bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Impact of Maternal BMI on Adverse Perinatal Outcomes in Shoulder Dystocia [36D]
Authors: Thayer Sydney Marie , Owens Sarah N. , Garg Bharti , Caughey Aaron B. 
Published: April 2020

INTRODUCTION:
Increasing BMI is associated with higher risk of shoulder dystocia (SD), but is it associated with other adverse perinatal outcomes (APOs) in the setting of SD? We sought to investigate this association.

METHODS:
This is a retrospective cohort study of singleton, non-anomalous, term vaginal deliveries complicated by SD between 2007–2011 using linked vital statistics and ICD-9 data. Neonatal outcomes included brachial plexus injury (BPI), clavicular fracture (CVF), 5-min-APGAR <7, neonatal intensive care unit admission (NICUa), and composite of severe neonatal outcomes (neonatal seizure, APGAR score ≤3, neonatal death). Maternal outcomes included postpartum hemorrhage (PPH), 3rd/4th-degree perineal lacerations (PLs), and maternal blood transfusion (MBT). Chi-square tests were used to compare rates of APOs among BMI categories. Multivariable logistic regression was used to control for diabetes status, race/ethnicity, age, education, insurance status, parity, and prenatal care.

RESULTS:
In a cohort of 21,489 births complicated by SD, we found statistically significant increasing rates of BPIs, CVFs, 5-min-APGAR <7, NICUa, and composite severe neonatal outcomes with rising maternal BMI. Incidence of PLs decreased significantly with increasing maternal BMI. Rates of PPH and MBT were not significantly different between groups. After controlling for confounders, there remained a statistically significant increase in odds of BPI, CVF, and NICUa (aOR 2.35, 1.59, and 1.26 respectively) and decreased odds of PLs (aOR 0.69, 95% CI 0.56–0.84) in obese women.

CONCLUSION:
Higher maternal BMI increases risk of complications in the setting of SD. Providers should exercise heightened awareness of the effect maternal BMI has on these potential outcomes when managing pregnancies complicated by SD.
Effect of a Health System Sponsored Mobile App on Perinatal Health Behaviors [13E]
Authors: Vartanian Keri , Rinaldi J.B. , Pieper Kevin , Jellison Trina 
Published: April 2020

INTRODUCTION:
The increasing popularity of pregnancy mobile applications raises the need for prenatal apps to include evidence-based content. We aimed to assess the potential for a health system-sponsored mobile app to improve health outcomes and increase healthy behaviors by providing personalized and reliable health information on pregnancy, postpartum recovery, and infant care.

METHODS:
The study took place over 18 months at the Providence St. Joseph Health system in Portland, Oregon. Our sample included women who received prenatal care at a Providence clinic and had a live birth at a Providence hospital. We compared a treatment group (app users) and a control group (non-app users) using a self-reported health behavior survey and outcomes data from electronic medical records. Providence Health and Services IRB approved this study.

RESULTS:
We enrolled 167 women in the treatment group and 400 in the control group. Compared to non-app users, app users had greater odds of breastfeeding beyond 6 months postpartum and of exercising three or more times per week during pregnancy. They also had lower odds of missed prenatal appointments. There was no significant impact of app use on nutritional measures or clinical outcomes, including premature births, low birth weight babies, and neonatal intensive care unit stays.

CONCLUSION:
The use of a prenatal mobile app and access to personalized, evidence-based health information was associated with an increase in certain healthy behaviors, while there was no impact on clinical health outcomes. More research is needed to determine the impact of mobile prenatal apps on pregnancy and infant outcomes.
Vitamin Deficiency After Bariatric Surgery and Pregnancy Outcomes [39D]
Authors: Harrison Rachel K. , Braun Emilie , Semons-Booker Kia , Lak Kathleen , Cruz Meredith , Wlodarczyk Katarzyna 
Published: April 2020

INTRODUCTION:
Women after bariatric surgery are frequently vitamin deficient. We sought to identify how vitamin deficiencies impact pregnancy outcomes in women with a history of bariatric surgery.

METHODS:
IRB approval was obtained. Clinical, demographic, and pregnancy information was collected on 158 women with a prior bariatric surgical procedure. Pregnancies were stratified by presence or absence of vitamin deficiency as per their medical record. Maternal and neonatal outcomes were analyzed via univariable and multivariable analyses.

