bluuebunny/crossref_metadata_2025_split huggingface dataset:
Current Practices in Hepatitis C Screening in Pregnant Women in a Regional Health System [36J]
Authors: Amgalan Ariunzaya , Scott Rachel , Tefera Eshetu , Sawney Shari , Deeb Hala , Fishbein Dawn 
Published: May 2019

INTRODUCTION:
In May 2018, AASLD and IDSA recommended that all pregnant women be screened for hepatitis C viral (HCV) infection, shifting away from risk-based testing. Our study examines prenatal HCV screening practices and results in a regional health system serving greater Washington DC.

METHODS:
We reviewed HCV results of pregnant women tested from January 2017-April 2018 across our health system and conducted a retrospective chart review of women who tested positive. We used Chi-square, Fisher Exact and Student t-tests for the bi-variate analyses, and multivariate logistic regression to determine predictors of HCV screening and antibody positivity. IRB approval was obtained.

RESULTS:
Of 10,362 pregnant women seen for outpatient prenatal visits, 3,067 (29.6%) were HCV screened; 44 (1.4%) were HCV antibody positive. Pregnant women were more likely to be HCV screened if they were older (ORadj 1.02, CI95 [1.01-1.02]), African-American or non-Caucasian (2.24 [2.02-2.49]; 1.74 [1.53-1.98]), HIV tested (4.25 [3.65-4.94]), HIV-infected (8.37 [4.77-14.70]), HBV-infected (1.45 [0.778-2.719]), or had private insurance (1.51 [1.37-1.66]). In review of HCV positive pregnancies, 70% were Caucasian, none had HIV, 2% had HBV, 59% had an opioid use disorder, 64% had IVDU history, 80% had ≥1 HCV risk factors; 5% completed HCV treatment, and 11% had fibrosis assessments (all F0). Pregnant women were more likely to be HCV antibody positive if they were Caucasian (ORadj 11.44 [CI95 3.99-32.82]), HBV-infected (15.27 [2.32-100.46]), or living in Maryland vs. DC (2.93 [1.17-7.32]).

CONCLUSION:
Our results identify racial disparities between HCV testing and positivity, and the need for improved HCV screening and treatment.
Evaluating Practice Patterns of Late Preterm Antenatal Steroid Administration and Adherence to Recommendations [8K]
Authors: Umesh Vaibhavi , Dinglas Cheryl , Garretto Diana , Herrera Kimberly 
Published: May 2019

INTRODUCTION:
After the Antenatal Late Preterm Steroids trial, ACOG recommended steroids in women with a singleton pregnancy at 34 weeks to 36 weeks 6 days following strict guidelines. Few studies have assessed the implementation of these recommendations and their impact on maternal/neonatal outcomes.

METHODS:
An IRB-approved retrospective cohort study was performed from October 2016 to October 2017. Records were reviewed to determine whether women fit criteria (singleton gestation, likely to remain pregnant >12 hours, no prior course of steroids, no pre-gestational diabetes, no signs of infection or other contraindications). Maternal, perinatal, delivery characteristics, and neonatal outcomes were obtained. Outcomes were compared using Chi-squared and Fisher exact test.

RESULTS:
Among 61 women who received late preterm steroids, 49 (80.3%) received them according to recommended guidelines. Among the 12 women (19.7%) who did not fit criteria: 6 (50%) were multiple gestations, 1 (8.3%) had preexisting diabetes, 3 (25%) had previously received a course of steroids and 4 (30%) had an imminent delivery. When comparing the two groups of women, there were no differences in age, race, body mass index and gestational age at delivery. However, there were higher rates of neonatal intensive care unit (NICU) admission, neonatal hypoglycemia and hyperbilirubinemia in those women who received steroids outside of recommended guidelines.

CONCLUSION:
In women who received late preterm steroids outside of recommended guidelines, there was a higher rate of poor neonatal outcomes. Providers should ensure proper administration of late preterm steroids based on the recommended guidelines until larger studies are done.
Increased Carrier Detection With Expanded Carrier Screening in Multiple Ancestries [7O]
Authors: Griswold Catherine , Yao Xinxin (Shirley) , Susswein Lisa R. , Fagbemi Adebanke F. , Pollevick Guido D. , Klein Rachel T. 
Published: May 2019

INTRODUCTION:
While ACOG, ACMG and NSGC recommend reproductive carrier screening for cystic fibrosis (CF) and spinal muscular atrophy (SMA), there are no guidelines to date routinely recommending expanded carrier screening for all reproductive patients. We sought to assess, by ancestry, the proportion of additional individuals who would be identified via an expanded panel compared to CF/SMA alone.

