bluuebunny/crossref_metadata_2025_split huggingface dataset:
Depression and Social Support During Antepartum Hospitalization: A Needs Assessment [19B]
Authors: Young Danielle , Preyss Melissa , Sipsma Heather , Hair Stephanie , Siddiqui Maryam 
Published: May 2017

INTRODUCTION:
Antenatal hospitalization occurs in nearly one million women every year. The overall prevalence of perinatal depression is near 20% and is undefined in this population. We aimed to define rates of depression and social support in a historically understudied, primarily low-income, African-American population.

METHODS:
Fifty women who were hospitalized for at least 48 hours during pregnancy for maternal or fetal indications were screened with the Edinburgh Postnatal Depression Scale (EPDS) and Personal Resource Questionnaire (PRQ). An EPDS score of 10 or higher was considered a positive screen.

RESULTS:
Twelve (24%) participants had an EPDS score of 10 or greater; three (6%) scores were higher than 20. Average PRQ score was 146.5 (±25.97). Approximately 30% of participants disagreed that they belonged to a group to which they felt important, and 16% neither agreed nor disagreed on this item. 30% reported that they could not count on relatives or friends for help, and 66% were indifferent (somewhat agreed, were neutral, or somewhat disagreed) that others have similar problems. Parents (81.63%) were overwhelmingly selected as support for an urgent needs crisis, followed by significant other/spouse/partner (67.35%) and other relative (59.18%).

CONCLUSION:
One in four women who were hospitalized during pregnancy struggled with depressive symptoms. Some women may have difficulty identifying adequate social support, although many reported adequate support networks. Despite the frequency of antenatal hospitalization, nearly two thirds of women were unsure if others had similar problems. More research is needed to identify ways to support pregnant patients and decrease isolation during hospitalization.
Are There Predictable Blood Pressure Patterns After Delivery in Women With Preeclampsia? [20B]
Authors: Hirshberg Adi , Sammel Mary , Srinivas Sindhu K. 
Published: May 2017

INTRODUCTION:
There is limited data on blood pressure(BP) patterns after delivery among women diagnosed with preeclampsia. We sought to investigate immediate postpartum BP trajectories and the impact of fluid balance on these patterns.

METHODS:
Prospective cohort of women with preeclampsia from 2005-2009. Group-based trajectories were created using latent-class models based on all individual BPs from delivery to 48 hours postpartum. Fluid balance was defined as input minus output from admission until 24 hours postpartum. Odd ratios were calculated for association between BP group, fluid balance, mode of delivery, length of labor, and disease severity.

RESULTS:
96 women were evaluated. A model identifying four distinct patterns best fit the BP trajectories (class 1 (n=28):initial decrease in BP followed by rise at discharge, class 2(n=11):persistently elevated BPs, class 3(n=25):rising BPs until discharge, class 4(n=32):normal BP control). There was a statistically significant association between maternal age (p=0.0004) and initial weight(p=0.0005), parity(p=0.02), history of hypertension(p=0.035) or preeclampsia(0.024), and gestational age at delivery(p=0.018) with BP group. Women with a fluid balance greater than 500 cc and cesarean delivery after more than 12 hours of labor were more likely to be in group 3 vs 4(OR 3.97, p=0.03; OR 8.4, p=0.001). Severity of disease(p=0.36) was not associated with BP group.

CONCLUSION:
There are distinct patterns of BP immediately postpartum. Persistent hypertension is associated with age, chronic hypertension, fluid balance, length of labor, and mode of delivery. Future investigations should evaluate whether diuresis, as a modifiable factor, can alter patterns of BP and expedite resolution of hypertension in the postpartum period.
Delivery With a Palliative Care Plan: Incidence of Complications at Early Versus Late Gestations [21B]
Authors: Krueger Sarah , Peterson Erika , Piquette Theresa , Saripalli Asheema , Amos Angela 
Published: May 2017

INTRODUCTION:
The purpose of this study is to compare the incidence of delivery complications in pregnancies with neonatal palliative care plans at early versus late gestational ages.

METHODS:
A retrospective cohort study was performed at a single center from 2008 to 2015. Patients with lethal fetal diagnoses between 24 and 42 weeks gestational age and a neonatal palliative care plan were identified. Two cohorts were compared based on gestational age: 24-32 weeks, and 32-42 weeks. The primary outcome was identified as the composite outcome of retained placenta, operative intervention, blood transfusion and maternal fever. Other maternal variables collected included: maternal age, weight, gravidity, parity, and the method of delivery. Continuous variables were compared using non-parametric Mann Whitney exact test; categorical variables were compared with a Fisher exact test or chi square.

