bluuebunny/crossref_metadata_2025_split huggingface dataset:
When Is Illicit Drug Screening Indicated in Pregnant Women on Labor and Delivery in Colorado? [3Q]
Authors: Son Shannon L. , Heyborne Kent , Sheeder Jeanelle , Guiahi Maryam 
Published: May 2017

INTRODUCTION:
Women on labor and delivery undergo illicit drug screening for various indications many of which may not be appropriate indicators of use. We investigated which indications are associated with positive testing.

METHODS:
We performed a historical cohort study of all pregnant women with positive drug screens on labor and delivery at a safety-net hospital in Denver, Colorado between 2010-2014. Testing was performed at provider discretion based on concern for substance use and patients were consented. Illicit drugs are included; tetrahydrocannabinol is not. Chart abstraction included testing indications, demographic, reproductive, social, and substance use characteristics. Descriptive statistics were computed.

RESULTS:
Between 2010-2014, there were 121 positive urine toxicology screens. Most women in our cohort were ≤30 years old (70.2%), white (81%), not Hispanic (55.4%), single (54.5%), and unemployed (90.9%). Obstetrical indications for testing: preterm labor (24.0%), placental abruption (14.0%), abnormal maternal behavior (11.6%), intrauterine fetal demise (6.6%), abnormal maternal vital signs (5.8%), outborn delivery (6.6%), precipitous delivery (3.3%), trauma (5.0%), pain (3.3%), and abnormal fetal monitoring (0%). Social indications for testing and frequencies of a positive test were: self-reported illicit drug use (61.2%), documented historical use (9.1%), no prenatal care (21.5%), and scant prenatal care (5.0%). 77% of positive tests had at least one social indication for testing.

CONCLUSION:
Over three-fourths of positive tests were performed based on social factors elicited from patient histories. While obstetric indications did provide some positive tests, emphasizing excellent history taking may optimize illicit drug testing strategies.
The Use of Omega-3 Fatty Acids to Improve Insulin Sensitivity in Pregnancy: A Pilot Study of Safety and Tolerability [6Q]
Authors: VanWinden Kristi R. , Montoro Martin , Silverstein Emily , Ovalle Blanca , Shulman Ira , Ouzounian Joseph G. 
Published: May 2017

INTRODUCTION:
Omega-3 fatty acid (n3 FA) consumption is associated with improved insulin sensitivity in some diabetic populations, but can cause adverse effects at high doses. The objective was to evaluate the tolerability of high-dose n3 FA supplementation in obstetric patients with diet-controlled gestational diabetes (GDM).

METHODS:
Women with diet-controlled GDM between 24 and 30 weeks of gestation were randomized in a prospective, double-blind fashion to receive either 2200 mg daily of commercial fish oil (1300 mg eicosapentaenoic acid (EPA) + 900 mg docosahexaenoic acid (DHA)) or an identical placebo for a minimum of 6 weeks. Pre-and post-treatment evaluations were calculated using the homeostatic model assessment of insulin resistance (HOMA-IR) and measures of safety and tolerability.

RESULTS:
In this pilot study, 14 GDM patients were randomized to treatment with fish oil (N=7) or placebo (N=7). Of these, 35.7% (3 in the treatment group, 2 in the placebo group) did not complete the treatment course due to intolerance. No clinically significant adverse effects, obstetric or neonatal complications were noted. Two patients in each group required initiation of medical therapy for glucose control subsequent to enrollment. While the pilot study was not adequately powered to detect a difference in objective measures of glucose control between the groups, no significant differences in fasting glucose, fasting insulin, or HOMA-IR levels were noted.

CONCLUSION:
High dose omega-3 fatty acid supplementation appears to be safe in pregnancy, but some patients have bothersome side effects that may limit compliance. The use of omega-3 fatty acids to mitigate insulin resistance in gestational diabetes warrants further investigation.
Recurrent Preterm Delivery in Women Receiving 17-P is Not Influenced by Prior Spontaneous Preterm Delivery Etiology [8Q]
Authors: Barton John , Rhea Debbie , Sibai Baha 
Published: May 2017

INTRODUCTION:
To compare rates of recurrent preterm delivery (PTD) in women receiving 17-P therapy for prior spontaneous PTD (sPTD) due to either Preterm Premature Rupture of Membranes (PPROM) or preterm labor (PTL).