RESULTS:
Among 158 women who met inclusion criteria, 102 (64.6%) were identified as vitamin deficient. There was no difference in maternal age, race/ethnicity, nulliparity, or pre-bariatric surgery weight when comparing women with and without vitamin deficiency. Vitamin deficient women had lower early pregnancy body mass index (BMI) (34.2±7.4 vs 37.0±8.0 kg/m2, P=.033), had a history of primarily malabsorptive procedure (86.7% vs 58.9%, P=.001), took supplements plus prenatal vitamins (85.3% vs 57.5%, P=.001), and had anemia at the time of delivery (59.4% vs 38.2%, P=.012). In univariable analysis, there were no differences in rates of preterm delivery, cesarean delivery, gestational diabetes, pregnancy-related hypertension, a composite maternal outcome, birth weight, large-for-gestational age, small-for-gestational age, or a composite neonatal outcome. These findings persisted in multivariable analysis after controlling for confounding factors.

CONCLUSION:
Pregnant women with vitamin deficiency after bariatric surgery were more likely to have undergone a primarily malabsorptive procedure, had lower BMI in pregnancy, and had higher rates of anemia at the time of delivery. They otherwise did not have worse maternal or neonatal outcomes compared to women without a vitamin deficiency.
Comparison of Preterm Birth Rates in Patients Treated With Methadone or Buprenorphine for Opioid Use Disorder [09E]
Authors: Gonzalez-Brown Veronica M. , Battin Megan , Walker Erin , Danzo Megan , Brown Morgan , Rood Kara M. 
Published: April 2020

INTRODUCTION:
Standard therapy for opioid use disorder (OUD) has been medication assisted treatment (MAT) using Methadone (MMT) or buprenorphine. Several studies have noted an increased risk of preterm birth (PTB) in women on methadone versus buprenorphine, but do not separate spontaneous or provider-initiated preterm birth. We aim to compare rates and types of PTB among pregnancies in women with OUD on MAT at our institution.

METHODS:
This is a retrospective cohort analysis of mother–neonate dyads with OUD on MAT who received prenatal care and delivered at a single academic institution from July 2013 to June 2018. All women in this study either received buprenorphine/naloxone (SUB) or MMT therapy during their antepartum and intrapartum care. Preterm birth was defined as delivery <37 weeks gestation. Frequencies were compared using chi-square. Multivariable analysis was used to control for possible confounders.

RESULTS:
We identified 718 mother–singleton neonate dyads, 22% of the cohort were treated with methadone and 78% with SUB. Overall preterm birth rate was 21.7% (156/718). MMT group had higher rates of PTB compared to SUB group (30.4% vs 19.2%, P=.003), that remained significant after controlling for smoking and history of prior preterm birth (aOR 1.84; 95% CI 1.24–2.74). However, there was no difference between rates of spontaneous PTB.

CONCLUSION:
In our cohort of OUD pregnant patients on MAT, the risk of overall PTB was increased in patients receiving MMT in pregnancy. However, our data suggests that this difference is only significant in provider-initiated PTB and that spontaneous PTB rates are similar between MMT and SUB.
Opioid Use After Cesarean Delivery in a Community Hospital Setting [25E]
Authors: Curro Valerie , Pardanani Setul 
Published: April 2020

INTRODUCTION:
The opioid epidemic is a serious public health concern that currently affects approximately 2 million Americans. Since cesarean sections are one of the most common surgeries performed in the United States, there have been many studies looking at opioid prescription practices. Prescribing patterns of opioids after cesarean vary widely and there is little information regarding normative patterns of practitioners. This study aims to assess our opioid prescribing practices after cesarean delivery at our hospital.

METHODS:
This is a prospective cohort study including women between the ages of 18–50 years old who underwent cesarean section. Data was collected through chart review and phone call follow-up after hospital discharge to determine the amount of opioid and oral NSAID medication used during both inpatient stay and after discharge, the number of narcotic pills leftover if applicable, pain score and activity level.

RESULTS:
59 patients were included, 13 were lost to follow-up, and 1 declined participation. 50% of participants had leftover pills, 38% percent never filled a prescription, and 12% percent consumed all pills. One patient required an additional narcotic prescription. Of the six different OB GYN practices, the number of narcotic pills prescribed ranged from 6 to 30 tablets.

