bluuebunny/crossref_metadata_2025_split huggingface dataset:
Weight Self-Awareness in Women with Gestational Diabetes Mellitus [28R]
Authors: Theva Meena , Has Phinnara , Werner Erica 
Published: April 2018

INTRODUCTION:
Excess gestational weight gain (GWG) is particularly important in gestational diabetes mellitus (GDM) where it increases risks of pregnancy and post-partum complications. We sought to assess self-awareness of body mass index (BMI) and GWG among women with GDM and the association between self-awareness and adherence to Institute of Medicine (IOM) GWG guidelines.

METHODS:
Cross-sectional study of women >18 years of age, fluent in English or Spanish, who were diagnosed with GDM (by Carpenter-Coustan criteria or Glucose Challenge Test >200mg/dl), delivered at term and received postpartum inpatient care at Women and Infants Hospital between in 2016. Post-partum day 2 surveys asked participants to assess their BMI, BMI classification, and GWG category (not enough, appropriate, or too much). Chart abstraction was used to obtain actual BMI, GWG, demographic data and pregnancy outcomes. Women who appropriately categorized their BMI and GWG were compared to those who did not with respect to GWG that was within or exceeded IOM guidelines (<40 lb if BMI <25 kg/m2; <25 lb if BMI 25-29.9 kg/m2; <20 lb if BMI >30 kg/m2).

RESULTS:
Of 220 women approached, 146 (66%) women met study criteria and consented; 98/146 (67%) exceeded IOM GWG guidelines. Women who exceeded guidelines compared to those who did not had similar baseline characteristics except with regard to first prenatal BMI (32.9 v. 30 kg/m2; p<0.04- Table). The two groups did not differ with regard to BMI self-awareness; 41.8% of those who gained excess GWG correctly categorized their BMI compared to 56.3% of those who limited their GWG; (p=0.11). However, women who exceeded GWG guidelines were more likely to lack self-awareness of their GWG. Only 18.4% of women who gained excess weight correctly classified their GWG, compared to 91.7% of the women who limited their GWG; (p<0.001).

CONCLUSION:
A majority of women with GDM exceed GWG IOM guidelines and are unaware of this excess weight gain. We must work to better educate women on GWG not only to help them adhere to the IOM goals but also to mitigate the associated pregnancy and post-partum risks.
Neonatal Outcomes After Hypertension in Twin Gestations: Potentially Protective? [29R]
Authors: Roberts Nicole A. , Hoffman Matthew , Chichester Melanie , Shlossman Philip 
Published: April 2018

INTRODUCTION:
To investigate whether and in what way neonatal outcomes vary in twin pregnancies affected by hypertension as compared with non-hypertensive twin pregnancies.

METHODS:
This was a retrospective cohort study of 1276 twin infants divided into four groups: non-hypertensives, chronic hypertensives, hypertensives developed during pregnancy without prior hypertension, prior hypertensives who developed pre-eclampsia in pregnancy. Outcomes assessed included gestational age at delivery, composite neonatal outcome, small for gestational age at less than the tenth percentile, 5 minute APGAR, and absolute birthweight.

RESULTS:
Chronic hypertensives were more likely to deliver prior to 34 weeks than non-hypertensives (OR 3.473; P=0.024) and were about 2.8 times more likely to have a low APGAR score (p = 0.0097) than women without hypertension. Women who developed hypertension in pregnancy were less likely than non-hypertensives to have one of the composite outcomes prior to adjustment (OR 0.6; p=0.008). This trend remained after adjustment for demographic variables but was not statistically significant (OR 0.679; p=0.090). Similarly, children of these women were less likely to have RDS (OR 0.89; p=0.025) prior to adjustment. Again, this became statistically non-significant after adjustment for demographic variation (OR 1.04; p=0.242).

CONCLUSION:
This study supports some trends toward improved neonatal outcomes with hypertensive disorders developed in pregnancy as compared with non-hypertensive twin pregnancies and poorer outcomes of chronic hypertensive relative to non-hypertensive twin gestations. Prospectively collected data allowing for differentiation between gestational hypertension and pre-eclampsia with severe features would help further clarify these findings.
Induction of Autophagy by Sera From Women With Ovarian Hyperstimulation Syndrome: Potential Predictive Marker [2OP]
Authors: Minis Evelyn , Irani Mohamad , Nasioudis Dimitrios , Witkin Steven S. , Spandorfer Steven D. 
Published: April 2018

INTRODUCTION:
Ovarian Hyperstimulation Syndrome (OHSS) affects 3–10% of women undergoing IVF. Identifying predictive biomarkers of OHSS can help its prevention. Given that autophagy is implicated in the regulation of ovulation, we examined the differential induction of autophagy by sera from women with OHSS and controls.

