bluuebunny/crossref_metadata_2025_split huggingface dataset:
Case Control Analysis of Fetal Congenital Heart Defects as a Risk Factor for Preeclampsia [10N]
Authors: Bears Breanne , Browne Kathleen , Turan Shifa , Turan Mehmet 
Published: April 2018

INTRODUCTION:
Fetal congenital heart defects (fCHD) may indicate an angiogenic imbalance that predisposes mothers to pre-eclampsia (PE.) It is unclear if this is due to other maternal risk factors of PE or from CHD itself. We sought to determine whether fCHD is an independent risk factor for maternal PE.

METHODS:
This was a case control study of singleton births delivered at the University of Maryland Medical Center from 2007 to 2016. Fetuses with CHD diagnosed by a fetal echocardiography were identified. Known chromosomal anomalies were excluded. The primary exposures of interest were known maternal risk factors for PE. Controls were matched 1 to 3 by history of PE, diabetes mellitus (DM,) and chronic hypertension (CHTN). Risk of PE was analyzed in fCHD vs. non-fCHD pregnancies. Data was analyzed using Chi-squared.

RESULTS:
251 fCHD cases met inclusion criteria. These were matched with 753 controls. PE occurred in 15 (6%) deliveries with fCHD and 44 (5.8%) matched controls. Early PE (<34 wks) occurred in 4 (1.6%) fCHD and 10 (1.3%) control pregnancies. Late PE (>34 wks) occurred in 11 (4.4%) fCHD and 34 (4.5%) controls. The presence of fCHD was not associated with PE (OR: 0.98; CI 0.53-1.79; p=0.94). When PE was separated into early and late, CHD was not associated with either early (OR=0.83; CI 0.26-2.67; p=0.75) or late PE (OR: 1.03; CI 0.51-2.07; p=0.93).

CONCLUSION:
Fetal CHD was not an independent risk factor for PE, early PE, or late PE. Further monitoring does not appear warranted in women with antenatal diagnosis of fCHD.
Temporal and Quantitative Associations of Electronic Fetal Monitoring with Outcomes [12N]
Authors: Taylor Rachel , Friedman Perry , Kim Sun Kwon , Wozniak Amy , Jovanovski Andrew , Ogunyemi Dotun 
Published: April 2018

INTRODUCTION:
To evaluate the use of intrapartum electronic fetal heart rate (FHR) monitoring (EFM) as a screening tool for adverse neonatal outcomes

METHODS:
This is a retrospective study of 22,126 term, singleton deliveries excluding repeat cesarean sections at a hospital system from 2013-2016. EFM data using standardized NICHD nomenclature was reviewed. Data was analyzed as discrete, quantitative, and tabulated as a) any FHR documentation during labor, b) first 60 minutes and c) last 60 minutes of labor. Primary outcome was a composite adverse outcome comprised of five-minute Apgar score < 4, umbilical arterial pH < 7.0, sepsis, seizures, encephalopathy, and respiratory failure. Secondary outcome was NICU admission. Independent associations were ascertained using logistic regression. Sensitivity, specificity, PPV and NPV were calculated.

RESULTS:
Any abnormal EFM was independently significantly associated with NICU (aOR=1.20 p=0.043) and primary outcome (aOR=1.98 p=0.018). Both first and last 60 minutes had independent associations with NICU. Last 60 minutes but not first 60 minutes was independently associated with the primary outcome, Accelerations and early decelerations were protective against NICU admissions and primary outcomes, while late and prolonged decelerations, bradycardia and tachycardia increased risk for both (Table). Negative predictive values for all EFM parameters ranged from 0.897-0.989 while the PPV ranged from 0.009-0.226.

CONCLUSION:
Both admission and terminal FHR are independently associated with NICU admissions but only terminal FHR is predictive of composite neonatal outcome. Accelerations and early decelerations are protective of adverse neonatal outcomes. FHR has high NPV but low PPV when used as screening for adverse neonatal outcomes.
Do Maternal Sociodemographic Factors Explain Race/Ethnic Differences in Neonatal Anthropometry in Low Risk Women? [14N]
Authors: Lambert Calvin , Pugh Sarah , Liu Aiyi , Ayele Fasil Takola , Grantz Katherine 
Published: April 2018

INTRODUCTION:
Racial/ethnic differences in birthweight exist. It is unclear to what extent these differences are due to correlates of social disadvantage. Our objective was to evaluate whether relationships between maternal race/ethnicity and neonatal anthropometry varied by maternal socio-demographic characteristics in a cohort of healthy, low-risk women.

