bluuebunny/crossref_metadata_2025_split huggingface dataset:
Concurrent Chemoradiotherapy Compared With Neoadjuvant Chemotherapy Followed by Radical Hysterectomy for FIGO Stage IIB Cervical Cancer Patients: A Systematic Review and Meta-analysis [ID 2683429]
Authors: Soliman Ahmed , Adel Rawda , Elnaggar Mohamed , Soliman Amr 
Published: May 2024

INTRODUCTION:
Cervical cancer is the fourth most common malignant disease and cause of cancer death in women worldwide. FIGO stage IIB includes cervical carcinomas with invasion of the parametria. Despite innovative treatment approaches, recurrence and mortality rates among patients with locally advanced cervical cancer (LACC) have not been significantly reduced. The current treatment recommendation for FIGO stage IIB is concurrent chemoradiotherapy (CCRT). Neoadjuvant chemotherapy followed by radical hysterectomy (NACT+HE) represents a valid alternative.

METHODS:
According to the PRISMA guidelines and Cochrane handbook recommendations, we systematically searched the following databases up to January 2023: PubMed, Scopus, Web of Science, and Cochrane CENTRAL for relevant studies and reports that compare NACT+HE versus CCRT for patients with LACC and specifically with FIGO stage IIB.

RESULTS:
Our search results revealed 1,034 records, of them only 6 studies (n=2,055); 2 clinical trials and 4 observational cohorts were eligible to be included in both qualitative and quantitative analyses. Patients with FIGO stage IB2–IVA showed no advantage for 5-year overall survival (OS), disease-free survival (DFS), or progression-free survival (PFS) with NACT+HE compared to CCRT (hazard ratio [HR] 0.66 [95% CI: 0.43–1.01]; HR 0.62 [95% CI: 0.23–1.65]; and HR 0.88 [95% CI: 0.51–1.50]). A subgroup analysis for patients with FIGO stage IIB showed a significantly better 5-year DFS for CCRT compared to NACT+HE (HR 1.86 [95% CI: 1.23–2.81]); however, no significant improvement was shown for 5-year OS and 5-year PFS (HR 0.88 [95% CI: 0.52–1.49] and HR 0.85 [95% CI: 0.56–1.29]), respectively.

CONCLUSION:
This meta-analysis did not show any advantage for women with LACC treated with the NACT+HE approach compared to those treated with the CCRT approach. However, in a stage-specific analysis of patients with FIGO stage IIB cervical cancer, CCRT was superior to NACT+HE in terms of DFS, whereas no significant difference was shown for OS or PFS.
Embryonic Parameters Associated With Outcomes of Single Blastocyst Frozen Transfer [ID 2683440]
Authors: Ahart Erin R. , Shu Yimin 
Published: May 2024

INTRODUCTION:
It is unclear how various in vitro fertilization cycle characteristics may ultimately influence the fertility outcomes of patients utilizing assisted reproductive technology. This study investigates embryo characteristics to determine which features are most associated with clinical intrauterine pregnancy after frozen embryo transfer.

METHODS:
This retrospective study evaluates 535 single blastocyst frozen embryo transfers (FETs) in 2022 and received IRB approval from the University of Kansas. Logistic regression analyses were used to evaluate embryo characteristics and likelihood of clinical intrauterine pregnancy (IUP), defined as positive fetal cardiac activity on ultrasound after 12 weeks of gestation. Blastocyst survival (percentage of live cells), blastocoele re-expansion, and morphological grade were evaluated prior to embryo transfer. Significant embryonic parameters included blastocyst developmental stage and blastocyst grade before cryopreservation, usage of preimplantation genetic testing for aneuploidy (PGT-A), post-warm blastocyst survival (percentage of live cells), degree of blastocoele re-expansion, blastocyst grading before transfer, and presence of zona pellucida.

RESULTS:
Among 535 FET cycles, 257 (48.0%) resulted in clinical IUP. Multivariate logistic regression analysis showed a significant independent influence of blastocyst development time (day 5/6) (odds ratio [OR] 0.571; P=.003), morphological grade before cryopreservation (day 5/6) (OR 0.648; P=.013), usage of PGT-A (OR 1.704; P=.010), and percentage of post-thaw live cells (OR 0.322; P=.001) on embryo transfer success rates. While fully expanded blastocysts showed a significantly higher rate of clinical IUP, the degree of blastocoele re-expansion did not appear to be independently related to ongoing pregnancy when multivariate logistic regression analysis was employed (OR 2.886; 95% CI: 0.824–10.105; P=.097).

