bluuebunny/crossref_metadata_2025_split huggingface dataset:
Impact of Depression in Teenage Pregnancy [17K]
Authors: Wan Steven , Ancar Farren , Tewari Hena , Kaushal Deepika 
Published: April 2020

INTRODUCTION:
Teenage pregnancy remains a public health concern. Maternal complications include increased C-section and instrumental deliveries. Infant complications include preterm births and neonatal death. Societal implications seen in teenage mothers include increased financial burden, unemployment, poor academic achievement, and physical abuse. In this study, we investigated a correlation between a diagnosed adolescent depression and pregnancy during adolescence (<20 years old).

METHODS:
We conducted a retrospective review of female patients, under the age of 20, diagnosed with depression and/or adolescent pregnancy at Texas Tech University Health Sciences Center clinics (including Obstetrics and Gynecology, Pediatric, and Family Medicine clinics) in Amarillo, Texas from January 1, 2013 to December 31, 2016 and conducted Z-test to analyze the statistical significance. IRB approval was obtained.

RESULTS:
Of the 490 teenage girls identified, 171 (34.9%) were pregnant but not depressed, 220 (44.9%) were depressed but not pregnant, and 99 (20.2%) were both depressed and pregnant. Of the 99 teenage girls, 35 (35.4%) of the patients had depression prior to pregnancy, 29 (29.3%) had PPD (postpartum depression), 19 (19.2%) had depression after conception without PPD, and 16 (16.2%) had depression after conception with unknown PPD.

CONCLUSION:
Research suggests that childbearing does not necessarily cause psychological distress among teenagers. However, after filtering out the data for PPD and those with indeterminate history, the result showed that teens were, on average, depressed first, and became pregnant after. This research shows that depression remains an important risk factor for teen pregnancy. Public policy and medical management should be encouraged to address this.
Impact of the 2015 ACOG Screening Guidelines on Prevalence of Postpartum Depression Among Privately Insured Women [18K]
Authors: Leboffe Emily , Pietragallo Helena , Leslie Doug , Goudong Lui , Ba Djibril , Chuang Cynthia 
Published: April 2020

INTRODUCTION:
The American College of Obstetricians and Gynecologists Committee on Obstetric Practice (ACOG) released a Committee Opinion on postpartum depression in 2015 recommending that women be screened at least once during the perinatal period. It is estimated that postpartum depression (PPD) is largely underdiagnosed. Without treatment, PPD can negatively affect the mother and infant. We hypothesized that the 2015 ACOG Committee Opinion led to an increase in postpartum depression diagnosis and prevalence.

METHODS:
Data from the Truven Health Analytics MarketScan database was used to analyze PPD prevalence in 244,624 privately insured women ages 13-45 both before and after the 2015 ACOG guidelines. A postpartum depression diagnosis was identified as a PPD ICD-9/10 claim code, other depression ICD-9/10 claim code, or an antidepressant prescription code during the first 12 months following delivery. A subgroup analysis including only women without prior mood disorders was also evaluated. IRB committee approval was obtained.

RESULTS:
Rates of PPD increased after the 2015 guidelines, when controlling for age, year, delivery complications, and geographic region (adjusted odds ratio, 1.04; 95% confidence interval, 1.01-1.07). ACOG guidelines did not significantly increase rates of PPD in a subanalysis of women without prior history of mood disorders (odds ratio, 1.02; 95% confidence interval, 0.98- 1.05).

CONCLUSION:
This study demonstrates that ACOG guidelines are effective in increasing postpartum depression diagnosis. However, the 2015 guidelines did not impact PPD prevalence in women with no history of prior mood disorders. These findings indicate that national committee guidelines can be effective in addressing the underdiagnosed status of postpartum depression.
Is Food Access Associated With Prevalence of Preterm Birth? [19K]
Authors: Fryer Kimberly , Tanner Jean , Sawangkum Peeraya , Salemi Jason , Campos Adriana , Wilson Ronee 
Published: April 2020

INTRODUCTION:
Low food access has been associated with an increased risk of obesity and cardiovascular disease, but little is known if food access increases the likelihood of adverse pregnancy outcomes. We aimed to determine if living in an area of low food access is associated with an increased prevalence of preterm birth in Florida.

