bluuebunny/crossref_metadata_2025_split huggingface dataset:
Pregnancy Outcomes and Anxiety in Nulliparous Women [30E]
Authors: Gimbel Lauren A. , Blue Nathan R. , Allshouse Amanda A. , Gimbel Bruce , Silver Robert R. 
Published: April 2020

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

CONCLUSION:
Maternal marijuana use is potentially associated with an increased risk of composite adverse pregnancy outcome of stillbirth, hypertensive disorders of pregnancy, preterm birth, and small-for-gestational-age births. However, the association was not significant when controlling for possible confounders. Future studies should focus on biologic evidence of marijuana consumption as compared to self-report.
Declining Insulin Requirements in Late Pregnancy: A Cause for Concern? [07D]
Authors: Wilkinson Barbara E. , McDonnell Marie , Palermo Nadine , Lassey Sarah C. , Little Sarah E. 
Published: April 2020

INTRODUCTION:
There is conflicting data on whether diminishing insulin requirement at the end of pregnancy is a sign of placental insufficiency. This study gathered descriptive data on women with diminishing insulin requirement and their obstetric and neonatal outcomes.

METHODS:
This was a retrospective cohort study of women who received antenatal care between November 2017 and May 2019 in a clinic of endocrinologists and obstetricians. We hypothesized that women with a declining insulin requirement would have increased rates of placental dysfunction-related complications (oligohydramnios, IUGR, abnormal dopplers, non-reassuring antepartum testing, or a cesarean delivery for non-reassuring fetal heart tracing).

RESULTS:
Our cohort consisted of 157 women: 30 Type 1, 43 Type 2 and 84 gestational diabetics. Twenty-one (13%) experienced a drop in insulin with an average decline of 28% starting at 34 weeks. There was no significant difference in complications related to placental dysfunction (33% vs 24%; P=.37). There was a significantly increased rate of polyhydramnios (43% vs. 9%; P<.01). Women who experienced a decline in insulin delivered one week earlier (median 36w4d vs. 37w4d; P<.01). NICU admissions rates were higher (62% vs. 33%; P<.01) independent of gestational age, and were secondary to respiratory distress (52% vs. 24%; P<.01) as there were no differences in rates of treated hypoglycemia.

CONCLUSION:
We found no relationship between a decline in insulin requirement and placental function-related complications. Interestingly, we found higher rates of polyhydramnios and NICU admissions for respiratory distress regardless of gestational age, suggesting a decline in insulin requirement has a greater impact on the neonate after delivery.
Macrosomia as a Marker for Adverse Perinatal Outcomes in Pregnancy Complicated by Diabetes Mellitus [24D]
Authors: Davitt Caroline , Packer Claire , Caughey Aaron B. 
Published: April 2020

INTRODUCTION:
We sought to examine the strength of macrosomia as a marker for adverse perinatal outcomes associated with poor glycemic control in women with a pre-gestational diagnosis of diabetes mellitus.

METHODS:
A retrospective cohort study of 8,535 women in California with singleton, vertex, non-anomalous gestations was performed to assess prevalence of adverse perinatal outcomes in macrosomic pregnancies complicated by diabetes mellitus. Macrosomia was defined as a birth weight greater than 4000 g. Neonatal outcomes examined included respiratory distress syndrome (RDS), hypoglycemia, jaundice, neonatal death (NND) and intrauterine fetal demise (IUFD). Maternal complications included preeclampsia, post-partum hemorrhage and chorioamnionitis. Confounding variables were controlled for and Chi-squared analyses with a P-value of less than 0.05 were considered statistically significant.

RESULTS:
Overall, macrosomia in pre-gestational diabetic women proved to be a reliable marker for increased perinatal complications. Neonatal complications were most pronounced, with macrosomic neonates at a significantly increased risk for RDS (3.81% vs 1.81% P<.001), hypoglycemia (1.24% vs 0.66% P=.007), jaundice (29.09% vs 23.06% P<.001), NND (0.19% vs 0.04% P=.024) and IUFD (1.38% vs 0.43% P<.001). Macrosomia characterized by birth weight of greater than 4500 g showed similar statistical significance in increased risk of each complication. Both classifications of macrosomia showed decreased incidence of chorioamnionitis (1.38% vs 2.52% P=.002, 1.06% vs. 2.36% P=.031).

CONCLUSION:
Macrosomia in diabetic women is a reliable marker for adverse neonatal outcomes, including increased risks for IUFD and neonatal death. Women should be counseled about these risks and managed accordingly throughout their pregnancies.
Correlation Between Indication for Cesarean Delivery and Postpartum Depression [10E]
Authors: Sega Annalisa , Cozart Ashely , Reyes-Foster Beatriz 
Published: April 2020

INTRODUCTION:
Postpartum depression (PPD) is the most common complication of childbearing yet has little etiological evidence. Understanding the potential connection between PPD and birth experience is essential to improving maternal health.

