bluuebunny/crossref_metadata_2025_split huggingface dataset:
Survey of Antepartum Women to Assess Barriers to Sequential Compression Device Compliance [30C]
Authors: Reinhard Megan , Flynn Kathryn , Palatnik Anna 
Published: April 2020

INTRODUCTION:
Sequential compression device (SCD) is recommended for antepartum venous thromboembolism (VTE) prophylaxis. Based on a prior study by our group, women's compliance with SCD on antepartum floor is low. The objective of this study was to design and pilot test a patient survey to identify barriers to SCD use.

METHODS:
SCD survey was designed and assessed for validity and interpretation of each question by face-to-face cognitive interviews with providers and patients admitted to the antepartum floor and prescribed SCD. The survey was then administered to 50 pregnant women admitted to antepartum floor. Patient-reported understanding of SCD purpose, bother, and reasons for non-compliance were included in the survey.

RESULTS:
All women reported they understood the purpose of SCD. Across 12 categories of bothersome aspects of SCD, the average total bother score was 30 (range 12–60). The most common reasons women identified as why SCDs were not worn at all times were: 1) discomfort; 2) too hot/sweaty; and 3) they wake me up. The most common responses to what women believe would make SCD easier to use were to have a wireless/cordless device, lighter weight/cooler material, and to have a better availability of nurses to assist with SCD placement.

CONCLUSION:
In this pilot study we validated and pilot-tested a survey to identify self-reported barriers to SCD use among antepartum pregnant women. Self-identified barriers to use centered around discomfort and restrictive nature of the device. Women identified fixing these barriers as well as needing more assistance with the device as important in increasing its use.
Necessity of Glycemic Agents in Patients With Hypothyroidism and GDM Versus Patients With GDM Alone [26D]
Authors: Feldman Kristina M. , Hussain Farrah N. , Schneider Emily , Chu Lam Melissa T. , Rosenn Barak , Brustman Lois 
Published: April 2020

INTRODUCTION:
Diabetes and hypothyroidism are frequent endocrine pathologies seen in pregnancy. The relationship between medication requirements in patients with concurrent hypothyroidism and GDM is not well established. Our hypothesis was that patients with concurrent hypothyroidism and GDM would be more likely to require hypoglycemic agents during their pregnancy.

METHODS:
This is a retrospective case-control study of 160 singleton pregnancies between August 2015 and August 2019. Patients with concurrent GDM and hypothyroidism were compared to BMI-matched controls with GDM alone. The primary endpoint was a descriptive composite of patients who required either a hypoglycemic agent (glyburide and insulin) or diet alone. Continuous measures were compared with t-tests or Wilcoxon rank-sum tests and categorical measures were compared using Chi-squared tests.

RESULTS:
80 patients with concurrent GDM and hypothyroidism were compared with 160 patients with GDM. The demographics amongst the two groups were similar including age and average BMI. There was a statistically significant difference in the percent of patients with concurrent GDM and hypothyroidism versus those with GDM alone with the use of medication for glycemic control (60% versus 47.1%, P<0.0001). Of the patients with concurrent GDM and hypothyroidism, 41.2% of patients required insulin therapy, versus 16.1% of patients with GDM alone (P<.0001).

CONCLUSION:
Our study suggests that patients with concurrent hypothyroidism and GDM had a greater need for hypoglycemic agents than those with GDM alone.
Improving Maternal and Neonatal Outcomes for Patients With Diabetes by Clinical Navigation [16D]
Authors: LeMoine Felicia , Odisho Roumta , Chapple Andrew , Sutton Elizabeth , Boggs Karli Mizell 
Published: April 2020

INTRODUCTION:
The Louisiana State University Obstetric Clinic (LSU-OBGYN Clinic) developed a navigation system to guide patients with diabetes through their prenatal care. We aimed to determine whether participation in the LSU-Diabetes Navigation System (LSU-DNS) could improve adverse maternal and neonatal outcomes associated with diabetes in pregnancy.

METHODS:
We conducted a retrospective cohort study of LSU-OBGYN Clinic patients with diabetes in pregnancy (n=191, 10/2015–09/2019; approved and monitored by Woman's Hospital IRB). The primary outcome was occurrence of a maternal-neonatal composite compared in patients before (n=148) or after (n=43) implementation of the LSU-DNS using Fisher exact and Wilcoxon Signed-rank tests. Composite variables included: antepartum admission, preterm delivery, pregnancy-induced hypertension, shoulder dystocia, failure of postpartum glucose tolerance testing, fetal demise, NICU admission, NICU length of stay, neonatal birthweight, large for gestational age, and neonatal hypoglycemia.