METHODS:
Sera were obtained before stimulation from 75 women at risk for OHSS (AMH>2 ng/mL); 34 of whom subsequently developed OHSS. The remaining 41 women served as controls. Sera were incubated for 48 hours with peripheral blood mononuclear cells (PBMCs) from a healthy donor, the PBMCs lysed and the level of autophagy determined by measuring the p62 (sequestrome-1) level. Cytoplasmic p62 is consumed during autophagy and so the p62 concentration is inversely related to the extent of autophagy. The p62 values between groups were compared by the Mann-Whitney test.

RESULTS:
There were no differences in age (34±5.3 vs 33.05±3.8 years), body mass index (23.4±3.5 vs 23.84.6 kg/m2), parity (0.2±0.5 vs 0.2±0.5) or number of harvested oocytes (25.6±5 vs 25.9±10.67) (P>.05) between the two groups. Median PBMC p62 levels were lower (autophagy was higher) following incubation with sera from women who developed OHSS (5.85 ng/mL) than with sera from controls (7.31 ng/mL) (P=.03).

CONCLUSION:
Baseline sera from women who developed OHSS induced a higher level of autophagy in PBMCs than did at risk women who did not develop OHSS. Excessive autophagy induction in the ovary may increase susceptibility to OHSS. The extent of autophagy induction by sera obtained prior to undergoing IVF could be a predictive marker of OHSS.
Effect of Removal of Pregnancy Category on Prescribing in Pregnancy: A Randomized [5OP]
Authors: Robinson Angela , Atallah Fouad , Weedon Jeremy , Chen Yi-Ju Amy , Apostol Radu , Minkoff Howard 
Published: April 2018

INTRODUCTION:
To assess the degree to which the removal of pregnancy drug categories (A, B, C, and D) from labeling information affects the likelihood that providers will prescribe medications.

METHODS:
From October 2015 through October 2016, a convenience sample of providers was recruited into a randomized, survey-based, study. The survey instrument described four clinical vignettes, one each for pregnancy categories A, B, C, and D. Each vignette described a pregnant woman with an indication for the drug in question, and provided detailed drug information. Two forms of the survey were randomly distributed; one presented the clinical vignette, drug information along, and the pregnancy category. The other presented the identical vignette and drug information but did the pregnancy category. Using a 5-point Likert scale the respondents were asked to estimate their likelihood of prescribing the drug.

RESULTS:
One hundred and sixty-two surveys were included in the analysis. In the model without covariates there was a significant form type (with or without letter categories) by drug category interaction (P=.003); simple effects analysis showed that provision of a letter significantly affected the decision to prescribe the category B (P<.001) and C drugs (P=.008) but not the A or D. Participants were significantly less likely to prescribe the B and C drugs when the letters were not available for review. After adding covariates (eg, age, gender, specialization, years of experience) to the model the interaction persisted (P<.001).

CONCLUSION:
Without the pregnancy category physicians are less likely to use category B and C drugs, the most common medications prescribed in pregnancy. Therefore, it is possible that in the absence of a letter, pregnant women's access to medications may become more restrictive, and further research is needed to address that concern and monitor for trends as the new system is well-established.
Development of a Risk Score to Predict Obstetric Anal Sphincter Injuries in Laboring Patients [8OP]
Authors: Woo Victoria G. , Hung Yun-Yi , Ritterman Weintraub Miranda M. L. , Wilson-Hannay Sarah , Ramm Olga 
Published: April 2018

INTRODUCTION:
We piloted the utility of a scoring system to predict patient risk of obstetric anal sphincter injury (OASIs) during labor.

METHODS:
Among the 9,800 women with singleton term cephalic vaginal deliveries within Kaiser Permanente Northern California between January and December 2013 with complete study data, 8.5% (n=833) of the nullipara and 3.5% (n=343) of the multipara incurred OASIs. Multivariable logistic regression and classification and regression tree analyses were used to identify risk factors. Maternal and gestational age, race/ethnicity, duration of second stage of labor, vacuum delivery, and history of OASIs were associated with OASIs. Stratified by parity, points were assigned to each risk factor as an integer on a 10-point scale based on effect size and impact in the regression analyses, and were externally validated within a similar separate patient cohort using multivariable logistic regression.

