bluuebunny/crossref_metadata_2025_split huggingface dataset:
Rate of Gestational Diabetes Between Active Duty and Non-active Duty Beneficiaries at a Military Treatment Facility [34D]
Authors: Odedokun Tolulope , Weir Larissa 
Published: April 2020

INTRODUCTION:
To compare the incidence of gestation diabetes mellitus (GDM) in active duty females compared with civilian dependents.

METHODS:
This retrospective cohort analysis was performed at a military medical center with IRB approval. Active duty and dependent status women who delivered between 01 June 2014 and 30 April 2015 were identified along with incidence of GDM. Additional data collected included fetal weight, delivery route, presence of shoulder dystocia, use of diabetes medications, age, gravidity, parity, gestational age at delivery, pre and post pregnancy body mass index (BMI) and race. Chi Squared analysis was used to compare rates of GDM. Sample size calculation determined the need for 391 women in each group to identify a 5% difference in rates of GDM with a power of 80%. P-values of <.05 were considered significant.

RESULTS:
Rates of GDM were similar between the two cohorts (active duty=9.95%, dependent=9.72%, P=.91). Age, gravidity and pre-pregnancy BMI were also similar between groups. The rate of diet controlled GDM were different between the two cohorts (active duty=53.8%, dependent=34.2%, P=.02).

CONCLUSION:
This study highlights that active duty females have similar rates of GDM as dependents. GDM is known to affect short and long-term maternal and neonatal outcomes and it can also impact a soldier's readiness following the pregnancy. Further research is required to determine the long term impact of GDM in active duty females and best practices to decrease rates of GDM in the military population.
Buprenorphine Versus Methadone in Pregnant Women With Opioid Use Disorder: A Cost-Effectiveness Analysis [06E]
Authors: Robin Arianna , Hersh Alyssa R. , Caughey Aaron B. 
Published: April 2020

INTRODUCTION:
Opioid use disorder (OUD) during pregnancy has increased more than fourfold since 1999. Methadone is the longstanding treatment of choice for OUD in pregnancy, but recent data demonstrate benefits of buprenorphine, as it is associated with improved neonatal outcomes despite increased drug cost and rates of discontinuation of therapy. This model compares cost-effectiveness of buprenorphine versus methadone in management of OUD during pregnancy.

METHODS:
We used a theoretical cohort of 22,400 pregnant women to approximate the number of pregnancies affected by OUD per year in the United States. Outcomes included maternal retention in maintenance treatment, maternal overdose, neonatal abstinence syndrome, preterm birth, intrauterine growth restriction, and cerebral palsy in addition to cost and quality-adjusted life-years. The cost-effectiveness threshold was set at $100,000/QALY. Model inputs were derived from the literature and varied in sensitivity analyses to assess robustness of the model.

RESULTS:
Despite lower rates of retention and higher associated overdoses, buprenorphine treatment during pregnancy saved over $102 million healthcare dollars and 563 QALYs, making it the dominant strategy over methadone treatment. In our cohort, buprenorphine treatment resulted in 2,886 fewer cases of NAS, 1,006 fewer preterm births, 299 fewer cases of IUGR, 32 fewer stillbirths, and 12 fewer cases of CP. Sensitivity analyses showed that our results were robust over a wide range of assumptions.

CONCLUSION:
Buprenorphine treatment should be considered a first-line option for opioid dependence in pregnancy, as it leads to improved neonatal outcomes compared to methadone despite increased drug cost and risk of treatment discontinuation.
Food Insecurity and Perinatal Outcomes in Gestational Diabetics [11D]
Authors: Cooper Shontreal , Graham Maura , Khangura Raminder , Schmidt Adrienne , Fang Victor , Bakaysa Stephanie 
Published: April 2020

INTRODUCTION:
This study's purpose was to 1) evaluate the association between food secure (FS) and food insecure (FI) households in patients with gestational diabetes (GDM) and without gestational diabetes (NGDM), 2) evaluate if GDM in FI households had adverse maternal and neonatal outcomes.

METHODS:
This was an observational study from October 2018 until July 2019. Postpartum women, who delivered, singleton infants ≥37 weeks gestation were recruited. Participants completed a food security survey using the USDA Household Food Security Survey Module. Surveys responses were classified as: FS and FI. The primary outcome was to evaluate the rate of FS in GDM & NGDM. We also evaluated: maternal weight (BMI, total gain), birth weight, mode of delivery, and NICU admission for hypoglycemia. A logistic regression analysis was used with a P<.05 considered significant.