METHODS:
Study sample derived from a national database of women receiving 17-P therapy as part of a PTD prevention program. Inclusion criteria: women meeting SMFM criteria recommendations for 17-P administration, documented history of prior sPTD, singleton gestation and receiving at least 4 weekly 17-P injections. Demographic and clinical risk factors for PTD as well as pregnancy outcomes were compared between those with prior history of sPTD with PTL vs PPROM. Rank and chi-square tests were used to compare study groups, with P-values < .05 considered statistically significant.

RESULTS:
2,084 women with prior sPTD were studied: 450 with prior PPROM, 1,634 with prior PTL. There were no significant differences between prior PPROM vs prior PTL study groups for race, ethnicity and pre-pregnancy BMI < 20 or >30. The number of previous PTDs (1.3 ± 0.6 vs 1.3 ± 0.6), gestational age of the most recent PTD (31.8 ± 4.6 vs 31.5 ± 4.5 weeks) and the total number of 17-P injections (18.7 ± 2.4 versus 18.9 ± 2.3) were also similar. Overall, with 17-P therapy, there were no significant differences between study groups for PTD at < 37.0, < 35.0 and < 32.0 weeks or sPTD < 37.0 weeks.

CONCLUSION:
In women receiving 17-P therapy, recurrent PTD and sPTD rates are not affected by the etiology of the prior sPTD.
The Rate of Elevated Antenatal Edinburgh Depression Score in Pregnancies Complicated by Gestational Diabetes [12Q]
Authors: Herrero Tiffany , Fratto Victoria M. , Nelson Evelyn , Hamlin Alyssa , Laurent Louise , Ramos Gladys A. 
Published: May 2017

INTRODUCTION:
The US Preventative Task Force recommends depression screening in pregnancy. The Edinburgh Depression Scale (EDS) is a self-administered screening tool for the diagnosis of depression. An EDS of greater than or equal to 10 is considered elevated and correlated with depression. Despite correlation with depression, maternal and neonatal outcome in high risk populations is unclear.

METHODS:
This is a retrospective study of singleton pregnancies with gestational diabetes at UC San Diego between 2010-2014 with an antepartum EDS. The primary outcome was the rate of elevated EDS and referral for treatment. The secondary outcomes included maternal characteristics, perinatal outcome, and postpartum follow-up.

RESULTS:
210 women met inclusion criteria. 53.2% (107/210) had an elevated EDS score and 71% (76/107) were referred for counseling. Of these, 24.5% (26/76) attended their counseling appointments. 18.7% (20/107) received pharmacologic treatment. Patients with a positive EDS score had a higher rate of PTD (19.6% vs 9.7% (p=0.05)), higher rate of obesity, and less weight gain. No statistical differences were noted in SGA, however, a trend toward a higher rate of these outcomes were noted in the group with elevated EDS (SGA 9.4% vs 2.9% (p=0.08). There were no differences in delivery method, rates of macrosomia, and diabetic control.

CONCLUSION:
53% of women with gestational diabetes had an elevated antenatal EDS and approximately 44.9% received treatment. Despite these interventions, a higher rate of PTD and lower weight gain was noted in those with an elevated EDS. Further studies are needed to determine the best intervention and its effect on perinatal outcomes.
The Rate of Cesarean Section Stratified by Maternal Age, Parity and Previous History of Cesarean Section [13Q]
Authors: Luck Marissa , Savitsky Leah , Speranza Rosa , Caughey Aaron 
Published: May 2017

INTRODUCTION:
The purpose of this study is to characterize the rate of cesarean sections (CS) in women < 35 years old against women of advanced maternal age (AMA) >35 years old. This data was further stratified by parity and history of cesarean section.

METHODS:
This is a retrospective cohort study of 9,676,773 non-anomalous, singleton deliveries 2012-2014 in the United States. In women with and without GDM, we conducted a chi-squared analysis of women < 35 years old and women of AMA and further stratified by parity and history of a CS.

RESULTS:
Significantly more CS performed on women with GDM than those without GDM in women < 35 years old and of AMA. In women < 35 years old, those with GDM were significantly more likely to have CS than those without GDM (37.0% vs. 26.2%, p < 0.001). Stratifying for nulliparous women < 35 years old with GDM, women were more likely to have CS than those without GDM (36.8% vs. 25.0%, p < 0.001), as well as multiparous women without a history of a CS, and women with a history of CS. Women of AMA with GDM were significantly more likely to have a CS than those without GDM (44.8% vs. 36.8%, p < 0.001).

