bluuebunny/crossref_metadata_2025_split huggingface dataset:
Outpatient Cervical Ripening With a Balloon Catheter: Systematic Review and Meta-analysis [38B]
Authors: Pierce-Williams Rebecca , Harper Lorie , Kuper Spencer , Sciscione Anthony , Berghella Vincenzo , Lesser Henry 
Published: April 2020

INTRODUCTION:
To evaluate the difference in time on Labor and Delivery with outpatient versus inpatient cervical ripening with a balloon catheter in low-risk women.

METHODS:
This was a systematic review and meta-analysis including only randomized controlled trials (RCTs). Electronic databases (PubMed, Scopus, and Cochrane Central Register of Controlled Trials) were searched for eligible articles from inception to July 2019. Those not comparing balloon use in both arms of the RCT were excluded. The reference lists of identified articles were examined to identify additional studies.

RESULTS:
Four RCTs, including 418 women, met inclusion criteria. Only one RCT directly compared balloon only cervical ripening in the two arms. Two RCT protocols allowed for use of prostaglandins after the balloon if amniotomy was unacceptable or for Bishop score <6. In one RCT, oxytocin was administered to the inpatient arm. The mean difference in time on Labor and Delivery when comparing the outpatient to inpatient groups was -5.39 hours (95% confidence interval (CI) -7.14 to -3.64). Among three studies with available data, there was no difference in duration of oxytocin use (mean difference 1.17 hours, 95% CI -0.16 to 2.50). The outpatient group was significantly more likely to deliver vaginally than the inpatient group (Odds Ratio 2.1, 95% CI 1.31 to 3.37).

CONCLUSION:
Based on this analysis, outpatient cervical ripening with a balloon catheter in low-risk women is associated with a decreased amount of time spent on Labor and Delivery and increased rates of vaginal birth. This will likely translate into decreased hospital costs and improved patient outcomes.
Rethinking Meningitis in Pregnancy: Meningitis Presenting as Dysarthria and Otalgia at 28 Weeks Gestation [39B]
Authors: Palmieri Alicia J. , Giglio Alexandra 
Published: April 2020

INTRODUCTION:
Bacterial meningitis is a rare, life-threatening disease with an incidence in the general population of 2.6–6 cases per 100,000 adults, and is even rarer in pregnancy. A study suggests that bacterial meningitis has an estimated mortality rate of >20% in adults.

METHODS:
A 27-year-old G1 at 28 weeks gestation presented with complaints of headache, fever, and difficulty speaking. Patient was reporting symptoms of otitis infection. On admission, patient's mental status declined, requiring intubation and sedation. Patient was febrile and had a leukocytosis. Lumbar puncture and blood cultures grew Streptococcus pneumonia. On admission, patient was started on broad spectrum antibiotics, which were switched to meropenem based on sensitivities. Secondary to CT evidence of increased intracranial pressure, an intracranial pressure catheter was placed. Fetal status was reassuring throughout hospitalization. Patient was intubated for 9 days before self-extubating. Patient showed clinical improvement and was discharged home after 16 days of inpatient treatment. Patient went on to deliver a full-term liveborn male neonate via normal spontaneous vaginal delivery.

CONCLUSION:
An observational study, showed that bacterial meningitis in pregnancy does not typically present with the typical clinical triad of fever, neck stiffness, and headache, but rather with headache (87%), altered mental status (73%), fever (60%), and signs of otitis infection (60%) [PMID 22925078]. These symptoms tend to be vague and difficult to decipher, but prompt diagnosis and treatment is crucial in maternal survival. This case report supports the most commonly associated symptoms found in patients with bacterial meningitis in pregnancy.
#BlackBreastsMatter: A Social Media Intervention Study to Increase Breastfeeding Among African-American Women [01C]
Authors: Oluloro Ann , Dauphin Cassy , Saad-Harfouche Frances , Deborah Erwin , Joseph Denagy 
Published: April 2020

INTRODUCTION:
Breastfeeding reduces the risk of breast cancer. Disparities exist in breastfeeding with about 59% of African-American infants ever being breastfed versus 75% of white infants. One possible explanation is that African-American women may not be discussing benefits of breastfeeding. Thus, this pilot study explores the use of social media to engage pregnant African-American women in education about breastfeeding and to test its impact on breastfeeding outcomes.

