bluuebunny/crossref_metadata_2025_split huggingface dataset:
Expanded Carrier Screening and Professional Society Guidelines: One Laboratory’s Experience [7E]
Authors: Westemeyer Maggie , Saucier Jennifer , Gold Bert , Hedriana Herman , Martin Kimberly A. 
Published: April 2018

INTRODUCTION:
In the recent ACOG Committee Opinion (no. 690), expanded carrier screening (ECS) was acknowledged as an acceptable carrier screening strategy. In addition, ECS panel development was proposed, in part, to include conditions with a carrier frequency of at least 1:100. However, carrier frequency data are limited for many conditions proposed for ECS. Using a general population, we determined carrier frequencies for 22 genes associated with conditions proposed by ACOG for ECS panel inclusion and examined if other genes/conditions met ACOG ECS criteria.

METHODS:
Carrier frequencies for 274 genes screened were calculated using 41,898 positive cases from general population carrier screening samples run at a reference laboratory.

RESULTS:
Observed general population carrier frequencies for 22 ACOG-proposed ECS panel genes were: HBA1/2=1:101, HBB=1:29, BLM=1:408, ASPA=1:450, CFTR=1:27, IKBKAP=1:363, ABCC8=1:260, FANCC=1:453, FMR1= 1:200, GALT=1:144, GBA=1:117, G6PC=1:321, TMEM216=1:653, ACADM=1:88, BCKDHA=1:856, BCKDHB=1:534, MCOLN1= 1:812, SMPD1= 1:185, PAH=1:42, DHCR7=1:68, SMN1= 1:58, and HEXA=1:197. Of 252 tested genes not proposed by ACOG, nine had observed carrier frequencies greater than 1:100 (GJB2=1:16, MEFV=1:31, ATP7B=1:71, SLC26A4=1:71, F11= 1:74, USH2A=1:74, GAA=1:80, PMM2=1:83, and GALC=1:86), and 11 had carrier frequencies between 1:100–1:150 (ACSF3=1:102, ALDOB=1:110, EYS=1:110, PKHD1= 1:110, HOGA1= 1:114, SLC12A3=1:114, CAPN3=1:130, SLC22A5=1:134, PEX6=1:145, GLDC=1:147, and CEP290=1:149).

CONCLUSION:
We demonstrated general population carrier frequencies for ACOG-proposed ECS conditions. Sixteen ACOG-proposed genes had general population carrier frequencies less than the 1:100 cutoff. Twenty ECS genes not recommended in the Committee Opinion No. 690 meet or are near the 1:100 cutoff and could be considered for ECS, given frequency and condition severity.
Understanding Commercially Sexually Exploited Youths’ Attitudes and Beliefs Towards Contraception and Pregnancy [8E]
Authors: Kelly Mikaela , Bath Eraka , Godoy Sarah , Ports Kayleen , Abrams Laura , Barnert Elizabeth 
Published: April 2018

INTRODUCTION:
Given the high reproductive health risks faced by commercially sexually exploited youth (CSEY), we sought to understand their attitudes and beliefs towards contraception and pregnancy.

METHODS:
We conducted semi-structured interviews with 21 female CSEY. Participants were recruited through group homes and a juvenile specialty court serving CSEY. Interviews were audio-recorded, transcribed, and coded for emergent themes using in-depth thematic content analysis.

RESULTS:
Overall, CSEY report relatively easy access to contraception. The youth intensely valued autonomy and expressed a strong preference for condoms as the primary form of contraception. Most respondents described an aversion towards hormonal birth control, attributed to personal experiences and peer accounts of side effects. Many also shared a common belief that hormonal methods are “unnatural,” cause infertility, and have low efficacy. Coupled with a preference for condom use was the reporting of frequent unprotected sex. Most had an attitude towards pregnancy of “if it happens, it happens.” Those who had been pregnant described confusion related to prenatal care and birthing, as well as frequent visits to the emergency room for pregnancy-related concerns.

CONCLUSION:
Given risks associated with their exploitation, to reduce unplanned pregnancy in CSEY, increased utilization of hormonal contraception is a promising option, in addition to reinforcing the importance of consistent condom use. For CSEY, contraceptive education that dispels prevailing myths, sets clear expectations regarding side effects, and emphasizes autonomy is most likely to be effective. Additionally, enhancing education about pregnancy and child-rearing can help CSEY appreciate the significance of their decisions regarding contraceptive use.
Ringed Placenta: Changes in Placental Perfusion Associated with Increased Mortality with Ventral Body Wall Defect [18E]
Authors: Tonismae Tiffany , Brown Brandon , Dungy-Poythress Lauren , Shanks Anthony 
Published: April 2018

INTRODUCTION:
Purpose is to assess perinatal morbidity/mortality among infants with ventral wall defects (VWD) and abnormal placental perfusion patterns on prenatal MRI.