CONCLUSION:
Narcotic use in the hospital can predict narcotic use at home in the first one to two weeks postoperatively. Most patients had unused narcotic pills. Prescribing practices at Stamford Hospital are highly varied among practitioners. Data from our study will help to standardize prescriptions for postoperative pain management after cesarean delivery.
Association Between Maternal Obesity Class, Adherence to Labor Guidelines and Perinatal Outcomes [04D]
Authors: Stafford Irene A. , Moustafa Ahmed S. Z. , Berra Alexandra , Spoo Lauren , Burgess Angela 
Published: April 2020

INTRODUCTION:
Although there is evidence to suggest that obese women with a BMI ≥40 experience increased rates of perinatal complications, there is limited data concerning rates of these complications compared to women with other BMI classes when guidelines for the safe prevention of the primary cesarean delivery are applied. The aims of this study were to determine labor guideline adherence by BMI class and to compare perinatal outcomes across BMI classes with guideline adherent labor management.

METHODS:
This study included low risk women with a singleton, term pregnancy admitted in active labor or undergoing induction between May 2014 and April 2017 after the prevention of the primary cesarean delivery guidelines were implemented at our center. Patients were identified using an institutional IRB approved database. All demographic and perinatal outcomes were recorded. Women with prior hysterotomy and cesarean for non-reassuring fetal status were excluded.

RESULTS:
13,029 women met criteria. Guideline adherence decreased with increasing BMI, with 96% adherence among women of normal weight (BMI>18.5–25) compared to 81% for class III obese women (P<.05 adjusted for race, parity, neonatal weight and age). When guidelines were followed, there was no difference in rates of infectious morbidity or a maternal composite outcome including blood transfusion (P=.96, .48, .84 respectively). Although newborns of women with class III obesity had higher rates of meconium (P<.05), a composite of neonatal outcomes was not different with increasing maternal BMI (P=.60).

CONCLUSION:
With guideline adherence, there were no differences in adverse perinatal outcomes with increasing BMI.
Using Tailored Opioid Prescribing to Reduce the Number of Opioid Tablets Prescribed Following Cesarean Delivery [39E]
Authors: Dayaa Joseph , Straube Lacey , Webster Carolyn , Stuebe Alison , McKenzie Christine 
Published: April 2020

INTRODUCTION:
Our project aim was to evaluate the effect of a tailored opioid prescribing (TLP) algorithm on the number of opioid tablets prescribed at hospital discharge after cesarean delivery.

METHODS:
The number of tablets to prescribe was determined by multiplying the number of opioid tablets used in the 24 hours before discharge by 5. If no opioids were used, up to 5 tablets were recommended. TLP was introduced through a series of PDSA cycles between November 2018 and April 2019. Outcome measures included opioid tablets prescribed, opioid use in the 24 hours prior to discharge, and patient satisfaction. Outcome data were compared from August to October 2018 (pre-implementation) and June to August 2019 (post-implementation). IRB approval was waived.

RESULTS:
During the pre-implementation (N=342) and post-implementation (N=305) periods, the median prescription tablets at discharge was 20 (IQR 20, 30) and 5 (0, 15) (P<.0001), respectively. The median opioid use 24 hours prior to discharge was 10 (0, 25) and 0 (0, 15) mg of oxycodone (P<.0001), respectively. The proportion of patients who did not use opioids in the 24 hours before discharge was 36.5% and 50.8% (P<.0001), respectively. The proportion of patients who were not prescribed opioids at discharge was 7.9% and 34.8% (P<.0001), respectively. Inpatient pain scores and patient satisfaction did not differ.

CONCLUSION:
TLP reduced the number of opioid tablets prescribed and increased the number of patients who were discharged without an opioid prescription. A tailored prescribing algorithm based on inpatient opioid use is an effective strategy to reduce excess opioid prescribing.
Differences in Birthweight With Gestational Diabetes and Thyroid Disease, Compared to Gestational Diabetes Alone [08D]
Authors: Hussain Farrah N. , Schneider Emily , Feldman Kristina M. , Chu Lam Melissa T. , Rosenn Barak , Brustman Lois 
Published: April 2020

INTRODUCTION:
Diabetes and thyroid disease are the most frequent endocrine pathologies seen in pregnancy. The metabolic stresses of pregnancy and associated carbohydrate intolerance places patients with hypothyroidism at additional risk of developing GDM. There is no data on how concurrent thyroid disease and GDM can affect neonatal birthweight. Our hypothesis was that women with concurrent GDM and hypothyroidism would have larger birthweight neonates.