RESULTS:
There were 74 patients (36-GDM, 38-NGDM; P=.01). Overall, 50 (68%) had FS & 24 (32%) had FI (P=.01). Of the 36 GDM patients, 47% (n=17) reported FI, versus 18% (n=7) of NGDM patients (P=.01). Overall, 12% (n=9) of patients had a NICU admission. In GDM group, significant findings between FI vs. FS included: higher maternal weight (BMI 36 kg/m2 vs. 30 kg/m2, total weight gain of 26.7 lbs vs. 16.7 lbs, P=.01) and NICU admissions for hypoglycemia (35% vs. 5%, P=.04).

CONCLUSION:
Gestational diabetics are at increased risk of experiencing FI and will have increased maternal weight gain. Infants of GDM in FI households are at more risk of NICU admission for hypoglycemia.
Influence of Psychiatric Medications on Neonatal Abstinence Syndrome in Women Treated for Opioid Use Disorder [17E]
Authors: Staszewski Cara , Herrera Kimberly , Persad Malini D. , Garretto Diana , Davis Jay , Garry David 
Published: April 2020

INTRODUCTION:
This study sought to evaluate the impact of prescribed psychiatric medications on newborn hospital stay in women undergoing treatment for opioid use disorder (OUD).

METHODS:
A cohort of women receiving either methadone or buprenorphine in management of OUD in pregnancy were identified from delivery and newborn records over a 10-year period. Women were excluded with delivery <24 weeks, multiple gestation or known anomalous fetus. Maternal demographics, medications, GA, mode of delivery, BW, NICU admission, newborn length of stay, NAS and treatment requirements for NAS were obtained. The study was IRB approved and standard statistics were used with a P-value of <0.05 considered significant.

RESULTS:
There were 180 women were identified with 101 (56%) receiving methadone and 79 (44%) receiving buprenorphine therapy. The groups were similar for age, parity, race, BMI, marital status, tobacco use, prenatal care, incidence of preterm birth, mode of delivery, and also had similar incidence of NAS (meth 91% vs bup 90%; P=.47). Buprenorphine users had a greater number of women prescribed psychiatric medications (meth 13% vs bup 35%; P<.001), higher GA at delivery (meth 37+2.8 wk vs bup 39+1.8 wk; P<.001), shorter newborn hospital stay (meth 14+10 d vs bup 9+8 d; P<.001) and fewer newborns with NAS requiring treatment (meth 56% vs bup 24%; P<.001). Psychiatric medication usage demonstrated a 4-fold likelihood of a longer newborn hospital stay (>10 d) and buprenorphine a shorter newborn stay.

CONCLUSION:
Psychiatric medication usage is an independent predictor of a longer newborn hospital stay in women undergoing treatment for opioid use disorder.
Comparison of Postoperative Opioid Use in Mothers Whose Neonates Are in Regular Nursery Versus in Neonatal Intensive Care [08E]
Authors: Mehri Sepideh , Ruggiero Lauren , Hoskins Iffath 
Published: April 2020

INTRODUCTION:
Postoperative opioid use presents pain management dilemmas because mothers should be alert and engaged with their neonates. Mothers with neonates in intensive care (NICU) have additional stresses and may desire “round the clock” vs “prn” pain management. We compared post-operative opioid usage in mothers with neonates in regular nursery (“regular”) vs. NICU.

METHODS:
From January 1, 2013 through December 12, 2018, postoperative opioid use for days 0 until discharge was retrospectively reviewed. Mothers with “regular” neonates constituted Group 1, and NICU neonates were Group 2. Perioperative substance abusers or chronic opioid users were excluded.

RESULTS:
All the 8136 charts reviewed had orders for narcotic and non-narcotic analgesics. Both agents were used by 84% and only non-narcotic analgesics by 16% of mothers. None used narcotics exclusively. All received narcotic prescriptions at discharge, regardless of postoperative opioid use. Group 1 had 6509 and Group 2 had 1627 mothers. Group 2 diagnoses included prematurity (12%), sepsis (4%), neonates with life threatening anomalies requiring major surgery (3%). No differences occurred in opioid usage between the 2 Groups (43% vs 45%, POD1; 81% vs 80%, POD2; 72% vs 70%, POD3; 20% vs 23%, POD4). Significantly more opioid usage occurred in mothers of neonates with life threatening anomalies.