CONCLUSION:
GDM is associated with increased risk of cesarean section in women who are < 35 years old and women of AMA. This is also shown when considering parity and cesarean section history. Further research is needed to determine etiology of these differences when considering maternal age, diabetes status and parity.
The Impact of Guidelines for the Collaboration Between Obstetricians & Midwives on Provider Satisfaction [15Q]
Authors: Madkour Amr , Smith Patricia , Lyvers Ashlee , Pinger Whitney 
Published: May 2017

INTRODUCTION:
Collaborative guidelines were instituted at our academic practice to streamline the existing process of consultation, collaboration, and transfer of care between obstetricians and midwives. We aim to investigate attitudes of providers toward the collaborative model, and how the implementation of an institutional guidelines document influences perceived provider satisfaction, oversight of collaboration, and delivery of patient care.

METHODS:
A qualitative survey of the faculty was administered using an electronic data capture system.

RESULTS:
Thirty-three faculty members were sent surveys, 76% were completed (n = 25, 16 obstetricians, 9 midwives). All respondents perceived collaborative practice improves patient outcomes. Formal guidelines were reported as necessary to direct collaborative practice by 44%, while another 44% reported them to be unnecessary. Respondents either agreed or strongly agreed (100%) that a collaborative model improves vaginal delivery rate, and patient satisfaction. While one respondent was neutral, and another disagreed that a collaborative practice improves provider satisfaction with care, the remaining 91% agreed or strongly agreed that it does. Finally, while 70% of respondents disagreed that collaborative practice increases provider perceived stress associated with patient care, 24% were neutral, 8% agreed, and 4% strongly agreed.

CONCLUSION:
The majority of respondents agree that a collaborative model benefits patients and providers, but equally agree and disagree with formal guidelines to direct collaboration. Subsequent analysis will explore the relationship between responses and the role of the respondent. Additional research investigating such guidelines will be beneficial in understanding collaborative models, and will assist practices interested in implementing similar models.
The Global Burden of Obesity on Pregnancy Outcomes in the Developed World [17Q]
Authors: Quiner Trevor , Perlow Jordan H. 
Published: May 2017

INTRODUCTION:
Essentially all major complications of pregnancy are more likely to occur in the obese gravida when compared to women with normal body mass indices. The purpose of this study was to estimate as accurately as possible, the quantitative burden of obesity on pregnancy outcomes in the developed world.

METHODS:
Pooled odds ratios for outcomes of interest related to maternal overweight and obesity were extracted from previously published meta-analyses. Rates of overweight and obesity in adult women in the Group of Eight countries were corrected for the decreased incidence in women prior pregnancy. The prevalence of each adverse outcome was extracted from published literature. Together this information was used to calculate the population attributable fraction that can be attributed to overweight and obesity each year for each outcome.

RESULTS:
Each year an estimated 3,168 stillbirths, 3,610 infant deaths, 570,449 cesarean deliveries, 1,105 neural tube defects, 780 cases of congenital heart defects, and 135,258 cases of preeclampsia can be attributed to maternal obesity in the Group of Eight countries. Calculations were also performed for maternal overweight.

CONCLUSION:
While the negative impact of maternal overweight and obesity is well known, it becomes easy to lose sight of the human cost of these increased odds ratios. By estimating the number of attributable cases this study humanizes the burden of overweight and obesity in the perinatal setting. Furthermore, this detailed estimate assists in the prioritization of public health efforts in the treatment and prevention of obesity and research into its proper management in pregnancy.
The Feasibility of a Patient-Centered Medical Home to Treat Pregnant Women With Opioid Use Disorder: A Pilot Study [19Q]
Authors: Mokhtari Neggin , Bobby Stephanie , Chang Judy C. , Gedekoh Robert , England Michael , Krans Elizabeth E. 
Published: May 2017

INTRODUCTION:
The patient-centered medical home (PCMH) is a healthcare model intended to improve healthcare quality while reducing costs. Pregnant women with opioid use disorder (OUD) require intensive healthcare resources. Therefore, a pilot study was conducted to establish the feasibility of a buprenorphine PCMH for pregnant women with OUD.

