of the time, regardless of aperture size. A comparison with a large sample from SDSS confirms that most twins are representative of the general population, but in each twin the differences between twin members is significant. A set of targeted line strengths reveal the AGN member of a twin pair is older and more metal-rich than the non-AGN galaxy, suggesting AGN galaxies in our sample may either have an earlier formation time or follow a different star formation and chemical enrichment history. These results are discussed within two simple, contrasting hypotheses for the role played by AGN in galaxy evolution, which can be tested in the future at a greater detail with the use of larger data sets.
Decreased Risk of Coronavirus Disease 2019–Related Hospitalization Associated With the Omicron Variant of Severe Acute Respiratory Syndrome Coronavirus 2
Authors: Ridgway Jessica P , Tideman Samuel , Wright Bill , Robicsek Ari
Published: June 2022

Among 134 223 patients with coronavirus disease 2019 (COVID-19), we assessed how risk of hospitalization changed at different intervals in the pandemic, controlling for prior COVID-19 immunity. In multivariable analysis, outpatients with COVID-19 during the Omicron-predominant time period had significantly lower odds of hospitalization compared to pre-Delta (adjusted odds ratio, 0.26 [95% confidence interval, .22–.32]).
Wallacean and Melanesian Islands Promote Higher Rates of Diversification within the Global Passerine Radiation Corvides
Authors: McCullough Jenna M , Oliveros Carl H , Benz Brett W , Zenil-Ferguson Rosana , Cracraft Joel , Moyle Robert G , Andersen Michael J
Published: June 2022

The complex island archipelagoes of Wallacea and Melanesia have provided empirical data behind integral theories in evolutionary biology, including allopatric speciation and island biogeography. Yet, questions regarding the relative impact of the layered biogeographic barriers, such as deep-water trenches and isolated island systems, on faunal diversification remain underexplored. One such barrier is Wallace’s Line, a significant biogeographic boundary that largely separates Australian and Asian biodiversity. To assess the relative roles of biogeographic barriers—specifically isolated island systems and Wallace’s Line—we investigated the tempo and mode of diversification in a diverse avian radiation, Corvides (Crows and Jays, Birds-of-paradise, Vangas, and allies). We combined a genus-level data set of thousands of ultraconserved elements (UCEs) and a species-level, 12-gene Sanger sequence matrix to produce a well-resolved supermatrix tree that we leveraged to explore the group’s historical biogeography and the effects of the biogeographic barriers on their macroevolutionary dynamics. The tree is well resolved and differs substantially from what has been used extensively for past comparative analyses within this group. We confirmed that Corvides, and its major constituent clades, arose in Australia and that a burst of dispersals west across Wallace’s Line occurred after the uplift of Wallacea during the mid-Miocene. We found that dispersal across this biogeographic barrier was generally rare, though westward dispersals were two times more frequent than eastward dispersals. Wallacea’s central position between Sundaland and Sahul no doubt acted as a bridge for island-hopping dispersal out of Australia, across Wallace’s Line, to colonize the rest of Earth. In addition, we found that the complex island archipelagoes east of Wallace’s Line harbor the highest rates of net diversification and are a substantial source of colonists to continental systems on both sides of this biogeographic barrier. Our results support emerging evidence that island systems, particularly the geologically complex archipelagoes of the Indo-pacific, are drivers of species diversification. [Historical biogeography; island biogeography; Melanesia; molecular phylogenetics; state-dependent diversification and extinction.]
Analysis of A-kinase Anchoring Protein 13 (AKAP13) in Peri-Ovulatory Oocyte Maturation [A328]
Authors: ScM Shahrzad Khaiat , Baig-Ward K. Maravet , Segars James , Evans Janice P.
Published: June 2022

INTRODUCTION:

Arrest of oocytes at prophase I of meiosis is crucial for fertility and is maintained by Protein Kinase A (PKA). PKA activity is regulated by A-kinase anchoring proteins (AKAPs) that bind the regulatory subunit of PKA to control enzymatic activity. AKAP13 is expressed in oocytes and granulosa cells of humans and mice. Female mice haploinsufficient for Akap13 showed reduced litter sizes. To determine if AKAP13 in oocytes contributes to female reproductive function, we used an oocyte-specific conditional knockout (cKO) to delete Akap13 in the final stages of oocyte growth.

METHODS:

Oocytes were collected from mice harboring an oocyte-specific conditional knockout of Akap13 mice, with Cre recombinase expression driven by the Zp3 promoter (Zp3-Cre+, Akap13flox/flox). Akap13 DNA and mRNA were assessed by polymerase chain reaction (PCR) and quantitative PCR (qPCR), respectively. Controls were oocytes harvested from Akap13+/flox mice lacking Cre. Oocytes from control or cKO mice were examined for morphology, meiotic resumption, spindle organization, and spindle positioning at metaphase II.

RESULTS:

Cre-mediated excision of Akap13 DNA in oocytes was confirmed using PCR. Oocyte mRNA levels of Akap13 in cKO mice were reduced by 90% compared to controls. Live-cell imaging revealed no differences in germinal vessel breakdown, polar body emission, or completion of meiosis I in cKO oocytes as compared to controls. Staining of fixed oocytes revealed that metaphase II spindles and chromosome alignment appeared normal in in vitro-matured cKO oocytes.