CONCLUSION:
Mothers with NICU neonates did not demonstrate increased postoperative opioid usage, in spite of the perceived added stresses. However, mothers with neonates having life threatening diagnoses utilized larger amounts of narcotics post-operatively. These findings may have future implications for post discharge pain management.
Infective Endocarditis in Pregnancy During the Opioid Epidemic [16E]
Authors: Brekke Emily , O'Brien John , Stromberg Arnold 
Published: April 2020

INTRODUCTION:
To compare the incidence and complications of infective endocarditis among opioid-using pregnant women from 2006–08 and 2016–18.

METHODS:
We conducted a cross-sectional analysis of hospitalizations using a publicly available, all-payer inpatient database in Kentucky. Duplicate patients were identified and removed.

RESULTS:
From 2006–08, 187,178 hospitalizations involved pregnancy of which 1,311 were diagnosed with opioid dependence, use, or abuse. Three of these women had ICD codes for endocarditis (0.23%). From 2016–18, 166,756 hospitalizations involved pregnancy, of which 5,222 were diagnosed with opioid dependence, use, or abuse (+398%). Three of these patients had rheumatic disease, leaving 37 patients (0.71%) with endocarditis related to their opioid use alone, P=.047. The 2016–18 population with endocarditis were white (100%); lived primarily in metropolitan counties (61%); and 57.1% were less than 30 years old. 11% of admissions were in the 1st trimester, 16.2% in the 2nd, 43.2% in the 3rd, and 16.2% postpartum, P=.012. 14% had a spontaneous or missed abortion. The median length of stay was 22.5 days. Ten deliveries were complicated by endocarditis, six by cesarean section. Five women underwent valvular surgery in 2016–18: four valve replacements and one total valve excision. Of the hospitalizations with a maternal mortality for 2016–18, three were complicated by endocarditis.

CONCLUSION:
A four-fold increase in hospitalization complicated by opioid use was observed as well as a significant increase in the rate of infective endocarditis in this population. Endocarditis contributed to maternal mortality, life-threatening morbidities, prolonged hospital stay, and increased cost.
Incidence of Fetal Cardiac Anomalies by Maternal Body Mass Index and Diabetes Status [20D]
Authors: Thayer Sydney Marie , Owens Sarah N. , Garg Bharti , Caughey Aaron B. 
Published: April 2020

INTRODUCTION:
We sought to examine the association between body mass index (BMI) and fetal cardiac anomalies (FCA) in women with pre-existing diabetes, gestational diabetes, and without diabetes.

METHODS:
This is a retrospective cohort study of women with singleton, term pregnancies between 2007 and 2011 using linked vital statistics and discharge data. Chi-square tests were used to compare rates of FCA in diabetic and non-diabetic women categorized by BMI class. Pre-pregnancy BMI was categorized into underweight, normal weight, overweight, obesity, and morbid obesity. Multivariable logistic regression was used to examine the association of BMI with FCA by diabetes classification, controlling for maternal race/ethnicity, age, parity, education, and insurance status.

RESULTS:
The cohort of 1,993,905 consisted of 392,008 (19.7%) obese pregnant women. A higher BMI class was found to be associated with increased odds of FCA, independent of diabetes status. Compared to women without diabetes, those with gestational and pre-existing diabetes have significantly increased odds of FCA (aOR 1.41, 95% CI 1.33–1.48; aOR 4.35 95% CI 4.01–4.71, respectively). A significant association was demonstrated between BMI category and FCA for women with pre-existing diabetes, gestational diabetes, and without diabetes.

CONCLUSION:
Diabetes status and higher BMI category were both found to be individually associated with increased odds of FCA. This study also demonstrated the compounding effect of diabetes status and obesity on the incidence of FCA. Obstetrical education for women in these categories should emphasize the increased potential of this pregnancy complication and the role of prenatal ultrasonography in the identification of fetal cardiac anomalies.
Reducing the Use of Opioids in the Peripartum Period—A Quality Improvement Initiative [34E]
Authors: Jones Sarah B. , Johnson Ann , Brownlow Hannah , Vest Pamela , Stinson Jeffrey 
Published: April 2020

INTRODUCTION:
The aim of this quality improvement initiative was to reduce the use of oral opioids in the inpatient postpartum period.