RESULTS:
Since 2015, the maternal-neonatal composite occurred in 112 (58.6%) patients; 89 (60.1%) of patients before the LSU-DNS was implemented and 23 (53.5%) patients that participated in the LSU-DNS (P=.48). While the overall composite is not significantly decreased in LSU-DNS participants in this interim analysis (currently n=43 patients have completed LSU-DNS participation), incidence of several individual outcomes were decreased in LSU-DNS patients compared to pre-LSU-DNS patients including: preterm delivery (21.4% vs. 29.7% respectively, P=.33), pregnancy-induced hypertension (20.1% vs. 26.4%, P=.55), shoulder dystocia (0% vs. 4.1%, P=.33), and large for gestational age neonates (19.0% vs. 23.6%, P=.68).

CONCLUSION:
The LSU-DNS may improve maternal and neonatal outcomes in patients with diabetes in pregnancy, however more patients are needed to adequately assess its effectiveness.
Influence of Obesity on Maternal and Neonatal Outcomes in Advanced Maternal Age Women [22D]
Authors: Hanneman Nonda , Sarker Minhazur , Caughey Aaron B. , Valent Amy M. 
Published: April 2020

INTRODUCTION:
Advanced maternal age (AMA) and obesity have been shown to independently influence maternal and neonatal outcomes. We sought to determine if obese AMA women had greater risk for adverse outcomes compared to non-obese AMA women.

METHODS:
A retrospective cohort study of non-anomalous, singleton AMA (age 35+) pregnancies at Oregon Health & Science University from 2009–2014 to assess if obesity (pre-pregnancy BMI 30+) impacted outcomes above AMA status alone. Maternal outcomes included gestational diabetes (GDM), pre-eclampsia (PET), and cesarean section (CS). Neonatal outcomes included NICU admission, SGA/LGA, preterm birth, and hypoglycemia. Univariate analyses were used to determine significant differences between groups (P<.05), and multivariate logistic regression adjusting for biologically plausible confounders was utilized to determine strength of association.

RESULTS:
Of the 7,953 deliveries during the study period, 1,712 were to AMA women with 459 obese (27%) and 1,253 non-obese (73%). Obese AMA women were associated with significantly increased rates of GDM (aOR 3.04, 95% CI 2.23–4.40), PEC (aOR 1.64, 95% CI 1.09–2.47), and CS (aOR 1.42, 95% CI 1.12–1.85). Neonates born to obese AMA women were associated with significantly increased rates of LGA (aOR 2.66, 95% CI 1.86–3.80) and hypoglycemia (aOR 1.98, 95% CI 1.10–3.58). There was no significant association between obesity in AMA women and SGA, preterm birth, or NICU admission.

CONCLUSION:
In AMA pregnancies, obesity is associated with significantly increased rates of GDM, PEC, CS, LGA neonates, and neonatal hypoglycemia. These results suggest that AMA pregnancies complicated by maternal obesity may benefit from earlier intervention and counseling.
Mode of First Delivery and Postpartum Weight Retention 1 Year After First Childbirth [25D]
Authors: Legro Nicole R. , Kjerulff Kristen H. 
Published: April 2020

INTRODUCTION:
The prevalence of obesity in the US has increased markedly in women in their reproductive years over the past 3 decades, partially due to higher rates of excessive gestational weight gain (GWG) and postpartum weight retention. Few studies have considered mode of delivery as an independent risk factor for postpartum weight retention and long-term obesity.

METHODS:
This was an IRB-approved prospective cohort study of 2,747 first-time mothers, aged 18 to 35 with singleton pregnancies. Postpartum weight retention was measured at 1 year after delivery and was defined as weight at 1 year compared to weight just before becoming pregnant. Logistic regression models assessed the association between mode of first delivery and subsequent weight retention of 10 pounds or more, adjusting for key confounders including pre-pregnancy body mass index, GWG, age, education, poverty status, smoking, race/ethnicity, pregnancy complications, gestational age, breastfeeding, and exercise habits during pregnancy and the first year after delivery.