CONCLUSION:

These studies suggest that impairment of female fertility in Akap13 haploinsufficient mice is not caused by impairment of oocyte meiotic maturation.
The Promise of Telemedicine: Are We Reaching the Underserved? [A300]
Authors: Ahsan Muhammad Danyal , Kulkarni Amita A. , Orakwue Chimsom F. , Ma Xiaoyue , Cantillo Evelyn , Chapman-Davis Eloise
Published: June 2022

INTRODUCTION:

The use of telemedicine has dramatically increased during the COVID-19 pandemic. We evaluated characteristics and experiences of underserved women utilizing telemedicine for gynecologic visits at an urban teaching hospital.

METHODS:

We conducted a prospective study of patients using telemedicine for gynecologic care from January 2021–September 2021. Patients completed a demographic survey and a modified Telemedicine Usability Questionnaire (TUQ) using a 1-5 Likert scale. Statistical analyses used Fisher’s exact test.

RESULTS:

One hundred ninety two patients consented to participate, and 157 completed surveys. The majority of patients were non-White (Hispanic 32%, Black 28%, and Asian 10%), with a median age of 40 years (range 18–69 years). A total of 61% had children and some level of education (24% GED or below, 28% vocational/associate degree, and 47% college or above), and 41% were employed, with 63% reporting an income of less than $40,000, and 85% being government insured (Medicaid/Medicare). Without telemedicine visits, 47% would have traveled 1–2 hours to appointments, with 46% spending more than $35 on travel, and 27% missing at least 1 work day for an in-person visit. The most common visit indications were lab/imaging results review (37%), postoperative follow-up (21%), and abnormal uterine bleeding (14%). The mean score overall for the entire TUQ was 4.3/5. Participants preferred telemedicine for follow-up visits rather than for initial visits (81% vs. 33%; P<.01).

CONCLUSION:

Underserved women utilizing telemedicine for gynecologic care reported largely positive experiences with improved access to health care, cost, and time savings over in-person visits. However, a higher preference for utilization was found for follow-up visits, providing an opportunity to further improve quality and access.
Prevalence of and Factors Influencing Breastfeeding Pre– and Post–COVID-19 [A305]
Authors: McCracken Johanna , Vozzola Amanda , Vozzola David E. , Roussos-Ross Dikea (Kay)
Published: June 2022

INTRODUCTION:

Current evidence suggests that the benefit of breastfeeding during the pandemic outweighs potential risks and may provide protection for the infant and mother. The purpose of this study was to determine whether the prevalence of breastfeeding changed after the COVID-19 pandemic.

METHODS:

With Institutional review board approval, a retrospective chart review of 916 randomly selected women seen between April 2019 and February 2020 (pre–COVID-19 cohort) and April 2020 and February 2021 (post–COVID-19 cohort) was conducted investigating demographics, birth history, breastfeeding, and insurance status. Bivariate correlations evaluated the relationships between breastfeeding and the data points.

RESULTS:

Overall breastfeeding rates between the pre– (72.5%) and post–COVID-19 (74.6%) cohorts were similar. Medicaid patients were less likely to breastfeed pre–COVID-19 (r=−0.13, P<.01) but were even less likely to breastfeed post–COVID-19 (r=−0.23, P<.001). Privately insured patients were more likely to breastfeed pre–COVID-19 (r=0.13, P<.01) and more so post–COVID-19 (r=0.22, P<.001). Black mothers were less likely to breastfeed pre– (r=−0.16, P<.01) and post–COVID-19 (r=−0.10, P<.05) when compared to other racial groups but were more likely to breastfeed post–COVID-19 than pre–COVID-19. Multiparous mothers were less likely to breastfeed similarly in both cohorts, pre– (r=−0.12, P<.05) and post–COVID-19 (r=0.15, P<.01). Factors that did not significantly influence breastfeeding included delivery type and White or Hispanic race.

CONCLUSION:

Uncertainty surrounding breastfeeding safety after the onset of COVID-19 did not significantly influence the prevalence of breastfeeding in our population. Private insurance and age positively influenced breastfeeding rates pre– and post–COVID-19, while Medicaid, Black race, and a higher number of pregnancies negatively influenced breastfeeding rates.
Sexual Assault and Homelessness in the Transgender Population: Are We Doing Enough? [A309]
Authors: Abern Lauren , Krempasky Chance , Diego Daniela , Maguire Karla
Published: June 2022

INTRODUCTION:

Transgender individuals are more than four times more likely than cisgender people to experience traumatic events such as rape and sexual assault. The purpose of this study is to determine the percentage of transgender individuals in our cohort that experienced sexual assault and homelessness.

METHODS:

Transgender individuals aged 18-64 participated in an online survey that included demographics as well as social and reproductive history.

RESULTS:

996 surveys were collected. The mean age was 28 (SD 10, range 18-64). The majority of participants were White (810; 85%), non-Hispanic (859; 89%), and had insurance (893; 90%). 787 (79%) individuals identified as transmasculine or assigned female at birth, and 209 (21%) identified as transfeminine or assigned male at birth. Of all transgender people, 47% have ever been sexually assaulted: 362 (50%) of transmasculine individuals, and 72 (37%) of transfeminine individuals. Although 19% had been homeless, 88% of all transgender people currently feel safe where they live.

CONCLUSION:

Even in our predominately White, well-insured population, many survey respondents relayed a history of sexual assault, and one in five had been homeless. As obstetrics and gynecology providers, we should be aware of these numbers and consider universal screening for trauma. We should focus on providing trauma-informed care to help establish a safe physical and emotional environment for patients.
Patient Perception of Telehealth Prenatal Care During the Early Part of the COVID-19 Pandemic [A310]
Authors: Dayaratna Sandra , Daniel Reba , Galloway Savannah , Mercier Rebecca
Published: June 2022

INTRODUCTION:

Routine prenatal visits were rapidly converted to telehealth (TH) visits during the beginning of the COVID-19 pandemic. Patient perceptions and experience with TH were surveyed. Demographic factors were assessed to see if there were any predictors of satisfaction.