RESULTS:
Different OASIs risk score cut-offs were assessed. Among nulliparous women, a score ≥6 had 40% sensitivity and 91% specificity, whereas a score ≥4 had 51% sensitivity and 84% specificity. Among multiparous women, a score ≥7 had 89% sensitivity and 60% specificity compared to a score ≥10, which had 74% sensitivity and 72% specificity.

CONCLUSION:
These pilot scores, demonstrating a reasonable predictor of OASIs risk, illustrate the utility of a clinical risk score to inform providers of patients' risk of OASIs prior to delivery and facilitate a shared decision-making approach to labor management.
Long-Term Safety and Efficacy of Elagolix Treatment in Women With Endometriosis-Associated Pain [11OP]
Authors: Surrey Eric , Taylor Hugh S. , Duan W. Rachel , Peloso Paul , Schwefel Brittany , Chwalisz Kristof 
Published: April 2018

INTRODUCTION:
Long-term safety and efficacy of elagolix, an oral, non-peptide GnRH antagonist for the management of endometriosis-associated pain, was evaluated in two 6-month (M) extension studies (Elaris EM-III and IV) of the pivotal, 6M, phase 3 studies (12M-overall treatment with 150 mg once daily [QD] or 200 mg twice daily [BID]).

METHODS:
Women with moderate/severe endometriosis-associated pain, randomized to receive elagolix in the pivotal studies, continued treatment during the extension studies (treated: Elaris EM-III, n=287; Elaris EM-IV, n=282). Baseline was before dosing in pivotal studies. Dysmenorrhea (DYS), non-menstrual pelvic pain (NMPP), and dyspareunia (DYSP) scores were recorded in a daily electronic-diary. Adverse events (AE), bone mineral density (BMD), and endometrium were assessed.

RESULTS:
DYS, NMPP and DYSP scores across dose groups were significantly decreased compared to placebo at M6 in the pivotal studies (P<.05; exception-DYSP 150 mg), and improvements in scores were maintained after 12M of treatment in Elaris EM-III (Extension-M6 mean percent change from baseline: DYS, 150 mg QD=−49%, 95% CI [−57,−41], 200 mg BID=−82%, 95% CI [−88,−76], NMPP, 150 mg QD=−49, 95% CI [−57,−41], 200 mg BID=−57%, 95% CI [−64,−49]; DYSP, 150 mg QD=−31%, 95% CI [−46,−16], 200 mg BID=−42%, 95% CI [−58,−25]). Hot flush was the most common AE over 12M of treatment (150 mg QD=29.5%; 200 mg BID=52.2%). At extension M6, there was a dose-dependent decrease in BMD from baseline, while mean lumbar spine BMD Z-score was within normal range (−2.0–+2.0). Mean change in endometrial thickness ranged 0.6 to −0.8 mm across doses. Elaris EM-IV results were generally similar.

CONCLUSION:
In women with endometriosis-associated pain, long-term elagolix treatment was associated with reductions in DYS, NMPP, and DYSP. No new safety concerns were identified with long-term elagolix use.
Barriers to LARC Training in OB-GYN Residencies [14OP]
Authors: Evans Megan L. , Espey Eve , Ogburn Tony , Breeze Janis , Zite Nikki 
Published: April 2018

INTRODUCTION:
Widespread provision of LARC relies on adequate provider training. Although LARC education and insertion techniques are required in the OB-GYN residency curriculum, barriers may negatively affect the quality of training.

METHODS:
This anonymous survey used structured questions about residents' experience with LARC training, including number of LARC insertions. The survey questions were administered electronically in conjunction with the 2016 resident CREOG in-service exam; de-identified data were categorized for analysis by US census regions (Northeast, West, Midwest, South).

RESULTS:
The response rate for questions about number of LARC insertion was 99%. As of January 2016, 32% of all residents inserted 1–10 IUDs and 31.7% inserted 11–25 IUDs; 39.6% of residents inserted 1–10 contraceptive implants. In total, 8% of chief residents had never inserted an implant and 10% had inserted between 1–10 IUDs Nearly a third of all residents and 40% of Southern residents identified financial barriers, including cost of the device and inadequate insurance coverage, to LARC training. Twenty percent of residents reported institutional policy and 27% reported lack of patient demand as additional barriers. Religious affiliation was reported as a significant barrier only by residents in the Midwest (27%, P<.001) compared to all other residents (6.4%). Residents with low insertion numbers identified institutional religious affiliation as a greater barrier to LARC training than residents with higher insertion rates.

