bluuebunny/crossref_metadata_2025_split huggingface dataset:
Public Perspectives on the Inclusion of Pregnant People in Clinical Trials [ID 2683498]
Authors: Wood Megan L. , Kons Kelly , Hershberger Sarah , Peck Lindsey , Sznajder Kristin , Horvath Sarah 
Published: May 2024

INTRODUCTION:
Pregnant people remain underrepresented in clinical trials despite extensive efforts to increase participation. The public’s perception about including pregnant people in research is limited, and no publications to date specifically include self-identified males. This research aims to elucidate the attitudes of reproductive-aged people in the United States regarding the inclusion of pregnant individuals in clinical trials.

METHODS:
An IRB-approved survey including five Likert-scale questions concerning the inclusion of pregnant patients in research was distributed via Facebook Marketing. Self-reported gender, race, ethnicity, education level, political affiliation, religion, relationship status, and contraceptive use and method were analyzed in bivariate analyses. Variables significant in the bivariate analyses were included in multivariable logistic regression models.

RESULTS:
Among 743 respondents, 405 (54.6%) agreed that pregnant people should be excluded from clinical trials and 392 (52.8%) agreed that the risks of including pregnant people in clinical trials outweigh the benefits. Females had lower odds of agreement (odds ratio [OR] 0.46 [95% CI, 0.33–0.65] and 0.39 [95% CI, 0.28–0.54], respectively). Most respondents (74.2%) agreed that pregnant people should obtain partner consent prior to participation; notably, males had 3.9 times greater odds of agreement (95% CI: 2.51–6.10). Paradoxically, 504 people (67.9%) agreed that including pregnant people in research is important for providing evidence-based medicine.

CONCLUSION:
Most participants agreed with excluding pregnant people from clinical research; however, self-identifying females were more likely than males to value the safe inclusion of pregnant people in clinical research to advance evidence-based obstetrical care. This juxtaposition highlights an important challenge to achieving equitable inclusion of pregnant people in clinical research and the importance of public perception in improving maternal and child health outcomes.
Gestational Diabetes Significantly Associated With Food Insecurity and Insurance Status in the United States [ID 2683536]
Authors: Nandwani Jaan , Nandwani Roshni , Mitra Ayon , Nelson Tracy 
Published: May 2024

INTRODUCTION:
Gestational diabetes (GD) is on the rise in the United States, posing risks to women's cardiovascular health, pregnancy, and their offspring's well-being. We sought to characterize the association between food insecurity and health care access and GD prevalence.

METHODS:
We analyzed data from 29,732 females aged 18+ in the 2021–2022 National Health Interview Survey to determine the prevalence of self-reported GD and its relationship with food security and health insurance status. We used χ2 tests to compare GD rates across different food security classifications and insurance statuses. Additionally, we cross-examined GD rates within food security groups based on insurance coverage.

RESULTS:
The overall GD prevalence among females was 5.70%. Stratified by food security, significant differences emerged (P<.05): 5.23% for high security, 7.99% for marginal security, 7.72% for low security, and 11.85% for very low security. We observed significant differences in GD rates by insurance coverage (P<.05): 5.57% for insured and 7.72% for uninsured respondents. Notably, when individuals were not highly food secure, there was no significant difference in the prevalence of GD between those who were insured or uninsured.

CONCLUSION:
This study highlights the significant associations between food insecurity, insurance coverage, and GD prevalence, although our cross-sectional analysis indicated that food insecurity may be the more salient factor. To combat GD's rise, policies should prioritize providing nutritious food access to pregnant women, potentially through mobile food units. Further research should explore whether food insecurity causally affects GD.
Developing a Maternal Health Worker Training Program in Rural Mississippi [ID 2683576]
Authors: Davis Julia O. , Flore Barbara J. , ME  , Ragunanthan Braveen , Burrell Raven , Boyles Robin , Ragunanthan Nina W. 
Published: May 2024

INTRODUCTION:
Mississippi faces the highest infant mortality rate and maternal mortality rate in the United States, with rates for Black women four times higher than for White women. Using community maternal health workers (MHWs) to support patients during pregnancy and postpartum has proven beneficial in other locations and could be transformative in rural Mississippi. We aimed to identify key patient needs to create a MHW training program in the rural Mississippi Delta, as a component of a broader maternal health quality improvement project.