METHODS:
We linked, at the census tract level, data on food access from the United States Department of Agriculture (USDA) Food Access Research Atlas to pregnancy outcome data from the Florida Community Health Assessment Research Tool Set. We defined a census tract as “low access to healthy food” if the tract was both low income and a significant number (≥500) or proportion (33%) of the population lives more than 1 mile (urban areas) or 10 miles (rural areas) from the nearest supermarket. Prevalence ratios and 95% confidence intervals were calculated using modified Poisson regression models.

RESULTS:
We analyzed 2,368,114 births in the state of Florida from 2008-2018 with nonmissing gestational age and food access designation. The preterm birth rate was 10.9% and 10.1% in areas with and without low food access, respectively. We calculated a prevalence ratio of 1.04 (95% CI 1.03–1.05) for the association between preterm birth and low food access after adjustment for maternal race/ethnicity.

CONCLUSION:
Living in an area of low food access was associated with a slight increase in prevalence of preterm birth in Florida. Food access and other measures of neighborhood deprivation may play a role in the risk of adverse perinatal outcomes.
Multiple Aneuploidy Pattern Detected by Non-invasive Prenatal Screening in Successive Pregnancies [25K]
Authors: Jarvis Erin , Fels Christina , Plonka Shira , Liao Franchesca , Klein Rachel T. , Weisberger James 
Published: April 2020

INTRODUCTION:
We present a case where non-invasive prenatal screening (NIPS) detected a similar pattern of multiple aneuploidies in sequential pregnancies.

METHODS:
Case Presentation (with patient consent): A 25 year-old G3P2 patient had NIPS, by massively parallel sequencing (MPS), in her second and third pregnancies. Her first NIPS result was positive for trisomies 18 and 21. Further bioinformatics review revealed possible partial trisomy 13 and complete trisomies 14 and 20, in addition to the previously reported trisomies. NIPS by MPS repeated at another lab was non-reportable. Amniocentesis revealed normal karyotype, microarray, FISH for the chromosomes of interest, and chromosome 14 uniparental disomy testing. Maternal karyotype, microarray, and chromosomal breakage studies were normal. Patient had a negative oncology evaluation. Patient had an insignificant medical and medication history. Patient delivered a healthy girl. Placenta was small with a normal karyotype. Her current pregnancy shows a similar NIPS pattern. Patient declined amniocentesis and further aneuploidy screening. Second trimester ultrasound detected fetal hyperechoic bowel. Repeat maternal chromosomal breakage studies were normal.

CONCLUSION:
NIPS analyzes cell-free DNA in maternal blood originating from maternal and cytotrophoblast cells. The similar NIPS pattern in both pregnancies indicates a likely maternal etiology. When multiple aneuploidies are observed by NIPS, possible etiologies include maternal benign tumor or malignancy and fetal, placental or maternal chromosome abnormalities. However, subsequent fetal and maternal evaluations were normal. This case highlights that NIPS may yield unexpected results that are not representative of the fetal or maternal karyotypes and an extensive multi-specialty work-up may be recommended in these scenarios.
Preterm Birth Risk and Recurrence Among Multiparous Women With Congenital Uterine Anomalies [26K]
Authors: Schwartz Amanda R. , Abdalla Azza , Wheeler Sarahn M. , Dotters-Katz Sarah K. 
Published: April 2020

INTRODUCTION:
Women with congenital uterine anomalies (CUA) are known be at high risk for preterm birth (PTB). We sought to determine the risk of PTB among multiparous women with known CUA as stratified by previous pregnancy history.

METHODS:
A retrospective cohort of women with a known CUA who delivered at 2 tertiary health systems, 2013-2019. We included multiparous women who were carrying non-anomalous, singleton gestations. The primary outcome was PTB before 37 weeks; secondary outcomes included PTB before 34weeks and median delivery gestational age (GA). Women with a history of PTB were compared to those without a history of PTB using Wilcoxon rank sum, ANOVA, Fisher’s exact, chi-square, and Kaplan-Meier survival curves.

RESULTS:
122 multiparous women with CUA met inclusion criteria; 48 (39.3%) had a prior PTB. The most common CUA was bicornuate (43.4%) followed by septate (27.9%), unicornuate (11.5%), didelphys (10.7%), and arcuate (6.7%). PTB before 37 weeks was more common among women with a prior PTB (45.8% vs. 25.7%, P=.02), as was PTB before 34 weeks (27.1% vs. 12.2%, P=.04). In addition, women with a prior PTB delivered earlier [median 37.1 (IQR 30.9-38.4) vs. 39.0 (IQR 36.9-39.4), P=.002].

