bluuebunny/crossref_metadata_2025_split huggingface dataset:
Incidence of Syphilis Among Women Hospitalized for Delivery in the United States, 2005-2014 [16I]
Authors: Rowe Meghan E. , Admon Lindsay K. , Dalton Vanessa K. 
Published: April 2018

INTRODUCTION:
Rising rates of congenital syphilis have captured national attention. Data on the incidence and distribution of syphilis among childbearing women are needed to inform prevention strategies. Our objective was to estimate trends in the incidence and regional distribution of syphilis among women hospitalized for obstetric delivery in the United States.

METHODS:
We performed a retrospective, serial cross-sectional analysis of all obstetric deliveries in the National Inpatient Sample between 2005 and 2014. National estimates were generated using multivariable logistic regression with predictive margins. Subgroup analyses were performed to estimate trends by rural vs. urban residence and hospital census region.

RESULTS:
8,193,707 hospital deliveries were identified. 2,386 deliveries were complicated by maternal syphilis, estimating 10,900 cases nationally. Compared to all other hospital births, higher proportions of women with syphilis were on Medicaid [74.3% (95% CI 71.4-77.0) vs. 43.6% (95% CI 42.5-44.7)], lived in urban counties [91.8% (95% CI 90.1-93.3) vs. 85.4% (95% CI 84.7-86.1)], and lived in the South [59.4% (95% CI 54.3-64.3) vs. 37.9% (95% CI 36.1-39.8)]. The incidence of syphilis diagnoses did not statistically increase over the study period when examining all deliveries: 2.6 (95% CI 2.1-3.2) per 10,000 in 2005-06 compared to 3.4 (05% CI 3.0-3.8) per 10,000 in 2013-14. Incidence did increase among urban women delivering in Midwest: 1.4 (95% CI 0.82-2.0) per 10,000 deliveries in 2005-06 to 3.5 (2.6-4.4) per 10,000 deliveries in 2013-14. No other time-trends were significant.

CONCLUSION:
The incidence of syphilis increased among urban women delivering in the Midwest between 2004-05 and 2013-14.
Individual Knowledge, Attitudes, and Practices Regarding Zika Virus During Pregnancy in Miami [19I]
Authors: Chandrasekaran Neeraja , Marotta Mabel , Taldone Sabrina , Singh Vivek , Koru-Sengul Tulay , Curry Christine 
Published: April 2018

INTRODUCTION:
On July 2016, the first case of United States based Zika virus infection was identified in Miami, FL. Till date, there are no studies assessing knowledge and behaviors of Zika virus in Miami, FL. In this study, we aimed to assess knowledge, attitudes, and practices of Zika virus amongst pregnant women residing in Miami, FL.

METHODS:
A cross-sectional design was utilized for this study and a survey was distributed to the antenatal clinics at University of Miami to pregnant women. Completed surveys were entered onto Redcap and analyzed using SAS studio (SAS Institute Inc. Cary, NC, USA). Pearson's chi-square or Fisher's exact test were used to compare categorical variables and multivariate logistic regression was utilized to adjust for confounding variables.

RESULTS:
A total of 224 women were surveyed from January 2017-May 2017. Seventy-five percent of women answered questions about Zika virus transmission, prevention, and vulnerable population. On prevention, 61.4% of wore long-sleeved clothing, 87.8% used mosquito repellant, and 54.9% used condoms during intercourse. On multivariate regression, employment was associated with answering six knowledge questions correctly. First trimester was associated with wearing long-sleeved clothing [OR:2.538(1.260-5.114), p=0.0091] and perception of changed behavior due to Zika virus [2.458(1.128-5.356), p=0.0236].

CONCLUSION:
Knowledge, attitudes, and practices regarding Zika virus amongst pregnant women residing in Miami are adequate. The role of employment and workplace environment in promoting health education on Zika virus should be further evaluated.
Identifying Characteristics of Antenatal 3-Hour GTT as Markers for Abnormal Postpartum Glucose Tolerance [20I]
Authors: Mikell Chelsea J. , Pollack Rebecca , Zhao Jing , Andrews Mary 
Published: April 2018

INTRODUCTION:
GDM is diagnosed on the basis of blood glucose levels that exceed specific glycemic thresholds. We sought to identify characteristics of antenatal glucose testing that may serve as markers for abnormal postpartum testing.