METHODS:
A retrospective case series of pregnancies complicated by VWD (omphalocele, OEIS sequence, and bladder exstrophy) performed over a 7-year period. Maternal and infant charts were reviewed for basic demographic data, placental pathology, and neonatal outcomes. MRI studies were reviewed by 2 experts with a specialized focus in fetal MRI.

RESULTS:
31 cases of VWD were noted, and 11 cases possessed a novel placental perfusion pattern of a “ringed placenta” (pattern of rings of hyperintense MR signal surrounding hypointense placental cotyledons) seen throughout the parenchyma. In cases with a ringed placenta, five of 11 (45%) survived until 6 months of age. For the control group of VWD without the ringed placenta fourteen of 20 (70%) survived until 6 months of age. The relative risk for stillbirth/neonatal demise vs stillbirth/demise within 24hrs was 1.32 vs. 2.3 in VWD with the ringed placenta.
Over 50% of infant demises with abnormal placental findings and 25% of normal placenta finding were found to be small for gestational age (SGA) at birth, while all of the surviving infants were within normal range birth weight for gestational age.

CONCLUSION:
Compared to those pregnancies without the “ringed placenta, cases of VWD with the ringed placenta had a higher rate of death and were more likely to be SGA at birth. We did not find an increased risk of extremely low birth weights. Further study is needed to characterize this finding.
Maternal Risk Factor Index and Primary Cesarean Delivery among Low-Risk Women in Texas in 2015 [19E]
Authors: Salahuddin Meliha , Mandell Dorothy , Lakey David , Patel Divya 
Published: April 2018

INTRODUCTION:
Cesarean delivery (CD) accounts for over one-third of all Texas births (∼400,000 annually), with primary CD accounting for 20% of the overall CD. We examined associations of maternal risk with primary CD among nulliparous, term, singleton, vertex (NTSV) deliveries in Texas.

METHODS:
NTSV deliveries to women ages 15-49 years were identified using the 2015 Texas birth file (Center for Health Statistics, Texas Department of State Health Services). A risk factor index was constructed (score range: 0-6), including preexisting diabetes mellitus (DM)/gestational DM (GDM), preexisting hypertension (HTN)/gestational HTN, eclampsia, infertility treatment, smoking during pregnancy, and pre-pregnancy overweight/obesity, and categorized as 0, 1, 2, and 3+ based on the number of risk factors present. Multivariable logistic regression models were conducted to examine the associations between the categorized risk factor index and primary CD, overall and by maternal race/ethnicity.

RESULTS:
Among the 116,273 NTSV deliveries, 26.6% had primary CD. The most prevalent risks among those with primary CD were pre-pregnancy overweight/obesity (60.9%), gestational HTN (10.3%), and GDM (5.8%). The adjusted odds for primary CD for 1, 2, and 3+ risk factors were 1.66 (95% CI 1.60-1.71), 2.61 (95% CI 2.48-2.74), and 4.07 (95% CI 3.58-4.62), respectively. This dose-response relationship was observed for all race/ethnic groups.

CONCLUSION:
Over 50% of NTSV deliveries with primary CD had at least one maternal risk factor. Women with a higher risk index score had elevated odds for primary CD. Understanding patterns of maternal risk associated with primary CD among NTSV deliveries is vital to reducing the overall CD rate in Texas.
Early Versus Late Amniotomy in Nulliparous Women Undergoing Induction of Labor [20E]
Authors: Doulaveris Georgios , Powell Kristin , Fisher Nelli , Frieden Faith , Stone Joanne , Bernstein Peter 
Published: April 2018

INTRODUCTION:
Our objective was to investigate the effect of early versus late amniotomy on obstetric and neonatal outcomes in nulliparous women undergoing induction of labor.

METHODS:
This was a retrospective cohort analysis of nulliparous patients undergoing induction of labor in seven academic New York hospitals over one year (2016) derived from a quality improvement database. Nulliparous women with a singleton gestation undergoing induction of labor requiring an amniotomy were included. Data selected for this analysis included timing of amniotomy, obstetric and neonatal outcomes. Early amniotomy was defined as artificially ruptured membranes prior to the active phase and late amniotomy after the onset of active phase of labor. Results were compared between early and late amniotomy groups. Standard univariate analyses were performed.