RESULTS:
Sixty-seven patients with lethal fetal diagnoses delivered with a palliative care plan between 24 and 42 weeks gestational age, 44 patients from 24 to 31 6/7 weeks and 23 patients from 32 to 42 weeks. There were 6 complications in early gestations (13.6%) and 2 in later gestations (9.6%), (P=.705). There was no significant difference in maternal demographics between the groups. There was a significant decrease in complications with increasing gravidity (P=0.01) and parity (P =.001) and an increase in complications with increasing maternal age (P=.091).

CONCLUSION:
More complications occurred in the earlier gestational age group, though this did not reach statistical significance. Complications occurred less often with increasing gravidity and more often with increasing maternal age.
Immediate Postpartum Intrauterine Device Insertion, Implant Insertion and Sterilization, U.S., 2008-2013 [33B]
Authors: Moniz Michelle , Chang Tammy , Heisler Michele , Admon Lindsay , Davis Matthew , Dalton Vanessa 
Published: May 2017

INTRODUCTION:
Our objective was to measure trends in immediate postpartum intrauterine device (IUD) insertion, contraceptive implant insertion, and tubal sterilization.

METHODS:
Among all delivery hospitalizations in the 2008-2013 National Inpatient Sample, we identified those with codes for tubal sterilization, IUD insertion, or contraceptive implant insertion. We used multivariate and multinomial logistic regression to examine associations between these outcomes and maternal and hospital characteristics over time.

RESULTS:
While the rate of sterilization remained similar over time, the rate of IUD/implant insertion increased over the study period (1.86 per 10,000 deliveries in 2008-09; 13.5 per 10,000 deliveries in 2012-13). Compared with receiving neither IUD/implant nor sterilization and adjusting for year and sociodemographic factors, IUD/implant insertion was more likely among women with medical comorbidity (adjusted odds ratio [aOR]=1.92; 95% confidence interval 1.72-2.13), with non-private insurance (aOR=5.23; 3.82-7.15), and delivering at teaching hospitals (aOR=19.8; 9.41-41.5). Sterilization was more likely among women with medical comorbidity (aOR=1.17; 1.14-1.20) and non-private insurance (aOR=2.20; 2.10-2.30), and less likely among women receiving care at urban versus rural facilities (aOR=0.59, 0.55-0.63). Comparing only women receiving IUD/implant insertion or sterilization, IUD/implant insertion was more likely among women with non-private insurance (aOR=1.9; 1.38-2.63), delivering at urban (aOR=2.18; 1.01-4.70) or teaching (aOR=17.6; 8.50-36.5) hospitals, and delivering later in the study period (aOR=4.51 in 2010-11; aOR=8.26 in 2012-13, compared to 2008-09).

CONCLUSION:
During delivery hospitalizations in the US from 2008-2013, the IUD/implant insertion rate increased by an order of magnitude. Immediate postpartum IUD/implant insertion is associated with medical comorbidities, non-private insurance status, and urban/teaching hospital status.
Immediate Versus Standard Postpartum Screening for Diabetes [35B]
Authors: Hsieh Frances , Blitz Matthew , Akerman Meredith , Simmonds Lisa , Rabin Jill , Meirowitz Natalie 
Published: May 2017

INTRODUCTION:
Current guidelines recommend women with gestational diabetes undergo diabetes screening 6-12 weeks postpartum, however the compliance rate is only about 50%. Failure to return for care is a major barrier to postpartum screening. We sought to determine whether immediate postpartum screening is as reliable as standard postpartum screening at 6-12 weeks postpartum.

METHODS:
This was a prospective cohort study with women with singleton gestations and gestational diabetes (A1 or A2). Patients underwent a 2-hour 75-g oral glucose tolerance test (OGTT) on postpartum day 2, and were asked to repeat the OGTT at 6-12 weeks postpartum. The sensitivity, specificity, negative predictive value (NPV), and positive predictive value (PPV) of the immediate postpartum OGTT were calculated as compared to the gold standard, the OGTT at 6-12 weeks postpartum. Results were considered abnormal if either the fasting blood glucose (BG) value was greater than 100mg/dL or the 2-hour BG value was greater than 140mg/dL.