METHODS:
This study was a randomized intervention enrolling eligible African-American women in Buffalo over 18 months into one of two private Facebook groups. The intervention arm received breastfeeding plus breast cancer risk-reduction messaging while the control arm received messaging about breastfeeding alone. A subset of the intervention and control arms failed to join the assigned Facebook group thus creating “true controls” for the study. Participants completed pre- and post-birth assessments.

RESULTS:
288 women (N=135 in intervention arm, N=153 in control arm) were randomized into the study. Pre-birth, 76.7% of true controls, 74.7% of breastfeeding-only, and 85.9% of the intervention-group were planning to breastfeed, but, respectively, only 24.6%, 34.6%, and 32.9% exclusively breastfeed post-birth. Breast cancer risk perceptions did not differ between pre-birth and post-birth for the intervention group. The percentage of controls who responded that their risk was “very low” or “somewhat low” significantly increased from 61.5% at pre-birth to 80.0% at post-birth.

CONCLUSION:
Exclusive breastfeeding is high among groups receiving social media messaging. Therefore, continued and improved efforts should be made to use social media to promote breastfeeding and its benefits.
A Quality Improvement Project for Care Transitions of Incarcerated Women [03C]
Authors: Davis Katherine M. , Tolleson-Rinehart Sue , Knittel Andrea K. 
Published: April 2020

INTRODUCTION:
Currently incarcerated pregnant women face significant barriers when they seek health care services within prisons and jails, but little is known about transitions from state prison health care systems to outside hospitals.

METHODS:
With the goal of developing a policy to improve these transitions, we conducted in-depth interviews with key stakeholders at a state prison, university hospital, and local private hospital to identify the barriers and facilitators to care transitions for incarcerated pregnant women.

RESULTS:
Key themes emerging from the interviews were operational, including transfer of medical records, communication between systems, and education of providers, and structural, including care of marginalized populations and implicit biases.

CONCLUSION:
Policy changes to improve transitions of care may include the addition of a dedicated pregnancy care coordinator and a standardization of a clinician-to-clinician sign-out process. This work has the potential to motivate changes to the policies that govern care of incarcerated pregnant women, and stimulate the delivery of more effective and efficient health care to this population.
Association of FQHC Expansion With Birth Weight Outcomes by Race and Neighborhood Segregation [07C]
Authors: Debbink Michelle , McClurg Asha B. 
Published: April 2020

INTRODUCTION:
Racial and spatial disparities in low birth weight (LBW) are well described. Neighborhood-level healthcare access may represent one pathway producing racial birthweight disparities. We assessed relationships between federally qualified health center (FQHC) expansion under the Affordable Care Act and LBW by race and segregation.

METHODS:
Retrospective cohort study of singleton births in Los Angeles County, 2009–2016. We geocoded births to Census Tract (CT) using vital records residential addresses. We calculated FQHC density by number of 10-mile driving radii around an FQHC that intersect a CT. We measured residential racial/economic segregation using Index of Concentration at Extremes (ICE). We used adjusted logistic regression models to estimate relationships between FQHC density and LBW by maternal race and segregation.

RESULTS:
A total of 967,491 births were included. LBW rates decreased over the study period, but racial disparities persisted. Women living in segregated neighborhoods (aOR 3.25; 95% CI 3.14–3.36), particularly black women (aOR 7.08; 95% CI 5.94 – 8.45), had greater odds of delivering a LBW infant. FQHC density increased by a median of 8 FQHC areas per CT (Mann-Kendall test-of-trend P<.001). The top-quartile CT for FQHC expansion was associated with decreased odds of LBW (aOR 0.67; 95% CI 0.65–0.68). Stratified by race and segregation, LBW odds decreased 37% (aOR 0.63; 95% CI 0.55–0.73) among black women and 56% (aOR 0.44; 95% CI 0.35–0.56) among black women in segregated neighborhoods.

CONCLUSION:
FQHC expansion in LA County decreased the odds of LBW for all women, particularly black women living in segregated neighborhoods.
Barriers and Drivers of Cervical Cancer Screening in Gonaives, Haiti [08C]
Authors: Bien-Aimé Danta , Holter Virginia 
Published: April 2020

INTRODUCTION:
Cervical cancer is the most common cancer and the second leading cause of cancer deaths in Haitian women. Early detection with early treatment that is completed at one clinic visit is an important strategy to target cervical cancer incidence and mortality rates but it is an underutilized resource.