METHODS:
IRB approved retrospective cohort study. A database was created from all women who underwent a postpartum 2-hour oral glucose tolerance test at the Carolinas Medical Center Diabetes Clinic in Charlotte, NC between 2012-2015. Inclusion criteria: singleton pregnancy, diagnosis of GDM, postpartum GTT completed 4-12 weeks post-partum. GDM was diagnosed by at least 2 elevated values on a completed 3-hour glucose tolerance test (Carpenter-Coustan). Data was indexed using two methods: clinical groups and by number of abnormal values. Four groups were defined: Group A; abnormal fasting value. Group B; all values < 200mg/dl. Group C; Any value ≥200mg/dl. Group D; Both an elevated fasting AND any value ≥200mg/dl. Patients were also grouped according to the number of abnormal values on 3h GTT; either 2, 3 or 4 abnormal values. Chi-square or Mantel-Haenszel tests were used for categorical variables. T-tests and generalized linear models were used for continuous variables. Poisson regression models were used to calculate relative risks (RR) and 95% confidence intervals.

RESULTS:
407 patients met study criteria. 57% were diagnosed with abnormal 2-hour postpartum glucose tolerance (PGT). Groups A, C, and D had a greater RR of abnormal 2-hour PGT compared to Group B. Four abnormal values on 3-hour antenatal GTT compared with two abnormal values was associated with a higher risk of abnormal PGT. These results are not statistically significant.

CONCLUSION:
No statistically significant markers for abnormal PGT identified from the antenatal 3-hour GTT. The population in our study represents patients compliant with post-partum glucose tolerance testing. Our results may have been affected because patients with poor control of GDM are less likely to be compliant with postpartum glucose tolerance testing.
Hypertensive Disorders in Pregnancy and Gestational Diabetes: Does Weight Gained in Pregnancy Matter? [29I]
Authors: Reed Christina C. , Longo Monica , Chiossi Giuseppe , Landgren Rachel , Chauhan Suneet , Huff Cristina Wallace 
Published: April 2018

INTRODUCTION:
The Institute of Medicine (IOM) released guidelines to optimize weight gain in pregnancy and prevent adverse outcomes. Our aim was to assess the role of pre-pregnancy BMI and maternal weight gain (MWG) as risk factors for hypertensive disorders (gestational hypertension or preeclampsia) and gestational diabetes (GDM).

METHODS:
A retrospective study reviewed weight gain during pregnancy including: women ages 18-45, singleton, prenatal care <20 weeks, no fetal anomalies, BMI ≥18.5, pre-pregnancy BMI and maternal weight at delivery. A multivariate logistic regression was used to determine the odds ratio (OR) of a composite maternal outcome (CMO) of hypertensive disorders and GDM, according to patient’s pre-pregnancy BMI (≥30 vs <30) and MWG (≥ vs < IOM recommendations per BMI category/trimester).

RESULTS:
Of the 494 women that met the inclusion criteria, 36% were obese and more than 50% had excessive weight gain in the 2nd and 3rd trimester. CMO was present in 22% of the study population. Obese women were more likely to develop the adverse CMO compared to normal/overweight women (p<0.01), and to deliver earlier (37.8±3 vs 38.3±2 weeks, p<0.02). Obese patients followed the IOM recommendations for MWG in the third trimester (100/176 vs 158/318, p=0.047). Multivariate logistic regression showed that obesity at entry to care, not trimester specific MWG, is associated with the composite outcome (aOR 2.0 with 95% CI 1.2-3.5; p<0.01).

CONCLUSION:
Pre-pregnancy BMI, more than MWG per trimester, significantly contributes to the onset of hypertensive disorders and GDM in pregnancy. Preconception counseling should focus on weight optimization before conception to improve maternal outcome.
Compliance with Timing Recommendations for Medically Indicated Deliveries and the Impact on Pregnancy Outcomes [32I]
Authors: Bicocca Matthew J. , Racusin Diana , England Joey , Ankumah Nana-Ama , Blackwell Sean C. , Refuerzo Jerrie S. 
Published: April 2018

INTRODUCTION:
The objective of this study was to determine compliance with ACOG recommendations for timing of medically indicated deliveries (MID) and the impact on pregnancy outcomes for high risk pregnancies.

METHODS:
A retrospective cohort study was conducted including pregnant women greater than 32 weeks gestation in an academic-affiliated, Maternal Fetal Medicine private practice who were scheduled for a MID. Women were divided between those who delivered prior to their scheduled MID and those who made it to their scheduled time of delivery. Outcomes were compared between groups including maternal, delivery and neonatal outcomes using chi-square and Mann Whitney U test.