RESULTS:
At 12 months after delivery the women who had delivered by cesarean were more likely to have a postpartum weight retention of 10 pounds or more (28.3%), than those who had delivered vaginally (22.8%), unadjusted OR 1.34 (95% CI 1.11–1.61 P=.003). Even after controlling for confounding variables, mode of delivery remained significantly associated with postpartum weight retention of 10 pounds or more, adjusted OR 1.30 (95% CI 1.05–1.60 P=.015).

CONCLUSION:
Cesarean delivery at first childbirth is associated with increased risk of weight retention of 10 pounds or more at 1 year postpartum.
Impact of Lactation Consultation on Breastfeeding Rates in Women With Gestational Diabetes [14D]
Authors: Griffin Laurie , Kole Martha Brown , Ding Jia Jennifer , Lord Megan , Has Phinnara , Werner Erika 
Published: April 2020

INTRODUCTION:
For women with gestational diabetes (GDM), breastfeeding can decrease type II diabetes risk; however they often face barriers to breastfeeding success, which may be addressed by lactation consultations. We sought to determine if lactation consultation during postpartum hospitalization was associated with breastfeeding success at three months post-partum in women with GDM.

METHODS:
Six hundred patients diagnosed with GDM by either the Carpenter-Coustan criteria or a 1-hour glucose challenge result over 200 mg/dl were prospectively enrolled. Patients completed surveys about infant feeding during their delivery hospitalization and at 3 months post-partum. For this secondary analysis, data regarding lactation consultations were extracted from the electronic medical record. Demographics and self-reported breastfeeding rates were compared between women with GDM who did and did not receive lactation consultations during their postpartum hospitalization.

RESULTS:
Complete data were available for 575 (96%) pregnancies of the cohort. Inpatient lactation consultations were completed for 444 (77%). Women who received lactation consults were more likely to report any breastfeeding attempts post-partum (82.2% vs 69.5%, P=.002) or exclusive breastfeeding at hospital discharge (37.7% vs 21.4%, P=.001) compared to women who did not receive lactation consultation. At the three months post-partum lactation consultation was associated with continued breastfeeding (87.8% vs 78.2%, P=.01) and exclusive breastfeeding (22.5 vs 13.5%, P=.03) among women who at least attempted breast feeding in the hospital.

CONCLUSION:
Among women with GDM, inpatient lactation consultations during the immediate postpartum period are associated with improved rates of breastfeeding and therefore may be a useful tool to decrease DM risk in this high-risk population.
Weight Retention and Risk of Pregnancy-Associated Hypertension in Subsequent Pregnancy [40D]
Authors: Franco Stephanie , Kawakita Tetsuya , Ghofranian Atoosa , Thomas Alexandra , Downs Sarah 
Published: April 2020

INTRODUCTION:
We sought to examine the rate of pregnancy-associated hypertension according to weight gain between pregnancies among obese women.

METHODS:
This was a retrospective cohort study of all women who had at least two pregnancies at 23 weeks' gestation or greater at a single academic institution. Women with prepregnancy body mass index (BMI kg/m2) less than 30 kg/m2 in the first pregnancy, a history of chronic hypertension, or pregestational diabetes in the first pregnancy were excluded. Women were stratified based on weight change between pregnancies. Our primary outcome was the rate of pregnancy-associated hypertension (gestational hypertension or preeclampsia). A multivariable logistic regression analysis was performed to calculate adjusted odds ratios (OR) and 95% confidence intervals (95% CI), controlling for predefined covariates.

RESULTS:
Of 1,046 women, 248 (23.7%), 453 (43.3%), and 345 (33.0%) had weight loss (BMI>2 kg/m2), stable weight (BMI change -2 to +2 kg/m2), and weight gain (BMI>2 kg/m2), respectively. Women with weight gain compared to those with stable weight were more likely to have pregnancy-associated hypertension (14.5% vs. 7.1%; adjusted OR 1.96 [95% CI 1.20–3.22]). Women with weight loss compared to those with stable weight had a similar rate of pregnancy-associated hypertension (2.1% vs. 7.1%; adjusted OR 0.96 [95% CI 0.52–1.78]).

CONCLUSION:
In our cohort of obese multiparous women, weight gain was associated with increased odds of pregnancy-associated hypertension compared to a stable weight.
Implications of Decreasing Insulin Requirements for Diabetes in Pregnancy: A Systematic Review [15D]
Authors: Prior Alexandra , Jain Venu 
Published: April 2020

INTRODUCTION:
Increased insulin resistance is a known physiologic change of pregnancy. For patients with gestational or preexisting diabetes being treated with insulin therapy, insulin requirements are expected to steadily increase throughout pregnancy. In a small subset of patients, insulin requirements decrease in the third trimester. It is felt by some practitioners that this clinical change is indicative of placental insufficiency, although current evidence is limited and conflicting.