RESULTS:
7104 medical charts were reviewed. 411 (5.8%) patients were nulliparous, undergoing induction of labor that required artificial rupture of membranes. 249 (60.6%) patients had an early and 162 (39.4%) patients had a late amniotomy. There was no statistically significant difference in the two groups in the rates of cesarean delivery (17.8% vs. 16%), operative delivery (10.8% vs. 8%), chorioamnionitis (5% vs. 6.8%), admission to neonatal ICU (6.6% vs. 8.6%) or an Apgar score less than 7 at one minute (7% vs. 6.2%). Women that underwent an early amniotomy had shorter active phase of labor (277.1 ± 11.4 mins vs. 347.8 ± 19.8 mins, p= 0.0009).

CONCLUSION:
Early amniotomy in nulliparous women undergoing induction of labor may shorten the active phase of labor without increasing the risk of adverse obstetric or neonatal outcomes.
Provider Perceived Barriers to 17P Use to Prevent Recurrent Preterm Births [21E]
Authors: Danilack Valery A. , Hosmer Jennifer , Littman Lisa , Frost Jordana , Clyne Ailis , O'Brien James 
Published: April 2018

INTRODUCTION:
Weekly prenatal injections of 17 Alpha-hydroxyprogesterone caproate (17P) reduce the risk of recurrent preterm birth, but are underutilized and new pricing structures have created additional barriers. We queried prenatal care providers about their use of 17P and aimed to identify barriers to patients obtaining the recommended regimen.

METHODS:
All twenty-six obstetric practices throughout Rhode Island were invited to complete a survey either on paper or online.

RESULTS:
Twenty-two practices completed the survey, including private practices and community- and hospital-based clinics. All practices reported prescribing 17P to patients for whom it was indicated. Overall, when practices were asked to what extent patients were prevented from getting the recommended regimen of 17P because of any access issues, 9% of practices answered “very much,” 18% answered “somewhat,” 36% answered “a little,” and 36% answered “not at all.” Barriers faced in prescribing 17P reported by more than half of practices included lack of insurance coverage and insurance restrictions. There were slightly more barriers reported for patients with private insurance than those with public insurance. Practices reported that at least some patients expressed concern or declined treatment with 17P for the following reasons: cost to patient (13/22 practices), schedule of weekly injections (12/22), dislike or fear of needles (10/22), fear of reaction or side effects of injection (10/22), transportation to clinic for injection (7/22).

CONCLUSION:
To ensure women are receiving a recommended regimen of 17P when indicated, it is important to improve patient education, streamline the insurance authorization process, and reduce barriers to obtaining 17P.
Biomarkers for Acute Brain Injury in Cord Blood [23E]
Authors: Little Sarah , Blennow Kaj , Zetterberg Henrik , Bibbo Carolina , Robinson Julian 
Published: April 2018

INTRODUCTION:
We investigated whether the second stage of labor (mode and duration) is associated with differences in biomarkers of neuronal injury in cord blood.

METHODS:
Using a prospective, longitudinal biobank of cord blood specimens, all women who underwent a forceps or vacuum delivery were matched to 3 controls: (1) an unlabored cesarean, (2) the shortest second stage within 3 months and (3) the longest second stage within 3 months. Cord blood samples were analyzed for two established biomarkers of acute axonal injury: total TAU and neurofilament light polypeptide (NFL).

RESULTS:
Our cohort consisted of 56 women. Maternal comorbidities and labor complications were similar across groups. Median levels of NFL, but not TAU, were statistically different across the 4 groups (forceps/vacuum 19.8 vs. unlabored cesarean 11.0 vs. short second stage 15.4 vs. long second stage 21.1; p<0.01). The most marked differences were by second stage duration irrespective of mode. Those with a second stages >2 hours (N=19) had a median NFL level more than twice that of those with an unlabored cesarean (22.7 vs. 11.0; p<0.01).

CONCLUSION:
Neurofilament light polypeptide levels (NFL) are significantly greater in cord blood after a prolonged second stage. While there is no current data to suggest this is associated with long term neurologic morbidity, the robust association of NFL with neuroaxonal injury in adults may prompt further research. Using biomarkers of acute brain injury may help obstetricians further clarify safety of varying second stage durations and/or help neonatologists better predict which neonates may benefit from interventions, such as therapeutic hypothermia.
Opioid Withdrawal During Pregnancy May Reduce Rates of Neonatal Abstinence Syndrome (NAS) [27E]
Authors: Stephens Angela , Raley Susanna , Street Linda , Browne Paul 
Published: April 2018

INTRODUCTION:
The incidence of Neonatal Abstinence Syndrome (NAS) has risen dramatically in the United States (U.S) during the past decade paralleling the increase in pregnant patients with opioid dependence. Current U.S. Drug Enforcement Agency (DEA) policy does not support opioid withdrawal during pregnancy. DEA policy and the paucity of Licensed Narcotic Treatment Programs in the U.S. that accept Medicaid payment has led to limited options for opioid-dependent patients who request voluntary withdrawal during pregnancy.