METHODS:
An explanatory sequential mixed-method design is being used for a stratified sample of 200 women, ages 25 years and older, in Gonaives, Haiti. IRB approval was received and each participant consents to participate. Interviews estimate the proportion of women who have received cervical cancer screening. Quantitative data collected includes socio-demographic background and barriers to screening. Twenty women sampled from the quantitative population are to be interviewed about perceived barriers to screening. Ten healthcare providers will be interviewed about the challenges of cervical cancer screening in the community.

RESULTS:
Data has been analyzed from 58 participants, 88% are aware of cervical cancer, 21% have had screening and report no family history of cervical cancer. Of the 79% who had not been screened, 8% had a family history of cervical cancer, 92% do not consider a $5 fee as a barrier, 25% admitted fearing screening, 38% need partner approval, 96% state access to treatment influences their decision to screen, 50% prefer not to know if they have cervical cancer.

CONCLUSION:
Access to treatment is a strong predictor for cervical cancer screening. The results of this social research address the implementation and barriers of cervical cancer screening efforts for vulnerable populations in developing countries with limited resources.
Factors in Prenatal Vaccine Knowledge and Uptake Among Minority Pregnant Patients [10C]
Authors: Patapoff Kelly E. , Razi Yasmine Y. , Woods Gabriella , Stohl Hindi E. , Nelson Anita L. 
Published: April 2020

INTRODUCTION:
To assess factors that predict acceptance or rejection of Tdap (Tetanus, Diphtheria, and Pertussis) vaccine in a clinic with uptake rates substantially higher than national averages in order to identify modifiable factors.

METHODS:
In summer 2019, we surveyed the generally low-income, English-speaking patients in the UCLA-Harbor Medical Center Obstetrics clinic in Torrance, California following an IRB-approved exempt protocol (#31225-02). Candidates were at least 18 years old and 32 weeks gestational age. With verbal consent, the survey was administered on a one-to-one basis with Chi-square analysis.

RESULTS:
A total of 97 patients was approached; 92 participated. 51% of subjects were age 20–27 (range 18–50); 52% were Hispanic/Latina, 25% African American, 5% Caucasian. Overall, 75% reported receiving the Tdap vaccine. Factors such as age (P=.18), ethnicity (P=.62), education (P=.85), and parity (P=.61) did not significantly differ between acceptors and non-acceptors of Tdap. Of the 23 Tdap non-acceptors, 13 said that they would still refuse vaccination even if they were reassured/counseled of its importance to newborn health. Most women (91%) who accepted the vaccine, reported that it had been recommended to them. 74% of acceptors said they understood why it was important to be vaccinated during pregnancy. Despite this claim of understanding, only 4% of women reported the father had received Tdap.

CONCLUSION:
None of demographic factors predicted rejection of Tdap. There may be factors outside vaccine literacy blocking uptake. Recommending Tdap strongly influences maternal uptake of the vaccine; but, understanding importance of Tdap did not translate into further action as illustrated by low spousal vaccination.
Impact of Minority Races on Clinical Trials on Progesterone for the Prevention of Preterm Labor [14C]
Authors: Bailey Josianne , Davis-Nelson Shareece , Martin Courtney , Mason Danielle , Yao Ruofan , Chan Elena 
Published: April 2020

INTRODUCTION:
It is unclear if clinical trial populations are adequately diverse to address this concern. The objective of this study was to determine if the study populations in published literature on progesterone effect on preterm labor were diverse enough to demonstrate a benefit for minority races.

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

RESULTS:
There were 52 clinical trials identified, nine of which met requirement for in-depth review. Progesterone decreased risk of preterm labor (RR 0.84, 95% CI [0.76–0.93]). Race adjusted pooled results were significant for Hispanic (RR 0.84, 95% CI [0.76–0.93]) and Asian (RR 0.86, 95% CI [0.78–0.95]), but not significant for white (RR 0.97, 95% CI [0.88–1.07]) or black (RR 0.91, 95% CI [0.82–1.01]).