METHODS:
In a prospective cohort of 1,645 low-risk singleton pregnancies included in the NICHD Fetal Growth Studies (2010-2013), neonatal anthropometry was measured by trained personnel using a standard protocol. Sociodemographic characteristics were ascertained by interview and included full-time employment/student status (yes/no), marital status, health insurance source (private/managed vs Medicaid/other), income, and education. Separate generalized linear models were used to test the effect of race/ethnicity and the combined effect of race/ethnicity and sociodemographic characteristics (with two-way interaction terms) on neonatal anthropometry adjusting for days from birth (except birthweight) infant sex, and maternal characteristics: age, height, pre-gravid weight, parity, and the other sociodemographic factors.

RESULTS:
Mean birthweight, and neonatal weight, length, head circumference and abdominal circumference at examination differed significantly by race (p<0.001 for all comparisons). No statistically significant interactions occurred between race/ethnicity and full-time employment/student status, marital status, insurance, or education in association with birthweight, neonatal weight, length, or head or abdominal circumference at examination. The interaction of income with race/ethnicity was marginally significant for abdominal circumference (p=0.027). There were no significant interactions of income with other neonatal parameters and the observed significance may have occurred by chance (1 of 25 models).

CONCLUSION:
Racial/ethnic differences in neonatal anthropometry were not explained by sociodemographic factors in low-risk women.
Is Cerclage Height Associated with the Incidence of Preterm Birth in Women with Physical Exam Indicated Cerclage? [16N]
Authors: Roman Amanda , Pachtman Sarah , Cruz Yury , Rochelson Burton , Fleischer Adiel , Berghella Vincenzo 
Published: April 2018

INTRODUCTION:
To determine whether there was a cerclage height threshold associated with spontaneous preterm birth in patients with physical exam indicated cerclage (PEIC).

METHODS:
We performed a retrospective multicenter cohort study of women with a PEIC. Functional cervical length and the cerclage height (distance from cerclage to the external cervical os) were obtained. Our cohort was grouped into thirds, based on cerclage height percentile. Our primary outcome was spontaneous preterm birth (SPTB) less than 34 weeks.

RESULTS:
113 women had PEIC and TVCL measurement after cerclage. There were 34 women with cerclage high 0-14mm, 42 women with cerclage high 15-18mm and 37 women with cerclage high 19-28mm. There were no differences in the incidence of SPTB < 34 weeks (44.1% vs 42.9% vs 40.5% respectively) (p=0.9). There were no differences at other gestational ages: SPTB < 24, <28, <32 or <37 weeks. The interval from cerclage to delivery was not significantly different: 11.5±6.8 vs 11.1 ±6.4 vs 13.4±6.8 weeks (p=0.2). It remained none significantly different after controlling for cervical dilation or degree of membrane prolapse into the endocervical canal.

CONCLUSION:
Longer cerclage height in women with physical exam indicated cerclage is not associated with a reduction in spontaneous preterm birth.
Quantitative Blood Loss is a More Accurate Measure of Blood Loss Compared to Estimated Blood Loss. [17N]
Authors: Ladella Subhashini , Nguyen Lynsa , O’Byrne Hollee , Cortez Cynthia 
Published: April 2018

INTRODUCTION:
Postpartum Hemorrhage (PPH) is the leading cause of maternal deaths worldwide. Visual estimation of blood loss (EBL) can result in underestimation of blood loss, causing delay and failure of early interventions for PPH, thus adversely affecting maternal morbidity and mortality. The California Maternal Quality Care Collaborative (CMQCC) hemorrhage toolkit suggests Quantitative Blood Loss (QBL) is a more accurate measure. The purpose of this study is to determine if QBL is a more accurate measure of blood loss than EBL at Community Regional Medical Center (CRMC) in order to standardize PPH management.

METHODS:
A retrospective cross sectional study was performed at CRMC on postpartum patients from February to June 2016. The variables investigated were pre- and post-delivery hemoglobin, EBL and QBL. The blood loss calculated from the difference between pre- and post-delivery hemoglobin levels was compared to the blood loss given by QBL and EBL.

RESULTS:
A total of 303 cases were reviewed. The mean QBL was 310.57mL and the mean EBL was 255.39mL. The difference was statistically significant (p=0.036). The Pearson correlation coefficient between change in hemoglobin and QBL was 0.28. For EBL, the correlation was 0.25. Both correlation coefficients were statistically significant (p<0.05).