METHODS:
We deduced the expected observation rate for CF and SMA based on published literature and our laboratory's detection rate for individuals of Hispanic, Caucasian, African American (AA), and Asian descent. We also reviewed observed detection rates for the same patient populations from a 180‐disorder expanded carrier screen completed over an 18 month period.

RESULTS:
Expanded carrier screening was performed on 2,468 self-reported Hispanic, 921 Caucasian, 339 AA, and 174 Asian individuals. Combining expected carrier frequencies for CF and SMA and observed frequencies for all other diseases on the expanded panel, 1 in 2 Caucasians and 1 in 5 individuals of other backgrounds would be expected to be positive. Compared with the expected carrier frequencies of CF and SMA alone, an expanded carrier screen increased the probability of identifying carriers by 10-, 7-, 9-, and 9-fold, respectively, for the four patient populations.

CONCLUSION:
Compared to testing for CF and SMA alone, an expanded carrier screen increased the probability of detecting a carrier for a disorder by 7- to 10-fold. Expanded carrier screening will identify a substantially greater number of carriers among various ancestries compared to testing according to current guidelines alone.
Maternal Sleep, Depressive Symptoms, and Risk for Spontaneous Shortened Gestation in Black and White Women [10O]
Authors: Webber Shannon , Gillespie Shannon , Porter Kyle , Christian Lisa 
Published: May 2019

INTRODUCTION:
Depressive symptoms and poor sleep quality have been associated with an increased risk of preterm birth (<37 weeks gestation). In 2013, the American College of Obstetrics and Gynecology (ACOG) redefined “term birth,” in recognition that early term birth (37 0/7 - 38 7/8 weeks gestation) also confers risk. Effects of these behavioral exposures on risk of shortened gestation - inclusive of both preterm and early term birth - have not been clearly defined.

METHODS:
To address this gap, this study examined the association between maternal depressive symptoms, self-reported sleep quality and spontaneous shortened gestation. The impact of race was also considered. Analyses included 317 women (135 Black, 182 White) who completed the Center for Epidemiologic Studies-Depression Scale (CES-D) and Pittsburgh Sleep Quality Index (PSQI) questionnaires during the second trimester of pregnancy. Reason for shortened gestation was confirmed by medical record review and only spontaneous cases were included.

RESULTS:
A significant race effect was observed; Black women were 2.35 times more likely than White women to have spontaneous shortened gestation (95% CI 1.34-4.11). In addition, a multivariable logistic regression analysis showed that women with both elevated CES-D scores (≥16) and PSQI scores (>6) were 3.29 times more likely to have spontaneous shortened gestation (95% Cl 1.33-8.15), compared to 2.26 times more likely (95% CI 1.19-4.31) when only elevated CES-D scores were present.

CONCLUSION:
Due to this additive risk factor effect, increased awareness and interventions targeting maternal sleep and mental health could contribute to reduction in risk of both preterm and early term birth.
Predicting the Likelihood of Delivering Preterm Using Data Collected From a Pregnancy Mobile App [13O]
Authors: Bradley Danielle , Landau Erin , Wolfberg Adam , Baron Alex 
Published: May 2019

INTRODUCTION:
The objective of this research was to create a predictive model for the identification of preterm delivery risk.

METHODS:
A predictive model to identify risk of delivering preterm was created using a supervised machine learning algorithm, specifically, a Gradient Boosting Decision Tree algorithm, as well as data from 121,740 users of a pregnancy mobile app. Data collected from users prior to the 26th week of pregnancy were used in the model. This allowed the model to predict risk of preterm delivery beginning at week 26.

RESULTS:
Of the total sample used to train the model, 46% delivered prior to 37 weeks. The model used 5,770 different features to model preterm birth likelihood. Self-report data, as well as in-app calculations based on reported data, were used to create the model. The features most influential to the model were 'daily data' such as, health symptoms and moods; characteristics of the current pregnancy including whether it was a single or multiple gestation; the frequency and type of healthcare appointments scheduled; personal health history information; and personal demographic information including age and BMI (height and weight). The model's positive predictive value was 0.75, with 0.41 sensitivity.

