bluuebunny/crossref_metadata_2025_split huggingface dataset:
Changing Patterns and Factors Associated With Mode of Delivery Among Pregnant Women With Human Immunodeficiency Virus Infection in the United States
Authors: Venkatesh Kartik K. , Morrison Leavitt , Livingston Elizabeth G. , Stek Alice , Read Jennifer S. , Shapiro David E. , Tuomala Ruth E. 
Published: April 2018

OBJECTIVE:
To describe patterns and factors associated with mode of delivery among pregnant women with human immunodeficiency virus (HIV) infection in the United States in relation to evolving HIV-in-pregnancy guidelines.

METHODS:
We conducted an analysis of two observational studies, Pediatric AIDS Clinical Trials Group and International Maternal Pediatric Adolescent AIDS Clinical Trials Network Protocol P1025, which enrolled pregnant women with HIV infection from 1998 to 2013 at more than 60 U.S. acquired immunodeficiency syndrome clinical research sites. Multivariable analyses of factors associated with an HIV-indicated cesarean delivery (ie, for prevention of mother-to-child transmission) compared with other indications were conducted and compared according to prespecified time periods of evolving HIV-in-pregnancy guidelines: 1998–1999, 2000–2008, and 2009–2013.

RESULTS:
Among 6,444 pregnant women with HIV infection, 21% delivered in 1998–1999, 58% in 2000–2008, and 21% in 2009–2013; 3,025 (47%) delivered by cesarean. Cesarean delivery increased from 30% in 1998 to 48% in 2013. Of all cesarean deliveries, repeat cesarean deliveries increased from 16% in 1998 to 42% in 2013; HIV-indicated cesarean deliveries peaked at 48% in 2004 and then dropped to 12% by 2013. In multivariable analyses, an HIV diagnosis during pregnancy, initiation of antiretroviral therapy in the third trimester, a plasma viral load 500 copies/mL or greater, and delivery between 37 and 40 weeks of gestation increased the likelihood of an HIV-indicated cesarean delivery. In analyses by time period, an HIV diagnosis during pregnancy, initiation of antiretroviral therapy in the third trimester, and a plasma viral load of 500 copies/mL or greater were progressively more likely to be associated with an HIV-indicated cesarean delivery over time.

CONCLUSION:
Almost 50% of pregnant women with HIV infection underwent cesarean delivery. Over time, the rate of repeat cesarean deliveries increased, whereas the rate of HIV-indicated cesarean deliveries decreased; cesarean deliveries were more likely to be performed in women at high risk of mother-to-child transmission. These findings reinforce the need for both early diagnosis and treatment of HIV infection in pregnancy and the option of vaginal delivery after cesarean among pregnant women with HIV infection.
Intrauterine Device Insertion Before and After Mandated Health Care Coverage
Authors: Heisel Erica , Kolenic Giselle E. , Moniz Michelle M. , Kobernik Emily K. , Minadeo Leah , Kamdar Neil S. , Dalton Vanessa K. 
Published: April 2018

OBJECTIVE:
To evaluate changes in out-of-pocket cost for intrauterine device (IUD) placement before and after mandated coverage of contraceptive services and to examine how changes in out-of-pocket cost influence IUD insertion as a function of baseline cost.

METHODS:
We conducted a cross-sectional pre–post analysis at the plan level using a large deidentified medical claims database to analyze our primary outcome, new IUD insertions among women enrolled in employer-sponsored health plans in 2009 and 2014, and our secondary outcome, out-of-pocket cost. Patient costs and utilization were aggregated by plan and year to conduct a plan-specific analysis. Plans were classified by mean out-of-pocket cost level: no out-of-pocket cost, low out-of-pocket cost (less than the 75th percentile), and high out-of-pocket cost (75th percentile or greater). A generalized estimating equation was used to evaluate average plan utilization of IUD services in 2009 and 2014 as a function of plan cost category and year.

RESULTS:
Overall, average plan utilization of IUD services demonstrated a significant increase between 2009 (12.5%, 95% CI 11.6–13.4%) and 2014 (13.8%, 95% CI 13.0–14.7%; P<.001). When plans were grouped by out-of-pocket cost level, significant differences in plan utilization over time were observed. Plans that went from high out-of-pocket cost in 2009 to no out-of-pocket cost in 2014 saw a higher average increase in the rate of plan IUD insertions over time (2.4%, 95% CI 0.04–4.5%) compared with plans with no out-of-pocket cost in both 2009 and 2014 (−1.0%, 95% CI −3.3 to 1.4%, P=.02). Among all women in all plans, the 75th percentile of out-of-pocket cost in 2009 was $368; this number dropped to $0 in 2014.

