bluuebunny/crossref_metadata_2025_split huggingface dataset:
Acceptability of Supplemental Progesterone to Prevent Preterm Labor and Low Birth Weight in Pregnant Zambian Women [32D]
Authors: Wong Jeffrey M.H. , Dogra Nupur , Kanga Neha , Ngoma Mary , Serghides Lena , Silverman Michael 
Published: May 2017

INTRODUCTION:
Intramuscular and vaginal progesterone are recommended for the prevention of preterm labor (PTL) in women with risk factors. Studies are emerging to indicate that HIV-infected women on combination antiretroviral treatments (cART) are at risk of PTL and low birth weight (LBW) and may benefit from supplemental progesterone. This study aims to determine the perceived acceptability of various modes of progesterone supplementation to prevent PTL and LBW in HIV-infected and HIV-uninfected women.

METHODS:
HIV-infected and HIV-uninfected women were recruited in Lusaka, Zambia. The participants completed a questionnaire to assess their concern for PTL and LBW, and their willingness and preference for oral, vaginal, or intramuscular progesterone supplementation for preventing PTL and LBW.

RESULTS:
The study questionnaire was completed by 147 participants. 98.6% of participants would consider using a medication to help prevent PTL and LBW, of whom 97.9% would consider using an oral form of progesterone. In addition, 83.3% and 84.0% of women would consider intramuscular and vaginal (gel or tablet) administration of progesterone respectively. When choosing between intramuscular and vaginal modes of progesterone, 60.5% of participants (n=147) preferred intramuscular progesterone, while 39.5% preferred vaginal progesterone. There were no differences in preference between HIV-infected (n=70) and HIV-uninfected (n=77) women.

CONCLUSION:
Pregnant Zambian women demonstrated a high degree of acceptance for all modes of progesterone supplementation for the prevention of PTL and LBW. Women preferred intramuscular over vaginal supplementation. Progesterone supplementation can be considered a feasible intervention for preventing PTL and LBW in both HIV-infected and HIV-uninfected pregnant Zambian women.
Association Between Partner-Relationship Satisfaction During Pregnancy and Maternal Postpartum Depression [39D]
Authors: Mesina Anna M. , Kjerulff Kristen H. , Deimling Timothy , Phaeton Rebecca , Repke John T. 
Published: May 2017

INTRODUCTION:
The purpose of this study was to investigate partner-relationship satisfaction during pregnancy and its association with postpartum depression. Several prenatal risk factors for postpartum depression have been identified, including history of depression, life stressors, and depression during pregnancy. However, little research exists on whether maternal-partner relationship dissatisfaction during pregnancy is associated with increased risk for postpartum depression.

METHODS:
This was a planned secondary analysis using data prospectively collected from interviews in the third trimester and at 1 month postpartum of women aged 18-35 who delivered their first singleton birth in Pennsylvania, 2009-2011 (N= 2,844). Relationship satisfaction was measured in the third trimester using items adapted from the Dyadic Adjustment Scale (DAS). Women scoring 12 or greater on the Edinburgh Postnatal Depression Scale (EPDS) at the 1-month interview were categorized as having postpartum depression. Multivariable logistic regression was used to evaluate the association between relationship satisfaction and postpartum depression, controlling for the confounders of marital status, poverty, race/ethnicity, age, history of anxiety/depression, and unintended pregnancy.

RESULTS:
Women in the lowest third on relationship satisfaction during pregnancy were significantly more likely to score as depressed on the EPDS (odds ratio, 2.14, 95% confidence interval, 1.29-3.55) in comparison to women in the highest third of the distribution, controlling for the confounders. Additional significant predictors were history of anxiety/depression, maternal age younger than 30, and non-white race/ethnicity.

CONCLUSION:
In this prospective cohort study, we found that low relationship satisfaction during pregnancy was a significant predictor of postpartum depression among first-time mothers.
A Comparison of Peripartum Scoring Systems of Anticoagulation for Venous Thromboembolic Prophylaxis [4K]
Authors: Orfanelli Theofano , Awomolo Adeola , Gomez Daniela , Doulaveris Georgios , Duzyi Christina 
Published: May 2017

INTRODUCTION:
Postpartum VTE is rare (0.16%), however, its potential for mortality make it an important focus for intervention. The American College of Obstetricians and Gynecologists (the College) and the Royal College of Obstetricians & Gynaecologists (RCOG) have proposed scoring guidelines for antepartum (AP) and postpartum (PP) prophylaxis. Threshold scores for treatment have not been validated. Our study compared the potential impact of these scoring thresholds at a regional perinatal center.