CONCLUSION:
This model based on patient-reported data could predict risk for delivering preterm, a serious obstetric complication, with accuracy levels sufficient to guide clinical action and screening by healthcare providers and health plans.
Safety of Taxane Chemotherapy in Breast Cancer During Pregnancy [28O]
Authors: O'Laughlin Andie , So Samantha , Fleischer Lindsay , Akoto Serwaa , Cardonick Elyce 
Published: May 2019

INTRODUCTION:
Breast cancer is the most common malignancy in pregnancy. Paclitaxel/Docetaxel (Taxanes) are standard treatment for high-risk early stage and advanced/metastatic breast cancer outside of pregnancy, with a better response rate and longer time to progression than standard anthracycline-based (AC) regimens. In pregnancy, women receive AC without taxanes even when sufficient time remains before delivery. This study compares neonatal outcomes in women receiving taxanes with those who delayed taxanes to the postpartum period.

METHODS:
This is a retrospective cohort study of women with breast cancer during pregnancy who completed anthracycline based therapy prior to delivery with/without the addition of taxanes identified from the IRB approved Cancer and Pregnancy Registry. Neonatal outcomes including birthweight, anomalies, and postnatal medical problems were compared between taxane and nontaxane exposed infants. In some cases, neonatal developmental and behavioral assessments were performed. Pregnancy complications for the women were compared.

RESULTS:
Fifty women who completed AC also received taxanes before delivery and are compared to 57 women electively delaying taxane therapy until postpartum. Gestational age, birthweight, growth restriction, and congenital anomalies were not statistically different between exposure groups. Pregnancy complications including spontaneous preterm birth or rupture of membranes were not statistically different. Twenty six children underwent developmental/behavioral assessment, 13 in each group. No difference in developmental or behavioral assessments were found, nor medical disorders diagnosed at a mean age of 44 months.

CONCLUSION:
Taxane use in pregnancy does not increase perinatal complications for the mother or infant, nor impact neonatal developmental/behavior when compared with conventional chemotherapy for breast cancer in pregnancy.
IUD Usage Among Transgender and Gender Diverse Individuals [1P]
Authors: Abern Lauren , de Guzman Glendell , Kiely Kristen , Cook Jake , Maguire Karla 
Published: May 2019

INTRODUCTION:
Although usage of the intrauterine device (IUD) is increasing, the prevalence among transgender and gender diverse individuals assigned female at birth is unknown. Our goal is to determine the reasons these individuals are choosing IUDs and if they are satisfied.

METHODS:
Transgender and gender diverse individuals assigned female at birth ages 18-64 participated in an online survey about their experiences with an IUD.

RESULTS:
104 surveys were completed. The mean age was 26.2 (SD 4.8). 21 (20%) identified as transgender, and 83 (80%) identified as genderqueer or non-binary. 26 (25%) were bisexual, 8 (8%) gay/lesbian, 28 (27%) pansexual, and 32 (31%) queer. The majority (84%) was white and had a college education (59%). 88 (85%) were sexually active, and 77 (88%) were at risk for pregnancy. 84 (81%) currently have an IUD. 66 (79%) have a progestin and 17 (20%) a copper IUD. Most common influential factors in choosing a specific IUD were menstrual manipulation (66%), duration (67%), and to avoid side effects experienced with other contraceptive methods (49%). 36 (35%) had an IUD in the past. Of these, 20 (56%) did not choose another IUD. 6 (30%) disliked side effects, 3 (15%) initiated testosterone, 2 (10%) experienced expulsion, and 2 (10%) had a hysterectomy. 2 (10%) became pregnant with an IUD. 1 (5%) desired pregnancy.

