bluuebunny/crossref_metadata_2025_split huggingface dataset:
Narcotic Use After Cesarean: Separate Versus Combined Regimens of Oxycodone and Acetaminophen [22E]
Authors: Birchall Courtney , Maines Jaimie , Pauli Jaimey M. 
Published: April 2020

INTRODUCTION:
In the management of post-cesarean analgesia narcotic medications remain a mainstay of treatment. It is well documented that NSAIDS and acetaminophen help reduce the amount of narcotic needed to control post-operative pain, however there is still no consensus on which multimodal regimen is superior. In our study we investigate the impact of different analgesic regimens on narcotic use during post-cesarean hospitalization.

METHODS:
This study is a part of a larger IRB approved study examining the impact of an Enhanced Recovery After Surgery (ERAS) protocol for cesarean deliveries. Data collected from 2/1/19–5/31/19 were part of the retrospective chart review of patients who underwent cesarean section. The study was powered to detect a 30% reduction in narcotic use between groups with of 86 per group. Statistical analysis was completed using SAS.

RESULTS:
The primary outcome was intravenous morphine mg equivalents (mEq) per 12-hour period while hospitalized. Analysis was performed on two dosing regimens: oxycodone (ordered separately from acetaminophen) (N=67), and combined oxycodone-acetaminophen (N=83). Ninety-five percent of patients additionally received NSAIDS in the form of ketorolac and/or ibuprofen. After controlling for potential confounders, patients in the oxycodone group received an average of 4.6 mEq/12 hours compared to the combination oxycodone-acetaminophen group who averaged 5.7 mEq/12 hours, P=.01. Over an average length of stay of 80.8 hours this equaled a difference of 7.41 mEq or 14.82 mg oxycodone, a 19.3% reduction.

CONCLUSION:
Our findings suggest that for patients undergoing cesarean section a regimen of oxycodone and acetaminophen ordered separately may lead to a clinically significant decrease in narcotic use during admission.
Factors Associated With High Inpatient Utilization of Oxycodone After Cesarean Delivery [14E]
Authors: Prasannan Lakha , Blitz Matthew J. , Rochelson Burton L. , Marchbein Harvey 
Published: April 2020

INTRODUCTION:
Few large studies have comprehensively evaluated which factors are associated with increased inpatient opioid analgesia after cesarean delivery. Our objective was to determine if specific maternal and peripartum risk factors are associated with high inpatient utilization of oxycodone after cesarean section.

METHODS:
IRB approved, retrospective case-control study of live singleton cesarean deliveries at 37 weeks of gestation or greater at a tertiary university hospital from 2013–2016. Patients were excluded for NSAID or opioid allergies, and incomplete medical records. Cases were patients with high oxycodone utilization (>90th percentile) and controls were those with normal oxycodone utilization (≤90th percentile). Patient demographics and clinical characteristics were examined to determine if they were associated with high oxycodone utilization. Statistical significance P<.05.

RESULTS:
A total of 7,415 deliveries were included. In this population, high utilization of oxycodone equated to greater than 42 mg/day (n=742). Maternal demographic factors associated with high utilization included advanced maternal age, Caucasian race, pre-pregnancy obesity, and multiparity. Peripartum factors associated with high utilization included prolonged postpartum hospitalization, repeat cesarean delivery, and increased birth weight. Among the social factors evaluated, smoking was associated with increased oxycodone use but prior drug use was not. Maternal comorbidities such as diabetes and hypertension, and pregnancy complications such as preeclampsia and obstetrical hemorrhage were not significantly associated with increased oxycodone use.

CONCLUSION:
After term cesarean deliveries, a number of maternal and peripartum factors are associated with increased inpatient oxycodone utilization. Our findings may help identify patient subgroups that necessitate interventions to prevent development of prolonged postoperative opioid use.
Opioid Use Disorder: A Poorly Understood Cause of Maternal Mortality in the United States [26E]
Authors: Mitra Anjali , Brandt Justin , Rosen Todd , Ananth Cande , Schuster Meike 
Published: April 2020

INTRODUCTION:
Maternal opioid use disorder (OUD) is a burgeoning public health issue with profound effects on perinatal morbidity and mortality in the US. However, whether OUD is implicated in maternal deaths, and if OUD is associated with temporal changes in maternal deaths in the US remains poorly understood.