METHODS:

Institutional Review Board approval was obtained. Electronic as well as paper surveys were distributed to 2,012 women who had experienced virtual prenatal visits from March 2020 to June 2020. Responses were stored on a password-protected computer file and analyzed using Pearson Chi-square test and Fisher’s exact test.

RESULTS:

A total of 333 (17%) women completed the survey (235 online and 98 paper). The majority of respondents agreed that TH made it easier to see their obstetrical provider during the onset of the pandemic (80%). Although 83% agreed that it is important to offer a TH program, 78% agreed that they would have been willing for in-person visits during the height of the pandemic. Only about one quarter (26%) of the patients reported that they would rather use TH versus coming in-person for a visit, and only 38% thought that TH interactions were equal to in-person visits. Medicaid patients (86%) indicated higher overall satisfaction with TH than commercially insured patients (69%; P=.009).

CONCLUSION:

Respondents were overall satisfied with TH prenatal care including ease in seeing and talking to their provider. Medicaid patients were more satisfied than commercially insured patients. In geographic areas with provider shortages, TH prenatal care may be an acceptable modality to deliver care, especially among patients insured with Medicaid.
Impact of Physician Densities on Gynecologic Cancer Outcomes in the United States [A316]
Authors: Smick Alexandra H. , Neff Robert , Holbert Michael
Published: June 2022

INTRODUCTION:

To examine the relationship between county-level obstetrician-gynecologist (GYN) and primary care physician (PCP) densities and gynecologic cancer outcomes and whether county socioeconomic factors affect cancer prognosis.

METHODS:

An analysis of gynecologic cancers (uterine, ovarian, cervical) in the Surveillance, Epidemiology, and End Results (SEER) database was performed from 2005 to 2018. County-level demographics were abstracted from SEER, population density from the U.S. Census, and physician density (GYN and PCP per 100,000 females) from the Area Health Resources File. PCP included family, internal, and general medicine physicians. Backward stepwise regression models were used.

RESULTS:

Final analysis included 120,000 patients from the SEER database comprised of those with cervical (14.4%), uterine (60.2%), and ovarian cancers (25.4%). Initial analysis included 620 U.S. counties (41% metropolitan, 59% nonmetropolitan). Mean GYN density was 12 per 100,000 females and mean PCP density was 99 per 100,000 females. Multivariate analysis for cancer stage by primary site showed that GYN density was inversely correlated with cancer stage at diagnosis (P=.001). Analysis also showed that percent Black population was positively correlated with cancer stage (P=.001), whereas household income was negatively correlated with cancer stage (P=.01). Multivariate analysis for 5-year survival by cancer stage showed no correlation with GYN or PCP density. We found that educational attainment (P=.01) and population size (P=.001) were positively correlated with 5-year survival (P=.01).

CONCLUSION:

Lower GYN density was associated with more advanced cancer stage at time of diagnosis across the United States. Nonmetropolitan county status was also associated with worse cancer outcomes. Targeting GYN physician supply in lower-density counties may help improve population-based gynecologic cancer care.
Poor Glycemic Control Is a Risk Factor for Triple-Negative Breast Cancer in Patients With Type 2 Diabetes [A323]
Authors: Miller Madison , Bell Myah , Holland Priscella , Ibrahim Vanessa , Jacobsen Gordon , Swain Monique
Published: June 2022

INTRODUCTION:

We sought to investigate the relationship between glycemic control, race, and the incidence of triple-negative breast cancer (TNBC) among patients with type 2 diabetes (T2D).

METHODS:

A retrospective cohort study evaluating 1,416 patients with T2D diagnosed with breast cancer between 2015 and 2020 was conducted. Tumor subtype was categorized as either hormone receptor-positive (ER+, PR+, or both) or triple-negative (ER/PR- and HER2/neu-). Based on Hgb A1c measured within 3 months of cancer diagnosis, patients were assigned to one of three categories: well-controlled (Hgb A1c less than 7.0), moderately controlled (Hgb A1c 7.0-9.4), or poorly controlled (Hgb A1c greater than or equal to 9.5) T2D.

RESULTS:

A significant increase in the percentage of non-Hispanic White patients with TNBC across the three levels of glycemic control was observed (P=.037). When racial comparisons of cancer subtype within categories of glycemic control were performed, a significant (P=.001) increase in the percentage of Black patients with TNBC compared with non-Hispanic White patients was only observed among those with well-controlled T2D.

CONCLUSION:

Although previous studies have shown that Black patients are 2 to 3 times more likely to develop TNBC than their non-Hispanic White counterparts, a statistically significant racial difference was only noted among our patients with well-controlled T2D. Thus, our data not only suggest that T2D may serve as a modifiable risk factor for the development of TNBC but also that the risk conferred by poor glycemic control may bear more significance for non-Hispanic White patients than Black patients.
Racial Disparity in Neonatal Outcomes in Pregnancies Conceived Via In Vitro Fertilization [A277]
Authors: Bar-El Liron , Yeshua Arielle , Eliner Yael , Chervenak Frank , Bornstein Eran
Published: June 2022

INTRODUCTION:

Increased adverse maternal and neonatal outcomes are seen in Black compared to White U.S. women. Pregnancies conceived via in vitro fertilization (IVF) represent a unique population, often with appropriate pre-pregnancy medical care, access to prenatal care, and overall higher socioeconomic status. Thus, we set out to assess whether similar racial disparities exist in pregnancies following IVF.