CONCLUSION:
IUDs are an excellent form of contraception and menstrual manipulation for transgender and gender diverse individuals, with few desiring removal. Providers should not overlook counseling this population in regards to the benefits of an IUD.
Understanding Barriers and Facilitators to Prenatal Care in African American and Hispanic Women [12P]
Authors: Valerio Melissa , Elerian Nagla , McGaha Paul , Krishnaswami Janani , French Lesley , Patel Divya A. 
Published: May 2019

INTRODUCTION:
Understanding individual, provider and community level barriers and facilitators to on-time entry into prenatal care is crucial to the elimination of disparities in the mortality and morbidity of women. The Healthy Families initiative, a state-funded collaboration, seeks to understand the association between maternal risk factors and infant death within community settings to improve birth outcomes. We examined needs in two communities of Black women (East Texas) and Hispanic women (South Texas).

METHODS:
Six focus group sessions were conducted with pregnant women and women who recently delivered. Qualitative methods were used to analyze data. Quantitative demographic and behavioral data were collected for sixty-four participating women. Across both sites, mean age of participants was 24 years, 56% had at least some college education; 50% were currently insured; and 55% were single.

RESULTS:
Data analyses identified four specific themes: 1) stress and perceived discrimination, 2) clinical and organizational-level experiences, 3) family and support, and 4) fathers and their roles. Some unexpected themes, such as maternal mental health and child's health outcomes were also identified. Women at both sites reported racial/ethnic disparities in accessing care, and needs for programs to facilitate linkages to services.

CONCLUSION:
Findings from focus groups were immediately incorporated into program planning for the collaboration. Changes to programming based on findings included: offering of group prenatal care, increasing access contraceptives through mobile health; strengthening linkages to existing resources through community health workers; increasing partnerships with nurse home visiting services; cultural competency/humility training for providers and front-end staff.
Risk Factors for Neonatal Intensive Care Unit Admission Among Growth Restricted Fetuses [25P]
Authors: Schmitz Jourdan E. , Nwabuobi Chinedu K. , Pargas Anaisy , Camisasca-Lopina Hannah , Sinkey Rachel G. , Odibo Anthony O. 
Published: May 2019

INTRODUCTION:
Growth restricted fetuses are at risk for admission to the neonatal intensive care unit (NICU). NICU admission is a proxy for long-term health consequences and societal costs. We aimed to assess risk factors for NICU admission among pregnancies complicated by fetal growth restriction.

METHODS:
This is a retrospective cohort study of non-anomalous, singleton, growth restricted fetuses - defined as estimated fetal weight (EFW) less than the 10th percentile - delivered in a single tertiary referral center from 01/2011 to 12/2016. Institutional Review Board approval was obtained. Factors significantly associated with NICU admission were identified using univariate analyses (P<.1). Multivariable logistic regression analysis was used to determine the final risk factors and to estimate adjusted odds ratios.

RESULTS:
594 pregnancies with fetal growth restriction met inclusion criteria. 204 (34.3%) resulted in NICU admission. Significant risk factors for NICU admission were smoking, EFW < 5th percentile, method of labor induction, non-reassuring fetal heart tracing, and gestational age at delivery. Labor induction with oxytocin or prostaglandins and higher gestational age at delivery appeared to be protective from NICU admission. If these risk factors were used to develop a prediction model, the area under the receiver-operator curve would be 0.83 (95% CI 0.79-0.86). The model would have a sensitivity of 50.0%, specificity of 92.3%.

CONCLUSION:
We identified several significant risk factors for NICU admission among growth restricted fetuses, which could be helpful in anticipating need for additional neonatal support at the time of delivery and for counseling women with growth restricted fetuses about risk of NICU admission.
Perceptions and Utilization of Prescription Drug Monitoring Programs: A Survey of ACOG members [1Q]
Authors: Roussos-Ross Dikea , Delcher Chris , Goodin Amie , Brown Joshua , Bae Jungjun 
Published: May 2019

INTRODUCTION:
ACOG Committee Opinion 711 addresses opioid use in pregnancy and recommends utilization of Prescription Drug Monitoring Programs (PDMPs) before prescribing opioids to any patient. According to the US Centers for Disease Control and Prevention, PDMPs (electronic databases that track controlled substance prescriptions) can inform clinical practice and are primary prevention tools for drug abuse/diversion and neonatal abstinence syndrome (NAS). An increasing number of states mandate PDMP use; however, little is known about how specific physician specialties perceive and use PDMPs. The purpose of this study was to query ACOG member perceptions and utilization of their state PDMP.