RESULTS:
141 patients have been enrolled in the study. At this interim analysis, 70 completed the immediate postpartum screening for diabetes, and 53 returned for screening at the standard timeframe. Only the 53 patients with complete data were included in our analysis. The immediate OGTT had a sensitivity of 82.4%, specificity of 47.22%, NPV of 85.0% and PPV of 42.4%.

CONCLUSION:
Screening for diabetes immediately on postpartum day 2 is not a reliable substitute for screening at the current standard timeframe. Continued research with additional patients, and an analysis of clinical characteristics, may determine for which patients immediate screening is useful.
Impact of an Individualized Weight-Tracking Tool on Gestational Weight Gain Knowledge [37B]
Authors: Reid Allison B. , Berggren Erica K. 
Published: May 2017

INTRODUCTION:
Only ∼one-third of US women meet Institute of Medicine (IOM) gestational weight gain (GWG) guidelines. Whether women understand these body mass index (BMI)-specific guidelines and whether additional education could improve knowledge is unclear. We hypothesized that an individualized, GWG-tracking tool would improve patient knowledge about GWG guidelines and BMI.

METHODS:
Women with singleton pregnancies at one outpatient clinic were recruited for a clinical trial. Over eight weeks, women 15 0/7-22 6/7 weeks’ with at least one prior prenatal visit were enrolled in the control group. Women 6 0/7-14 6/7 weeks’ were enrolled in the intervention group at their first prenatal visit and received a GWG card from study staff who helped women record preconception weight, BMI, and BMI-specific GWG guidelines. Women were encouraged to record weight at each prenatal care visit. All women completed a GWG knowledge-based questionnaire at 15 0/7-22 6/7 weeks’. Groups were compared using bivariate analyses.

RESULTS:
Among 125 women, 45 (36%) comprised the intervention group. The intervention and control groups were similar in age, race/ethnicity, education, income, parity, and preconception BMI. Compared with control, intervention group women were not more likely to correctly define “BMI” (52% vs. 63%, p=0.5), correctly classify their preconception BMI (48% vs. 51%, p=0.9), recall their BMI-specific GWG guidelines (51% vs. 67%, p=0.1), or think they would meet GWG guidelines (58% vs. 50%, p=0.5).

CONCLUSION:
Our intervention did not improve GWG or BMI knowledge. These data underscore the deficit in fundamental knowledge among pregnant women, which may contribute to the limited success of GWG interventions.
Risk of Cesarean With Obesity and Advancing Maternal Age [5C]
Authors: Petersen Shariska , Khangura Raminder , Fitzgerald Michael , Sousa Denise , Goyert Gregory 
Published: May 2017

INTRODUCTION:
The objective of this study is to examine the impact of obesity on cesarean birth rate in an older group of primigravid women.

METHODS:
This retrospective study analyzed data on nulliparous women over 34 years of age who delivered between January 2013 and July 2016 at a single institution. Abstracted data included: BMI, gestational age at delivery, mode of delivery, spontaneous or induced labor, indication for cesarean, and co-morbidities (chronic hypertension, diabetes, preeclampsia, IUGR).

RESULTS:
One hundred thirty one patients were included. Obesity rate was 48% (BMI greater than 30kg/m2) with a mean maternal age of 37.5 years. The overall C/S rate was 61.8% (81/131). Twenty-seven patients had c/s prior to active labor, 31 were associated with labor induction, and 23 were associated with spontaneous labor. Obese patients had a 122% increase odds of cesarean birth, compared to those with a BMI at or below 30. For every one unit increase in BMI, there was a 7% increase in the odds of cesarean birth. Obese African American patients had a 141% increase odds of cesarean birth when compared to all other groups. For all groups, the most common indication for cesarean section was non-reassuring fetal status.

CONCLUSION:
This population confirms the association of increasing BMI with higher C/S rates and this is exaggerated in older nulliparous women. The further increase in rate in African American patients may be related to the increased incidence of clinically significant fibroids associated with malpresentation or obstruction and warrants further study to enhance our counseling for these patients.
An Abnormal 1 Hour Glucose Screen and Ultrasound Evidence of Hyperglycemia Should Be Managed as Gestational Diabetes [6C]
Authors: Crimmins Sarah , Mo Cecilia , Nassar Yomna , Harman Chris , Turan Ozhan 
Published: May 2017

INTRODUCTION:
To investigate the risk of impaired glucose metabolism (IGM) and ultrasound findings consistent with hyperglycemia on maternal and neonatal outcomes.