METHODS:
IRB approved retrospective case-control study of 240 singleton pregnancies between August 2015 and August 2019. Patients with GDM and hypothyroidism were compared to BMI-matched controls with GDM alone in a 1:2 ratio. Baseline characteristics were similar. The primary endpoint was comparison of birthweight. T-tests, Wilcoxon rank-sum tests, and Chi-squared tests were used as appropriate.

RESULTS:
There were 80 patients with GDM and hypothyroidism compared to 160 patients with GDM only. In third trimester, patients were euthyroid with no additional titration of thyroxine, and GDM was treated with a goal average glucose of <105 mg/dL. Mean birthweight in the GDM with hypothyroidism group was 3316.2 g (SD 446.4 g), compared with 3229.4 g (SD 486.8 g) in the GDM alone group. This difference was not statistically significant (P<.2).

CONCLUSION:
There was no significant difference in neonatal birthweight between patients with GDM and hypothyroidism versus GDM alone. Although not statistically significant, there was an absolute difference of 86.8 g in the mean birthweight of neonates between these groups. Further prospective study with larger sample sizes and varying glycemic and metabolic control is warranted.
An Elevated Fasting GTT Doesn't Increase Adverse Outcomes Compared With Other GTT Elevations [03D]
Authors: Satti Mohamed A. , Mackeen A. Dhanya , Young Amanda J. , Paglia Michael J. 
Published: April 2020

INTRODUCTION:
To determine if an isolated elevated fasting blood sugar (FBS) has an increased risk for adverse maternal and neonatal outcomes compared to isolated elevated values at 1, 2, or 3 hours on the glucose tolerance test (GTT).

METHODS:
A retrospective cohort study of pregnant women who completed a GTT between 23–32 weeks, had an isolated elevation of one of the GTT results and delivered from 7/12–6/18 was performed. The composite primary maternal outcome included preeclampsia, cesarean, operative vaginal delivery, and perineal lacerations. Composite neonatal outcome was calculated as a secondary outcome. Sensitivity analyses of obese patients were performed.

RESULTS:
Nine hundred and nine women met inclusion criteria: 252 had an elevated FBS and 657 had a non-fasting isolated GTT elevation. There were clinically non-significant differences in race, age, BMI and nulliparity between the groups; outcomes were adjusted for these variables. The primary outcome did not differ between groups. APGAR <7 was higher with an elevated FBS (9.1% vs 2.6%, P<.01); there were no differences in other neonatal outcomes. In obese patients, there were no differences in composite maternal or neonatal outcomes. APGAR <7 was higher in those with an elevated FBS (13.4% vs 3.3%, P<.01) as was neonatal hyperbilirubinemia (10.6% vs 5.6%, P=.01).

CONCLUSION:
There are no significant differences in maternal/neonatal composite outcomes between isolated abnormal FBS on GTT compared to other isolated elevations, regardless of obesity status. In obese women, there was a higher incidence of APGAR <7 and neonatal hyperbilirubinemia in the group with elevated FBS on GTT.
Diagnosis of Postpartum Depression in Women With Prolonged Antenatal Admission [11E]
Authors: Berra Alexandra , Palmer Grace , Davis Beth R. , Sangi-Haghpeykar Haleh , Stafford Irene A. 
Published: April 2020

INTRODUCTION:
The prevalence of postpartum depression is approximately 10%. Antepartum depression has been associated with greater maternal stress during the postpartum period. There is a paucity of research concerning length of antenatal admission, reason for admission and subsequent postpartum depression scores as measured by the Edinburgh Postnatal Depression Score (EPDS) screening tool.

METHODS:
After Institutional Review Board approval, all pregnant women who were admitted to the antepartum unit from September 2017 to August 2018 at our center were identified and corresponding obstetric and demographic variables and EPDS scores were recorded. Women with postpartum EPDS scores greater than or equal to 10 were identified as having postpartum depression. Number and length of antepartum admissions, and reason for admission were compared among women with and without postpartum depression. Chi square testing was used for analysis.