CONCLUSION:
Multiparous women with CUA are at high risk for PTB. While a history of preterm birth increases risk, even women with prior term birth(s) had high rates of PTB. Overall use of prophylactic treatments such as cerclage and progestogen supplementation was low. Future studies should investigate therapeutic options for the prevention of PTB among women with CUA, irrespective of prior pregnancy history.
Risk-Factor Based Lead Screening and Correlation With Blood and Bone Lead Levels in Pregnancy [27K]
Authors: Johnson Katherine , Specht Aaron , Salahuddin Saira , Erlinger Adrienne L. , Wylie Blair , O'Brien Karen 
Published: April 2020

INTRODUCTION:
Lead exposure has devastating neurologic consequences for children and may begin in utero. The American College of Obstetricians and Gynecologists recommends prenatal lead screening using a risk factor-based approach rather than universal blood testing. The clinical utility of this approach has not been studied. We evaluated the association of bone and blood lead with a prenatal risk assessment questionnaire.

METHODS:
We enrolled a convenience sample of parturients ≥34 weeks’ gestation, with a singleton pregnancy, who were admitted from the obstetrical triage unit. We measured blood lead before delivery and bone lead ≤4 days postpartum using a portable X-ray spectrometer. We defined detectable blood lead as ≥2 ug/dL and detectable bone lead as ≥10 ug/g. The IRB approved the study.

RESULTS:
We enrolled 102 participants, of whom 100 had lead measured. We identified ≥1 risk factor among 78% of participants; none had clinical blood lead testing. The median blood lead was 0.2 ug/dL (0.2–0.4) and median bone lead was 3.8 ug/g (2.0–6.6). Blood lead, but not bone lead, was significantly higher for parturients born outside the US (P=.01). Two participants (2.2%) had detectable blood lead, while 16 (16.2%) had detectable bone lead. The questionnaire had good sensitivity but poor specificity when using blood (sensitivity 100%, specificity 22%), and bone (sensitivity 94%, specificity 25%) as the gold standard for lead exposure.

CONCLUSION:
This study showed that a risk-based approach for detecting lead exposure identifies parturients with high lead levels, but this approach was infrequently used clinically and has poor specificity.
Second Stage Cesarean Deliveries: Does Amount of Pushing and Fetal Station Increase Maternal Morbidity? [29K]
Authors: Mokhtari Neggin , Gold Stacey , Kawakita Tetsuya 
Published: April 2020

INTRODUCTION:
Cesarean deliveries due to arrest of descent are considered to have more complications compared to cesarean deliveries due to other indications. We sought to examine if duration of pushing and fetal station at time of cesarean delivery increases rates of maternal morbidity.

METHODS:
A retrospective cohort study of all women undergoing cesarean delivery from January 2016 to June 2018 at a single hospital was performed. We compared the risks of blood transfusion, superficial and deep incisional surgical site infection (SSI) and postpartum endometritis according to hours of pushing in the second stage (2-4 hours vs. 5 or more hours) and fetal station (≤0 vs. +1 to +5) at time of cesarean delivery. Multivariable logistic regression was performed to calculate adjusted odds ratios (aOR) with 95% confidence intervals (95% CI). IRB approval: STUDY00000045.

RESULTS:
Of 165 (5.6%) who had arrest of descent, 124 (75%) women were pushing for 2-4 hours, while 41 (25%) pushed for five or more hours at time of their surgery. Women who pushed at least 5 hours compared to those who pushed for 2-4 hours had similar rates of blood transfusion, SSI, and endometritis (aOR 0.23 [95% CI 0.03, 1.83], aOR 1.28 [95% CI 0.37, 4.40], aOR 1.25 [0.31, 5.13], respectively). Women who had fetal station of +1 to+5 compared to those who had fetal station of ≤0 had similar rates of blood transfusion, SSI, or endometritis.

CONCLUSION:
Increased length of time of pushing and lower fetal station in the second stage of labor did not significantly increase the rate of maternal complications.
The Effects of Late Preterm Betamethasone in Multiple Gestations [30K]
Authors: Reynolds Krystal , Lawless Paige , Fricke Erin 
Published: April 2020

INTRODUCTION:
The administration of late preterm betamethasone in singleton gestations is an effective intervention for reducing neonatal respiratory morbidity. However, this intervention has not been studied in multiple gestations, which have higher rates of pregnancy complications resulting in admission and delivery from 34 to 36 weeks gestation. We aimed to evaluate the effects of betamethasone in multiple gestations during the late preterm period.