METHODS:
The Pregnancy Recovery Center (PRC) was created by five buprenorphine-licensed obstetricians and one addiction certified nurse in 2014. The PRC provides co-located buprenorphine, prenatal care, counseling, and social services support through a PCMH approach. Feasibility was measured by the ability to enroll, treat and retain patients. Successful completion (retention) was defined by negative drug screens, compliance with prenatal care, buprenorphine and counseling appointments. Additional outcomes were also compared between PRC vs non-PRC buprenorphine patients.

RESULTS:
Of 50 pregnant women enrolled from July 2014 to July 2015, 32 (64%) women successfully completed the program. The mean age was 28.1 years and 95.5% of women were white. Among 32 PRC and 78 non-PRC patients, buprenorphine dose at delivery was significantly higher for PRC vs non-PRC patients (18.4 vs 14.7 mg; P < .01), but neonatal abstinence syndrome (NAS) treatment rates were similar between the groups (46.2% vs 43.8%, P=.82). Fewer hospital charges for antepartum and delivery hospitalizations ($23,554.00 vs $183,703.00) were found for PRC vs non-PRC patients.

CONCLUSION:
A buprenorphine PCMH is feasible and may improve maternal and neonatal outcomes for pregnant women with OUD. Future large-scale clinical trials are needed to compare outcomes associated with alternative healthcare delivery models such as PCMHs for this population.
Reduction of Nulliparous Term Singleton Vertex Cesarean Deliveries With Feedback and Monitoring [23Q]
Authors: Child Reesa , DeCesare Julie 
Published: May 2017

INTRODUCTION:
Rates of cesarean deliveries have been increasing, and substantial regional variation for total cesarean delivery rates is 22.6% to 39.7%. The objective of this study is to reduce primary cesarean deliveries in nulliparous term singleton vertex (NTSV) births through a feedback and monitoring program.

METHODS:
This retrospective chart review involves analysis of all nulliparous term singleton vertex cesarean deliveries at Sacred Heart Health System from January 2015 through March 2016. Key components were extracted during chart review based on recommendations by the American College of Obstetricians and Gynecologists/SMFM Obstetrics Consensus. Individual monthly cesarean rates compared to blinded peers were then provided to physicians from June 2016 to present.

RESULTS:
From January 2015 through October 2015, there were a total of 308 NTSV cesarean deliveries. Indications included labor dystocia (28.1%), non-reassuring fetal heart tracing (NRFHT) (21.6%), and suspected fetal macrosomia (4.9%). In cases of suspected fetal macrosomia, an average birth weight of 4,140 grams was noted. Only 16.7% of the 66 cases of NRFHT had interventions documented prior to cesarean delivery. Of the 86 cases involving labor dystocia, only 10.5% met the definition of labor arrest or prolongation as defined by the American College of Obstetricians and Gynecologists/SMFM Obstetrics Consensus. Operative deliveries were attempted in only 2 cases of labor dystocia prior to cesarean delivery.

CONCLUSION:
Based on retrospective chart review, modifiable opportunities for decreasing cesarean deliveries in our institute were identified. Planned monthly feedback from June 2016 to June 2017 will be provided to physicians to trend the overall cesarean rates among nulliparous term singleton vertex deliveries.
The Effect of Body Mass Index on Glyburide Therapy in Pregnancy [26Q]
Authors: Henry Rosanne , Louis-Jacques Adetola , Miladinovic Branko , Nwabuobi Chinedu , Whiteman Valerie 
Published: May 2017

INTRODUCTION:
To determine association between glycemic control and body mass index (BMI) in women with gestational diabetes mellitus (GDM).

METHODS:
Retrospective study of women diagnosed with GDM and delivered at a university-affiliated hospital between November 2011 and November 2014. Adequate glycemic control was defined as: Fasting blood glucose less than 95 mg/dL or 1 hour postprandials greater than 140 mg/dL. BMI at delivery was calculated. The primary outcome was glycemic control using blood glucose log closest to the time of delivery. Parametric and non-parametric tests were employed for statistical analyses as appropriate.

RESULTS:
171 women met eligibility criteria: 10.5% overweight (n=18), 62.6% obese (n=107) and 24.6% morbidly (n=42). Four women (2.3%) with BMI in the normal range at delivery were not included in the analyses because of the small number. Gestational age at initiation of glyburide was 32 weeks (p=0.51). The glyburide daily dose at delivery was 5 mg for both the overweight and obese groups and 10 mg for the morbidly obese group. Total weight gain was similar in the three groups (p=0.53). There was no difference in glycemic control amongst the BMI groups (p=0.204), using the blood glucose log, however, there was a significant difference in HgbA1c levels (p=0.01).