METHODS:
This is a cross-sectional analysis of maternal deaths in the US from 1999–2017 using death certificate data from the Centers for Disease Control and Prevention. Maternal mortality was defined as any death during pregnancy or within 365 days after delivery. Opioid-attributable deaths were identified using ICD-10 codes. Changes in maternal mortality ratios (MMR) per 100,000 live births among OUD between 1999–00 to 2016–17 were quantified by rate ratios (RR), derived from log-linear regression models, before and after adjusting for maternal age and race/ethnicity.

RESULTS:
5.6% (n=1,225) of 21,918 maternal deaths between 1999–2017 were identified as OUD-related. The overall MMR from OUD increased from 11.2 to 48.5 per 100,000 live births between 1999 to 2017, a 76.9% relative increase. The RR (95% confidence interval [CI]) of OUD-related MMR in 2000–10 and 2016–17, compared to 1999–00 (reference), were 43.1 (95% CI 13.7–135.5), and 155.0 (95% CI 49.9–483.0), respectively. By 2017, the MMR from opioids in white women increased to 5.0 per 100,000 while in black women it was 4.0 per 100,000.

CONCLUSION:
OUD is a growing cause of maternal mortality in the US, which affects white more than black women.
Takes Two to Make Three: Pregnant Women With Substance Use Disorder's Intentions for Partner's Role [36E]
Authors: Smid Marcela Carolina , Charles Jasmin , Cavin Tyler , Cochran Gerald , Varner Michael , Gordon Adam 
Published: April 2020

INTRODUCTION:
Nearly 9 out 10 pregnant women with substance use disorder (SUD) have unintended pregnancies. Little is known about women with SUD's intentions regarding their partner's role in their life. The objective of this study was to determine the proportion of pregnant women with SUD who plan on current partner and/or “father of the baby” involvement in their life and to characterize partner drug use.

METHODS:
An anonymous survey was distributed from December 2018—September 2019 to pregnant women seeking care in specialty multi-disciplinary prenatal clinic for women with SUD. Descriptive statistics were used to describe participant's responses.

RESULTS:
We collected 110 individual surveys. More than 7 out of 10 pregnant women reported that they planned partner involvement in their life (n=78, 71%) or their infant's life (n=80, 73%). The majority (n=55, 51%) planned for partner attendance at all or most prenatal visits. 54% (n=59) reported partner drug use in the past year, specifically opioids (n=39, 66%), methamphetamines (n=35, 59%), marijuana (n=31, 52%), cocaine (n=16, 27%), benzodiazepines (n=9, 15%) and other (n=3,5) (66% used two or more substances). On a Likert scale (1 not interested—10 really interested), women reported a median score of 8 (range 1–10) when rating interest in partner drug treatment access within the prenatal setting, peer support for partners, education for partners about maternal addiction treatment, parenting and special care for infants.

CONCLUSION:
Because most pregnant women with SUD intend partner involvement, further studies on the role of partner in maternal pregnancy and SUD trajectories are urgently needed.
Pregnancy-Related Weight and Postpartum Depressive Symptoms: Do the Relationships Differ by Race/Ethnicity? [31E]
Authors: Green Tiffany , Son Yena , Simuzingili Muloongo , Mezuk Briana , Hagiwara Nao 
Published: April 2020

INTRODUCTION:
There are significant racial/ethnic disparities in the prevalence of postpartum depression. Prior research suggests that the relationships between weight status and depression may vary by race/ethnicity among the general population. However, few studies have investigated whether race/ethnicity moderates the relationships between pregnancy-related weight and postpartum depressive symptoms (PPDS). This study examines the relationships between pregnancy-related weight and maternal PPDS overall and by race/ethnicity.

METHODS:
This study used data from the Early Childhood Longitudinal Study-Birth Cohort (N≈6950). Ordinary least squares and logistic regression were used to examine whether pregnancy-related weight, including preconception obesity and gestational weight gain, were associated with PPDS. Stratified analyses were used to assess whether these relationships varied by race/ethnicity.

RESULTS:
Preconception obesity was associated with higher levels of postpartum depressive symptoms (β=1.208, 95% CI 0.995–1.467). In contrast, gestational weight gain adequacy was not associated with PPDS. Among non-Hispanic (NH) whites, preconception obesity was positively associated with PPDS (β=1.016, 95% CI 0.448–1.584). In contrast, among Hispanics, preconception overweight was associated with lower levels of depressive symptoms (β=-0.887, 95% CI -1.580 to -0.195). There were no statistically significant relationships between pregnancy-related weight and PPDS among NH black or Asian women. However, both NH blacks and Asians were significantly more likely to report PPDS compared to NH whites.