METHODS:
A search strategy was developed to identify studies that compared maternal and neonatal outcomes in women with insulin-dependent diabetes who experienced a decrease in insulin requirement against those with insulin requirements that did not decrease in the third trimester. A systematic review was then carried out using MEDLINE, EMBASE, Cochrane Library, EBSCOHost CINAHL, Scopus, WOS Core Citation Indexes, Biosis Citation Index and Proquest Dissertations & Thesis Global databases.

RESULTS:
1514 studies were identified using the search strategy, and 21 were selected for full-text review. Data extraction from these studies is ongoing.

CONCLUSION:
There are currently no guidelines to inform management of insulin-dependent diabetes in pregnancy when insulin requirements drop. However, this clinical scenario is often considered to be an indication for increased surveillance and/or delivery. This review will help clarify whether the additional surveillance of such patients is warranted, and may aid in the development of future guidelines regarding the management of such patients.
Incidence of Abnormal Glucose Values Following Delivery in Women With Gestational Diabetes [18D]
Authors: Swor Erin C. , Armijo Gabrielle , Ramos Gladys A. , LaCoursiere D. Yvette 
Published: April 2020

INTRODUCTION:
Limited evidence guides the immediate postpartum (PP) management of gestational diabetes (GDM). Protocols vary from universal, selective, or not screening glucose levels after delivery. We assessed the incidence of PP hyperglycemia, treatment, and risk factors for diabetes medications at discharge.

METHODS:
An IRB-approved retrospective cohort study of all women with GDM delivering at a large academic medical center that employs universal PP screening between Jan 2015-Nov 2017 was conducted to assess PP blood glucose (BG) levels and treatment.

RESULTS:
1039 women were included (GDMA1 n=509, GDMA2 n=503, GDMA2 vs T2DM n=27). Only 14% of women had 1 or more episodes of PP hyperglycemia (BG greater than 180 mg/dl). PP hyperglycemia increased with intensity of antepartum glucose management (1 or more elevated values: 11% diet, 17% oral medications, 22% insulin; p 0.01). Total daily insulin dose at admission was associated with increasing PP hyperglycemia (P=.015). Hyperglycemia was associated with non-white race (OR 1.53, 95% CI 1.0–2.3) and diabetes severity (GDMA2 OR 1.59, 95% CI 1.1–2.3; GDMA2 vs T2DM OR 11.14, 95% CI 4.8–25.9) and inversely associated with Cesarean delivery (OR 0.44, 95% CI 0.3–0.7) 20 women (1-GDMA1, 13 -GDMA2, 6-GDMA2 vs T2DM) were discharged on hypoglycemic medications.

CONCLUSION:
Only 1 in 7 women with GDM had immediate PP hyperglycemia. Universal PP screening resulted in evaluating over 1000 women to identify very few who were ultimately discharged on medications. GDM type and total insulin dose are strong predictors of those at risk. These findings should inform in-hospital screening protocols for postpartum GDM management.
Geographic Distribution of Medicaid-Claimant OB-GYNs Approved to Prescribe Buprenorphine for Opioid Use Disorder [15E]
Authors: Nguemeni Tiako Max Jordan , Culhane Jennifer , Meisel Zachary F. 
Published: April 2020

INTRODUCTION:
High incidences of opioid use disorder (OUD) during pregnancy and neonatal abstinence syndrome (NAS) are manifestations of the U.S. opioid epidemic. Buprenorphine is an effective treatment for OUD, but with restricted access due to prescribing barriers. Neonates with in-utero buprenorphine exposure have milder NAS symptoms and shorter hospital stays. We sought to describe the geographic distribution of buprenorphine-approved obstetrician-gynecologists (ob-gyns).

METHODS:
To identify buprenorphine-waiver status and geographic location, we linked the Drug Addiction Treatment Act buprenorphine-waived provider list to the Centers for Medicare & Medicaid Services Physician Compare dataset, and extracted all physicians of the specialty “obstetrics and gynecology.” We obtained state NAS data from state agencies' reports, and classified counties based on rural-urban continuum codes.