CONCLUSION:
In addition to blastocyst quality prior to cryopreservation, post-thaw blastocyst survival is an independent predictor of embryo recovery and further development potential. Additional understanding of the potential contributors to failed FETs can inform strategies for improvement. Further investigation is needed to determine how to minimize embryonic cell damage during the vitrification and warming process.
Effects of Non-Cavity-Distorting Intramural Fibroids on IVF Outcomes in Patients With Recurrent IVF Failure: Does Myomectomy Change IVF Outcomes? [ID 2683663]
Authors: Buyuker Ceyda 
Published: May 2024

INTRODUCTION:
Uterine fibroids are the most common benign smooth muscle tumors of the uterus. However, there is no consensus on whether myomectomy improves IVF success in women with non-cavity-distorting intramural fibroids. The aim of this study was to compare the IVF and pregnancy outcomes of women who had non-cavity-distorting intramural fibroids and underwent myomectomy versus women who had intramural fibroids, but did not undergo myomectomy.

METHODS:
This was a retrospective cohort study at Acibadem Maslak Hospital, IVF Center, between 2019 and 2020. The Acibadem University Ethical Committee approved the study protocol, which complied with the Declaration of Helsinki (2021-05/02). Data of 128 women aged between 25 and 43 years who have at least two intramural non-cavity-distorting fibroids of 2–6 cm in size were used. All patients had at least two IVF failures. The intervention group comprised women who decided to proceed to myomectomy before IVF (group 1, n=56). The control group was established women with intramural fibroids who reject myomectomy (group 2, n=71).

RESULTS:
In regard to IVF result parameters and perinatal outcomes, there was no statistically significant difference between the two groups. Between study groups, there were no statistically significant differences in the perinatal outcomes. Myomectomy surgery did not increase miscarriage and biochemical pregnancy rate (odds ratio [OR] 0.9; 95% CI, 2.8–3.7).

CONCLUSION:
Myomectomy does not substantially affect pregnancy or live birth rates according to the results of this study.
Correlates for Transfusion at Delivery Among Latinx Birthing Patients at a Tertiary Care Center [ID 2683569]
Authors: Castellon Loren , Martinez-King L. Carolina , Hitti Jane 
Published: May 2024

INTRODUCTION:
We observed a higher transfusion rate among Latinx compared to non-Latinx individuals. We sought to determine whether this disparity resulted from preexisting anemia or acute blood loss at delivery, to devise targeted prevention strategies.

METHODS:
We conducted a retrospective cohort study of 1,960 births between April 1, 2021, and March 31, 2022. Demographic and obstetric factors, hematocrit (Hct), pregnancy outcomes, and anemia treatment were abstracted. Anemia was defined as Hct less than 33%. Statistical differences between groups were evaluated by chi-squared or independent-sample t-tests. Odds ratios (ORs) and 95% CIs were calculated by logistic regression, adjusting for confounders.

RESULTS:
Transfusion at delivery occurred among 21 (8.0%) Latinx and 77 (4.5%) non-Latinx patients (OR 1.84; 95% CI, 1.12–3.04; P=.015). Latinx patients were younger (mean 30 versus 32 years; P<.001), more likely to receive Medicaid (85% versus 80%; P=.05), not speak English (21% versus 6%; P<.001), deliver preterm less than 37 weeks (33% versus 19%; P<.001), and have complex cesarean delivery (CD) (5.7% versus 3.2%; P=.049). Preexisting anemia was statistically associated with transfusion (P<.001) but not with Latinx ethnicity. Oral and intravenous iron did not differ between groups. After adjustment for anemia and CD, Latinx ethnicity remained significantly associated with transfusion (adjusted OR 1.73; 95% CI, 1.18–2.28; P=.04).

CONCLUSION:
Latinx patients were more likely to require complex CD; with preexisting anemia, this likely increased the risk for transfusion. Recognition of risk factors for complex CD in addition to prompt diagnosis and management of anemia are key for preventing transfusions.
Intravenous Iron Supplementation in Pregnancy: Comparisons of Dosage and Latency of Infusion Based on a Quality Improvement Project on Maternal Transfusion Reduction [ID 2683380]
Authors: Pfeiffer Alixandria F. , Chang Nathalie H. , Byrne John J. , Berkus Michael , Doyle Nora M. 
Published: May 2024

INTRODUCTION:
Optimal dosing of intravenous iron supplementation (IVFe) and latency of the infusion for pregnant patients with iron deficiency anemia has been minimally evaluated. We analyzed the effects of specific IVFe dosage parameters as part of an institution-based protocol on maternal peripartum hemoglobin (Hb) levels stratifying by time of infusion to delivery.