CONCLUSION:
Pregnancy-related weight is associated with higher levels of PPDS, but only among NH white women. Addressing preconception weight could help to reduce overall levels of PPDS but doing so might not mitigate racial/ethnic disparities in postpartum mental health.
Obstetric Provider Perspectives on Opioid Prescribing After Childbirth [23E]
Authors: Osmundson Sarah S. , Iwelu Chibbi , Dawoud Febronia , Pourali Sarah P. , Carpenter Heidi , Graves Connie 
Published: April 2020

INTRODUCTION:
To evaluate how practice design and provider demographics inform opioid prescribing after childbirth.

METHODS:
We conducted a survey of obstetric providers in 4 hospital systems including 2 academic medical centers (n=121), a community-based hospital (n=55), and a free-standing birth center (n=9), which collectively perform 15,000 deliveries annually. “High prescribers” were defined as providers who routinely prescribed opioids after vaginal birth or reported opioid prescribing after cesarean in the top quartile compared to peers.

RESULTS:
Between 6/10/2019–7/31/2019, 192 of 234 (82%) eligible providers completed the survey. Respondents reported prescribing a median of 15 tablets (IQR 12–20) after cesarean and 10% routinely prescribed opioids after vaginal birth. Overall, 63% of respondents endorsed that they would limit opioid prescribing even with increased patient calls. However, 46% responded that very few/no calls were an acceptable frequency after cesarean and 2/3 said <10% of women would be acceptable. High prescribers (n=49, 26%) were older and more likely to come from non-academic hospitals and state that their income or reputation depended on patient satisfaction. They were more likely to take home call and answered more calls per shift. They were less likely to consider overprescribing a major concern after childbirth or desire more prescribing education. After adjusting for covariates, increasing years in practice (aOR 1.06 [1.03–1.11]) and taking call from home (aOR 4.48, [1.27–15.75]) were significantly associated with being a high prescriber.

CONCLUSION:
While obstetric providers endorse reducing opioid prescribing, patient complaints could temper this enthusiasm. Strategies to reduce opioid prescribing after childbirth should consider provider practice structure.
Obesity in Early Pregnancy Has a Stronger Association to Pre-eclampsia and Diabetes Than Weight Gain [28D]
Authors: Roman Tania , Boyd Angela R. , Munoz Jessian L. 
Published: April 2020

INTRODUCTION:
To evaluate the association of obesity in early gestation and weight gain during pregnancy to pre-eclampsia, pre-gestational and gestational diabetes rates.

METHODS:
We conducted a retrospective cohort study at our center from January 2013 to December 2015. Women with singleton pregnancies, who started prenatal care at less than 20 weeks, and who completed delivery at our center were included. The primary outcome was pre-eclampsia. Secondary outcomes were pre-gestational (PGDM) and gestational diabetes (GDM). Body mass index (BMI) was taken from the initial OB visit and stratified into five different categories: 18–24.9, 25–29.9, 30.0–34.9, 35.0–39.9, and ≥40 kg/m2. Obesity was defined as BMI ≥30 kg/m2. Weight gain was stratified into four different categories: <5, 5–10, 11–15, >15 kg. Statistical analysis was performed using Chi-square test for group comparisons. A P-value of <0.05 was considered significant.

RESULTS:
687 women met inclusion criteria and were included in this study. There was a direct relationship between pre-eclampsia and increasing BMI (9.25%, 10.61%, 15.58%, 15.79%, 20.0%, P=.0795). When BMI was divided into non-obese (<30) versus obese (≥30), there was a significant association with pre-eclampsia (P=.0127). There was a significant association with PGDM as BMI increased (P<.0001); as well as a trend to higher rates of GDM. There was no association between pre-eclampsia and weight gained during pregnancy (P=.912).

CONCLUSION:
Obesity appears to be more important than weight gained during pregnancy in the development of pre-eclampsia and gestational diabetes. This highlights the importance of pre-conception weight reduction and optimization for the prevention of morbidity in pregnancy.
Optimizing Care for Mothers and Newborns Affected by Opioid Use Disorder [27E]
Authors: Rodriguez Tatiahna Rivera , Goodman Jean R. 
Published: April 2020

INTRODUCTION:
Recent years have seen a rise in maternal opioid-related deaths and Neonatal Abstinence Syndrome (NAS). Screening with a validated, standardized tool can streamline identification of pregnant women with Opioid Use Disorder (OUD). The NIDA Quick Screen (NIDA) is a tool that has not been validated in this population and may help identify those with OUD.