CONCLUSION:
Women in plans with the greatest reduction in out-of-pocket cost after mandated coverage of contraception had the greatest gains in IUD insertion. This suggests that baseline cost should be considered in evaluations of this policy and others that eliminate patient out-of-pocket cost.
An Evaluation of the Implementation of Pharmacist-Prescribed Hormonal Contraceptives in California
Authors: Batra Priya , Rafie Sally , Zhang Zhiwei , Singh Amay V. , Bird Chloe E. , Sridhar Aparna , Sullivan J. Greer 
Published: April 2018

OBJECTIVE:
To evaluate the implementation of pharmacist-prescribed hormonal contraceptives in California after a recent expansion of pharmacists' scope of practice.

METHODS:
A probability sample of 480 licensed California retail pharmacies (stratified by nonrural or rural location and independent or chain status) was included in a cross-sectional “secret shopper” telephone survey assessing the availability of pharmacist-prescribed hormonal contraceptives and service details. Survey data were analyzed using weighted descriptive statistics, CIs, and Wald tests.

RESULTS:
Findings included data from 457 pharmacies (response rate 95.2%). Only 5.1% of pharmacies reported providing pharmacist-prescribed hormonal contraceptives (95% CI 2.9–7.2%). This proportion did not differ significantly between rural and nonrural pharmacies (P=.83) nor between independent and chain pharmacies (P=.40). Five of the 22 pharmacies that were providing pharmacist-prescribed hormonal contraceptives informed secret shoppers that all allowed hormonal methods were available; most of these pharmacies (77.3%) did proactively describe that a health history was required before receiving medications. Only half of pharmacies providing pharmacist-prescribed hormonal contraceptives would do so for minors although this was allowed by law.

CONCLUSION:
In the first year after statewide protocol implementation, only a small proportion of retail pharmacies across California has begun offering hormonal contraception services. In the absence of additional supportive legislation regarding reimbursement for pharmacist services, increases in scope of practice regulations to build a larger network of contraceptive providers may not be effective in increasing access to birth control.
Perinatal Outcomes in Women With a History of Chronic Hypertension but Normal Blood Pressures Before 20 Weeks of Gestation
Authors: Youngstrom Mallory , Tita Alan , Grant Janatha , Szychowski Jeff M. , Harper Lorie M. 
Published: April 2018

OBJECTIVE:
To compare the perinatal outcomes of normotensive women with those of women with a history of chronic hypertension with normal blood pressures before 20 weeks of gestation, stratifying the latter by whether they were receiving antihypertensive medication.

METHODS:
We conducted a retrospective cohort study of all singletons with a history of chronic hypertension from 2000 to 2014. Exclusions were blood pressure greater than 140/90 mm Hg before 20 weeks of gestation, fetal anomalies, major medical problems other than hypertension, and diabetes. For the same time period, a randomly selected group without a diagnosis of chronic hypertension was chosen using the same exclusion criteria. Outcomes were compared among women without chronic hypertension, women with chronic hypertension on no antihypertensive medication but with blood pressures less than 140/90 mm Hg before 20 weeks of gestation, and women with chronic hypertension on antihypertensive medication with blood pressures less than 140/90 mm Hg before 20 weeks of gestation. The primary outcome was a perinatal composite of stillbirth, neonatal death, respiratory support at birth, arterial cord pH less than 7, 5-minute Apgar score 3 or less, and seizures. Secondary outcomes assessed were preterm birth before 37 and 34 weeks of gestation, small for gestational age, and preeclampsia.

RESULTS:
Of 830 women with chronic hypertension and blood pressures less than 140/90 mm Hg before 20 weeks of gestation, 212 (26%) were not taking antihypertensive medication and 618 (74%) were. These groups were compared with 476 women without chronic hypertension. Women with hypertension were more likely to be older and have baseline renal disease and diabetes compared with women in the no hypertension group. The perinatal composite was more common in both hypertensive groups: no antihypertensive medication (9.9%) and antihypertensive medication (14.6%) compared with women in the control group (2.9%) (adjusted odds ratio [OR] 2.9, 95% CI 1.21–6.85 no antihypertensive medications compared with no chronic hypertension; adjusted OR 5.0, 95% CI 2.38–10.54 antihypertensive medications vs no chronic hypertension). The risk of early preterm birth, small for gestational age, and preeclampsia was not significantly increased in women with chronic hypertension and no antihypertensive medications compared with women without chronic hypertension.