METHODS:
ACOG District XII Committee on Health Care for Underserved Women distributed a voluntary anonymous email survey to 5,000 ACOG members (adjusted participants n=1,470, minus unread/bounced/opt-out). The survey instrument was developed by an OB/GYN and health services researcher workgroup to assess perceptions and utilization of PDMPs. Adjusted response rate=27% (n=397).

RESULTS:
Most (78%) were registered with their PDMP and 52% agreed that ...mandating physician use of the PDMP was a “good idea.” Most respondents agreed that the PDMP is a primary prevention tool for drug abuse/diversion (70%), addiction (68%), and/or doctor shopping (63%), but few agreed that it was an NAS primary prevention tool (22%). Respondents use the PDMP for patients currently using opioids (33%), and for patients suspected of drug abuse (29%). In qualitative responses, some reported frustration with PDMPs.

CONCLUSION:
ACOG members are diverse in their perceptions regarding the utility and purpose of PDMPs. Increased education is needed regarding clinical utility of PDMPs.
Tracking and Reminder Systems in OB/GYN Practice: A Survey of Practitioners [6Q]
Authors: Booher Morgan , White Chase , Goldberg Jay 
Published: May 2019

INTRODUCTION:
In 2006, ACOG initially published a committee opinion which recommends that each office establish a simple, reliable tracking and reminder system to improve patient safety and quality of care and to minimize missed diagnoses. We surveyed current OB/GYN practitioners on their tracking and reminder systems.

METHODS:
A paper survey was distributed during a risk management talk at the 2018 ACOG Annual Clinical Meeting. Data were summarized, and groups were compared using chi-squared test for independence and Fisher's exact test.

RESULTS:
53 OB/GYN practitioners completed the survey. 30% were familiar with the ACOG committee opinion for tracking and reminder systems. 51% had been sued. 79% thought that patients were always responsible for obtaining ordered tests and referrals, whereas 40% thought that providers were. Providers who had been sued were more likely to think that providers were responsible for following up on results. Belonging to a practice with > 11 providers was associated with being less likely to believe providers were responsible for tracking results. Working at an academic center was associated with being less likely to tracking results. Overall, 75% had a tracking system for pap smears; 68% for biopsies; 55% for lab tests; 62% for screening mammograms; 58% for diagnostic mammograms; 42% for ultrasounds; and 28% for specialist referrals.

CONCLUSION:
OB/GYN providers inconsistently follow the ACOG committee opinion recommendations for tracking and reminder systems. The majority believed that patients were primarily responsible for obtaining ordered tests and referrals.
The Case for Universal Endocervical Sampling at Colposcopy for High-Grade Cervical Dysplasia [10Q]
Authors: Chiavetta Danielle Marie , Garcia Lisa Marie , Holschneider Christine H. , Aoyama Chisa 
Published: May 2019

INTRODUCTION:
Using a population of patients with high-grade cervical dysplasia (CIN2+) who underwent universal endocervical sampling (ECS) at colposcopy, we sought to determine the rate of high-grade ECS at time of colposcopy and presence of endocervical disease at time of treatment in two patient cohorts: patients for whom ECS at the time of colposcopy is preferred by ASCCP (pECS) versus patients for whom ASCCP denotes performance of ECS as acceptable (aECS).

METHODS:
Retrospective review of a consecutive cohort of women with biopsy-proven CIN 2+ for which they underwent excisional treatment between 2005 and 2015. Endocervical disease at time of procedure was defined as positive top hat loop electrosurgical excision procedure specimen, positive endocervical margin of cold knife cone, or positive ECC at time of excision. Fisher's exact and student's t-tests were used to examine clinical outcomes.

RESULTS:
390 women who underwent universal ECS at time of colposcopy received treatment for CIN2+. The frequency of a positive ECS is somewhat less in the aECS than in the pECS cohort (42.4% v 53.1%, p 0.048); yet, the frequency with which a positive ECS is associated with high-grade endocervical disease in final pathology after excisional treatment is equivalent (28.5% of pECS v 28.6% of aECS, p 0.987), regardless of patient age, parity, immunosuppression, menopausal status, or prior treatment.

CONCLUSION:
A positive ECS result at time of colposcopy is predictive of endocervical disease whether ASCCP preferred or ASCCP acceptable ECS was performed, thus suggesting the value of universal ECS at time of colposcopy.