METHODS:
We conducted a retrospective chart review of multiple gestations who delivered between 34/0 and 36/6 weeks. The study included 322 women with 645 neonates. The primary outcome was a composite respiratory outcome that included the need for any respiratory support within 72 hours after birth, as defined as the need for continuous positive airway pressure (CPAP) or high-flow nasal cannula for at least 2 consecutive hours or supplemental oxygen with a fraction of inspired oxygen of at least 30% for at least 4 continuous hours. Secondary outcomes included rates of mechanical ventilation and hypoglycemia.

RESULTS:
The primary outcome occurred in 132 of 388 infants (34%) in the betamethasone group and 75 of 249 (30.1%) in the non-betamethasone group (P=.380). There was no difference in need for mechanical ventilation (P=.987). Neonatal hypoglycemia was significantly more common in the betamethasone group (41% vs 27.3%, P=.004).

CONCLUSION:
Administration of betamethasone to women with multiple gestations did not reduce the rate of neonatal respiratory complications in the late preterm period, but increased the rate of hypoglycemia.
The Nutritional Adequacy of Prescription Versus Nonprescription Prenatal Vitamins [33K]
Authors: Kelly Rachel E. , Tian Elli Y. , Howard David 
Published: April 2020

INTRODUCTION:
To descriptively compare nutritional content of prescription to nonprescription prenatal vitamins (PNVs) through consideration of the American College of Obstetricians and Gynecologists (ACOG) recommendations for a healthy pregnancy.

METHODS:
We utilized 2 publicly available online databases, Dietary Supplement Label Database and DailyMed, to obtain a list of all currently available PNVs. Inclusion criteria was based on initial search results from keyword “prenatal.” Exclusion criteria were single ingredient supplements, or duplicates. Duplicates were supplements listed separately because of different package forms for sales purposes, but were identical (i.e. same manufacturer, nutritional label/content), or those present in both databases. PNV ingredients were recorded from nutritional labels and compared to ACOG micro-nutrient guidelines.

RESULTS:
We obtained a total sample of 307 PNVs (110 prescription, 197 nonprescription). Of the prescription PNVs, 0% met calcium requirements, 100% met folic acid requirements, 82% met iron requirements, and 16% met vitamin D requirements. Of the nonprescription PNVs, 8% met calcium requirements, 98% met folic acid requirements, 11% met iron requirements, and 33% met vitamin D requirements. Each PNV was assigned a score from 0-4, based on the number of the 4 ACOG supplementation recommendations they met. Of the prescription PNVs, 12% scored ≥3, and 20% of the nonprescription PNVs scored ≥3. No single prescription PNV met all 4 ACOG recommendations, and 2 nonprescription PNVs did.

CONCLUSION:
We found no meaningful difference in nutritional adequacy of prescription versus nonprescription PNVs with respect to ACOG recommendations. Tailored supplementation should be considered as an alternative to PNVs.
The Yield of Intraoperative Fetal Monitoring During Nonobstetric Surgery [34K]
Authors: Chang Jeremy , Pluym Ilina D. , Adams Starsha , Afshar Yalda 
Published: April 2020

INTRODUCTION:
While ACOG supports indicated surgery for pregnant patients, there is no clear consensus on optimal fetal monitoring for such cases. We examined whether continuous intraoperative electronic fetal monitoring (ciEFM) for nonobstetric surgeries after viability impacts decision for obstetric intervention and subsequent perinatal outcomes.

METHODS:
IRB approval was obtained for this retrospective cohort study conducted at a single academic center between January 2013 and March 2019. Demographic and outcome data were compared between ciEFM vs pre/post-procedure EFM. Multiple logistic regression was applied to adjust for clinical covariates.