METHODS:
Retrospective case-control study of singleton, non-anomalous fetuses with IGM and gestational diabetes (GDM). IGM was defined as a one hour GST of greater than 134 but less than 2 abnormal values on 3 hour GTT. Ultrasound evidence of hyperglycemia was defined as abdominal circumference greater than 95th percentile and/or polyhydramnios. Individuals with IGM were divided into those with ultrasound evidence of hyperglycemia (IGM-US) and those without (IGM). Maternal demographics, delivery (gestational age (GA) at delivery, delivery mode, shoulder dystocia, lacerations), postpartum hemorrhage (PPH), and neonatal outcome (birth weight percentile (BW%), NICU admission, hypoglycemia, respiratory complications, glucose, and length of stay) were recorded. Composite morbidity was tabulated. Delivery and neonatal outcome variables were compared in individuals with IGM-US, IGM, and GDM. Odds ratios were calculated and adjusted with maternal age, race and gestational age at delivery.

RESULTS:
A total of 324 individuals with an abnormal 1-hour were included (96 with IGM-US, 108 with IGM, and 120 with GDM). In comparison to the IGM group, IGM-US had higher rates of induction, cesarean delivery, BW% > 90th percentile at delivery, and respiratory complications in the neonate (p less than 0.05 for all). Individuals with IGM-US had significantly larger neonates by birth weight and percentile than individuals with GDM (67.04[3.9-99.9 v 59.9[1.7-99.9](p = 0.001). The remaining outcomes were similar.

CONCLUSION:
Women with IGM and ultrasound markers of hyperglycemia should be identified and managed as a gestational diabetic.
Amniotomy Affects the Urine Protein Creatinine Ratio Accuracy in the Diagnosis of Preeclampsia [9C]
Authors: Quinn Sara , Lennon Jessica , Gonzalez Aaron Herrera , Dierking Elizabeth , Anasti James 
Published: May 2017

INTRODUCTION:
Preeclampsia is a leading cause of obstetric related morbidity and mortality, making prompt diagnosis crucial. While the gold standard for evaluation of maternal urinary protein is a 24 hour urine collection, the spot urine protein creatinine ratio (Up/Ucr ratio) greater than 0.3 g/gcr has been instituted as an alternative. No studies have evaluated the effect of amniotomy, spontaneous or artificial, on the accuracy of the Up/Ucr ratio. We hypothesize the proteins and creatinine found in amniotic fluid may erroneously alter the test result leading to an incorrect diagnosis of preeclampsia.

METHODS:
We performed a case-control trial where each patient served as their own control. An initial random catch urine was obtained for Up/Ucr ratio in women with intact membranes. Following amniotomy a second random catch Up/Ucr ratio was obtained. The urine samples were analyzed in the hospital chemistry department and results compared for consistency.

RESULTS:
The 49 study patients had the following characteristics; Age: 28.8 ± 5.8y, Gravid: 2.7 ± 1.5, Gestational age: 39.1 ± 1.8wks, and BMI: 31.2 ± 6.6 kg/m2. Co-morbidities included 3 gestational diabetic, 2 chronic hypertensive and one preeclamptic patient. Post-amniotomy Up/Ucr ratio was significantly higher than Pre-aminotomy (1.1±2.1 vs 0.23 ± 0.15, p=0.001). The prevalence of Up/Ucr greater than 0.3 g/gcr was higher post amniotomy than pre-amniotomy (28 vs 8, p =0.001).

CONCLUSION:
Amniotomy results in false elevation of the Up/Ucr ratio. Obtaining urine via straight catheterization may be necessary to reduce false positive results.
Adverse Pregnancy Outcomes Among Women With Urinary Tract Infections: Comparing Sensitive and Resistant Organisms [27C]
Authors: O'Malley Katharine , Suharwardy Sanaa , Sie Lillian , Lee Henry C. , Gibbs Ronald S. , Aziz Natali 
Published: May 2017

INTRODUCTION:
The primary aim of this study was to examine whether uropathogen resistance affects the rate of preterm birth. Second, to examine whether uropathogen resistance affects the rate of perinatal maternal or neonatal infectious morbidity.

METHODS:
Retrospective cohort study of pregnant women who (1) received obstetric care and delivered at Stanford Children’s Hospital/Lucile Packard Children’s Hospital on the university teaching service and (2) had at least one positive urine culture (≥ 100,000 colony-forming units (cfu) per milliliter (mL)) performed through the Microbiology Lab between January 1, 2010 and August 31, 2014. Urine cultures that yielded likely contaminants were excluded from our analysis. We categorized organisms as “sensitive” or “resistant” based on reported antimicrobial resistance. The primary outcome was preterm birth at < 37 weeks of gestation. Secondary outcomes were composite maternal and neonatal infectious morbidities.