CONCLUSION:
Residents face a variety of barriers to LARC insertion training and many residents insert fewer than 10 devices during residency.
The Postpartum Challenge: Best Practices to Improve Return Rates in Los Angeles County Hospitals [21OP]
Authors: Celaya Anna K. , Jaque Jenny , Katzir Lirona , Garcia Erika , Jackson Ashaki , Saleeby Erin 
Published: April 2018

INTRODUCTION:
Nearly 40% of women do not attend their postpartum visits. Attendance rates are even lower in underserved populations. Increasing patient participation, especially in communities of low resources, involves a multi-faceted approach in care coordination. We highlight a bundle of systems changes implemented by three Los Angeles County Department of Health Services (LAC DHS) hospitals to improve the rates of postpartum visits.

METHODS:
We collected baseline data on postpartum visits for women who delivered in the LAC DHS from July 2016 to June 2017. A bundle of interventions were implemented throughout the health system including: 3rd trimester scheduling of postpartum visits, appointment confirmation on day of discharge after delivery for both 3-week and 6-week visits, congratulations calls with appointment reminders at 1 week post-delivery, reminder calls the day before appointments, and coordinating pediatric visits at discharge with existing maternal appointments. During the bundle implementation year, data collection continued and performance improvement was assessed at 6 months and 1 year after baseline assessment. Services were identified by CPT, ICD-9-CM and ICD-10-CM codes.

RESULTS:
Six months following baseline, 47% (n=753) of patients attended postpartum visits. One year following baseline, 58% (n=954) of patients attended. There was a statistically significant difference chi-square (1, N=3,251)=36.11, P<.001, with a 60% improvement in follow-up rates.

CONCLUSION:
Increased postpartum return rates in resource-limited setting can be achieved through coordinated efforts. Performance improvement teams can utilize a bundle of structured activities and track change through rapid cycle improvement initiatives.
Breaking Down Barriers to Transgender Health Care: Would a Transgender-Only Clinic Help? [22OP]
Authors: Abern Lauren , Maguire Karla 
Published: April 2018

INTRODUCTION:
The transgender community faces many barriers to care. As a result, they can be reluctant to seek health care and often have under-addressed medical needs. The aim of this study is to determine the type and frequency of barriers to care, how they find competent providers, and if they prefer a transgender-only clinic.

METHODS:
Transgender patients ages 18–65 participated in an online survey which included demographics, medical history, and perceptions of the healthcare system.

RESULTS:
120 surveys were collected. Mean age was 23.4 (SD 6.5, range 18–53), and majority was white (101, 84%). 119 (89%) had insurance with most (65, 54%) through a family member or employer. 34 (28%) had a minimum of a college degree, and 70 (58%) of people surveyed made less than $24,000 a year. Of the respondents, 83 (69%) experienced barriers to care. The majority (70, 84%) reported cost as a factor while 47 (57%) had problems with access to care. 33 (40%) experienced stigma and 23 (28%) reported discrimination. 79 (77%) find competent providers through word of mouth and 17 (17%) search the internet. Only 25 (23%) desired care in a transgender-only clinic. Comments reflect that many are uncomfortable for fear of being identified as transgender.

CONCLUSION:
Most transgender patients surveyed face barriers to care. These must be acknowledged and addressed so that health care they receive can be accessible and improved. The majority did not prefer to receive care in a clinic exclusive to transgender individuals, which is important to consider when working towards decreasing these barriers.
Enhanced STI Retesting Services [23OP]
Authors: Diniz Clarissa P. , Witter Frank R. , Coleman Jenell S. 
Published: April 2018

INTRODUCTION:
Chlamydia, gonorrhea, and trichomoniasis (CGT) retesting 3 months after treatment is recommended, however retesting rates are low. Untreated sexually transmitted infections (STI) can lead to adverse reproductive outcomes, and reinfections have even worse outcomes compared with the initial infection. To increase retests, we implemented alternative options of home-based self-testing and clinic-based “fast-track” appointments in a large academic practice.

METHODS:
OB/GYN patients who were CGT positive in 2016 and not retested were telephoned. We offered postage-paid home-test kits or fast-track appointments with medical assistants. Chi-squared and logistic regression were performed.