RESULTS:
Of 1,060 cases reviewed, 43 (4.1%) were performed after viability (gestational age (GA) range: 23.7 to 36.4 weeks). ciEFM was used in 24 cases (56%). Two cases required intraoperative resuscitation in the ciEFM group, one with fluid bolus and one with emergent delivery (P=.49). ciEFM cases lasted longer (105 vs 40 minutes, P<.01) and were more likely to be performed under general anesthesia (83.3% vs 26.3%, P<.01). ciEFM had no association with non-reassuring postoperative EFM (18.2% vs 15.4%, P=1.00), postoperative tocolytic use (29.2% vs 10.5%, P=.26), or GA at delivery (37.1 vs 37.2, P=.92). There was no association on the rate of preterm delivery when adjusted for type, or length of surgery, and type of anesthesia (aOR 1.82, 95% CI 0.20-16.4, P=.59).

CONCLUSION:
ciEFM does not significantly affect intraoperative or postoperative obstetrical outcomes. This data can help obstetric providers allocate limited resources, reassure other surgical providers, and appropriately counsel patients who are about to undergo nonobstetric surgery.
Use, Misuse and Overuse of Antenatal Corticosteroids [39K]
Authors: Chakravarthy Shruti , Reddy Rishika , Ducey James , Fruhman Gary , Cojocaru Liviu 
Published: April 2020

INTRODUCTION:
Antenatal corticosteroids (ACS) are a mainstay in the management of women at risk for preterm delivery, however previous studies raised concerns for long-term consequences including increased risk of metabolic disease and neuro-developmental effects. The purpose of this study was to review our hospital’s use of ACS in view of these possible risks.

METHODS:
After Institutional Review Board approval, a retrospective chart review from January 2011 through December 2017 was performed. Pregnancies in which ACS were administered in anticipation of preterm delivery were included. Those who delivered elsewhere or had incomplete charts were excluded. Data collection and descriptive analysis were performed with Research Electronic Data Capture.

RESULTS:
ACS were administered in 432 pregnancies, of which 391 met inclusion criteria. Of these, 77.5% delivered preterm. However, 42.5% of all 391 pregnancies delivered at or above 34 weeks. Only 51.7% of all pregnancies delivered in the first seven days of administration of ACS, falling to only 35% when excluding those who delivered within 24 hours of the first dose. The most common indication for ACS administration was threatened preterm labor (70.1%). Of these, 43.8% delivered in the first seven days, falling to 24.5% when excluding those delivering in the first 24 hours.

CONCLUSION:
While three-quarters of women receiving ACS delivered preterm, a large proportion delivered at 34 weeks or greater and not within the optimal time frame of one to seven days. Further studies are needed to evaluate our administration of ACS, and particularly our assessment of preterm labor, to avoid unnecessary exposure and potential consequences.
Uterine Anomalies Associated With Intrauterine Growth Restriction and Hypertensive Disorders During Pregnancy [40K]
Authors: Gomez Fabiola Gallardo , Ruiloba Francisco J. , Arellano Fernanda Vera , Davila Jose Luis , Ramirez Santes Victor Hugo , Hernandez Cruz Rosa Gabriela 
Published: April 2020

INTRODUCTION:
Congenital anomalies of the uterus have a worldwide prevalence of 2-4% in women of reproductive age, the associated perinatal outcomes are recurrent gestational loss, preterm birth, and anomalous presentations with increased risk of caesarean section. Smaller studies have suggested the link between hypertensive disorders, intrauterine growth restriction and uterine anomalies. The purpose of this study was to compare the rate of hypertensive disorders and intrauterine growth restriction in pregnant women with a known uterine anomaly to the rate in the normal pregnant population.

METHODS:
A population-based retrospective cohort of all live births in Institute of Perinatology (2018-2019) was analyzed. Clinical characteristics of patients who were gravid for more than 28 weeks, and had an uterine anomaly. The rate of hypertensive disorders and intrauterine growth restriction among women with uterine anomalies was calculated and compared among women without uterine anomalies.

RESULTS:
From January 1, 2018 to July 7, 2019, there were 95 women seen in our third level center who were gravid for more than 28 weeks and had a uterine anomaly. A greater proportion of women with a uterine anomaly had a hypertensive disorder (6.3%) and intrauterine growth restriction (11.5%) than women without a uterine anomaly (3.0%) (P=.001) and 6% 8 (P=.001) respectively.

CONCLUSION:
The prevalence of pregnancies with uterine abnormalities is increasing. Understanding the specific pregnancy outcomes that are associated with these high risk pregnancies will be crucial for appropriate management and multidisciplinary to avoid adverse perinatal outcomes.