METHODS:
All pregnant women receiving care at Loyola University Medical Center Outpatient Center between January 2019 and July 2019 were eligible for NIDA screening at two time points: New Obstetric Visit and/or Return Obstetric Visit. NIDA, which screens for tobacco, alcohol, nonprescription medication use, and illicit drug use, was administered as standard of care by a nurse or research assistant at the start of the visit. A chart review of screened patients was then completed to validate results. *IRB and/or animal use committee approval was waived for this study.

RESULTS:
Out of 187 eligible patients screened, 4 (2.14%) resulted positive for OUD by systematic chart review. Of the patients identified for OUD, 3 (75%) were using prescribed opioids and 1 (25%) was using non-prescribed opioids (heroin). None (0%) of the patients with OUD (prescribed) screened positive by NIDA. Conversely, the patient with OUD (non-prescribed) screened positive via “illicit drug use.”

CONCLUSION:
As evidenced by the study, NIDA is not sufficiently sensitive to capture the nuances of current opioid use, specifically prescription medication, in the pregnant population. Additionally, the inability of NIDA to indicate whether opioid use is current or previous, is a critical limitation in obstetric care.
Postpartum Depression Risk Following Prenatal Diagnosis of Major Fetal Anomalies [29E]
Authors: Herrera Christina L. , Byrne John J. , Schell Rachel C. , Nelson David B. , Dashe Jodi S. 
Published: April 2020

INTRODUCTION:
To evaluate how the diagnosis of major fetal anomalies and resulting pregnancy outcomes affected the risk of postpartum depression, as assessed by the Edinburgh Postnatal Depression Scale (EPDS).

METHODS:
Singleton pregnancies with prenatal diagnosis of major fetal anomalies were ascertained from prospectively-maintained databases that included perinatal outcomes and subsequent EPDS responses from 1/2010 to 5/2018. EPDS scores ≥13 were considered positive and prompted referral for mental health follow-up, which was verified by electronic chart review. Statistical analyses were performed using odds ratios and χ2 with P<.05 considered significant. IRB approval was obtained.

RESULTS:
912 women had a prenatal diagnosis of an anomalous fetus and postpartum EPDS screening, and 82 (9%) screened positive. Positive screening was more common with multiple fetal anomalies (15.3% vs 8.0%, P=.004) or aneuploidy (17.1% vs 8.6%, P=.02). Pregnancies complicated by fetal death (N=79, 8.6%), neonatal death (N=52, 5.7%), and termination for anomaly (N=69, 7.6%) were significantly more likely to screen positive than those with neonatal survival to discharge (all OR >2, P<.001). 34 (40%) screen-positive women attended their follow-up appointment with a mental health provider, and 18 (53%) were diagnosed with a depressive disorder.

CONCLUSION:
Women with prenatal diagnosis of major fetal anomalies and perinatal loss had a two-fold increased likelihood for positive depression screening using EPDS. More than half of screen positive women who seek mental health follow-up were diagnosed with a depressive disorder. Effective screening with intervention is warranted in this vulnerable population.
Methadone and Gestational Weight Gain [21E]
Authors: Rosenthal Emily , Cruz Yury , McCurdy Rebekah 
Published: April 2020

INTRODUCTION:
Treatment of patients with opioid use disorder (OUD) with either methadone or buprenorphine is recommended in pregnancy. An association between weight gain and methadone has been reported outside of pregnancy. We sought to identify factors associated with excessive gestational weight gain in patients with OUD on methadone.

METHODS:
This is a retrospective cohort study of pregnant patients with OUD treated with methadone at our institution from 2012–2017. The primary outcome was gestational weight gain. We compared women with non-excessive vs. excessive gestational weight gain based on Institute of Medicine (IOM) guidelines, based on pre-gestational body mass index (BMI). Chi square and t-tests were used to compare baseline characteristics. Linear regression was used to determine an association between methadone dose and gestational weight gain, and multiple linear regression was used to adjust for covariates.

RESULTS:
There were 289 patients identified. Characteristics were similar between groups, with the exception of methadone dose (133.37 mg non-excessive weight gain vs. 150.57 mg excessive weight gain; 95% CI -32.28, -2.12; P=.026). There was a significant association between methadone dose and gestational weight gain (Pearson R=0.12; unstandardized β=0.036; 95% CI 0.002, 0.07; P=.04). In multiple linear regression, there was an inverse relationship between initial BMI and gestational weight gain (unstandardized β=-0.88; 95% CI 1.40, -0.35; P=.001). The association with methadone dose remained significant after adjusting for covariates (unstandardized β=0.057; 95% CI 0.016, 0.098; P=.007).