CONCLUSION:
Successful treatment of GDM with Glyburide is not affected by BMI, using the blood glucose log as a glycemic control marker. However, HbA1c level was different between the BMI groups. Since HbA1c is a marker for long-term glycemic control, this deserves further study to examine its role in management of GDM amongst obese gravidas.
The Effect of Betamethasone on Middle Cerebral Artery Doppler Flow in Fetuses With Elevated Peak Systolic Velocities [27Q]
Authors: Luffy Katherine , Hoopes Sarah , Nitsche Joshua F. 
Published: May 2017

INTRODUCTION:
Administration of betamethasone (BMZ) has been shown to decrease the morbidity and mortality associated with preterm birth, and is given to patients with a variety of complications such as preterm labor, PPROM, fetal growth restriction, and alloimmunization, among others. As middle cerebral artery (MCA) Dopplers are used to monitor fetal hemodynamics in patients with many of these conditions, we sought to determine if administration of betamethasone is associated with changes in MCA Doppler parameters in fetuses with an abnormally elevated MCA peak systolic velocity (PSV).

METHODS:
A retrospective longitudinal study was conducted including women with a fetal MCA PSV greater than 1.3 MoM that had an MCA Doppler assessment within one week before and one week after betamethasone administration. Pre- and post-BMZ MCA PSV were compared using a repeated measures t-test.

RESULTS:
20 fetuses met inclusion criteria with diagnoses of alloimmunization (13), parvovirus infection (3), fetal growth restriction (2), and twin-twin transfusion (2). The pre-BMZ PSV of 1.60±0.16 MoM was significantly lower than the post-BMZ PSV of 1.41±0.16 MoM (p < 0.0001). 13 of the 20 fetuses had a second post-BMZ MCA Doppler performed with a PSV of 1.5±0.24 MoM which was not significantly different from the initial post-BMZ MCA PSV (p=0.231).

CONCLUSION:
Our data suggest that maternal betamethasone administration lowers the MCA PSV in fetuses with an initially elevated MCA PSV. This should be taken into account when using MCA Dopplers to monitor fetal hemodynamics in patients receiving BMZ.
The Cost-effectiveness of Tenofovir Prophylaxis to Prevent Mother-to-Child Transmission of Hepatitis B Infection [28Q]
Authors: Sargent James , Sharshiner Rita , Caughey Aaron B. 
Published: May 2017

INTRODUCTION:
In the setting of maternal Hepatitis B (HBV) antigen positivity and a HBV DNA level greater than 200,000 IU per milliliter there is increased risk of vertical transmission to the neonate. Infected infants are at risk for chronic HBV infection and its complications (cirrhosis, hepatocellular carcinoma, death). Tenofovir (with standard postpartum HBV immunoprophylaxis) has safely prevented vertical transmission of HBV infection without the risk of viral resistance seen with alternative therapies. We designed a model to examine the cost-effectiveness of Tenofovir prophylaxis when compared to postpartum immunoprophylaxis alone.

METHODS:
A decision-analytic model was built using TreeagePro and incorporated probabilities, costs, and utilities from the literature. This model was applied to a theoretical cohort of 100,000 women in order to assess the outcomes of maternal side effects and consequences of neonatal HBV transmission. A cost-effectiveness threshold was set to $100,000 per quality-adjusted life year; the robustness of the model was assessed with sensitivity analyses.

RESULTS:
In our model, Tenofovir prophylaxis resulted in 12,845 fewer cases of vertical HBV transmission, 3,468 fewer cases of cirrhosis, 1,387 fewer cases of hepatocellular carcinoma, and 388 fewer liver transplants. The use of Tenofovir conferred a savings of $232.77 per pregnancy, and—on sensitivity analysis—was the cost-effective strategy to a baseline transmission risk of 5.4% or up to a 17.7% transmission risk with the use of Tenofovir.

CONCLUSION:
In high-risk pregnancies with HBV infection, Tenofovir administration—in addition to standard postpartum immunoprophylaxis—is the cost-effective strategy to reduce the risk of vertical HBV transmission.