METHODS:
This pilot study was designed to assess safety and efficacy of voluntary withdrawal using methadone. The study is a prospective cohort comparing patients who enrolled in methadone withdrawal to a cohort of patients who chose to remain in methadone maintenance.

RESULTS:
31 pregnant patients were identified with opioid dependency at our institution from 2014 to present (ICDM 10). 15 patients were in the withdrawal program and 16 chose to remain in maintenance. 4 of those in the withdrawal program remain pregnant. One was lost to follow up. The rate of NAS in the methadone maintenance cohort was 33% (5/15). The rate of NAS in the successful withdrawal group was 0% (6/6). The rate of NAS in the failed withdrawal group was 100% (3/3). There was one pregnancy loss in each group. There was a spontaneous abortion in the maintenance group and one perinatal death at 26 weeks in the withdrawal group.

CONCLUSION:
Successful, supervised opioid withdrawal during pregnancy may reduce rates of Neonatal Abstinence Syndrome as compared to opioid maintenance.
Optimal Timing of Delivery for Women with Hormone Receptor-Positive Breast Cancer [30E]
Authors: Kuo Kelly , Senz Kayli , Caughey Aaron B. 
Published: April 2018

INTRODUCTION:
Data are limited regarding the optimal management of breast cancer in pregnancy. We aimed to compare strategies for the management of estrogen or progesterone hormone receptor-positive (HR+) tumors, and to determine the optimal gestational age for induction in regards to chemotherapy status and maternal-fetal outcomes.

METHODS:
A decision-analytic model was designed comparing 32 different strategies for scheduled delivery between 24-39 weeks gestation, with chemotherapy induction either at 24 weeks or delayed until after delivery. Baseline estimates of stage-specific mortality and the impact of delayed chemotherapy on survival rates were obtained from the literature. Our model included the risk of intrauterine fetal demise, spontaneous delivery, respiratory distress syndrome, cerebral palsy, and neonatal demise at each gestational age.

RESULTS:
For women receiving antenatal chemotherapy, delivery at 39 weeks yielded the highest maternal and overall QALYs at all cancer stages. For women with stage I disease deferring chemotherapy until after delivery, no significant increase in 5-year mortality occurred until after 30-31 weeks gestation; induction at 37 and 38 weeks yielded the highest quality-adjusted life years (QALYs) from the maternal and societal perspectives, respectively. For women with stage II and III disease deferring chemotherapy, overall QALYs were maximized at 37 and 31 weeks, respectively. In univariate and multivariate sensitivity analyses, our model remained robust across reasonable ranges for all variables of interest.

CONCLUSION:
For women with operable HR+ breast cancer diagnosed in early pregnancy, antenatal chemotherapy and delivery at term are recommended; however, delaying chemotherapy until the postpartum period is reasonable for early stage disease.
Pregnancy Outcomes in Women with Gestational Diabetes Mellitus Diagnosed in the First Versus Second Trimester [31E]
Authors: Fahey Jacqueline , Wong Thalia , Afshar Yalda , Scibetta Emily , Janzen Carla , Rao Rashmi 
Published: April 2018

INTRODUCTION:
First trimester screening is recommended for patients at higher risk for gestational diabetes mellitus (GDM). We sought to compare pregnancy outcomes in women diagnosed with GDM in the first versus second trimester.

METHODS:
This was a retrospective cohort study evaluating patients with GDM at a university clinic. The early diagnosis group had abnormal first trimester GDM testing. The late diagnosis group had normal first trimester testing, followed by abnormal second trimester testing. Mean differences in treatment interventions and maternal/neonatal outcomes were compared between groups.

RESULTS:
Of 115 total patients, 32 (28%) were diagnosed with GDM in the first trimester and 83 (72%) were diagnosed in the second trimester. There was no difference in number of antenatal testing visits, ultrasounds, or patients requiring medication for glycemic control (p = 0.78, p = 0.92, p = 0.92). Mean gestational age at medication initiation was earlier in the early diagnosis group (24.2 vs. 31.5 weeks; p < 0.001). There was no clinically meaningful difference in mean number of prenatal visits (11.7 vs. 10.4; p = 0.04) or nutrition consults (2.2 vs. 1.7; p = 0.005). Both groups had similar incidence of cesarean delivery and postpartum hemorrhage (p = 0.87, p = 0.57). There was no difference in minor or major adverse neonatal composite outcomes (p = 0.74, p = 0.48).