METHODS:
A systematic approach to pain management during the postpartum hospitalization was employed. A step-wise approach was implemented that included non-pharmacologic interventions, scheduled non-opioid pain medications, and oral opioids for breakthrough pain. Outcomes for the first 8 months were compared to baseline data from all patients delivered in 2017.

RESULTS:
In the vaginal delivery group 2889 patients were evaluated. The average number of opioid tablets taken was 0.53 per patient compared to 1.64 per patient in the baseline group, a 68% reduction. The average number of patients who received any opioid during their postpartum hospitalization was 12.4% compared to 33.6% in the baseline group, a 63% reduction. In the Cesarean section group 1162 patients were evaluated. The average number of opioid tablets taken was 6.5 per patient compared to 10.2 per patient in the baseline group, a 36% reduction. The average number of patients who received any opioid during their postpartum hospitalization was 78.4% compared to 95.3% in the baseline group, an 18% reduction.

CONCLUSION:
This quality improvement project evaluated a systematic approach to pain management in the postpartum period that includes a scheduled non-opioid pharmacologic, non-pharmacologic pain interventions, and oral opioids for breakthrough pain. The results demonstrate a clear reduction in oral opioid pain medication consumption during the postpartum hospitalization.
Incidence of Fetal Anomalies by Maternal Body Composition and Diabetes Status [19D]
Authors: Owens Sarah N. , Thayer Sydney Marie , Garg Bharti , Caughey Aaron B. 
Published: April 2020

INTRODUCTION:
We sought to examine the association between body mass index (BMI) and fetal anomalies (FA) in women with pre-existing diabetes, gestational diabetes, and without diabetes.

METHODS:
This is a retrospective cohort study of women with singleton, term pregnancies between 2007 and 2011 using linked vital statistics and discharge data. Chi-square tests were used to compare rates of FA in diabetic and non-diabetic women categorized by BMI. Pre-pregnancy BMI was categorized into underweight, normal weight, overweight, obesity, and morbid obesity. Multivariable logistic regression was used to examine the association of BMI with FA by diabetes classification, controlling for maternal race/ethnicity, age, parity, education, and insurance status.

RESULTS:
The cohort of 1,993,905 consisted of 392,008 (19.7%) obese pregnant women. Higher BMI was found to be associated with increased odds of FA, independent of diabetes status. Underweight pre-pregnancy BMI was associated with decreased odds of FA compared to normal-weight. Women with gestational and pre-existing diabetes have significantly increased odds of FA (aOR 1.17, 95% CI 1.14–1.19; aOR 1.82 95% CI 1.74–1.90, respectively). A significant association was demonstrated between BMI category and FA for women with pre-existing diabetes and no diabetes but this relationship was not found with gestational diabetes.

CONCLUSION:
Diabetes status and higher BMI were found to be individually associated with increased odds of FA. This study also demonstrated the compounding effect of diabetes status and obesity on the incidence of FA. Obstetrical education for these women should emphasize the increased potential of this pregnancy complication and the role of prenatal screening for FA.
To Determine If Maternal Adverse Outcomes Predicted by Obstetric Comorbidity Index (OBCMI) Varies According to Race [32C]
Authors: Ranjit Anju , Olufajo Olubode , Zogg Cheryl , Robinson Julian N. , Luo Guoyang 
Published: April 2020

INTRODUCTION:
To use nationwide data to determine if including race/ethnicity to the Obstetric Co-morbidity Index (OBCMI) improves its ability to predict severe maternal morbidity/mortality.

METHODS:
The National Inpatient Database (2010–2014) was used to identify all admissions for deliveries. Patient demographics including race/ethnicity (white, black, Hispanic) and co-morbidities were extracted. Primary outcome was defined as presence of severe maternal morbidity/mortality using ICD-9 codes. Using a stepwise logistic regression model, as previously described, maternal comorbid conditions predicting the primary outcome were determined. With separate models constructed for each race/ethnicity, weights assigned to each condition were used to determine the race/ethnicity-specific OBCMI. For each group, models predicting the primary outcome by their race specific OBCMI and other races' OBCMI was compared using c-statistic.