RESULTS:
197 women with UTI were eligible for analysis - 68 (34.5%) had pregnancies complicated by “sensitive” uropathogens and 129 (65.5%) had pregnancies complicated by “resistant” uropathogens. In univariate analysis, the rate of preterm birth was not statistically different; 19.1% among women with sensitive uropathogens and 22.5% among women with resistant uropathogens (P=0.58). UTI with a “resistant” uropathogen was not associated with an increased risk of preterm birth in multi-factorial analysis that included risk factors for preterm birth (aOR 1.2, 95% CI 0.58-2.69). We found no statistical difference in composite maternal and neonatal infectious morbidities.

CONCLUSION:
UTI with a “resistant” uropathogen was not associated with an increased risk for preterm birth nor with composite maternal and neonatal infectious morbidities.
Allostatic Load During the Interconception Period in Women Who Had Gestational Diabetes Mellitus [14C]
Authors: Herrman Sarah , Hobel Calvin , Shalowitz Madeleine , Ramey Sharon 
Published: May 2017

INTRODUCTION:
Gestational diabetes mellitus (GDM) is a condition disproportionately affecting racial/ethnic minorities, but the reasons for this disparity remain unclear. GDM in one pregnancy also greatly predicts GDM in future pregnancies. Allostatic load (AL) measures cumulative effects of physical and psychological stress on multiple body systems. Directly measuring and monitoring AL presents a novel way of assessing health risk biomarkers in mothers. We aim to determine the relationship between maternal AL and GDM in the interconception period.

METHODS:
Data collection occurred through the 5-site NIH Community Child Health Network. AL was analyzed as an absolute value plus individual indices to determine associations to GDM at both 6 and 12 months postpartum. ANOVAs were performed to assess relationships between AL, stress, and resiliency in women with and without GDM.

RESULTS:
There are significant differences in AL between the GDM (N=61) and non-GDM (N=1421) groups at 6 and 12 months (P < .001), particularly in the African-American group at both time points (P < .001). There was no significant change in AL from 6 to 12 months postpartum for either group. There were no significant differences between the groups for self-reported measures of stress and resiliency. Total chronic life stress is significantly correlated with AL at both times for both groups (P < .01).

CONCLUSION:
Differences in AL between mothers with and without GDM highlights a worse picture of health postpartum for women with GDM, especially African-American women. Women with increased AL and GDM need more rigorous and focused interconception care in order to prevent GDM and improve overall health.
Adverse Neonatal Outcomes Among Women With Hypertensive Disorders of Pregnancy [28C]
Authors: Rincon Monica P. , Kuo Kelly , Sabol Bethany , Burwick Richard 
Published: May 2017

INTRODUCTION:
The American College of Obstetricians and Gynecologists (the College) provided new guidance for diagnosis and management of hypertensive disorders of pregnancy. The impact of these changes is unclear; so we sought to compare adverse neonatal outcomes among women with hypertensive disorders of pregnancy.

METHODS:
Retrospective cohort study of singleton deliveries occurring greater than or equal to 23 weeks gestational age from September 2015 to March 2016 in a single institution. Subjects were screened for hypertension in pregnancy utilizing hospital discharge codes, and diagnoses confirmed by individual chart review. Subjects were placed into 4 groups by College criteria: chronic hypertension (CHTN), gestational hypertension (GHTN), preeclampsia (PE) without severe features (SF), and PE with SF.

RESULTS:
In our cohort of 1,399 consecutive deliveries, 193 women (13.8%) with hypertensive disease met inclusion criteria; CHTN (3.1%), GHTN (3.2%), PE without SF (3.6%) and PE with SF (4.1%). Women with CHTN had higher BMI and were less often nulliparous compared to those with GHTN or PE (BMI p < 0.001; nulliparous p=0.001). Subjects with CHTN delivered earlier than those with GHTN or PE without SF (p=0.003). Rates of adverse neonatal outcomes were increased with CHTN compared to GHTN (preterm birth p=0.040; NICU admission p=0.021; RDS p=0.026), but adverse outcomes were similar between CHTN and PE without SF.

CONCLUSION:
We find that women with CHTN have rates of adverse neonatal outcomes similar to women with PE without SF, but higher than GHTN. Our findings reinforce the College’s recommendation to maintain vigilance in pregnancies complicated by CHTN.