CONCLUSION:
Higher methadone dose is associated with increased gestational weight gain. Further study is needed to determine the nature of this association.
Pregnancy Outcomes by Type of Bariatric Surgery [32D]
Authors: Wlodarczyk Katarzyna , Harrison Rachel , Semons-Booker Kia , Braun Emilie , Lak Kathleen , Cruz Meredith 
Published: April 2020

INTRODUCTION:
As obesity rates increase, more women of childbearing age opt for surgical intervention for weight loss. The objective of this study was to evaluate whether the mechanism of weight loss related to the type of bariatric surgery (malabsorptive vs. restrictive type) impacts pregnancy outcomes.

METHODS:
IRB approval was obtained. This was a single center, retrospective cohort study of 182 singleton pregnancies after bariatric surgery that delivered between 2006 and 2019. Women were separated based on malabsorptive or restrictive type of procedure. Pregnancy outcomes were compared using univariable and multivariable analyses.

RESULTS:
Of the 182 patients, 41 women had a restrictive procedure and 141 had a malabsorptive procedure. Women with malabsorptive procedures were more likely to have a baseline vitamin deficiency (72.0% vs 35.3%, P=.001), a lower early pregnancy BMI (34.3±6.7 vs 39.2±9.1, P=.001), and anemia at term (59.4% vs 33.3%, P=.004). A maternal composite outcome was not higher in malabsorptive versus restrictive surgeries (7.1% vs 2.4%, P=.271). A composite fetal outcome was also not higher in the malabsorptive group (27.7% vs 34.2%, P=.421). In multivariable analysis, there were no differences in maternal or neonatal outcomes between groups, although there was a trend for higher rates of SGA infants in the malabsorptive group (aOR 4.85, 95% CI 0.58–40.63).

CONCLUSION:
The type of bariatric procedure does not impact neonatal outcomes, rate of GDM or hypertension in pregnancy, or mean GA at delivery. Women with a malabsorptive procedure were frequently vitamin deficient, anemic, and had lower BMI in early pregnancy.
Novel Clinical Navigation System to Improve Prenatal Care for Patients With Diabetes in Pregnancy [27D]
Authors: Odisho Roumta , LeMoine Felicia , Castillo-Quek Jaimee , Chapple Andrew , Sutton Elizabeth , Boggs Karli Mizell 
Published: April 2020

INTRODUCTION:
Treatment of diabetes in pregnancy requires coordination of resources by obstetric providers. In a high volume, high acuity, low resource academic practice with multiple providers, gaps in care can occur. The Louisiana State University Obstetric Clinic (LSU-OBGYN Clinic) developed a navigation system to guide patients with diabetes through prenatal and postnatal care. We aimed to test the effectiveness of the LSU-Diabetes Navigation System (LSU-DNS) to improve adherence to ACOG standard of care treatment of diabetes in pregnancy.

METHODS:
We conducted a retrospective cohort study with LSU-OBGYN Clinic patients with diabetes in pregnancy (10/2015–09/2019; n=191). Receipt of ACOG recommended standard of care treatment of patients with diabetes in pregnancy (assessed by: receipt of diabetes education, Maternal Fetal Medicine consultation, growth ultrasounds, weekly fetal monitoring, postpartum glucose testing, and attendance to prenatal appointments) was evaluated before (n=148) or after (n=43) implementation of the LSU-DNS using Fisher exact and Wilcoxon Signed-rank tests.

RESULTS:
In our cohort, 60 (31%) patients had preexisting diabetes (n=15 Type 1 DM; n=45 Type 2 DM) and 131 (69%) had gestational diabetes. Patients were on average 31±6 years old with a mean body mass index of 37.0±8.7 kg/m2. 49.7% were African American and 90.0% used government-assisted health insurance. Overall adherence to standard of care was significantly improved with the LSU-DNS (before LSU-DNS 78±15% compliance vs. after LSU-DNS 86±13% compliance; P=.0002), and all individual metrics significantly improved except for prenatal appointment attendance.

CONCLUSION:
A clinical navigation system for management of diabetes in pregnancy improves adherence to standard of care guidelines.