RESULTS:
Of the 239 women with antenatal admissions, 50 met criteria for the diagnosis of postpartum depression (20.9%). This is a statistically significant difference when compared to the national average as reported by the CDC (10%; p less than 0.0001). There was no significant difference among depressed women with respect to length of antepartum admission (P=.79) or reason for antepartum admission (P=.71).

CONCLUSION:
Women with any antepartum admission are at increased risk of postpartum depression. It is important that all women with an admission prior to delivery are screened in the early postpartum period for signs and symptoms of depression. Women who are admitted to the antepartum unit may benefit from psychologic assessment at the time of admission.
Pregnancy Outcomes Among Class 3 Obese Women With Normal Early Glucola [31D]
Authors: Mitchell Courtney , Dillon Jacquelyn , Ellet Tressa , Siegel Anne , Dotters-Katz Sarah K. , Denoble Annalies 
Published: April 2020

INTRODUCTION:
ACOG recommends early screening for glucose intolerance in obese women, who are at increased risk of insulin resistance. We aimed to assess the risk of developing GDM based on the value of a normal early 50g oral glucose challenge test (GCT).

METHODS:
Retrospective cohort of non-anomalous singleton pregnancies with maternal BMI ≥40 at one institution, 2013–2017. Pregnancies with multiple gestation, late entry to care, type 1 or 2 diabetes, and missing diabetes-screening information are excluded. Primary outcome was development of GDM. Secondary outcomes include fetal growth restriction, fetal macrosomia, gestational age at delivery, large for gestational age, delivery BMI, total pregnancy weight gain, labor induction, shoulder dystocia, and cesarean delivery. Bivariate statistics compare demographics, pregnancy complications and delivery characteristics of women with early GCT >100 and women who with early GCT 101–134. Regression models used to estimate odds of primary outcome.

RESULTS:
Of 169 women, 66 (39%) had an early GCT <100, and 103 (61%) had an early GCT of 101–134. Women with low normal eGCT were more likely to use recreational drugs (P=.03). Other baseline demographics did not differ. The rate of GDM was low in this population (5.3%), with no difference in the rate of GDM between women with a low normal eGCT and high normal eGCT (P=.9). The median neonatal birthweight was higher in the normal GCT group as compared to the low GCT (P=.03).

CONCLUSION:
Among women with class 3 obesity, the specific value of an early normal GCT was not predictive of developing GDM by the third trimester.
Pregnancy Outcomes for Patients With Excessive Gestational Weight Gain Stratified by Class of Obesity [33D]
Authors: Oliva Mariana , Sipe Bradley , Odibo Linda , Odibo Anthony O. 
Published: April 2020

INTRODUCTION:
Excessive gestational weight gain (EWG) increases risk of large for gestational age (LGA) neonates, hypertensive disorders of pregnancy and cesarean delivery. There is limited data on EWG in the obese population. We aim to compare pregnancy outcomes among obesity classes in women with EWG.

METHODS:
This is a secondary analysis from a prospective study of pregnant women undergoing fetal growth assessment. Obese participants were sorted into cohorts of adequate gestational weight gain (AWG) and EWG as defined by the Institute of Medicine guidelines. The groups were further stratified by class 1, class 2, and class 3 obesity (BMI 30–34.9, 35–39.9, >40 respectively). The primary outcome was LGA neonates. Secondary outcomes included: hypertensive disorders of pregnancy, gestational diabetes (GDM), preterm delivery (PTD), composite adverse neonatal outcomes (CANO, including neonatal ICU admission, neonatal death, seizures, intraventricular hemorrhage, respiratory distress syndrome, necrotizing enterocolitis, and pH <7.10) and small for gestational age (SGA) neonates. Chi-square tests were used to compare outcomes between the cohorts when stratified by class of obesity.

RESULTS:
405 obese women were identified, of which 256 experienced EWG and 68 experienced AWG. Among all obese women, EWG was not associated with LGA (P=.35), GDM (P=.12), CANO (P=.75), gestational hypertension (0.87), preeclampsia (P=.68), PTD (P=.91), or SGA (0.21). When stratified by class of obesity there were no differences in the primary or secondary outcomes.

CONCLUSION:
EWG among obese women was not associated with increased risk of LGA, CANO, GDM, PTD, hypertensive disorders of pregnancy and SGA regardless of obesity class.