CONCLUSION:
Despite normal baseline blood pressures without medications before 20 weeks of gestation, women with chronic hypertension are at an increased risk of adverse perinatal outcomes compared with women without.
Transfer of Inhaled Cannabis Into Human Breast Milk
Authors: Baker Teresa , Datta Palika , Rewers-Felkins Kathleen , Thompson Heather , Kallem Raja R. , Hale Thomas W. 
Published: April 2018

OBJECTIVE:
To evaluate the transfer of delta-9-tetrahydrocannabinol and its metabolites into human breast milk after maternal inhalation of 0.1 g cannabis containing 23.18% delta-9-tetrahydrocannabinol.

METHODS:
In this pilot pharmacokinetic study, breast milk samples were collected from mothers who regularly consumed cannabis, were 2–5 months postpartum, and exclusively breastfeeding their infants. Women were anonymously recruited for the study. After discontinuing cannabis for at least 24 hours, they were directed to obtain a baseline breast milk sample, then smoke a preweighed, analyzed, standardized strain of cannabis from one preselected dispensary, and collect breast milk samples at specific time points: 20 minutes and 1, 2, and 4 hours. Quantification of delta-9-tetrahydrocannabinol and its metabolites in these collected breast milk samples was performed by high-performance liquid chromatography tandem mass spectrometry.

RESULTS:
A total of eight women were enrolled. Most were occasional cannabis smokers and one a chronic user. Delta-9-tetrahydrocannabinol was detected at low concentrations at all the time points beyond time zero. No metabolites were detected at any time point. Delta-9-tetrahydrocannabinol was transferred into mother's milk such that exclusively breastfeeding infants ingested an estimated mean of 2.5% of the maternal dose (the calculated relative infant dose=2.5%, range 0.4–8.7%). The estimated daily infant dose was 8 micrograms per kilogram per day.

CONCLUSION:
This study documents inhaled delta-9-tetrahydrocannabinol transfer into the mother's breast milk. Low concentrations of delta-9-tetrahydrocannabinol were detected. The long-term neurobehavioral effect of exposure to delta-9-tetrahydrocannabinol on the developing brain is unclear. Mothers should be cautious using cannabis during pregnancy and breastfeeding.
Prescription and Other Medication Use in Pregnancy
Authors: Haas David M. , Marsh Derek J. , Dang Danny T. , Parker Corette B. , Wing Deborah A. , Simhan Hyagriv N. , Grobman William A. , Mercer Brian M. , Silver Robert M. , Hoffman Matthew K. , Parry Samuel , Iams Jay D. , Caritis Steve N. , Wapner Ronald J. , Esplin M. Sean , Elovitz Michal A. , Peaceman Alan M. , Chung Judith , Saade George R. , Reddy Uma M. ,   for the Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-be (nuMoM2b) Study
Published: April 2018

OBJECTIVE:
To characterize prescription and other medication use in a geographically and ethnically diverse cohort of women in their first pregnancy.

METHODS:
In a prospective, longitudinal cohort study of nulliparous women followed through pregnancy from the first trimester, medication use was chronicled longitudinally throughout pregnancy. Structured questions and aids were used to capture all medications taken as well as reasons they were taken. Total counts of all medications taken including number in each category and class were captured. Additionally, reasons the medications were taken were recorded. Trends in medications taken across pregnancy and in the first trimester were determined.

RESULTS:
Of the 9,546 study participants, 9,272 (97.1%) women took at least one medication during pregnancy with 9,139 (95.7%) taking a medication in the first trimester. Polypharmacy, defined as taking at least five medications, occurred in 2,915 (30.5%) women. Excluding vitamins, supplements, and vaccines, 73.4% of women took a medication during pregnancy with 55.1% taking one in the first trimester. The categories of drugs taken in pregnancy and in the first trimester include the following: gastrointestinal or antiemetic agents (34.3%, 19.5%), antibiotics (25.5%, 12.6%), and analgesics (23.7%, 15.6%, which includes 3.6%; 1.4% taking an opioid pain medication).

CONCLUSION:
In this geographically and ethnically diverse cohort of nulliparous pregnant women, medication use was nearly universal and polypharmacy was common.