METHODS:
We conducted quality improvement interviews with 18 obstetric patients (10 prenatal, 8 postpartum) at Delta Health Center, a federally qualified health center in Mound Bayou, Mississippi. We queried patients about strengths and gaps in their prenatal care and their opinions on MHWs. We also queried the obstetrics and gynecology and pediatrics teams at Delta Health Center to identify key pregnancy, postpartum, and infant care and development topics needed for MHW training.

RESULTS:
17/18 (94%) of the patients interviewed were in support of the MHW program. The following themes emerged in patient interviews: desire for psychologic support, connection to community resources, and help managing high-risk pregnancy conditions. We designed a 2-week training for MHWs that covers: MHW Responsibilities, Pregnancy Care, Childbirth, Postpartum Care, and Newborn Care and Infant Development. Based on patient feedback, the training prioritizes content related to psychological support and high-risk pregnancy care.

CONCLUSION:
Patients expect MHWs to be valuable assets for their care. Maternal health workers have the potential to support pregnant women in rural health care settings, ultimately enhancing maternal–fetal health outcomes.
Evaluating TeamBirth's Effect on Autonomy for Minoritized Populations in Labor [ID 2683585]
Authors: Oliphant Morcquess , Moore Simas Tiffany A. , Leung Katherine 
Published: May 2024

INTRODUCTION:
Prioritization of maternal autonomy and communication can greatly affect obstetric care experiences. We implemented TeamBirth—an initiative designed to center the patient, their preferences, and autonomy through standardized team communication in labor. We sought to understand how TeamBirth affected obstetric care experiences, through self-reported autonomy, for minority populations.

METHODS:
TeamBirth “huddles” in labor included patients, labor support persons, physicians, and nursing team members participating in standardized communication approaches, supplemented with whiteboard and decision-support guides. From May 2021 to May 2022, surveys administered postpartum inpatient were collected from birthing persons. We used the Mother’s Autonomy in Decision Making Scale (MADM) to measure autonomy. MADM scores in the highest quartile (scores ranged 34–42) were considered as having high autonomy.

RESULTS:
Over one-third (36.4%) of the 762 respondents were of minoritized populations (eg, Black, Hispanic) versus White (63.3%). When considering race/ethnicity, high autonomy was not related to minoritized group (P=.944). The majority (86%) of high autonomy respondents had one or more huddles, compared to 71% with low autonomy (P<.001). When evaluating the relationship of number of huddles to high autonomy, the minority group was not different compared to White patients (interaction P=.915).

CONCLUSION:
Patients who experienced huddles during intrapartum care reported higher autonomy regardless of minority status. Use of the TeamBirth initiative has potential to increase autonomy and improve obstetric experiences. Early data indicate that patient experiences of minoritized populations can be improved with TeamBirth; additional investigation is indicated.
Exploring Trust in Pregnancy Care Clinicians Among Latine Patients in Spanish and English: A Qualitative Study [ID 2683628]
Authors: Molina Rose L. , Casul Giuliana Rivera , Bazan Maria , Del Pilar Pazos Herencia Yessamin , Hacker Michele R. , Guise Jeanne-Marie 
Published: May 2024

INTRODUCTION:
Trust between patients and clinicians is critical for better experiences and outcomes, yet there is no consensus on how trust is defined and measured in pregnancy care. We aimed to explore how patients define trust in clinicians; facilitators and barriers to building trust; and how trust may be eroded and rebuilt over time.

METHODS:
A bilingual, multicultural team led this qualitative focus group study. The semistructured discussion guide included definitions of trust based on a literature review, how trust is built, when trust is lost, external factors that influence the patient–clinician relationship, previous pregnancy experiences, and sources of trustworthy information during pregnancy. The discussions were audiorecorded and transcribed in the language in which they were held. We performed thematic content analysis on transcripts using both deductive and inductive approaches in each language. Codes were organized and synthesized according to emerging themes. The IRB approved this study.

RESULTS:
We held eight focus groups of Hispanic/Latine pregnant and postpartum patients; five were held in Spanish and three in English with a total of 35 participants. We identified five constructs of trust: communication, comfort, caring, competency, and accompaniment (“acompañamiento”). Facilitators of trust were warm interpersonal dynamics, continuity with clinician and care team, rapid direct communication with clinician, and language concordance. Barriers of trust were inadequate or inaccurate information, rotating clinicians, cold interpersonal dynamics, and language discordance. There were few differences between Spanish and English groups.