METHODS:
We conducted a retrospective cohort study of patients admitted for maternity care over 4 months. Each patient was assigned an AP and PP risk score using both guidelines. Any VTE occurring up to 6 weeks postpartum was obtained by a review of the medical records. Fischer's exact test was used for categorical variables.

RESULTS:
311 women were included in our study. Using the RCOG scoring thresholds 29.2% of AP patients would require treatment compared to 10.9% of women when using the College guidelines (p < 0.001). Similarly for PP patients, 124 women (39.9%) would require treatment based on the RCOG guidelines compared to 63 women (20.3%) when using the College guidelines (p < 0.001). If prophylaxis were performed at a threshold score of 3 instead of 2 for PP patients by College criteria, 28 women (9%) would be treated.

CONCLUSION:
Significantly more patients would require prophylactic anticoagulation treatment based on the RCOG guidelines. Utilizing College guidelines and increasing the threshold for treatment would facilitate targeting patients at risk without an excessive burden of increased cost and complication rate to the global patient population.
Etiologies and Risk Factors of Placental Abruption and Neonatal Mortality: A Retrospective Study [6K]
Authors: Araji Sarah , Khoury Aldo , Elkafrawi Deena , Miller Jacob 
Published: May 2017

INTRODUCTION:
Placental abruption is defined as bleeding at the decidual-placental border leading to placental separation prior to delivery of the fetus. Placental abruption is a significant cause of maternal and perinatal mortality. In this retrospective study, we aim to evaluate the correlation between various causes and risk factors of placental abruption and neonatal mortality.

METHODS:
A retrospective chart review of placental abruption patients at SJRMC between 1986-1996 was conducted. Preeclampsia, eclampsia, HELLP, CHTN, preterm labor and placenta previa were recorded. Smoking, alcohol and cocaine use were assessed. Perinatal morbidity was based on length of NICU stay; neonatal mortality was defined as stillbirth or death.

RESULTS:
Our sample size was 271 pregnant women with placental abruption. Sixteen of 271 had HELLP (5.90%), 76 of 271 had preeclampsia (28.0%), and 22 of 271 had CHTN (8.11%). Forty of 271 used cocaine (14.7%), 104 of 271 smoked (38.4%) and 45 of 271 used alcohol (16.6%). Nine of 271 pregnant women with placental abruption had placental previa (3.32%). 37 of 271 infants were stillborn (13.6%) and 44 of 271 were dead on discharge (16.2%). HELLP syndrome was directly proportional to infant death (P=0.026; 95% CI, 0.26 to 4.03). Preeclampsia was proportional to neonatal mortality (P=0.000); CHTN was statistically significant for neonatal mortality (P=0.0010). Cocaine and alcohol correlated with increased neonatal mortality (P=0.0057; P=0.0220).

CONCLUSION:
CHTN, HELLP, preeclampsia, and placenta previa as causes of placental abruptions were found to be statistically significant predictors of neonatal mortality. Smoking, cocaine and alcohol use were directly proportional to neonatal mortality.
Variation in Preferences of Pregnant Women for Outcomes Related to the Use of Anticoagulants in Pregnancy [16K]
Authors: Thomas Hannah , Wuebbolt Danielle , Nguyen Vanessa , Murphy Kellie , Sermer Mathew , D'Souza Rohan 
Published: May 2017

INTRODUCTION:
Women requiring anticoagulants in pregnancy face increased maternal and fetal risks. The trade-offs women are willing to make to ensure optimal pregnancy outcomes are not known. This study was conducted to compare preferences of pregnant women with and without cardiac disease, for maternal and fetal outcomes resulting from anticoagulant use in pregnancy.

METHODS:
A cross-sectional study was conducted on pregnant women with cardiac or non-cardiac medical disorder. Study participants were presented with seven vignettes that described a combination of maternal and fetal outcomes related to the use of anticoagulants during pregnancy. Participants were asked to rank these vignettes and assign them with “utility values” (preferences) on a visual analogue scale (VAS), by the standard gamble (SG) and time trade-off (TTO) methods. These were presented on a scale of 0-100 where 0 represented maternal and fetal death, the worst outcome, and 100 represented perfect maternal-fetal health, the best.