CLINICAL TRIAL REGISTRATION:

ClinicalTrials.gov, NCT01322529.
Maternal Pyrexia and Villitis of Unknown Etiology
Authors: Graham Dorothy F. , Sung Eileen , Berry Bligh 
Published: April 2018

BACKGROUND:
Villitis of unknown etiology is an inflammatory placental condition associated with adverse pregnancy outcomes, including fetal growth restriction and preterm birth.

CASE:
We describe maternal pyrexia with daily rigors in the third trimester of two consecutive pregnancies in the same woman. In her second pregnancy, we found no evidence of infection despite an extensive antenatal investigation (blood and urine cultures, serologies, chest X-ray, abdominal ultrasonogram, echocardiogram). The fetus was closely monitored for growth and well-being until spontaneous labor ensued at 36 weeks of gestation, followed by the birth of a vigorous female neonate who weighed 2.235 kg and was healthy. Placental pathology was consistent with villitis of unknown etiology and displayed more prominent abscess formation than is usually described. The patient's first pregnancy 4 years previously followed a similar but milder pattern, without preterm delivery but with similar placental pathology.

CONCLUSION:
Maternal pyrexia in both pregnancies was ultimately attributed to placental inflammation secondary to a maternal immunologic response to the fetal–placental unit. A placental origin for maternal pyrexia should be considered in cases in which a maternal cause cannot be identified and the pregnancy managed in light of the possible association with adverse fetal outcomes.
Pregnancy Exercise and Nutrition With Smartphone Application Support
Authors: Kennelly Maria A. , Ainscough Kate , Lindsay Karen L. , O'Sullivan Elizabeth , Gibney Eileen R. , McCarthy Mary , Segurado Ricardo , DeVito Giuseppe , Maguire Orla , Smith Thomas , Hatunic Mensud , McAuliffe Fionnuala M. 
Published: April 2018

OBJECTIVE:
To evaluate the effect of a healthy lifestyle package (an antenatal behavior change intervention supported by smartphone application technology) on the incidence of gestational diabetes mellitus (GDM) in overweight and obese women.

METHODS:
Women with body mass indexes (BMIs) 25–39.9 were enrolled into this randomized controlled trial. The intervention consisted of specific dietary and exercise advice that addressed behavior change supported by a tailor-designed smartphone application. Women in the control group received usual care. The primary outcome was the incidence of GDM at 28–30 weeks of gestation. To reduce GDM from 15% to 7.2%, we estimated that 506 women would be required to have 80% power to detect this effect size at a significance of .05, that is, 253 in each group.

RESULTS:
Between March 2013 and February 2016, 565 women were recruited with a mean BMI of 29.3 and mean gestational age of 15.5 weeks. The incidence of GDM did not differ between the two groups, 37 of 241 (15.4%) in the intervention group compared with 36 of 257 (14.1%) in the control group (relative risk 1.1, 95% CI 0.71–1.66, P=.71).

CONCLUSIONS:
A mobile health-supported behavioral intervention did not decrease the incidence of GDM.

CLINICAL TRIAL REGISTRATION:
ISRCTN registry, https://www.isrctn.com/, ISRCTN29316280.
Direct Percutaneous Endoscopic Jejunostomy for the Management of Gastroparesis in Pregnancy
Authors: Rupani Sawan Vijay , Ergen William F. , Weber Frederick , Peter Shajan 
Published: April 2018

BACKGROUND:
Providing meaningful nutrition in cases of refractory hyperemesis during pregnancy can be challenging; although intragastric enteral nutrition is the most common approach, it is contraindicated in certain cases and carries the risk of increased nausea and vomiting.

CASE:
A 36-year-old primigravid woman with a history of gastroparesis presented at 16 weeks of gestation with nausea and vomiting. With no improvement with conventional approaches and signs of malnutrition, a direct percutaneous endoscopic jejunostomy was placed. Her nutritional status improved, and the pregnancy ended in the delivery of a healthy neonate.

CONCLUSION:
Direct percutaneous endoscopic jejunostomy in pregnancy is an option in patients in whom intragastric feeding is contraindicated and may offer a more secure approach than percutaneous gastrojejunostomy.
Timing of Etonogestrel Implant Insertion After Dilation and Evacuation
Authors: Cowett Allison A. , Ali Rose , Cooper Mary A. , Evans Mark , Conzuelo Gabriel , Cremer Miriam 
Published: April 2018

OBJECTIVE:
To compare the 6-month use rate of the etonogestrel implant placed immediately after dilation and evacuation (D&E) with placement 2–4 weeks postprocedure.