METHODS:

We performed a retrospective analysis of the CDC's natality database (2016–2018) of births conceived via IVF in women who self-identified as non-Hispanic Black and non-Hispanic White. Pearson's Chi-square test was used to compare several pregnancy and neonatal outcomes among women of both races. Multivariate logistic regression adjusted the outcomes for potential confounders. Results are presented as adjusted odds ratios (aORs) with a 95% confidence interval (CI). Statistical significance was set as P-value less than .05.

RESULTS:

Non-Hispanic Black women had a lower risk for gestational diabetes (aOR 0.8, CI 0.7–0.9), hypertensive disorders of pregnancy (aOR 0.8, CI 0.7–0.9), eclampsia (aOR 0.9, CI 0.9–1), and neonatal immediate and prolonged ventilation (aOR 0.7, CI 0.7–0.8; aOR 0.75, CI 0.6–0.8; respectively) than non-Hispanic White women. No difference was found in the rate of preterm deliveries, maternal intensive care unit admissions, gravid hysterectomies, neonatal intensive care unit admissions, and newborn antibiotics (P>.05).

CONCLUSION:

Based on this extensive U.S. database, maternal and neonatal complications that are generally seen more frequently in Black women are, in fact, lower in Black compared to White women in the IVF population. These findings may indicate that different socioeconomic factors, rather than race per se, are at play. Further research is needed to explore the causes of this disparity.
Postpartum Depression Rates and Breastfeeding Outcomes Among Physicians [A280]
Authors: Eischen Emily , Awomolo Adeola , Crowe Susan , Braden Andrea L. , Lehman Kristina , Louis-Jacques Adetola
Published: June 2022

INTRODUCTION:

There are limited data on postpartum depression (PPD) rates in physicians. Physicians are vulnerable due to unique stressors such as strenuous work hours, limited maternity leave, and other work-related barriers. Our objectives were to assess the rates of PPD in physicians as well as the relationship between PPD and breastfeeding outcomes.

METHODS:

We conducted a cross-sectional survey of physicians with a singleton pregnancy during the most challenging time of their career. Survey questions were adapted from the CDC's Infant Feeding Practices Study and Pregnancy Risk Assessment Monitoring System, along with investigator-developed questions. Analyses were completed via STATA version 17.

RESULTS:

A total of 637 respondents met eligibility. Most were non-Hispanic White (77%). A majority surpassed national breastfeeding initiation (99%) and exclusive duration rates (72%), and most met personal breastfeeding goals (78%). There were associations between race (P=.04), birth year (P=.001), and medical specialty (P=.02) and meeting breastfeeding goals. Twenty-five percent of participants experienced PPD. PPD rates were higher in White than non-White respondents (25% vs. 18%, P=.03). Asians had the lowest rates of PPD (15%), whereas Hispanics/Latinx physicians had the highest rate (31%). Most commonly selected reasons for PPD were sleep deprivation (80%), infant feeding (44%), lack of adequate maternity leave (41%), and lack of support at work (33%). There was an association between meeting breastfeeding goals and exhibiting PPD (P=.003).

CONCLUSION:

Although the physicians in our study were highly successful at breastfeeding compared to the national rates, the postpartum depression rates were higher than the national rates.
Acupuncture as Treatment for Pelvic Girdle Pain in Pregnancy: A Literature Review [A282]
Authors: Fang Jennifer , Balica Adrian
Published: June 2022

INTRODUCTION:

Pelvic girdle pain (PGP) is often regarded as a normal result of physiologic changes during pregnancy, but it may also cause significant disability that cannot be ameliorated by standard conservative measures such as analgesics and physical therapy. This review seeks to explore the recent literature regarding the efficacy of acupuncture as an alternative treatment for PGP.

METHODS:

References were obtained through a search of PubMed and Google Scholar databases using the keywords “pelvic girdle pain,” “pregnancy,” and “acupuncture.” Nine papers published within the past 10 years were selected that studied acupuncture use for PGP during pregnancy.

RESULTS:

Six of the selected studies were randomized controlled trials (RCTs), and the remaining three papers were surveys/qualitative studies. All RCTs comparing acupuncture to standard treatment demonstrated a statistically significant improvement in pain intensity, disability, and quality of life. Two RCTs also demonstrated that adjuvant acupuncture therapy was superior to other modalities such as manipulation and stabilizing exercises alone. The qualitative studies showed that 21% of women sought out acupuncture during pregnancy, and all patients reported a subjective improvement in pain. However, 66% of providers hesitate to perform acupuncture on pregnant patients, citing unfounded concerns that acupuncture can cause miscarriages, despite no reported major adverse effects.

CONCLUSION:

Though higher powered studies still need to be conducted, current literature shows that acupuncture use in pregnancy is safe and effective at reducing PGP and is more efficacious than standard treatments alone. Physicians should consider promoting acupuncture for pregnant patients with PGP whose pain is refractory to other conservative measures.
Effects of Antiretroviral Therapy on Weight Gain and Hypertensive Disorders of Pregnancy in Persons With HIV [A118]
Authors: Nissim Oriel , Haney Ashley , Lazenby Gweneth
Published: June 2022

INTRODUCTION:

Recent evidence suggests an association of increased weight gain when switching to a tenofovir-based antiretroviral therapy (ART). Given the potential for medical complications of obesity, we sought to determine if persons with HIV prescribed tenofovir alafenamide (TAF) during pregnancy were more likely to experience excessive weight gain, diabetes, and hypertensive disorders.