RESULTS:
90 pregnant women (40 with and 50 without cardiac disease) completed the interviews. The median age was 32 [29-36] years and the median gestational age was 29.5 [22-34.3] weeks. The cardiac and non-cardiac groups had similar demographic characteristics. While no consistent trends were observed with VAS and TTO methods, with SG, women with cardiac disease consistently assigned higher utility values for the seven outcomes as compared with those without cardiac disease.

CONCLUSION:
Women with cardiac disease value adverse pregnancy outcomes more favorably than non-cardiac patients. Whether this finding is related to risk-taking attitudes among cardiac patients, needs to be further explored.
Vaginal Progesterone – Cost and Health Care Utilization for Preventing Preterm Births in the United States [19K]
Authors: Eke Ahizechukwu C. , Onasanya Oluwadamilola , Johnson Clark T. 
Published: May 2017

INTRODUCTION:
To examine the cost and healthcare utilization patterns of vaginal progesterone for the prevention of preterm-births in women with singleton gestations and a sonographic short cervix in the United States.

METHODS:
Using a nationwide database (MarketScan) of patients' de-identified healthcare and medication utilization, we assessed vaginal progesterone use and preterm-birth associated health care spending from January 2010 through December 2014. We compared the utilization rates across regions, states and age groups to estimate indirect benefits. We estimated national reductions in the number of preterm births, and preterm-birth associated costs.

RESULTS:
By December 31, 2014, the national utilization rate of vaginal progesterone was 62.5% in the Midwest, 63.6% in the Northeast, and 62.4% in the southwest. Relative reductions in preterm birth were 33% in 2012–2013 (95% CI, 29 to 37) and by 25% in 2013–2014 (95% CI, 23 to 27). Rates of hospitalization for preterm labor in 2010–2012, 2012–2013, and 2013–2014 were 24, 18, and 12 cases per 10,000 person-years with corresponding relative reductions of 52% in 2010-2012 (95% CI, 48 to 57) and 58% (95% CI, 47 to 59) in 2013–2014. Utilization rates was highest for Prometrium [78% (95% CI, 71 to 84)], Crinone [56% (95% CI, 51 to 63)] and Endometrin [28% (95% CI, 23 to 34)]. Nationally, for the 2010–2014 period, there was an estimated reduction of 65,250 hospitalizations for preterm births, saving approximately $113 million in treatment costs.

CONCLUSION:
Since the introduction of vaginal progesterone, preterm birth associated health care utilization and medical expenditures for U.S. hospitals have decreased substantially.
Does Intramuscular Progesterone Help Women With Prior Preterm Birth Screened for Ultrasound-Indicated Cerclage? [25K]
Authors: Wood S. Lindsay , Williams Bria N. , Tang Ying , Owen John 
Published: May 2017

INTRODUCTION:
Weekly intramuscular 17α-hydroxyprogesterone caproate (17P) is endorsed by the American College of Obstetricians and Gynecologists for recurrent preterm birth (PTB) prevention. Cerclage is indicated in patients with prior PTB and a midtrimester cervical length (CL) less than 25 mm. We aimed to assess if these two preventive strategies, when combined, confer additive benefit in prolonging gestation.

METHODS:
Retrospective cohort of all singletons delivered at a single center that underwent CL screening from 2011 to 2016 for prior PTB. Exposure was any 17P use. Primary outcome was gestational age (GA) at delivery. Secondary outcomes included cerclage, preterm labor (PTL) admission, and preterm premature rupture of membranes (PPROM). ANCOVA was used to assess the relationship between 17P and delivery GA, controlling for cerclage, initial CL, number of prior PTB, and GA of earliest prior PTB.

RESULTS:
Of 409 patients who underwent CL screening, 293 received 17P (group 17P), and 116 did not. Groups did not differ by age, race, BMI, payer, number of prior PTB, or initial CL. GA of earliest prior PTB was lower in group 17P (27.4 vs 29.9 weeks; P < .001). Delivery GA occurred earlier in group 17P (35.7 vs 37.2 weeks; P=.002). Group 17P also had higher rates of PPROM (22.2% vs 11.2%; P=.011), PTL admission (42% vs 25%; P=.001), and cerclage (18.1% vs 5.2%; P < .001). After controlling for confounders, delivery GA remained significantly lower in group 17P (34.9 vs 35.9 weeks; P=.027).