RESULTS:
Of 204 pregnancies scheduled for a MID, 94.6% (N=193) were compliant with ACOG recommendations. Non-MID occurred for primarily neurologic or malignancy indications. Seventy-seven (38%) delivered prior to their scheduled delivery date. The most frequent indications included labor (31.2%), preeclampsia (26.0%), gestational hypertension (24.7%) and multiple gestation (15.6%). These women had significantly earlier gestational age at delivery (35.4 vs 37.6 weeks; p = 0.0001), higher primary cesarean delivery rate (40.3 % vs. 20.5%; p =0.002), higher rate of NICU admission (53.2% vs 23.6%; p = 0.0001), and greater NICU days (11.4 vs. 1.9; p = 0.0001). No differences in maternal age, parity, race, or BMI were noted between groups.

CONCLUSION:
Compliance with ACOG guidelines for MID were achieved in 9 out of 10 high risk pregnancies. Deliveries prior to the scheduled date were due to labor, hypertensive disorders, and multiple gestation, and associated with late preterm birth, higher cesarean rate and NICU stay.
What Happens after a Failed External Cephalic Version? [36I]
Authors: Katukuri Vivek R. , Andrews Suzanne , Leeman Lawrence , Yonke Nicole 
Published: April 2018

INTRODUCTION:
To compare perinatal outcomes following a failed external cephalic version (ECV) to a successful ECV and a planned cesarean delivery

METHODS:
This was a retrospective cohort study from January 2012 to June 2015. We included singleton, nonanamolous live births delivered after 36 weeks. We performed a comparison of perinatal outcomes between women who had an unsuccessful ECV, a successful ECV and a planned cesarean delivery. The primary outcome was a composite of neonatal outcomes, which included APGAR <7 at 5 minutes, NICU or intermediate care nursery admission, need for respiratory support and hypoglycemia. A secondary outcome was final mode of delivery among women attempting ECV.

RESULTS:
We identified 236 pregnancies meeting inclusion criteria, 126 (53.3%) of which attempted ECV with 110 (46.7%) undergoing planned cesarean delivery. The success rate of external cephalic version (ECV) was 50.7% (n=64). Among women who had successful ECV, the rate of cesarean section was 25% (n=16). Among women with failed ECV, the rate of the primary outcome was 6.8% (n=4), versus 12.9% (n=7) in the successful group and 10.9% (n=12) in the planned cesarean group (p=0.59). There was no difference in the rates of Apgar score <7 at 5 minutes, NICU or intermediate care nursery admission, need for respiratory support or hypoglycemia.

CONCLUSION:
ECV was not associated with an absolute risk increase in the primary composite outcome compared to planned cesarean for fetal malpresentation. This evidence provides support for ECV as a safe alternative for women with fetal malpresentation who desire a vaginal delivery regardless of outcome.
Coccidioidomycosis in Pregnancy: A Retrospective Review [7J]
Authors: Hermann Catherine , Lee Annie , Gray Kendra , Huls Christopher Kevin 
Published: April 2018

INTRODUCTION:
Coccidioides is a fungus endemic to the southwestern United States. While uncommon during pregnancy, it is associated with disseminated disease and has historically carried an almost universal fatality rate in pregnant women. There has been little research to guide proper treatment during pregnancy. This retrospective review set out to assess cases of coccidioidomycosis at Banner University Medical Center-Phoenix to determine outcomes and success of managing these patients.

METHODS:
Charts were compiled for review based on inclusion criteria of coccidiomycosis diagnosed prior to or during pregnancy. 23 subjects met criteria and were enrolled. Primary outcome measure was maternal mortality. Secondary outcome measures included rates of maternal intensive care unit admission, maternal disseminated disease, neonatal intensive care unit admission, preterm delivery, disease transmission to neonates, birth defects, maternal drug toxicity secondary to treatment of coccidioidomycosis, evidence of placental or uterine pathology, and length of hospital stay.

RESULTS:
Descriptive statistics were used to analyze the data. None of the 23 subjects died as a result of coccidioidomycosis in pregnancy. The rate of maternal disseminated disease was 17.39%, and there was a 56.25% rate of maternal drug toxicity. Median and mean lengths of hospital stays were 7.5 days and 8.9 days, respectively.