METHODS:

This is a retrospective cohort study of pregnant persons with HIV who delivered a live infant during the study period (January 1, 2009, to December 31, 2020). ART was classified as including TAF or no TAF. Median weight gain was compared using Wilcoxon rank sum tests (WRST). A Friedman test was used to compare median weights measured at antenatal visits. We compared the proportion of persons with gestational diabetes (GDM) and hypertensive disorders (HDP) by ART groups using chi-square and Fischer’s exact tests.

RESULTS:

We observed 189 persons who were prescribed ART during pregnancy: 30 with TAF and 159 without TAF. Median weight gain was similar between groups: TAF, 7.8 kg (95% CI, 3.4–13.6 kg); no TAF, 6.8 kg (95% CI, 2–10.8 kg), WRST P=.41. Repeated measures of median weight at antenatal visits were similar between groups (Friedman test P=.72). GDM was an infrequent outcome (TAF, 0; no TAF, 5 [3%]; P=1.0). HDP were common but similar between groups (TAF, 11/28 [39%]; no TAF, 58/156 [24%]; P=.89].

CONCLUSION:

Use of TAF during pregnancy did not result in significant weight gain or increased risk of GDM or HDP. Pregnant persons should not be counseled to avoid TAF during pregnancy to avoid these outcomes.
Impact of COVID-19 Knowledge on COVID-19 Vaccination Rates During Pregnancy [A125]
Authors: Vilarino Valerie , Agasse Eva , Rodriguez Gabriella , Galli Johnny , Shafazand Shirin , Potter JoNell
Published: June 2022

INTRODUCTION:

Immunization against SARS-COV-2 protects pregnant persons from severe COVID-19 illness. Pregnant individuals are less likely (19.2%) to be vaccinated against COVID-19 than their non-gravidas counterparts (69.6%). This disparity may be attributed to a lack of knowledge regarding the risks of SARS-COV-2 infection in pregnancy and the benefits and safety of vaccination. This study aims to determine the impact of patients’ self-reported COVID-19 knowledge on COVID-19 vaccination rates during pregnancy.

METHODS:

A total of 359 postpartum patients consented to participate in an institutional review board‒approved cross-sectional survey at an urban academic medical center in Miami, Florida between July and September 2021. Participants self-reported their COVID-19 vaccination status and answered questions to assess their general knowledge regarding COVID-19 infection and its impact on pregnancy, as well as knowledge of current guidelines for vaccination in pregnancy and safety of vaccination in pregnancy and breastfeeding. Correct responses to each item earned 1 point, while incorrect responses detracted 1 point, yielding knowledge scores ranging from –5 to +5.

RESULTS:

The mean knowledge score across participants was 1.7±1.77. Controlling for age and education, a 1-point increase in knowledge score was associated with a 1.6-times increase in the odds of vaccination. There was a monotonic increase in vaccination rates as knowledge score rose (P<.001).

CONCLUSION:

The strongly positive correlation between knowledge scores and vaccination emphasizes the vital role that knowledge plays in the decision to be vaccinated for gravida individuals. This elucidates the importance of empowering pregnant persons with reputable and accurate information to increase the likelihood of vaccination in this at-risk population.
Association of GDF15-GFRAL-RET Pathway With Hyperemesis Gravidarum Confirmed by Sequencing Families [A163]
Authors: Fejzo Marlena , Wang Xinran , Mancuso Nick , MacGibbon Kimber , Mullin Patrick
Published: June 2022

INTRODUCTION:

The placenta hormone gene GDF15 is the greatest genetic risk factor for hyperemesis gravidarum (HG), shifting the field away from human chorionic gonadotropin as the most likely causal factor. In maternal serum, GDF15 levels are increased in hospitalized patients, patients with second-trimester vomiting, and in those prescribed antiemetics. Variants in GDF15 are associated with familial and recurrent HG. GDF15 signals through the brainstem receptor GFRAL and co-receptor RET to cause taste aversion, appetite loss, vomiting, cachexia, and chemotherapy-induced nausea. Herein we set out to determine whether rare variants in this pathway occur in families affected by HG.

METHODS:

Whole-exome sequencing was performed on 16 families with >3 individuals affected by HG to identify potentially causal variants. Institutional review board approval was obtained.

RESULTS:

Two of 16 families had rare/novel missense variants at the RET-BMS1 locus segregating with HG. The variants were not detected in unaffected family members nor in 660 unaffected individuals.

CONCLUSION:

This study adds evidence the GDF15-GFRAL-RET complex is involved in the etiology of HG. HG is associated with increased risk of adverse outcomes, including maternal suicidal ideation, post-traumatic stress disorder, preterm birth, and neurodevelopmental delay in offspring. Current antiemetic treatments are often ineffective in reversing pregnancy weight loss caused by HG, so novel approaches are needed. This pathway is under intense investigation by pharmaceutical companies to treat disorders of weight loss and, conversely, weight gain, and may lead to novel treatments for HG. The study has implications for genetic testing and counseling of patients with a family history of HG.
Effects of the COVID-19 Pandemic on Routine Maternal Vaccine Uptake [A176]
Authors: Cotter Savannah B. , Taylor Lauren L. , Grace Rebecca , Miao Di , Coleman Maame Aba , Ratan Bani M.
Published: June 2022

INTRODUCTION:

This study examines the impact of the COVID-19 pandemic on influenza and Tdap (tetanus, diphtheria, pertussis) vaccine uptake in a pregnant, low-income population.