CONCLUSION:
In a population with prior PTB followed with CL screening and ultrasound-indicated cerclage, 17P did not prolong gestation.
Factors Associated With Availability of Nurse-Family Partnership Programs in the State of Texas [27K]
Authors: Cuvillier James , Fisch Stanley 
Published: May 2017

INTRODUCTION:
Current teen pregnancy rates generate significant social and economic costs, with highest rates in Hispanic, African American and socioeconomically disadvantaged youth. Their children are more likely to face health problems, incarcerations, unemployment, and to perpetuate teen pregnancies. Research-supported Nurse-Family Partnerships (NFPs) involving antepartum and postpartum nurse-home visits significantly improve teen pregnancy outcomes in Texas. Our objective was to evaluate socioeconomic, obstetrical, and perinatal outcomes of Texas counties currently served by NFPs.

METHODS:
We analyzed Texas and national population statistics, birth rates, socioeconomic factors, and obstetrical and neonatal outcomes extracted from federal and state databases.

RESULTS:
Currently, 21 Texas NFPs serve eligible women in 34 out of 254 Texas counties. These counties have higher average teen birth rates (44 per 1000) and higher average maternal poverty rates (33%) than the state of Texas (34 per 1000; 30%) and the United States (21 per 1000; 27%). They also have a higher proportion of absent prenatal care (4.5%), and infants with very low birth weights (1.7%). Across Texas, access to prenatal care decreases with decreasing maternal age, and teens have the highest rate of absent prenatal care (6.6-8.5%) and lowest rate of care starting the first trimester (6.6-8.5%). Absent prenatal care was also correlated with higher representation of birth defects.

CONCLUSION:
Texas NFPs serve counties with relatively high rates of teen pregnancies, maternal poverty, and absent prenatal care. This baseline data allows for advocacy, funding, and expansion of NFPs in Texas counties with comparably high levels of low-income, first-time mothers, including critically underserved Texas-Mexico border counties.
Focal Placenta Accreta: Risk Factors, Adverse Obstetrical Outcomes, and Recurrence in Subsequent Pregnancies [10L]
Authors: Mullen Clodagh R. , Battarbee Ashley N. , Ernst Linda M. , Peaceman Alan M. 
Published: May 2017

INTRODUCTION:
To assess the risk factors for and obstetrical outcomes associated with manually extracted placentas with pathologic diagnosis of focal accreta.

METHODS:
This was a retrospective case control study of patients with adherent placentas requiring manual extraction from January, 2009 to December, 2014 which underwent pathologic examination. Women with diagnosis of focal accreta on placental pathology were compared to those without focal accreta. All women with an antepartum diagnosis of placenta accreta were excluded. No cases of placenta increta were found. Chi-squared, t-test, and multivariable regression were performed to identify risk factors for and adverse obstetric outcomes associated with focal accreta.

RESULTS:
Four-hundred and ninety-one women met inclusion criteria. Those with focal accreta (n=100) were more likely to have a previous cesarean (19.0% vs 10.7%, p=0.03), prior uterine surgery (35.0% vs 19.7%, p=0.001), and in vitro fertilization (35.0% vs 19.7%, p=0.001). Adverse obstetrical outcomes were more common in women with a focal accreta including hemorrhage, transfusion, and peripartum hysterectomy. There were no differences in neonatal outcomes. In multivariable analysis, focal accreta remained associated with all maternal hemorrhagic morbidities. In the 130 observed subsequent pregnancies, there was an increased risk of adherent placenta requiring manual extraction (42.9% vs 19.0%, p=0.04) and recurrence of pathologic finding of focal accreta (29.6% vs 6.8%, p=0.05) in those women who had a focal accreta in the index pregnancy.

CONCLUSION:
For patients with adherent placentas requiring manual extraction, the pathologic finding of focal accreta is associated with an increased risk of hemorrhagic morbidity and retained placenta in subsequent pregnancies.
Do Differences Exist Between Groups With Varying Numbers of Abnormal Values on the Glucose Tolerance Test? [15L]
Authors: Shaia Kathryn , Connolly Katherine , Soffer Marti , Amorosa Jennifer , Wagner Brian , Stone Joanne 
Published: May 2017

INTRODUCTION:
To determine whether patients with one abnormal value on the glucose tolerance test (GTT) have different outcomes compared to patients with varying numbers of abnormal values.