CONCLUSION:
In studies on progesterone for preterm labor, Hispanic and Asian races were underrepresented, whereas white and black races were major contributors.
Predictors of Trust Towards Physicians Among Black Americans [18C]
Authors: Hansen Anna C. , McLouth Christopher , O'Brien John , Oser Carrie 
Published: April 2020

INTRODUCTION:
Severe racial disparities exist among American women with respect to fetal, neonatal, and maternal outcomes. Few studies have examined the relationship between black women's trust towards physicians and pregnancy outcomes, drug use, or incarceration.

METHODS:
This project utilizes survey data from the Black Women in the Study of Epidemics Project (NIDA R01-DA011967). IRB approval was obtained. Between 2008–2011, 643 women completed a baseline interview concerning health status and care utilization, including 240 incarcerated women and 197 women on probation. Approximately half reported current drug use. Follow-up interviews occurred at 6-, 12-, and 18-months. Physician trust was measured continuously using a validated 11-item scale (Anderson & Derrick, 1990). Data analysis was performed using mixed models to account for the longitudinal data.

RESULTS:
Drug use at baseline, current pregnancy, and past history of a birth-related problem were all significantly related to physician trust. Women who had ever experienced a birth-related problem and women who reported drug use at baseline had lower levels of physician trust than women who had not experienced these problems (P<.05). Women who were currently pregnant endorsed a higher level of trust in their physician than women who were not pregnant (P<.05). Baseline incarceration status was not significantly related to physician trust.

CONCLUSION:
Given the established relationship between high physician trust and favorable patient outcomes, future interventions must address disparities in black women's trust, with specific focus on drug-using women and women with past birth complications. Pregnancy should be considered an opportune time to enhance trust between patient and physician.
Race/Ethnic Differences on Postpartum Re-presentation [19C]
Authors: Smithson Sarah , Greene Naomi , Campbell Diahnn , Esakoff Tania 
Published: April 2020

INTRODUCTION:
Racial disparities may contribute to risk for postpartum readmission. We aim to identify racial/ethnic differences in indications for postpartum re-presentation.

METHODS:
This cohort study was conducted at a large urban US medical center. Demographic and obstetric data were collected on all patients who delivered within the study window (2012–2018) and re-presented for evaluation within 30 days of discharge from delivery admission. Indications for re-presentation were divided into the following categories; hypertension, infection (endometritis, urinary tract infection, wound infection), hemorrhage, and other (upper respiratory infection, edema, mastitis, etc). We evaluated the association between race and indication using chi square tests and performed logistic regression to account for potential confounding.

RESULTS:
A total of 1217 re-presented for evaluation within the study window. Black women were more likely to re-present for hypertension (P=.002). The adjusted odds ratio for black women re-presenting for hypertension versus white women was 2.09 (1.32, 3.33). In univariate analysis, black women were less likely to re-present for postpartum hemorrhage. However, this did not remain significant after adjusting for confounders. There were no statistically significant associations between race/ethnicity and the other indication groups.

CONCLUSION:
Black women are more likely to re-present for evaluation of hypertension within 30 days of delivery discharge. This association held true even after adjusting for age, BMI, delivery method, gestational age, multifetal gestation, and marital status. This group may most benefit from outpatient resources such as telemedicine and close follow up for blood pressure monitoring and medication adjustments.
Racial and Socioeconomic Differences in Social Work Reporting Patterns for Positive THC in Pregnancy [21C]
Authors: Ndife Kenneth , Hoffman Shelley , Peters Hannah , Edmonds Brownsyne Tucker 
Published: April 2020

INTRODUCTION:
Women of color and low socioeconomic status (SES) are more often reported to child protective services (CPS) upon testing positive for drug use in pregnancy. We set out to examine CPS reporting and referral patterns by race and SES among hospital social workers (SW) for pregnant women testing positive for isolated marijuana use.

METHODS:
Retrospective chart review study of pregnant women seeking obstetrical care at a Midwestern academic hospital in 2017. Patients were included if their lab work indicated one or more positive tetrahydrocannabinol (THC) drug screening results, with no other illicit drug use reported or screened positive throughout pregnancy. Lab reports, provider referrals to SW, SW notes, and reporting to CPS were collected. This study was approved by the IRB.