RESULTS:
A total of 3,830,958 deliveries were identified, among which 1,867,534 (48.7%) were white, 513,412 (13.4%) were to black, and 759,906 (19.8%) were Hispanic mothers. Severe maternal morbidity/mortality was present in 79,310 (2.07%) women. For each point increase in OBCMI derived for white women, the odds ratios for the outcome were 1.30 (CI 1.29–1.30) for white, 1.31 (CI 1.30–1.31) for black and 1.34 (CI 1.33–1.35) for Hispanic women. The c-statistic for these models were 0.652, 0.651 and 0.650 for white, black and Hispanic women, respectively. The odds ratios and c-statistics for models using black and Hispanic specific OBCMI were similar when compared between races/ethnicities.

CONCLUSION:
The obstetric comorbidity index provides a simple predictive tool to determine likelihood of severe maternal morbidity at the time of delivery, and race/ethnicity does not seem to play a large role in its predictive ability.
“There is no baby”—A Case of New Onset Psychotic Denial of Pregnancy in the Third Trimester [01E]
Authors: Chase Tess , Shah Akash , Maines Jaimie 
Published: April 2020

INTRODUCTION:
Psychoanalytic theory states that pregnancy denial stems from a woman's inability to adapt to her new maternal role and leads to increased morbidity and mortality of mother and neonate.

METHODS:
A 33-year-old primigravida at 37 6/7 weeks gestation presented with new onset psychotic pregnancy denial. She was previously treated for major depressive disorder and discontinued pharmacotherapy during pregnancy. She had no history of psychosis. At 37 5/7 weeks, she reported to her husband, “There is no baby.” She was admitted to the antepartum service. Followed by a team of obstetricians, Maternal Fetal Medicine specialists, and psychiatrists, it was decided to initiate antipsychotic pharmacotherapy after delivery of the fetus. She was found to have capacity for decision making and provided informed consent for a cesarean section. She delivered a male infant at 38 1/7 weeks. She was started on psychotropic medication, and showed poor response. On postpartum day six she was transferred to inpatient psychiatry and underwent 12 bilateral electroconvulsive therapy (ECT) treatments during her 4-week inpatient and 2-week outpatient partial hospitalization. She has since returned to work, follows with outpatient psychiatry, and has a healthy relationship with her neonate.

RESULTS:
Patient informed consent was obtained for submission of a case report.

CONCLUSION:
This case highlights the interplay between medical, ethical, and legal systems. It presents challenges of peripartum psychiatric care and shows successful use of ECT for psychotic denial of pregnancy. It's reasonable to deliver before 39 weeks for worsening psychiatric disease. Proper care of mother and fetus depends on interdisciplinary care.
Gestational Weight Gain Video Module Improves Patient Knowledge of Weight Gain in Pregnancy [12D]
Authors: Milone Gina F. , Tiwari Mahesh , McInerney Hailey , Franz Brynn , Potkin Katya , Persad Malini D. 
Published: April 2020

INTRODUCTION:
Approximately 70% of pregnant women gain weight outside of the National Academy of Medicine's established guidelines for gestational weight gain (GWG) in pregnancy. We set out to determine if a GWG video module improves patient knowledge of GWG goals.

METHODS:
A prospective cohort study was performed from January 2019 through August 2019 with Institutional Review Board approval. Women were allocated to routine care versus a video arm after informed consent was obtained. Both arms completed a baseline GWG knowledge questionnaire. Those undergoing routine care received provider counseling. Those in the video arm underwent routine counseling and viewed a 5-minute video module based on the American College of Obstetricians and Gynecologists and National Academy of Medicine approved material on body mass index (BMI) specific GWG goals. The GWG knowledge questionnaire was repeated in 4 weeks. Maternal demographics and baseline characteristics were collected from the electronic medical record. Independent sample t-tests, chi square analyses and Fisher exact tests were used to compare arms, with a P<.05 deemed statistically significant.

RESULTS:
A total of 52 women were included in the study, 26 in the routine counseling arm and 26 in the video module arm. Maternal demographics and baseline characteristics including BMI were similar between groups. Compared to routine counseling, women in the video module arm had a statistically significant increase in GWG knowledge (10.0±2.0 versus 12.5±2.3, P<.001).

CONCLUSION:
Compared to routine provider counseling, a GWG video module significantly improves patients' knowledge of GWG goals. Utilization of a GWG video enhances provider counseling.