METHODS:
This mixed methods study compares PPD in women who underwent urgent versus elective cesarean deliveries to understand the impact of delivery on the childbirth experience. Retrospective analysis of Listening to Mothers Survey III identified connections between indication for cesarean delivery and PPD. A pre-interview survey utilizing EPDS was administered to mothers who gave birth via cesarean within 12 months. Twenty-five participants with PPD were randomly selected for interviews. Interviews included questions about birth story and postpartum experiences which provided subjective measures of maternal well-being. Interview data was subjected to thematic qualitative analysis using Grounded Theory method. Study is UCF IRB approved.

RESULTS:
Average EDPS score of urgent cesarean section participants was 10.7±6.4, with 68.5% scoring greater than 8 (n=120). Average EDPS score of elective participants was 8.96±5.7, with 52.7% greater than 8 (n=93). The difference in mean score was statistically significant (P<.05). Interview findings revealed several important themes: support, medical interaction, stress, recovery, breastfeeding and sleep. In several cases, participants with PPD were not properly screened, or responses to screening tools were ignored. Several of our study participants reported medical interactions where they felt rushed or ignored by their providers.

CONCLUSION:
The results support our hypothesis that urgent cesarean sections have higher incidence and severity of PPD. Interview analyses highlight important points for potential physician PPD guidelines.
Liposomal Bupivacaine Decreases Pain Scores and Narcotic Use After Cesarean Delivery [19E]
Authors: Kindig Marilyn , Mouch Alexandra , Adams Darren , Maxwell Rose , Yaklic Jerome 
Published: April 2020

INTRODUCTION:
Liposomal bupivacaine (LB; Exparel 1.3%) is an extended-release, local anesthetic administered perioperatively for management of postoperative (PO) pain. When used as a liposomal suspension, bupivacaine has a fast onset of action with a duration up to 72 hours. This study examines patient reported pain scores (PRPain) and total morphine equivalents (ME) in patients receiving LB administration via transversus abdominis plane block (LB-TAP) or incisional infiltration (LB-II).

METHODS:
Women receiving LB-TAP (n=107) or LB-II (n=185) after cesarean delivery between January 2018 and January 2019 were included in the study. LB-TAP under ultrasound guidance and LB-II were performed by obstetrician-gynecologists. The infusion solution (80 mL, consisted of 20 ml 1.3% liposomal bupivacaine, 30 ml 1/2% bupivacaine and 30 ml injectable saline) was compounded by the pharmacy and sent to the operating room for injection. Primary endpoints are PRPain scores (10-point visual analog scale) and total PO ME used.

RESULTS:
Women receiving LB-TAP (5.5±1.6) reported higher PRPain than women receiving LB-II (4.6±1.7) on PO day 0 (P<.001). However, groups did not differ on PRPain on PO day 1 or PO day 2. Groups were similar for total ME (LB-TAP=25.18 mg ±42.2 vs LB-II=24.92 mg ±51.3; P<.97).

CONCLUSION:
Our results show that initial differences in PRPain scores on PO day 0 for women receiving LB-TAP versus LB-II were not evident on PO day 1 or PO day 2. LB-TAP and LB-II resulted in similar ME, which was noted to be much lower than a recently published narcotics reducing protocol.
Does Treatment of Antenatal Depression Reduce Postpartum Opioid Consumption? [12E]
Authors: Luck Marissa , Sakowicz Allie , Allen Emma , Daiter Maya , Miller Emily S. 
Published: April 2020

INTRODUCTION:
Major depressive disorder (MDD) has been associated with increased opioid use after a cesarean section, however, it is unclear whether treatment of depressive symptoms antenatally to achieve symptom remission reduces postpartum opioid consumption or whether the history of MDD itself reflects an increased risk. We sought to determine whether there were differences in inpatient postpartum opioid use in those with active depressive symptoms proximate to delivery versus those who were euthymic in women with a history of MDD.

METHODS:
This retrospective cohort study included women who received prenatal care and delivered at an academic, single tertiary care hospital between 9/2015 and 1/2019. This project underwent a full IRB review. Women were included if they had a documented history of diagnosed or suspected MDD and had a third trimester depression screen performed. Women were characterized as having depressive symptoms proximate to delivery if their 3rd trimester PHQ9 was ≥10. The number of morphine milligram equivalents (MME) used during the postpartum hospitalization was calculated for each patient. Bivariable and multivariable analyses were performed.

RESULTS:
Of the 321 women who met inclusion criteria, 70 (22%) had depressive symptoms proximate to delivery. These women consumed significantly more opioids postpartum (44±119 vs 23±49 MME, P=.03) and opioid consumption increased with increasing third trimester PHQ9 score (β=2.6, 95% CI 1.0–4.2). These findings persisted in multivariable analyses.

CONCLUSION:
In our study, women with depressive symptoms proximate to delivery consume more opioids in the postpartum period. Targeted depression treatment efforts may help reduce postpartum opioid use.
Toxicology Testing in Pregnancy: Evaluating the Role of Social Profiling [34C]
Authors: Perlman Nicola C. , Smith Nicole A. 
Published: April 2020

INTRODUCTION:
Clear guidelines for toxicology testing of pregnant women are lacking, despite significant repercussions associated with positive tests. Implicit bias may lead to inconsistent ordering of urine toxicology (UTox) in pregnancy.