CONCLUSION:
Patient perspectives about building trust with clinicians are critical for improving the quality of patient–clinician relationships, especially when language barriers exist.
Voices From the Field: Amplifying Clinicians' Perspectives for Black Maternal Equity [ID 2683631]
Authors: Chachere Breanna , Rhone Tonia J. , Shin Grace , Marroquin Hyacinthe Raquel A. , Amutah-Onukagha Ndidiamaka N. , Meadows Audra R. 
Published: May 2024

INTRODUCTION:
Nationally, Black birthing individuals face a disproportionate burden of maternal mortality and severe maternal morbidity. Although there is growing research interest in tackling these inequities, a significant gap exists in incorporating the insights and perspectives of interprofessional front-line clinicians. This study sought to learn the experiences and viewpoints of physicians, certified nurse-midwives (CNMs), and registered nurses (RNs) to identify strategies for addressing maternal care inequities.

METHODS:
In collaboration with our community advisory board, we constructed semistructured questions to conduct interviews and focus groups with obstetrical clinicians. Transcripts were coded using NVIVO, utilizing inductive and deductive approaches, and content and narrative analysis to identify themes. Participant consent and IRB exemption status were obtained.

RESULTS:
We interviewed 20 clinicians: 6 ob-gyn physician interviews, 3 CNMs, and 14 RNs across two focus groups between January and July 2023. Key themes emerged regarding systemic challenges and opportunities. Identified challenges include 1) clinician bias and poor communication, 2) unequal care, 3) patient mistrust, and 4) lack of administrative data. Opportunities for future directions include 1) implementation of clinician training and simulation with an equity lens, 2) standardization of maternal care with safety bundles, 3) incorporation of group prenatal care and expansion of postpartum wraparound services, and 4) disaggregation of clinical operations data by race.

CONCLUSION:
This study identifies key challenges and opportunities to address the Black maternal health crisis. Our findings inform priorities to guide ACOG's collective action and commitment to eliminating racial inequities that lead to disparate health outcomes.
Oxytocin Compared With Prostaglandin as First Agent in Prelabor Rupture of Membranes [ID 2683446]
Authors: O'Neill Margaret R. , Birchall Courtney , Leung Katherine , Leftwich Heidi K. 
Published: May 2024

INTRODUCTION:
Prelabor rupture of membranes (PROM) occurs in 8% of term deliveries. After PROM, induction of labor (IOL) is recommended to decrease risk of intra-amniotic infection and time to delivery. Therefore, finding the safest, most effective way to induce labor in this patient population is important to clinical practice.

METHODS:
The goal of this investigation is to compare rate of vaginal delivery among patients receiving oxytocin versus prostaglandin as a first-line agent for IOL after PROM. Secondary outcomes include time to vaginal delivery, parity, and cervical dilation. This study involves a secondary analysis of an IRB-approved retrospective chart review investigating cervical ripening in all patients who delivered from 2020 to 2021 at our institution.

RESULTS:
A total of 365 patients presented with term PROM during the study period. The sample was primarily nulliparous (61.8%) with mean gestational age of 39.1 weeks. More patients in the oxytocin group than the prostaglandin group delivered vaginally (86.2% versus 82%). Patients treated with oxytocin as first agent were found to have faster time to any delivery than prostaglandin as first agent (median 14.9 versus 25.7 hours; P<.001). This result was regardless of parity or whether a cervical exam was documented at time of presentation.

CONCLUSION:
In our study population, patients induced with oxytocin had a faster time to vaginal delivery without affecting risk of cesarean, regardless of nulliparity status or cervical dilation at time of presentation, supporting a more standard use of oxytocin as a first-line for term PROM IOL.
YouTube Video Characteristics as Indicators for Adherence to Accurate Water Birth Guidelines [ID 2683502]
Authors: Chen Jamie , Fleming Erika G. , Collamore Katherine , Oladipo Antonia F. 
Published: May 2024

INTRODUCTION:
The accessibility of YouTube videos has made it a popular platform for seeking and sharing pregnancy advice, especially experiences related to “natural” delivery methods like water births. Therefore, it is important to understand which video characteristics amassed more views as well as explore the relationship between characteristics and accuracy of information. We aim to assess what components of water birth YouTube videos are predictive of more accurate content with evidence based on American College of Obstetricians and Gynecologists (ACOG) guidelines.