METHODS:
This is a randomized controlled trial of women seeking abortion between 14 0/7 and 23 5/7 weeks of gestation and desiring the etonogestrel contraceptive implant at an urban family planning clinic. Participants were randomized to device insertion immediately after the D&E compared with delayed insertion in 2–4 weeks. The primary outcome was implant use rate at 6 months after insertion and was determined by follow-up phone interviews. Secondary outcomes included repeat pregnancy rates and method satisfaction. The sample size of 120 participants was calculated based on a power of 0.80 to demonstrate a 20% difference in implant use rates between groups assuming 40% of women overall are not using the device 6 months after the procedure.

RESULTS:
Between November 2015 and October 2016, 148 participants were enrolled. Seventy-three participants (49.3%) were randomized to and underwent immediate implant insertion after D&E. The remaining 75 (50.6%) were randomized to delayed insertion. There were no significant differences in sociodemographic characteristics between the groups. Placement rate was 100% in the immediate group compared with 42.7% in the delayed group (P<.01). At 6 months, 40 of 43 (93%) women from the immediate group who completed follow-up continued use of the implant, whereas 19 of 30 (63.3%) women from the delayed group who completed follow-up were using the device (P=.002). Follow-up rates were low at 58.9% in the immediate group compared with 40.0% in the delayed group.

CONCLUSION:
Women were more likely to be using the etonogestrel implant at 6 months after D&E if they underwent immediate compared with delayed insertion. The very high loss to follow-up rate makes it difficult to draw conclusions about acceptability of the device and pregnancy rates.

CLINICAL TRIAL REGISTRATION:
ClinicalTrials.gov, 02037919.
Disparities in Adherence to National Comprehensive Cancer Network Treatment Guidelines and Survival for Stage IB–IIA Cervical Cancer in California
Authors: Pfaendler Krista S. , Chang Jenny , Ziogas Argyrios , Bristow Robert E. , Penner Kristine R. 
Published: April 2018

OBJECTIVE:
To evaluate the association of sociodemographic and hospital characteristics with adherence to National Comprehensive Cancer Network treatment guidelines for stage IB–IIA cervical cancer and to analyze the relationship between adherent care and survival.

METHODS:
This is a retrospective population-based cohort study of patients with stage IB–IIA invasive cervical cancer reported to the California Cancer Registry from January 1, 1995, through December 31, 2009. Adherence to National Comprehensive Cancer Network guideline care was defined by year- and stage-appropriate surgical procedures, radiation, and chemotherapy. Multivariate logistic regression, Kaplan-Meier estimate, and Cox proportional hazard models were used to examine associations between patient, tumor, and treatment characteristics and National Comprehensive Cancer Network guideline adherence and cervical cancer–specific 5-year survival.

RESULTS:
A total of 6,063 patients were identified. Forty-seven percent received National Comprehensive Cancer Network guideline–adherent care, and 18.8% were treated in high-volume centers (20 or more patients/year). On multivariate analysis, lowest socioeconomic status (adjusted odds ratio [OR] 0.69, 95% CI 0.57–0.84), low–middle socioeconomic status (adjusted OR 0.76, 95% CI 0.64–0.92), and Charlson-Deyo comorbidity score 1 or higher (adjusted OR 0.78, 95% CI 0.69–0.89) were patient characteristics associated with receipt of nonguideline care. Receiving adherent care was less common in low-volume centers (45.9%) than in high-volume centers (50.9%) (effect size 0.90, 95% CI 0.84–0.96). Death from cervical cancer was more common in the nonadherent group (13.3%) than in the adherent group (8.6%) (effect size 1.55, 95% CI 1.34–1.80). Black race (adjusted hazard ratio 1.56, 95% CI 1.08–2.27), Medicaid payer status (adjusted hazard ratio 1.47, 95% CI 1.15–1.87), and Charlson-Deyo comorbidity score 1 or higher (adjusted hazard ratio 2.07, 95% CI 1.68–2.56) were all associated with increased risk of dying from cervical cancer.

CONCLUSION:
Among patients with early-stage cervical cancer, National Comprehensive Cancer Network guideline-nonadherent care was independently associated with increased cervical cancer–specific mortality along with black race and Medicaid payer status. Nonadherence was more prevalent in patients with older age, lower socioeconomic status, and receipt of care in low-volume centers. Attention should be paid to increase guideline adherence.