CONCLUSION:
In our study, QBL appears to be a more accurate measure of blood loss than EBL. Additional data from deliveries at CRMC in 2017 are being reviewed given that the process of QBL has continued to improve with better education, compliance and changes in available resources. We hope to find a stronger correlation between QBL and blood loss.
Are Vitamin D Levels Lower in the Breast Milk of Bariatric Surgery Patients? [18N]
Authors: Persad Malini D. , Perseleni Tatyana , Baker David , Pimentel Veronica , Buckley Ayisha , Garretto Diana 
Published: April 2018

INTRODUCTION:
To determine if bariatric surgery is associated with lower levels of vitamin D in breast milk.

METHODS:
A prospective cohort study of pregnant women was conducted at a university hospital between June 2014 to July 2015. Included in the study were pregnant women with singleton gestations who had a history of bariatric surgery (gastric bypass group) and pregnant women with no history of malabsorption (controls). Samples collected included maternal postpartum blood, colostrum, transitional milk, and mature milk. Each sample was analyzed for 25-hydroxyvitamin D (25(OH)D) level. Parametric and nonparametric statistics were used to compare groups, with a p value < 0.05 as statistically significant.

RESULTS:
A total of 110 women were included in the study. Women that had undergone bariatric surgery were more likely to be white, Hispanic, and have higher pre-pregnancy and pregnancy BMIs. Vitamin D levels in breast milk decreases with increasing time from delivery regardless of surgical history (Table 2). Women in the bariatric surgery group had significantly higher 25(OH)D levels in transitional milk but similar levels in colostrum and mature milk when compared to

CONCLUSION:
Vitamin D levels in breast milk decreases with increasing interval from delivery. Interestingly enough, vitamin D levels were higher in transitional milk of women that had undergone bariatric surgery. Neonatal vitamin D supplementation should be considered when transitional and mature milk is utilized as the primary nutritional source regardless of maternal bariatric surgery history.
Term Meconium Stained Amniotic Fluid: Maternal and Neonatal Risks [19N]
Authors: Kim Sun Kwon , Friedman Perry , Madan Ichchha , Haltigin Christopher , Awrow Mirna , Ogunyemi Dotun 
Published: April 2018

INTRODUCTION:
To determine the independent associations of meconium stained amniotic fluid

METHODS:
This is a retrospective review of 4085 (12.2%) women at 37-42 weeks with meconium staining compared to 29397 (87.8%) women who delivered at a single hospital system from 1/2013-12/2016. The primary outcome was a composite neonatal adverse outcome comprised of five-minute Apgar score < 4, umbilical arterial pH < 7.0, sepsis, seizures, encephalopathy, and respiratory failure. Secondary outcome was neonatal intensive care unit (NICU) admission. Logistic regression and hierarchical regression analysis were used.

RESULTS:
Prenatal factors which positively independently correlated with meconium staining were African-Americans, nulliparity, BMI and public insurance but negatively associated with male fetal gender and multiple pregnancies. For intrapartum factors, vaginal delivery, epidural analgesia, chorioamnionitis and abnormal fetal heart rate patterns were associated with increased risks while abruption and opioid use were associated with decreased meconium staining. Meconium staining was significantly positively correlated with both neonatal composite adverse outcomes and NICU admission. Hierarchical analysis showed that meconium staining significantly increased albeit by a small percentage the variability accounted for both NICU admission (R2=0.015, R2Adjusted=0.017; p<0.001, β=0.037) and the primary outcome (R2=0.004, R2Adjusted=0.005; p<0.001, β=0.021) when controlled for accelerations, late, variable, and prolonged decelerations, tachycardia, bradycardia and minimal variability.

CONCLUSION:
Amniotic fluid meconium staining during labor indicates a slightly increased neonatal risk beyond what is explained by abnormal fetal heart rate patterns.
Implementing a Universal Perinatal Depression Screening and Treatment Program in a Community Setting [21N]
Authors: Lau Kiger , Pardanani Setul 
Published: April 2018

INTRODUCTION:
Depression is one of the most common perinatal conditions, and fewer than half of cases are recognized. ACOG and USPSTF recommend that all pregnant women be screened during perinatal care. This is a quality improvement approach to implementing a universal perinatal depression screening and treatment program at Stamford Hospital, as well as a validity test of Patient Health Questionnaire-2 and -9 (PHQ2/9).

METHODS:
A didactic session on perinatal depression was held for OB/GYN and Family Medicine providers. In the following year, a retrospective chart review compared screening rates and management outcomes using the PHQ-2/9 and the Edinburgh Postnatal Depression Screen (EPDS).