METHODS:
A YouTube search on “water birth” was conducted using the filter “most viewed.” The first 100 videos were selected using a strict inclusion criteria, and video characteristics were recorded. Video views ranged from 457,296 to 78,035,874. Reviewers scored videos in accordance with published guidelines using the “ACOG Water Birth Rubric.” Chi-squared goodness-of-fit and independence tests were performed to assess significance of differences between groups.

RESULTS:
Out of 96 videos, 13.1% from North America were scored as accurate, versus 15% from other continents (P=.5754). Only 14.4% of videos from personal channels were accurate, despite comprising 71.8% of all videos in the top 100. All videos from doulas and midwives scored neutral, and there were no videos from health care professionals with advanced degrees. Commercial videos had the highest amount of accurate videos at 16.6%. Videos with a supportive figure in the thumbnail had significantly less videos graded as inaccurate (3.5%) compared to those without (18%; P=.0003).

CONCLUSION:
Patients use YouTube videos as a resource for pregnancy information, particularly for alternative birthing practices. North America has some of the most popular videos and personal channels that often deviate from ACOG guidelines. Our findings highlight an urgent need for health care professionals to guide patients towards evidence-based resources, especially for alternative birth practices, and contribute accurate and informative content on such platforms.
What's in a Name? Provider Type and Delivery Outcomes for Nulliparous, Term, Singleton, Vertex Pregnancies in an Urban Hospital [ID 2683515]
Authors: Vorawandthanachai Thammatat , Sher Olivia , Kumar Vani , Ajayi Blessing , Ram Kavitha T. 
Published: May 2024

INTRODUCTION:
Few studies have compared the rates of cesarean section of nulliparous, term, singleton, vertex (NTSV) pregnancies between those managed by physicians and those managed by midwives. Our aim was to compare those rates and to determine whether there were any associated differences in neonatal outcomes.

METHODS:
This was a retrospective cohort study of NTSV pregnancies at an urban hospital over 3 months. Two groups were compared: patients who were managed by physicians and those managed by midwives. Our primary outcome was the rate of primary cesarean delivery for each group. Patient demographics and outcomes were compared using a χ2 analysis for categorical variables and Mann–Whitney U test for continuous variables, with significance being alpha <.05. Our study was approved by the Maimonides IRB.

RESULTS:
Between January and March 2023, there were 315 NTSV deliveries. Of these, 230 (73%) were admitted by physicians and 85 by certified nurse-midwives (27%). The NTSV patients admitted and managed by physicians were significantly more likely to undergo cesarean delivery (30.9% versus 16.5%; P=.01). This trend remains significant (P=.04) when adjusted for high-risk maternal comorbidities (ie, diabetes, hypertension, and maternal body mass index). There were no significant differences of neonatal outcomes between physician and midwives groups in Apgar scores (1 minute P=.43, 5 minutes P=.19), neonatal intensive care unit (NICU) admissions (P=.84), or NICU stay length (P=.89).

CONCLUSION:
The NTSV pregnancies managed by midwives resulted in fewer cesarean deliveries with similar neonatal outcomes. Further investigation is needed to assess causes of the difference between provider types and to develop interventions to address the discrepancy.
Association Between Proximity to Delivery Hospital and Postpartum Contraception Choice [ID 2683622]
Authors: Barbee Olivia , Class Quetzal A. 
Published: May 2024

INTRODUCTION:
Proximity to prescribers may present a barrier to postpartum contraceptive care. We examine associations between postpartum contraceptive choice and residential proximity to the prescribing, delivery hospital.

METHODS:
After IRB approval, we collected electronic medical record data from 2020 to 2022 at an inner-city, academic hospital and used CDXGeoData to determine residential distance to the hospital. Contraceptive choice at delivery, 2 weeks, and 6 weeks postpartum, focusing on long-acting reversible contraception (LARC) versus other contraceptives, was compared across distance to hospital.