CONCLUSION:
The results of this study suggest that coccidiomycosis in pregnancy continues to be rare and no longer carries the death sentence it once did despite high rates of maternal disseminated disease. However, maternal toxicity associated with treatment is high, and indicates a need for further study into prevention and management of these side effects.
The Effect of Planned Mode of Delivery in Morbidly Obese Women [29J]
Authors: Nicholls-Dempsey Laura , Czuzoj-Shulman Nicholas , Abenhaim Haim Arie 
Published: April 2018

INTRODUCTION:
Morbidly obese women have a higher risk of experiencing adverse pregnancy outcomes. The aim of this study is to determine which planned mode of delivery, elective cesarean section versus vaginal delivery, presents better maternal outcomes in morbidly obese women.

METHODS:
We conducted a population-based, retrospective cohort study using the United States' Health Care Cost and Utilization Project's Nationwide Inpatient Sample to evaluate maternal outcomes in morbidly obese women without comorbidities delivering between 2000 and 2014. Multivariate logistic regression was used to compare outcomes in morbidly obese women according to mode of delivery.

RESULTS:
We identified a total of 77,666 deliveries in otherwise healthy morbidly obese women. The planned cesarean group comprised 13.4% of the cohort. When compared to women in the planned vaginal group, the planned cesarean group was at higher risk for transfusion (OR 1.48 [95% CI 1.23–1.77]), chorioamnionitis (OR 1.61 [1.44–1.81]) and major puerperal infection (OR 1.28 [1.05–1.56]). Women in the planned cesarean group had a lower risk of postpartum cardiomyopathy (OR 0.07 [0.02–0.22]), amniotic fluid embolism (OR 0.08 [0.02–0.31]), deep vein thromboembolism (OR 0.25 [0.08–0.79]), sepsis (OR 0.18 [0.07–0.44]) and wound dehiscence (OR 0.36 [0.23–0.59]). These reduced risks in the latter are partly due to the high rate of cesarean among planned vaginal deliveries in which morbidities appeared highest.

CONCLUSION:
Emergency cesarean section presents higher risks compared to planned cesarean section. Given that many planning a vaginal delivery will undergo emergency cesarean section, morbidly obese women should be informed of the high rate of failed vaginal delivery and subsequent risks.
Comparison of Management Options for Twin Pregnancies Affected by Midtrimester Incidental Cervical Shortening [30J]
Authors: Qureshey Emma , Quinones Joanne , Sarno Albert , Rust Orion 
Published: April 2018

INTRODUCTION:
Prematurity is the leading cause of neonatal death and twin gestations account for 25% of preterm deliveries. Cervical shortening is a risk factor for preterm delivery. The purpose of our study is to evaluate strategies to prevent spontaneous preterm birth in twins with a short cervix by transvaginal sonogram.

METHODS:
Retrospective cohort study comparing expectant management, vaginal progesterone and cerclage in the management of cervical shortening (<2.5 cm) in twins. Information regarding baseline characteristics and pregnancy outcomes were obtained. Comparisons were made using Student t-test for continuous variables and χ2 analysis or Fisher exact test for categorical variables.

RESULTS:
Between January 2006 and July 2016, 93 pairs of twin gestations with cervical shortening were identified. Strategies included expectant management (n=41, 44.1%), cerclage (n=30, 32.3%) and vaginal progesterone (n=22, 23.7%). Demographic characteristics were similar between groups. A trend was observed towards a shorter cervical length in cerclage group (1.67 cm expectant management, 1.31 cm cerclage and 1.77 cm vaginal progesterone, P=.06). Delivery information was available for 73 patients. Gestational age at delivery was similar between groups (31.7 weeks +- 4.6 in expectant management, 30.6 weeks +- 4.9 in cerclage and 32.5 weeks +- 3.9 in vaginal progesterone, P=.39). Rate of chorioamnionitis was also similar.

CONCLUSION:
Our data suggest that the gestational age at delivery of twin gestations with cervical shortening is not impacted by management strategy. There was no benefit to cerclage placement in preventing preterm birth. Large randomized studies comparing expectant management, vaginal progesterone and cervical cerclage are essential before altering clinical practice.
Evaluation of Fetal Movement Tracking Mobile Applications Using an Adapted APPLICATIONS Scoring System [31J]
Authors: Cowles Steven , Weise Fleckenstein Maria Daniela , Quiner Trevor E. 
Published: April 2018

INTRODUCTION:
Fetal movement tracking is commonly encouraged by clinicians as a means of antenatal surveillance. We sought to identify the most comprehensive and top-rated mobile applications for fetal movement tracking that are available for patient and research use.