RESULTS:
294 of 295 patients seen for a postpartum visit were screened using one or more tools. In this study, the PHQ2/9 had a sensitivity of 33% and specificity of 100%; those for the EPDS were 63% and 90%, respectively. Of the patients with a positive screen, 76% were referred to and seen by a Behavioral Health specialist. The overall prevalence of postpartum depression was 4%; 2 patients were prescribed antidepressant medications.

CONCLUSION:
This study established baseline postpartum depression screening rates, prevalence and treatment trends at Stamford Optimus Clinic. The condition is under-detected and poorly documented in this population; however, there was a high referral rate to behavioral health specialists after positive screens. The PHQ-2/9 was not as effective as the validated EPDS for depression screening. Future initiatives will utilize this data to create protocols to expand screening, standardize diagnoses, and improve management of perinatal depression.
English- and Spanish Speaking Males are Similarly Uninformed about Pregnancy Health Risks [22N]
Authors: Schiller Andrew , Mellon Michelle , Nelson Anita L. , Stohl Hindi E. 
Published: April 2018

INTRODUCTION:
Male partners of pregnant women may have a significant impact on the decisions a pregnant woman makes regarding her prenatal care. Understanding male partners’ perceptions of reproductive health may help elucidate some of the influences that impact pregnancy decision-making. This study seeks to evaluate the understanding of pregnancy health risks among English- and Spanish-speaking male partners of pregnant women.

METHODS:
Men were individually interviewed in private areas of a prenatal clinic at a public teaching hospital. IRB approval was granted by LABioMed and Western University of Health Sciences. Statistical significance was identified with a Chi Square test when P<.05.

RESULTS:
125 surveys were analyzed. 18% of respondents were Spanish-speaking, while 62% were Hispanic. 26% of men couldn't name one pregnancy-related health risk in an open-ended question; language preference did not significantly impact risk naming (P=.313). 42% of men knew that the risk for blood clot increases during pregnancy when presented with a list of health problems; no significant impact of language preference was observed (P=.413). 82% of men considered the birth control pill as more hazardous to a woman’s health than pregnancy; no significant impact of language preference was observed on this perception (P=.890).

CONCLUSION:
Men are largely unaware of the health risks of pregnancy regardless of English or Spanish language preference. Educating men about those risks may help both them and their partners make informed decisions before and during pregnancy, potentially increasing the chance of their compliance with healthcare provider recommendations for contraception or pregnancy.
Poor Understanding of Pregnancy-Associated Health Risks Among Indigent Pregnant Women [23N]
Authors: Mellon Michelle , Schiller Andrew , Nelson Anita L. , Stohl Hindi E. , Dong Fanglong 
Published: April 2018

INTRODUCTION:
Health risks associated with pregnancy may be poorly understood by pregnant women, placing them at risk of developing these complications, delaying diagnosis, or making poorly-informed decisions. This study evaluates the health literacy among pregnant women to highlight potential gaps that exist in maternal health knowledge.

METHODS:
This study was conducted in the prenatal clinic at a public teaching hospital. Women were individually interviewed, one-on-one, in private areas in the clinic. IRB approval was granted by LABioMed and Western University of Health Sciences. Statistical significance was identified with a Chi Square test when P<0.05.

RESULTS:
Altogether 184 surveys were collected. Five percent of women who were asked about specific pregnancy-related health risks were able to identify all seven correctly from a multiple-choice list; 30.6% correctly answered that the risks of blood clots, diabetes, and high blood pressure increased in pregnancy. These findings were associated with higher education (P=.0171), but independent of age (P=.6588), previous pregnancy (P=.7599), and gestational age (P=.5771). When asked if pregnancy or birth control pills are more hazardous to a woman’s health, 75% of participants noted the latter regardless of age (P=.5689), previous pregnancy (P=.4439), gestational age (P=.8469), and education (P=.994).

CONCLUSION:
Our study highlights that a large percentage of pregnant women are unaware of the health risks associated with pregnancy. As pregnancy has a large impact on a mother’s health, it is crucial to understand where educational gaps exist so they may be appropriately addressed by clinicians.
Patient Perceptions of Clinical Research in Pregnancy [30N]
Authors: Clapp Mark , Mesina Omar , Goldfarb Ilona 
Published: April 2018

INTRODUCTION:
In 2017, the Federal Policy for the Protection of Human Subjects removed pregnant women as a “vulnerable” population and the associated restrictions on research. Little is known about the women's attitudes toward research in pregnancy. Our goal was to understand the types of trials in which pregnant women would enroll and to identify barriers to participation.