RESULTS:
Nine percent of STI tested patients were positive. The majority were black (92%) with median age 25 (IQR: 21–30). Younger women (<25) were more likely to be retested by their provider (P=.04). Among 61 (48%) patients not retested, 44 (72%) were reached and agreed to retest. Twenty (45%) patients elected home-testing, 12 (60%) kits were returned, and 2 (17%) were STI positive. Twenty-four (55%) patients elected fast-track appointments, 17 (71%) completed the appointment, and 3 (18%) were STI positive. Overall, 5/44 (11%) retests were positive, all had Medicaid insurance. The adjusted odds of home testing were 4.67 (95% CI: 1.07–20.33, P=.04) higher among older women (>24). There was no difference between older vs younger women on positive retest (AOR=0.932, 95% CI: 0.34–2.55, P=.891).

CONCLUSION:
A large proportion of women retested positive for an STI. Alternative retesting options like home-testing or fast-track visits should be widely used to increase retesting. Further examination of patients' decision-making about home-testing versus fast-track appointment may further improve care delivery.
Probability of Pregnancy after Intended Postplacental versus Interval Intrauterine Device Placement [3F]
Authors: Hunter Tegan , Gurney Elizabeth P. , Schreiber Courtney , McAllister Arden , Sonalkar Sarita 
Published: April 2018

INTRODUCTION:
We sought to determine the one-year probability of pregnancy following intended postplacental intrauterine device (IUD) insertion compared with intended insertion at a postpartum visit (interval insertion), using decision analysis methodology.

METHODS:
We developed an evidence-based decision model comparing one-year probability of pregnancy following intended postplacental or intended interval IUD placement. We obtained proportion estimates from the literature for mode of delivery, successful IUD placement, IUD type, postpartum visit attendance, IUD expulsion and discontinuation, and contraceptive use, choice, and efficacy after IUD discontinuation. We performed a sensitivity analysis and a Monte Carlo simulation to account for variations in proportion estimates.

RESULTS:
The one-year probabilities of pregnancy among women intending to receive a postplacental IUD following vaginal or Cesarean delivery are 94/1,000 and 68/1,000 respectively; one-year probability of pregnancy is 174/1,000 for women intending to receive an interval IUD. For interval IUD placement to have effectiveness equal to postplacental placement, 94.0% of women delivering vaginally and 97.2% of women delivering by Cesarean would need to attend postpartum care. Once placed, postplacental IUDs have effectiveness lower than interval IUDs: one-year probabilities of pregnancy following IUD placement at a vaginal delivery, Cesarean delivery, and an interval visit are 88/1,000, 51/1,000, and 24/1,000, respectively.

CONCLUSION:
After accounting for barriers to successful placement and retention, intended postplacental IUD insertion results in a lower 1-year probability of pregnancy as compared with intended interval IUD insertion.
The Patch Wear Profile from SECURE: A Once-Weekly Low-Dose Contraceptive Patch Study [7F]
Authors: Nelson Anita L. , Kaunitz Andrew M. , Kroll Robin , Simon James A. , Castaño Paula M. , Garner Elizabeth I.O. 
Published: April 2018

INTRODUCTION:
AG200-15 (Twirla®) is an investigational transdermal contraceptive delivery system (TCDS), which delivers daily exposure of levonorgestrel (LNG) and ethinyl estradiol (EE) similar to oral doses of 120 μg LNG and 30 μg EE. We examine various aspects of patch adhesion and wearability with AG200-15 TCDS.

METHODS:
SECURE was a single-arm, open-label, Phase 3 study conducted in US women 18 years or older, with no restrictions on body mass index or weight (NCT02158572). Subjects recorded patch-related characteristics daily in electronic diaries; irritation/itching and patch adhesion were also evaluated by the investigator at each visit. Irritation/itching scores were rated from 0 (none) to 3 (severe). Patch adhesion scores were rated from 0 (no/small amount of lifting off skin) to 4 (entire patch falling off).

RESULTS:
In 2,031 women across 13 cycles, 6.2% reported a local site reaction. The subject-rated mean skin irritation/itching score was 1.31, and most women reported their worst skin irritation as none, mild, or moderate (26.2%, 32.0%, and 26.6%, respectively). The investigator-reported mean skin irritation score was 0.18, and most women were determined by the investigator to have none or mild skin irritation (85.0% and 12.6%, respectively). The mean subject- and investigator-rated patch adhesion scores were 0.52 and 0.04, respectively. Treatment discontinuation due to application site irritation/itching occurred in 1.9% of women.

CONCLUSION:
Overall, results of various subject- and investigator-rated patch characteristics provide favorable support for patch adhesion and wearability of the AG200-15 TCDS.