CONCLUSION:
Early GDM diagnosis and intervention in high-risk patients may positively impact their pregnancy by achieving similar maternal and neonatal outcomes without increasing the burden of clinic visits compared to those diagnosed in the second trimester.
Falling Third-Trimester Insulin Requirements and Adverse Pregnancy Outcomes: A Systematic Review [32E]
Authors: Sayyar Parastoo , Alavifard Sepand , D'Souza Rohan 
Published: April 2018

INTRODUCTION:
There is conflicting evidence on whether falling insulin requirements in the third-trimester are associated with adverse pregnancy outcomes. Our objective was to systematically review the literature to determine the association between a ≥15 percent fall in insulin dose (PFID) and adverse pregnancy outcomes.

METHODS:
We searched Medline, Embase and PubMed from inception until October 2016 for English language articles describing falling insulin requirements and pregnancy outcomes. Article screening and data extraction was performed in duplicate. As significant clinical and methodological heterogeneity was anticipated, no formal meta-analysis was planned. Outcomes were described as proportions.

RESULTS:
We identified 1011 publications, of which three observational studies met eligibility criteria. Two studies that used ≥15 PFID were included in the quantitative analysis. Pregnancies with ≥15 PFID were associated with small-for-gestational-age (SGA) fetuses (6/40 vs. 7/153, p=0.04; risk ratio (RR) 2.95 [1.08, 8.07]). There were no differences in large-for- gestational-age fetuses (14/40 vs. 58/153; RR 1.07 [0.68, 1.70]), low 5-minute Apgar scores (6/40 vs. 16/153; RR 1.93 [0.52, 7.14]), caesarean deliveries (25/40 vs. 105/153; RR 0.90 [0.70, 1.17]), extreme preterm (3/35 vs. 2/104) birth, stillbirths (1/35 vs. 1/104) or hypertensive disorders (9/35 vs. 19/104, p=0.34).

CONCLUSION:
This systematic review of observational studies found no association between ≥15 PFID and adverse pregnancy outcomes, except for a higher number of SGA fetuses. This was not causal. Early delivery based on ≥15 PFID cannot be recommended. Instead, clinical management should involve continued maternal-fetal surveillance, exploring possible obstetric and metabolic reasons for this PFID, and treatment of the primary cause.
Pregnancy Outcomes in Patients with Neuromyelitis Optica: A Systematic Review [33E]
Authors: Wuebbolt Danielle , Andrejevic Katarina , Nguyen Vanessa , D'Souza Rohan , Wyne Ahraaz 
Published: April 2018

INTRODUCTION:
Neuromyelitis Optica (NMO) is an antibody-mediated disorder characterized by recurrent myelitis and optic neuritis. Our objective was to systematically review pregnancy outcomes in women with NMO to aid counselling and management.

METHODS:
We searched MEDLINE, EMBASE, Web of Science, and PubMed from 1946 until August 2016 for relevant articles. Article selection, data extraction and quality assessment (QA), using the Joanna Briggs QA tool, were performed in duplicate. Outcomes were reported as proportions.

RESULTS:
We identified 2096 studies and included 22 studies describing 146 pregnancies in 112 women with NMO. QA scores for case reports and series were 7/8 and 5/10 respectively. The mean maternal age was 30±4 years and diagnosis-to-pregnancy interval was 6±4 years. De novo symptoms developed in 37%. Maternal outcomes included one postpartum death, one haemorrhagic stroke, one case of respiratory paralysis and 27 relapses, most of which involved myelitis (16) and optic neuritis (6). Relapses were treated with high-dose corticosteroids (20), plasmapheresis (15), immunosuppressants (11) and intravenous immunoglobulin (6), resulting in complete (12) or partial (10) recovery in most. In two cases symptoms worsened despite treatment, requiring emergency caesarean delivery. There were 121 (83%) livebirths, 115 (95%) of which were >37 weeks, 18 pregnancy terminations, five miscarriages, two stillbirths and no adverse outcomes on postnatal follow up (average 9 months).

CONCLUSION:
NMO is often diagnosed in pregnancy. Although women with NMO are at risk for relapses requiring aggressive management with high-dose corticosteroids, plasma exchange and immunosuppressants, retrospective data suggest that maternal and perinatal outcomes are comparable to the general population.