RESULTS:
Seventy-seven patients met eligibility criteria. 63.6% were white and 77.8% were publicly insured. The average age was 25 years (18–37). However, documentation and reporting by providers and SW's were inconsistent, raising concerns regarding the quality and reliability reporting procedures. We noted the following inconsistencies: 1) Provider notification of SW varied, 2) inconsistent reporting by SW to DCS, 3) lack of standardized documentation in medical record.

CONCLUSION:
We identified numerous barriers to collecting the data needed to assess the relationship between race, SES, and CPS reporting. Uniform and universally applied reporting procedures are needed for future assessment, measurement and quality control in this arena. Given the widespread movement toward decriminalization, it will be important to document and study the impact of marijuana use in pregnancy on services and penalties rendered.
Racial Differences in Substance Use Patterns During Pregnancy [23C]
Authors: Gottula Jessica , Thomas Megan , Devaiah Ganga , Lambers Donna , Dhanraj Dave 
Published: April 2020

INTRODUCTION:
Substance use during pregnancy remains a significant public health problem. Studies have reported racial differences in substance use, however this has not been addressed in the pregnant population. This study describes associations between maternal race and substance use patterns in pregnancy.

METHODS:
A retrospective study of singleton births from August 2013 through December 2014 was conducted using universal urine drug screen (UDS) collected at the initiation of prenatal care. Excluded were multiple gestations and preterm deliveries. The data is shown by frequency of substance use (no use, any use, use of specific substances) and maternal race (Caucasian, African American, Asian).

RESULTS:
2,270 patients met study criteria. There were 1,030 (45%) Caucasians, 802 (35%) African Americans, and 117 (5%) Asians identified. Caucasian and African Americans had approximately the same rates of substance use, 30.0% and 32.5% respectively. It is notable that 93.1% of African Americans with a positive UDS were positive for only THC, compared to 63.8% of Caucasians. Polysubstance use was much higher in Caucasians than any other racial group, with 31.7% of Caucasian users positive for opiates, 12.0% for benzos, and 5.8% for cocaine. No Asians had a positive UDS.

CONCLUSION:
Our study addresses the racial differences of substance use during pregnancy, specifically detailing the substances used. Our study strongly suggests the need for local and state initiatives to better understand the racial trends for substance use in pregnancy in order to tailor prenatal care interventions that optimize pregnancy outcomes.
Opioid Maintenance Therapy (OMT) Outcomes on Maternal Weight Gain [24E]
Authors: Davis Jay , Heiselman Cassandra , Staszewski Cara , Cochrane Elizabeth , Gruttadauria Michelle , Garretto Diana 
Published: April 2020

INTRODUCTION:
The Institute of Medicine's (IOM) guidelines provide recommendations for appropriate gestational weight gain based solely on pre-pregnancy body mass index (BMI). Opioid use disorders (OUD) are known risk factors for poor nutrition and inadequate weight gain. We sought to compare methadone vs buprenorphine OMT effects on obtaining appropriate maternal weight gain.

METHODS:
We conducted an IRB approved retrospective cohort study using electronic medical records from an academic center between 2007 and 2017. Inclusion criteria: women with a singleton pregnancy receiving OMT with either methadone or buprenorphine. Exclusion criteria: women with a pre-viable delivery, multiple gestation pregnancy, or anomalous fetus incompatible with life. We compared both OMT groups for differences in insufficient, appropriate, or excessive weight gain based upon IOM's guidelines. P-value <.05 was considered significant.

RESULTS:
181 pregnancies were analyzed. 51% (n=93) received buprenorphine and 49% (n=88) received methadone. Patients in the methadone arm were more likely to be prescribed medications at a methadone/pain clinic vs OB provider (P<.05). Baseline demographics for both groups were similar in age, parity, race and BMI. There were no statistically significant differences in inadequate, appropriate, or excessive weight gain between the 2 groups (P=.47). Additionally, there were no statistical differences between the groups regarding recommended weight gain, regardless of BMI (P=.53).

CONCLUSION:
The findings amongst our cohorts revealed there is no superiority of either OMT selection to achieve the recommended weight gain in pregnancy. This data illustrates that the decision to select the optimal OMT should be guided by other factors than achieving the ideal weight gain.