METHODS:
We reviewed all births from 1/1/2015 to 12/31/2018, and identified mothers with UTox sent outside of routine prenatal care. Demographic data was compared in women with UTox and without. Sociodemographic characteristics were examined with Chi-square, fisher's exact, or Wilcoxon rank sum test; adjusted logistic regression models were used for multivariate analysis. Models were adjusted for age, race, marital status, and mean income by residential ZIP code.

RESULTS:
UTox was sent on 2.8% (574) of 20,274 mothers. Women with UTox were younger (P<.0001), more likely “single” (P<.0001), living in the lowest income ZIP code (P<.0001), and were less likely to be white (P<.0001). In multivariate analyses, increasing age and Asian race appeared protective against UTox ordering (OR 0.95 [0.93–0.97]); (OR 0.22 [0.11–0.45]), while Native American race was not (OR 4.66 [1.98–10.99]). Black race was borderline (OR 1.235 [0.981–1.555]). Income by ZIP code exhibited a dose effect, with residence in lower versus higher income ZIP codes more likely to be associated with UTox ordering (OR 2.70 [1.87–3.90] vs. OR 1.68 [1.14–2.48]).

CONCLUSION:
Maternal age, race, marital and socioeconomic status may impacted providers' decisions to order urine toxicology testing. Evidence-based guidelines for toxicology evaluation are essential to more appropriately triage women for whom testing is medically indicated, and to decrease implicit bias in decision making.
Buprenorphine-Naloxone Versus Buprenorphine for Treatment of Opioid Use Disorder in Pregnancy [07E]
Authors: Perry Briana N. , Vais Simone , Miller Melissa , Saia Kelley A. 
Published: April 2020

INTRODUCTION:
Treatments for opioid use disorder (OUD) in pregnancy remain understudied. The safety and efficacy of buprenorphine (BUP), a partial opioid agonist, and methadone, a full opioid agonist, in pregnancy has been established (1). Outside of pregnancy, the combination of BUP and naloxone (BUP-NX), a partial opioid antagonist, is commonly favored due to the decreased risk of diversion (2). Historically, women on BUP-NX are transitioned to BUP in pregnancy due to concerns for fetal exposure to naloxone (3,4). Recently, several small retrospective studies explored the use of BUP-NX in pregnancy and found no adverse maternal or neonatal outcomes (5,6). This is the first study to directly compare BUP-NX and BUP use in pregnancy.

METHODS:
This single-center, retrospective cohort study assessed 33 pregnancies managed with BUP-NX and 22 managed with BUP. Maternal outcomes included demographic characteristics, gestational age at treatment initiation, number of prenatal visits, gestational age at delivery, concurrent prescribed psychiatric medications, unprescribed or illicit substance use per urine drug screening, and delivery outcomes. Infant outcomes included birth weight, Apgar scores, and neonatal abstinence syndrome outcomes (diagnosis, treatment, and length of hospital stay).

RESULTS:
There was no significant difference in prenatal care utilization, maternal substance use, delivery outcomes, or neonatal outcomes. Among a subgroup of women transitioned from BUP to BUP-NX mid-pregnancy, no incidences of treatment destabilization were observed post-transition.

CONCLUSION:
Our study finds that BUP-NX is non-inferior to BUP in the treatment of OUD in pregnancy and supports the growing body of data indicating the safety of BUP-NX use in pregnancy.
A Prospective Evaluation of Opioid Consumption Patterns Following Vaginal and Cesarean Deliveries [03E]
Authors: Saini Amanda , Holtz David 
Published: April 2020

INTRODUCTION:
There has been increasing pressure placed on healthcare providers to limit excess narcotic prescription. The purpose of our study is to evaluate opioid prescription and consumption patterns following vaginal and cesarean deliveries.

METHODS:
This is an IRB-approved prospective observational study conducted at a private academically-affiliated institution. Demographic and delivery information was abstracted from the medical record. Information regarding opioid type and number of pills prescribed and used was collected via telephone survey after discharge. Results are reported as five-milligram (5mg) oxycodone pills.

RESULTS:
Postpartum opioid utilization is reported for 142 patients. One hundred and one patients received a prescription at discharge. The median number of 5 mg oxycodone pills prescribed after both vaginal and cesarean delivery was 20. The median number of pills used after vaginal and cesarean delivery was 0 and 5, respectively. Of those who filled prescriptions after discharge, the utilization rate after vaginal deliveries was 9.2% and after cesarean deliveries, 43.5%. After 101 deliveries, 1135 opiate pills were unused. There was no relationship between demographics, smoking status, depression/anxiety, use of psychoactive medication, spontaneous versus operative vaginal delivery, planned versus unplanned cesarean delivery, or primary versus repeat cesarean delivery and post-discharge opioid consumption. There were statistically significant relationships between both inpatient opiate use and insurance type with post-discharge opiate consumption.

CONCLUSION:
Postpartum patients consume 0–40% of prescribed pain medication. Predictive factors of post-discharge opiate use include inpatient consumption and insurance type. Limiting the number of pills prescribed in the postpartum period can decrease excess narcotics available for abuse or diversion.