METHODS:

This retrospective cohort study included women initiating prenatal care before (May–November 2019) or during the COVID-19 pandemic (May–November 2020) at two large Medicaid clinics. All patients entered prenatal care before 20 weeks of gestation and delivered full-term. Medical records were reviewed for vaccine uptake and demographic data. Multivariate logistic regression analysis was used to compare vaccination rates prior to and during the COVID-19 pandemic. Additional analysis was performed to identify association of demographic factors with vaccine uptake. Institutional review board‒ approval was obtained for this study.

RESULTS:

A total of 939 patients were included, with 462 initiating care prior to and 477 initiating care during the COVID-19 pandemic. Influenza vaccination uptake was 78% (362/462) in the pre-pandemic group, significantly decreasing to 61% (291/477) in the pandemic group (P<.01; OR, 0.38; 95% CI, 0.26–0.53). Tdap vaccination uptake was 85% (392/462) in the pre-pandemic group, significantly decreasing to 76% (361/477) in the pandemic group (P<.01; OR, 0.56; 95% CI, 0.40–0.79). Unvaccinated patients were significantly more likely to be non-Hispanic Black patients when compared to Hispanic patients both pre-pandemic (P<.01; OR, 0.34; 95% CI, 0.21–0.56) and during the pandemic (P<.01; OR, 0.24; 95% CI, 0.15–0.38), while there was no significant difference in age or parity in relation to vaccination status.

CONCLUSION:

Routine vaccination uptake significantly decreased during the COVID-19 pandemic in a low-income population of pregnant women, with decrease more pronounced on influenza vaccine than on Tdap vaccine uptake.
Is Maternal Anemia Associated With Hypotension During a Scheduled Cesarean Delivery? [A180]
Authors: Bharucha Jinai , Rimsza Rebecca , Palanisamy Arvind , Raghuraman Nandini , Bligard Katherine H.
Published: June 2022

INTRODUCTION:

Hypotension is the most common complication of anesthesia during cesarean delivery (CD) and is associated with both maternal and neonatal morbidity. Maternal anemia presents additional cardiovascular stress, which could compromise the reserve available to overcome the vasodilation associated with spinal anesthesia. We investigated whether maternal anemia predisposes patients to spinal-related hypotension.

METHODS:

We performed an institutional review board‒approved retrospective cohort study including all women delivering non-anomalous, term singletons via scheduled CD under spinal anesthesia from 2004 to 2014 at a tertiary-care center. Anemia was defined as admission hemoglobin <11 g/dL. The primary outcome was intraoperative hypotension, defined as 30% decrease in systolic blood pressure (SBP) from baseline or SBP<90 mmHg, and was compared between anemic and non-anemic patients. Multivariable logistic regression was used to adjust for confounders. Prophylactic vasopressor infusion was not a standard of care during the study period.

RESULTS:

Of 1,988 patients included, 742 (37%) had anemia. Anemic patients were younger and less likely to be nulliparous or to have gestational diabetes (P<.01 for all). Incidence of intraoperative hypotension was greater in non-anemic patients (52.0% versus 45.8%; P<.01). However, after adjusting for known risk factors for spinal-related hypotension, the risk of hypotension in anemic patients was similar to that in non-anemia patients (aOR, 0.79; 95% CI, 0.59–1.05).

CONCLUSION:

Maternal anemia is not associated with hypotension during scheduled CD. These findings argue against the need for additional measures to prevent intraoperative hypotension in anemic patients.
Implementation of Trauma-Informed Care Strategies in a Multidisciplinary Maternal-Fetal Care Center [A186]
Authors: Cole Joanna CM , Zajac Lindsay , Budney Alexandra , Spinner Susan , Schindewolf Erica , Teefey Christina Paidas
Published: June 2022

INTRODUCTION:

Little is known about traumatic stress among expectant parents who receive a prenatal diagnosis of a birth defect. The current study aimed to identify traumatic stress symptoms among expectant parents carrying fetuses with confirmed fetal anomalies and describe the ways in which a fetal care center, with an embedded psychosocial support team, provides trauma-informed strategies to mitigate the effects of trauma throughout the pregnancy via collaborative prenatal care visits.

METHODS:

A retrospective analysis of 4,391 pregnant patients and 3,570 partners in a fetal center was performed with institutional review board approval. Traumatic stress symptoms in response to the confirmed fetal diagnosis were assessed using the Impact of Events Scale–Revised (IES-R). Exploratory descriptive analyses examined rates of overall traumatic stress symptoms and elevated subscale scores.

RESULTS:

In total, 28.7% of mothers and 24.2% of fathers reported elevated traumatic stress symptoms in response to their confirmed fetal diagnosis, with clinically significant risk endorsed among 16.2% and 13.4% respectively. Symptoms of intrusion and avoidance were most notable among parents. Trauma-informed care strategies provided by a multidisciplinary care team, in collaboration with the psychosocial support team to identify, support, and intervene with high-risk parents, were implemented.