RESULTS:
Out of 31,211 obgyns who treat patients with Medicaid insurance, only 1.8% (560) can prescribe buprenorphine. Only 292 out of 3220 counties have at least 1 buprenorphine-approved ob-gyn. Among the 292, 76.4% (223) are metropolitan, 23.6% (69) are non-metropolitan. All 10 states with the highest opioid overdose deaths rates have at least 1 buprenorphine-approved ob-gyn (2 to 48). West-Virginia and Maine, however, have the highest NAS rates (50.6 and 80 per 1000 births respectively, compared to 8 nationally), but each have only 4 buprenorphine-approved ob-gyns.

CONCLUSION:
Buprenorphine is a mainstay and guideline-recommended treatment for OUD in pregnancy. The geographic distribution of buprenorphine-approved ob-gyns in the US is variable and does not reflect the incidence of NAS. Policy and educational interventions could improve buprenorphine access during pregnancy to limit the opioid epidemic's impact on maternal-fetal outcomes.
Antepartum Edinburgh Depression Score: Implications for Postpartum Care [04E]
Authors: Zornberg Giselle Z. , Lyall Melinda , Ramos Gladys A. , Herrero Tiffany , LaCoursiere D. Yvette 
Published: April 2020

INTRODUCTION:
Depression is a common complication that impacts perinatal outcomes. There is a paucity of literature investigating associations between an elevated Edinburgh Depression Score (EDS) 10 or greater and treatment (pharmacologic and behavioral) on postpartum visit adherence and contraception.

METHODS:
A retrospective cohort study of women with a singleton liveborn delivery who were screened antenatally using the EDS between 2010 and 2016 was performed. Primary outcomes were postpartum visit attendance within 12 weeks and contraception use. Secondary outcomes included contraceptive choice and effect of treatment on outcomes. Institutional Review Board approval was obtained for this study.

RESULTS:
1,730 patients underwent antenatal EDS screening, and 619 (36%) had an elevated EDS. Women with an elevated EDS were more likely to be black, have higher parity, have a history of depression, or a history of drug or tobacco use. After controlling for potential confounders, women with an elevated EDS had decreased postpartum visit attendance (adjusted OR (aOR) 0.75, 95% CI 0.57–0.98, P=.03) and increased contraception use (aOR 1.37, 95% CI 1.01–1.86, P=.04), specifically with higher sterilization rates (aOR 2.13, 95% CI 1.38–3.27, P=.001). The magnitude of both postpartum visit nonattendance and sterilization rates increased with increasing EDS. Psychotherapy, but not antidepressant use, was associated with improved postpartum visit attendance, especially among those without prior diagnosis of depression (71.5% vs 92.9%, P=.03).

CONCLUSION:
Antenatal depressive symptomatology is associated with postpartum visit nonattendance and higher sterilization rates, with effect sizes modulated by symptom severity. Treatment with psychotherapy may improve postpartum visit attendance among women with depressive symptoms.
Assessment of Anxiety and Depression During Prolonged Antepartum Admission [05E]
Authors: Peterson Jessica , Koelper Nathanael , Srinivas Sindhu 
Published: April 2020

INTRODUCTION:
To determine the prevalence of depression and anxiety on the inpatient antepartum unit, the impact of length of stay, and provider screening patterns.

METHODS:
Prospective cohort of women admitted to the antepartum inpatient unit for >1 week. The Patient Health Questionnaire (PHQ2) and The Hospital Anxiety and Depression Scale (HADS) were given at admission and weekly. Patients also took a survey about perceived screening patterns.

RESULTS:
36 patients were screened from 12/2018 to 4/2019. 13 were admitted to the antepartum unit for >1 week. 46.7% and 7.7% initially screened positive on the HADS and the PHQ2 respectively. After one week, 6/7 that initially screened positive on the HADS continued to screen positive and 30.8% of patients screened positive on the PHQ2. 47% of patients reported they were assessed for mood disorders daily. After discharge, 9 patients (64%) attended their postpartum visit, 6 were screened for mood disorders (66.7%) and 2 endorsed depressive symptoms (33.3%). Of the 2 patients who endorsed depressive symptoms, 1 screened negative while admitted and 1 had screened positive. 25 providers took a survey about their screening habits. 32% of providers reported screening weekly, an equal proportion reported never screening.

CONCLUSION:
Nearly half of the women screened had a positive initial screen on the HADS and continued to screen positive. Inpatient screening patterns varied widely and most patients did not have close interval follow-up. A standardized screening method and short interval follow-up is needed to better treat these women who are at high risk for mood disorders.