RESULTS:
We identified 3,705 births: 53.5% Black, 30.3% Hispanic, and 73.7% utilizing public health insurance. Residential distance to the hospital was 0–1,724 miles with 74.2% living within 10 or fewer miles. Those residing within 10 miles were more likely to be non-Black (X2 (2)=12.02; P<.01), Hispanic (X2 (2)=83.91; P<.001), single (X2 (3)=33.54; P<.001) and primiparous (X2 (3)=13.09; P<.01). Cesarean section was more frequent (32.5% versus 28.1%; X2 (2)=6.58; P<.01) and gestational age shorter (U=1171108; P<.05) for those living further from the hospital. Postpartum tubal ligation did not differ across groups. LARC uptake at discharge and 2 weeks postpartum trended towards being higher for women who lived further (X2 (1)=3.49; P=.06; aOR 1.15; 95% CI, 0.96–1.39).

CONCLUSION:
There is a trend towards increased LARC uptake if the patient resides further from their delivery hospital after controlling for confounding factors. Our findings add to understanding of patient preferences and barriers to care.
Memorial Regional Hospital Placenta Accreta Spectrum Program: Quality Evaluation of Outcomes [ID 2683637]
Authors: Solis Josselyn , Thompson Safeya , Myers Erin , McCreath Wayne , Kang Julie H. 
Published: May 2024

INTRODUCTION:
Placenta accreta spectrum (PAS) affects 1/272 deliveries with a mortality rate of 7%, which is often related to life-threatening hemorrhage. Morbidity related to PAS is often due to complications such as hemorrhage requiring blood transfusion, intensive care unit (ICU) admission, and prolonged hospital stay. The American College of Obstetricians and Gynecologists supports a multidisciplinary approach to management of pregnancies complicated by PAS, and as such our protocol for management of PAS was started in 2016. Our approach to the management of PAS includes a high-risk navigation team, monthly multidisciplinary team meetings, early admission for surgical planning, a dedicated team with 24-hour coverage, blood bank specialist involvement at the time of surgery, the availability of backup surgeons, and coordination with other surgical subspecialties.

METHODS:
This project is a quality review of outcomes of 216 females between 2016 and 2023. Using linear regression analysis, we evaluated four primary outcomes: quantitative blood loss (QBL), blood products transfusion (BPT), length of stay (LOS), and ICU admissions.

RESULTS:
Linear regression outcomes showed that our QBL, BPT, and LOS among non-ICU patients is lower than the national average and within national average among those admitted to the ICU, with the exception of BPT. Finally, placenta pathology and location may not be a major factor negatively affecting surgical outcomes among PAS patients in a structured program and should be a factor considered when developing PAS centers.

CONCLUSION:
Our findings from our quality review support the use of a multidisciplinary and surgically structured approach for managing patients with PAS.
Racial Disparities in Maternal Blood Transfusion in the United States by Mode of Delivery: A Population-Based Retrospective Cohort Study [ID 2683649]
Authors: Pour Parnian Hossein , Rajasingham Maya , Muraca Giulia M. 
Published: May 2024

INTRODUCTION:
Despite well-documented racial disparities in maternal health in the United States, gaps remain in characterizing the distribution of these disparities within specific interventions and outcomes during childbirth, such as blood transfusion. We aimed to assess racial disparities in maternal blood transfusion in the United States overall and stratified by mode of delivery.

METHODS:
We performed a population-based retrospective cohort study of term, live births (2016–2021) using U.S. Natality Files. Regression models were constructed to estimate adjusted odds ratios (aORs) and 95% CIs of maternal blood transfusion (during labor or delivery) by self-identified maternal race in the total population, and among subgroups stratified by mode of delivery. Models were adjusted for maternal and obstetric practice factors.

RESULTS:
The study included 15,936,920 deliveries; maternal blood transfusion occurred in 3.7 per 1,000 deliveries. Compared with White individuals (3.5 per 1,000 transfusion rate), higher odds of transfusion were seen among American Indian and Alaskan Native (AIAN) (aOR 2.31; 95% CI, 2.19–2.44) and Pacific Islander individuals (aOR 1.65; 95% CI, 1.46–1.86). The frequency of transfusion and racial disparities in transfusion rates varied substantially by mode of delivery. For example, among forceps deliveries, compared with White individuals (9.1 per 1,000 transfusion rate), Chinese individuals had a nearly twofold higher rate of transfusion (aOR 1.93; 95% CI, 1.30–2.87), whereas Black individuals had a nearly 30% lower rate (aOR 0.71; 95% CI, 0.56–0.91).

CONCLUSION:
Racial disparities in maternal blood transfusion persist after adjustment for several confounders, particularly within AIAN and Pacific Islander individuals, and vary by mode of delivery.