CONCLUSION:

Recognizing that expectant parents who receive a fetal anomaly diagnosis are at heightened risk for experiencing traumatic stress symptoms, maternal–fetal care teams should implement trauma-informed care into daily prenatal clinical practice and incorporate psychosocial support services, including parental mental health screening, psychosocial assessment, and clinical interventions, to reduce the negative effects of trauma for parents prior to birth.
Characteristics and Outcomes Associated With COVID-19 Infection in Pregnancy [A189]
Authors: Sznajder Katharine , Jefferson Celeena R. , Kim Seohyun , Weinfield Nancy S.
Published: June 2022

INTRODUCTION:

Data on COVID-19 in pregnancy are skewed toward infection at time of labor and delivery, and few studies have controlled for confounding variables. We aimed to explore the sociodemographic and health risk factors for COVID-19 at any point in pregnancy and its impact on maternal outcomes in a diverse cohort during the first year of the pandemic.

METHODS:

We conducted a retrospective cohort study using data abstracted from the electronic medical record within Kaiser Permanente Mid-Atlantic States, an integrated health care system, from March 15, 2020, to March 15, 2021. We included women at least 15 years old and pregnant during that timeframe, comparing those who tested positive for COVID-19 to those who did not. We used multivariable logistic regression to identify risk factors for COVID-19 infection during pregnancy. We then used propensity score matching to create a comparison group to explore associations between infection and key outcomes.

RESULTS:

Among 18,285 pregnant members, 1,036 (5.7%) tested positive for COVID-19 during pregnancy, with 26%, 31%, and 43%, respectively, diagnosed in each trimester of pregnancy. Patients with COVID-19 were more likely to be young, Latina, obese, and multiparous; being White or Asian was protective (P<.001). Patients with COVID-19 during pregnancy were more likely to be hospitalized apart from delivery (P=.029). There were no significant differences in fetal demise, cesarean delivery, preterm delivery, gestational diabetes, hypertensive disorders of pregnancy, venous thromboembolism, postpartum readmission, or maternal death between groups.

CONCLUSION:

Our study was consistent with previously identified disparities in COVID-19 infection. Outcome data were surprisingly reassuring.
Clinical Relevance of Ovarian Vein Thrombosis in Pregnancy and Postpartum [A197]
Authors: Greenman Michelle , Bustamante Bethany , Nizam Aaron , Yeisley Christopher , Grimaldi Gregory , Goldberg Gary L.
Published: June 2022

INTRODUCTION:

Ovarian vein thrombosis (OVT) is a rare complication of pregnancy and can result in sepsis, extensive thrombosis and secondary venous thromboembolism (VTE). Treatments range from observation to anticoagulation and antibiotics. This study aims to identify the incidence of secondary VTE and factors that correlate with subsequent VTE.

METHODS:

After institutional review board approval, a cross-sectional study of patients diagnosed with OVT in the peripartum period from 2012 to 2020 at our institution was performed. The incidence of secondary VTE and their clinical management was reviewed. Descriptive statistics were performed to identify risk factors for secondary VTE. Numeric variables were compared using Mann-Whitney U test, and categorical variables were compared using chi-square or Fischer’s exact test.

RESULTS:

A total of 37 postpartum patients with OVT were included. The incidence of secondary VTE was 16.2% (6 patients). Patient characteristics including age, race, BMI, tobacco use, mode of delivery, cesarean hysterectomy, and chorioamnionitis were similar between patients with OVT alone and OVT with secondary VTE (P=.918, .911, 1, .115, 1, .62, .535, respectively). Radiographic measurement of OVT extension into the IVC or renal veins as both continuous or nominal variables did not confer increased risk of secondary VTE.

CONCLUSION:

Secondary VTE following OVT occurred in 16% of women in this select population. No clinical or demographic factors were found to be significant for a higher risk of developing VTE. Although OVT is rare, it is associated with significant maternal morbidity and mortality. Future studies are needed to identify high-risk patients for secondary outcomes of OVT and improve therapeutic guidelines.
Effect of Race in the Diagnosis of Fetal Growth Restriction in a Multicultural Urban Population [A202]
Authors: Chen Cindy , Kon Maria , Rathi Sourish , Vincent Sarah J. , Ram Kavitha T.
Published: June 2022

INTRODUCTION:

Despite significant differences in fetal growth curves based on maternal race/ethnicity, fetal growth restriction (FGR) continues to be defined by the Hadlock formula generated from a study involving 392 predominantly White pregnancies. Accuracy in FGR diagnosis is crucial to prevent iatrogenic preterm delivery and unnecessary antenatal surveillance and intervention. We sought to compare the diagnostic accuracy of FGR in fetuses classified by Hadlock criteria versus Eunice Kennedy Shriver National Institute of Child Health and Human Development racial/ethnic-stratified criteria in a multicultural urban population.

METHODS:

A retrospective recalculation of estimated fetal weight (EFW) and abdominal circumference (AC) in fetuses diagnosed with FGR over a 5-year period using NICHD race-specific fetal growth criteria was performed. FGR was defined as EFW or AC less than 10th percentile. Chi-square analysis was performed to evaluate the differential effects of recalculation across racial groups.

RESULTS:

A total of 384 pregnancies with FGR were identified in 147 (38.3%) Asian, 114 (29.67%) Hispanic, 111 (28.9%) Black, and 12 (3.3%) White mothers. Recalculation normalized growth in 64 (16.7%) pregnancies and was disproportionate, with the greatest effect in pregnancies of Black mothers (29, 26.1%), followed by Hispanic mothers (17, 14.9%) and Asian mothers (18, 12.2%) (P=.01).