METHODS:
Application distribution platforms were searched systematically and a list of fetal movement tracking applications was created. Comprehensiveness was by inclusion of: guidelines from professional societies, real-time tracking functions, mechanisms for manual entry of data, and the ability to monitor trends, the ability to export data. We used a modified APPLICATIONS scoring system to evaluate the comprehensiveness, accessibility, and functionality of qualifying applications.

RESULTS:
A total of 104 individual fetal movement tracking applications were identified on the Google Play Store and the Apple App Store. Of these, twenty-six were identified as being available on both operating systems. Seven applications were eliminated for not being free or for being associated with a specific healthcare center. Of the remaining applications, no application received a perfect score on the APPLICATIONS scale and there was significant heterogeneity in the completeness of each application. Comprehensive pregnancy tracker applications were more likely to be complete than stand-alone fetal movement tracking applications.

CONCLUSION:
Identification of the most comprehensive and user-friendly mobile applications for tracking fetal movement could allow for greater patient compliance and the ability to perform more comprehensive research in the potential benefits of fetal movement monitoring.
Prenatal DHA Supplementation and Pregnancy Outcomes in Women With Diabetes [39J]
Authors: Fowose Mobolaji , Hamilton Owen J. C. , Colditz Graham , Tuuli Methodius G. , Carter Ebony B. 
Published: April 2018

INTRODUCTION:
Docosahexaenoic acid (DHA) supplementation may improve pregnancy outcomes, but its role in patients with diabetes is unclear. The object of this study was to determine the association between DHA and pregnancy outcomes in women with diabetes.

METHODS:
We performed a retrospective cohort study of pregnant women with type 1, type 2 and gestational diabetes who delivered at Barnes-Jewish Hospital from 2012 to 2016. Women prescribed prenatal vitamins (PNV) with DHA were compared to those prescribed PNV without DHA. The primary outcome was hypertensive disorders of pregnancy. Secondary outcomes included preterm birth (PTB), neonatal hyperbilirubinemia and postpartum depression. Outcomes were compared between women who used PNV with and without DHA. Logistic regression was used to control for potential confounders.

RESULTS:
Of 298 women in the cohort, 30 (10.1%) took a PNV with DHA. DHA use was significantly lower among women who were obese, African American, Latina, and had medical co-morbidities and was higher in those with a history of PTB. Women taking a PNV with DHA were less likely to develop hypertensive disorders of pregnancy after adjusting for obesity, race, medical comorbidities, and history of PTB (20.0% versus 50.0%, aOR 0.29; 95% CI 0.10–0.84). There was no significant difference in neonatal hyperbilirubinemia, PTB and postpartum depression.

CONCLUSION:
PNV supplementation with DHA is associated with a reduced risk of hypertensive disorders of pregnancy in a high-risk cohort of women with diabetes. Larger prospective studies are needed to determine the impact of DHA on maternal and neonatal outcomes in women with diabetes.
Patterns and Correlates of Cervical Cancer Screening Initiation in a Large Integrated Healthcare System [1K]
Authors: Becerra-Culqui Tracy A. , Lonky Neal M. , Chen Qiaoling , Chao Chun R. 
Published: April 2018

INTRODUCTION:
The cervical cancer incidence rate has not declined among 24–25 year-olds between 2000 (2.79 per 100,000) and 2013 (2.93 per 100,000). We studied cervical cancer screening initiation in young women and how woman and provider factors affect the timing of screening initiation to effect prevention. We examined patterns and correlates of cervical cancer screening initiation among women turning age 21 in a large community-based practice.

METHODS:
Female members who turned age 21 (baseline) during 2013–2015 and had not previously received Papanicolaou (Pap) test were evaluated during 2016 using electronic health records. Incidence rate and cumulative incidence of screening initiation was calculated. Associations between patient and provider characteristics and screening initiation were evaluated using multivariable Cox models.

RESULTS:
Of 38,257 women studied, the Pap screening initiation rate was 44 per 100 person-year(s). Approximately 40% initiated screening within 1 year after turning age 21. I Asian/Pacific Islanders, Medicaid enrollees, those whose primary language is not English, those with a recent inpatient visit, those with a primary care physician (PCP) in specialties other than family practice, and those cared for by a male rather than female PCP less often initiated screening. History of Human Papilloma virus and flu vaccination, a history of pregnancy, contraception use, and sexually transmitted infections had more timely screening initiation.

CONCLUSION:
Less than half of the women insured for preventative services initiated screening at age 21. Strategies to improve adherence to screening initiation guidelines should consider a tailored approach for at risk subgroups and addressing initiation challenges associated with male physicians.