METHODS:
An anonymous survey was distributed by non-clinical staff on the postpartum units to women who delivered a viable, liveborn fetus from June to September 2017. The survey was designed, tested, and distributed at a single academic center with IRB approval.

RESULTS:
100 of the 265 distributed surveys were returned (38%). Of participants, 34% had previously participated in research, and 43% would consider participating in pregnancy. Women were unlikely to participate in trials with medications with no data in pregnancy (80%), experimental vaccinations (68%), trials with a placebo (45%), or research with unknown effects on breastfeeding (79%). Women were willing to participate in studies with more ultrasounds (51%) and additional blood work (60%) prenatally. Women were more accepting of trials involving infection prevention (55%) and pain control (60%) in labor. The effects of demographic variables were assessed on a woman’s likelihood of participation in pregnancy using a univariate logistic regression; race, education, physician visits in the prior year, and employment type were statistically significant (p<0.05).

CONCLUSION:
Even in a population familiar with clinical trials, significant barriers exist to acceptance of participation during pregnancy. This data can help guide project design and strategies to increase enrollment in clinical trials.
Concordance of Self-Reported Weight and Initial Prenatal Weight in an Obese Pregnant Population [31N]
Authors: Ratan Bani M. , Sellner Allison A. , Hollier Lisa M. 
Published: April 2018

INTRODUCTION:
The 2009 Institute of Medicine guidelines recommend 11-20 pounds of weight gain during pregnancy for women with BMI ≥30, with 1.1-4.4 of this in the first trimester. However, many women are unaware of this and do not monitor their weight prior to initiating prenatal care. This study compares self-reported pre-pregnancy weight versus first prenatal visit weight in an obese, low-income population.

METHODS:
A retrospective cohort of 1,440 women receiving care at a large Medicaid clinic from 2013-2016 with BMI ≥30 was reviewed. Women who initiated prenatal care before 14 weeks gestation were included. Self-reported pre-pregnancy weight was compared with weight at first prenatal visit using paired t-test. Demographic data was compared using unpaired t-test and ANOVA.

RESULTS:
Inclusion criteria was met by 842 women, with mean gestational age of 9.2 weeks. Pre-gravid weight varied significantly from initial prenatal care weight, with mean absolute difference of 5.4 pounds (P<.001). 30.7% of patients had an increase in weight of greater than 5 pounds. There was no statistical significance between weight difference in planned versus unplanned pregnancies (P=.50). Patients with BMI>40 had a smaller difference between reported and first visit weights than those with BMI 30-34.9 (mean 0.64 vs 2.83 pounds, P<0.01).

CONCLUSION:
In an obese, low-income population, self-reported and initial first-trimester visit weight can differ significantly. It is unclear if this is due to poor recall of pre-pregnancy weight or early weight gain. More awareness of pre-pregnancy weight and the guidelines regarding weight gain are needed prior to the initiation of prenatal care.
Prenatal Magnesium Sulfate and Time to First Stool in Late Preterm Infants [32N]
Authors: Jones Cresta W. , Petrashek Kara , Wenzlaff Miranda , Simpson Pippa , Pan Amy Y. 
Published: April 2018

INTRODUCTION:
Reports suggest an increase in bowel obstruction or delayed transit time in preterm infants exposed to magnesium sulfate prior to delivery, but there are limited data in a later preterm cohort. Delayed stooling may be the first sign of more severe bowel dysfunction. Our goal was to examine the effect of magnesium sulfate on time to first stool in infants 32 weeks 0 days and 33 weeks 6 days gestational age.

METHODS:
A retrospective chart review of infants delivered between 32 weeks 0 days and 33 weeks 6 days gestational age at an academic medical center were examined from August 2012 to December 2014. Time to first stool and exposure to magnesium were studied in 120 infants who met study criteria. Indication for magnesium treatment was identified. Neonatal records were reviewed for evidence of adverse bowel events.

RESULTS:
No difference in time to first stool was identified comparing infants not receiving magnesium (time to first stool 0.72 days) with infants receiving magnesium for preeclampsia (0.72 days) and for tocolysis (0.77 days), P = 0.93. Time to first stool was inversely proportional to gestational age (p=0.008). No adverse bowel events were identified in either group.

CONCLUSION:
In infants born at 32w0d - 33w6d, there does not appear to be an increase in time to first stool with exposure to prenatal magnesium sulfate. Therefore, magnesium can be considered as an option for tocolysis, as well as utilized for treatment of preeclampsia with severe features, without delaying bowel transit time in this cohort.