CONCLUSION:

Application of NICHD race-specific criteria reversed the diagnosis of a substantial number of FGR pregnancies, with the greatest reversal seen in pregnancies of Black mothers. More research is needed to evaluate the neonatal and long-term outcomes of fetuses misdiagnosed as FGR based on the old growth standards, as iatrogenic preterm delivery and steroid administration carry potential morbidity later in life.
Increased Risk of Cesarean Delivery in Severely Obese Patients Who Are Induced Electively or For Obese Status Alone [A212]
Authors: Myers Brittany A. , Root Emily A. , Mukherjee Anish , Gaskins Jeremy , Pierson Rebecca C. , Kline Jessica
Published: June 2022

INTRODUCTION:

Prepregnancy obesity is reaching epidemic proportions in the United States. Maternal obesity alone is not an indication for induction of labor (IOL). Recent studies have shown that elective IOL >39 weeks does not increase cesarean delivery (CD) rates; however, patients with severe obesity (BMI >40) are not represented in many of these trials, creating a gap in our ability to provide patient-centered care.

METHODS:

A retrospective chart review of patients with BMI >40 between May 2016 and December 2020 at a single institution was conducted. Exclusion criteria included: scheduled CD, vaginal birth after cesarean delivery, repeat CD, multiple-gestation pregnancies, delivery <20 weeks, or intrauterine fetal demise. Demographic and other clinical features were analyzed using ANOVA and Fisher tests. The primary outcome was analyzed using linear and logistical regression models.

RESULTS:

There were 1,010 deliveries, of which 545 met study criteria. The median BMI was 43.9 (IQR, 41.8–48.5; range, 40.0–92.9). The groups by BMI classification were matched for age, gravida/para, and race. A total of 72.5% of patients were induced during this study period. Of patients who underwent IOL for obesity alone (n=99), 27% delivered via CD, versus 12% for patients who presented in spontaneous labor. Regression models showed significant association between increasing BMI and CD from BMI >40 to BMI 60.

CONCLUSION:

In patients with BMI >40 who undergo elective induction of labor, there is a significant increase in cesarean delivery rate as opposed to those who present in spontaneous labor.
Maternal and Neonatal Outcomes in Recipients of Solid Organ Transplantation [A213]
Authors: Nguyen Hoang Yen , Yao Ruofan
Published: June 2022

INTRODUCTION:

Pregnant patients who have received solid organ transplantations face high morbidity and mortality. Risks of preeclampsia and preterm delivery were previously observed, but data on gestational diabetes, maternal and neonatal ICU admissions were sparse. Most data regarding maternal and neonatal outcomes have been derived from the transplantation registry and single-center retrospective studies.

METHODS:

This was a retrospective study using the California Office of Statewide Health Planning and Development Linked Birth File. Exposure was defined as a history of heart, lung, liver, or kidney transplantation using maternal ICD-9 codes. Primary outcomes included risks of preeclampsia, preterm delivery, cesarean delivery, maternal and neonatal ICU admissions. Secondary outcomes included blood transfusion, hysterectomy, unplanned cesarean delivery, low Apgar score, neonatal intubation, stillbirth, and neonatal death.

RESULTS:

This study included 3,186,249 patients in the control group and 263 patients in the exposure group. The most commonly transplanted organs are kidneys, followed by liver, heart, and lungs. When compared to controls, patients with heart, liver, or kidney transplant had significantly increased risk of preeclampsia, preterm delivery, cesarean delivery, and maternal and neonatal ICU admissions. Risks of hysterectomy, unplanned cesarean delivery, neonatal intubation, and stillbirth in the exposure group were similar to the control group. Patients with kidney transplantation presented with the highest rates of the aforementioned complications, with further increased risks of maternal blood transfusion, low Apgar score, and neonatal death.

CONCLUSION:

Pregnancies of recipients of solid organ transplantation are associated with higher morbidity and mortality for both patients and neonates compared to the general population.
Postpartum Depression in Women With Hypertensive Disorders of Pregnancy [A220]
Authors: Otto Abigail M. , Kistner Margaret , Schultz Elyse , Tjaden Anne , Yang Linda , Prock Paula White
Published: June 2022

INTRODUCTION:

Depression affects 10–15% of women during and after pregnancy. Studies have shown that increasing stressors increase rates of depression. Preeclampsia, a hypertensive disorder of pregnancy, often results in stressful sequelae at various points in pregnancy, including preterm birth and prolonged hospitalization. We hypothesize that women with hypertensive disorders of pregnancy are at an increased risk for peripartum depression.

METHODS:

We conducted a retrospective study and examined women who delivered at Loyola University Medical Center between January 1, 2014, and December 31, 2019. Our cohort included 6,270 women and 7,125 pregnancies. We collected information including Edinburgh Postnatal Depression Scale (EPDS) scores, hypertensive status, demographics, and clinical characteristics.

RESULTS:

In our cohort, 79.51% of mothers had no hypertensive disorders, 10.22% had chronic or gestational hypertension, and 10.22% had preeclampsia. Predicted population average EPDS scores were higher for preeclamptic women than for all other women at all time points (P<.05). At 28 weeks of gestation, immediately postpartum, and 2–6 weeks postpartum, odds of peripartum depression for preeclamptic women were 1.72 times (P=.01), 1.45 times (P=.02), and 1.40 times (P=.03) those for normotensive women, respectively.

CONCLUSION:

Maternal mental health is an emerging focus within obstetrics with the larger goal of reducing maternal morbidity and mortality. In our study, women with hypertensive disorders had higher EPDS scores and higher odds of having depression. Those with preeclampsia specifically had the highest risk at all points in pregnancy. Understanding hypertensive disorders as a risk factor for depression may help us better support at-risk mothers.