METHODS:
We conducted a retrospective chart review of women undergoing a glucose challenge test (GCT) followed by a GTT from July 2010-July 2015. Patients with pre-gestational diabetes were excluded. Primary outcomes were infant birth weight and mode of delivery. Secondary outcomes included shoulder dystocia, NICU admission, and development of preeclampsia. Data was analyzed via multivariable regression models.

RESULTS:
5,913 charts were reviewed. 5,124 patients had a normal GCT. 499 had an abnormal GCT and zero abnormal values on the GTT (Group 0). 147 had one abnormal value on the GTT (Group 1), and 143 had two or more abnormal values on the GTT (Group 2). After controlling for maternal age, infant sex, and gestational age, group 0 had a significant increase in rate of cesarean delivery, birth weight, NICU admission, shoulder dystocia and preeclampsia compared to patients with a normal GCT. Group 1 had a significant increase in rate of cesarean delivery, birth weight, NICU admission and preeclampsia when compared to group 0. No significant differences in outcomes existed between group 1 and group 2, the treated gestational diabetics.

CONCLUSION:
Glucose intolerance is a spectrum with an increasing number of abnormal GTT values leading to an increased likelihood of poor outcomes. Patients with an abnormal GCT should be counseled on potential maternal and neonatal morbidities and the potential to modify outcomes with treatment.
Differences in Social Support in Perinatal Depression [19L]
Authors: Scibetta Emily , Dossett Emily C. , Hom Patricia , Gutierrez Griselda , Moini Moraya , Reina Astrid 
Published: May 2017

INTRODUCTION:
Depression during pregnancy is a known risk factor for low birth weight (LBW) and preterm birth (PTB). Identifying social risk factors for depression in pregnancy can impact directed perinatal services aimed at reducing PTB and LBW. This study describes associations between partner status and depression in pregnant women in high prevalence areas for PTB and LBW in Los Angeles.

METHODS:
From December 2013 through August 2016, community health workers conducted a novel prenatal risk assessment with evidence-based screening tools for psychosocial risk factors in women enrolling into a Los Angeles County prenatal care program. Depression was measured using Center for Epidemiological Studies-Depression scale. Chi-square tests were performed.

RESULTS:
Analyses included data from 3,214 women. This cohort exhibited high rates of depression (23%). Women scoring high for depression were significantly less likely to report being married (chi-square=53, p less than 0001) or living with the father of their babies (chi-square= 71, p less than 0001). Unmarried women (35%) scored higher for depression than married women (21%). Women who did not live with the father of their babies (40%) scored higher for depression than those who did (26%).

CONCLUSION:
Married and cohabitating pregnant women were significantly less likely to score high for depression. These findings suggest that social supports are critical pregnant women's mental health, which we know impacts PTB and LBW. Women with limited partner support could benefit from increased mood surveillance and psychological interventions during prenatal care.
Differences in Patients With a Positive Drug Screen for Opiates Versus Other Substances in Pregnancy [20L]
Authors: Stephens Amanda J. , Holcomb Garret , Ouyang David W. 
Published: May 2017

INTRODUCTION:
Opioid abuse has reached epidemic levels in the past decade drastically changing the landscape of drug abuse in the US. Current guidelines for drug screening in pregnancy may not reflect contemporary patterns of use and over sample women of color and low socioeconomic status.

METHODS:
This is a retrospective cohort study of obstetric patients who had urine drug screens (UDS) ordered between 2013 and 2015 in a suburban tertiary care hospital. Of those with a positive UDS, we compared the characteristics of those with positive opiate screens to those who screened positive for other substances excluding opiates.

RESULTS:
112 UDS were positive during the study period, 45 (40.2%) for opiates and 67 (59.8%) for other substances, most commonly marijuana (n=60), benzodiazepine (n=10), and cocaine (n=8). Subjects with positive opiate screens were more likely to have private insurance compared to other insurances (P < .05). Publicly insured were more likely to test positive for nonopiates than opiates. African Americans were significantly less likely to test positive for opiates compared to subjects of other races (P < .05). Caucasians' use was similar between the two groups (42% opiate, 43% other). A history of substance abuse was more common in those who screened positive for non-opiates whereas subjects whose infants required NICU admissions were more likely to test positive for opiates. Current or former tobacco use was similar between these two groups.

CONCLUSION:
Women who screen positive for opiates compared to other substances during pregnancy are different. A separate validated screening method for opiate use in pregnancy is needed.