METHODS:
We reviewed average changes in maternal Hb pre-infusion and pre-delivery over a 3-year period (2020–2023) after the implementation of a maternal transfusion reduction bundle was incorporated at our Level IV maternal care center in 2020. Pregnant patients who received IVFe and delivered at our institution were included and compared by IVFe dosage forms (800 mg) and infusion latency (by 2-week increments). We excluded patients with known antepartum blood transfusion. Maternal demographics and all comparison groups were analyzed among each other using GraphPad Prism software.

RESULTS:
Two hundred ninety-five patients met inclusion criteria. Demographics of maternal age, body mass index (BMI), nulliparity, and ferritin levels were similar in all groups. We found a statistically significant difference in improved pre-delivery Hb with larger IVFe doses (P=.002) and longer infusion-delivery periods (P=.049). A Tukey post-hoc test revealed that the highest yield on mean delta Hb was after 6–8 weeks or longer of latency with doses greater than 800 mg versus less than 2 weeks at doses of 800 mg or lower (2.6–3.1 g/dL; P<.0001).

CONCLUSION:
Latency periods of at least 6 weeks with IVFe dosages of 800 mg or greater, regardless of maternal BMI or starting ferritin, may markedly improve pre-delivery Hb levels and ultimately reduce maternal morbidity hemorrhage complications.
COVID-19 and Hypertensive Disorders of Pregnancy: Is the Placenta the Problem? [ID 2683611]
Authors: Siblini Tamara , Kulkarni Sanjana , Aslam Muhammad F. , Baracy Michael G. 
Published: May 2024

INTRODUCTION:
The objective of this study is to evaluate the association between COVID-19 infection in pregnancy and placental pathology in order to assess the mechanism of its association with hypertensive disorders of pregnancy (HDP).

METHODS:
This was a retrospective cohort study that compared placentas of patients who tested positive for COVID-19 during their pregnancy (n=70) to placentas of patients who tested negative for COVID-19 (controls, n=210). Patient demographics, comorbid conditions, and pregnancy complications were obtained from the electronic medical record.

RESULTS:
Compared with pregnancies negative for COVID-19 infection, maternal COVID-19 infection was not associated with increased incidence of placental pathology including acute funisitis, acute chorioamnionitis, chronic villitis, chorionic pseudocysts, decidual necrosis, Tenney Parker changes, intervillous hemorrhage, infarcts, villous calcifications, meconium-stained amniotic fluid, inflammatory changes, or vascular VTE changes. Based on the logistic regression analysis, after controlling for other variables in the model, the risk of developing HDP was 72.4% higher in patients who tested positive for COVID-19 versus those who did not (odds ratio 1.72; 95% CI [1.09, 2.73]; P=.02).

CONCLUSION:
Patients who test positive for COVID-19 during pregnancy have an increased risk of HDP. However, there is no association between COVID-19 infection in pregnancy and pathologic findings on placental histology. This suggests that COVID-19 does not exert its effects of increasing the risk of HDP via placental infection or inflammation. Rather, COVID-19 may contribute to the pathogenesis of HDP through cytokine storm, dysregulation of the renin–angiotensin–aldosterone system, or systemic hyperinflammatory response.
The Effect of Food Environment on Pregnancy Outcomes [ID 2683379]
Authors: Clinton Tiffany Alexis , Pitts D’Angela S. , Flint Jessica , Speak Alicia C. , Fly Allison , Kim Sun Kwon 
Published: May 2024

INTRODUCTION:
In large urban cities, fast food restaurants and convenient stores dominate the food sector leaving limited access to quality healthy foods. Food insecurity is a modifiable risk factor of social drivers of health. We hypothesize that low-access food environment is associated with gestational diabetes, preterm deliveries, hypertensive disorders, and other comorbidities.

METHODS:
A retrospective cohort study was performed to determine the effects of food environment on pregnancy outcome using geographic data from 3,898 patients who delivered after 20 weeks of gestation in a large inner-city hospital between 2014 and 2019. The USDA Food Access Research Atlas was used to extrapolate census tract data from neighborhoods that have been previously identified as low-access areas. Demographics were obtained by chart abstraction. Chi-squared tests were used for analysis.

RESULTS:
Of the 3,684 patients, 1,377 (37.4%) of the population lived in low-access food environments. There is a higher rate of neonatal intensive care unit (NICU) admission in low-access food environments compared to high access (8.6% versus 7.5%; P<.001). Contrarily, there is a lower rate of gestational diabetes mellitus (11.3% versus 13.6%; P=.0381) and preterm delivery (13.2% versus 16.7%; P=.0043) in women living in low-access food environments. There was no significant difference between hypertensive disorders (P=.0874) and fetal growth restriction (P=.8465).

CONCLUSION:
This study demonstrates that low-access food environment is associated with statistically significant higher rates of NICU admission. Unlike other risk factors, food environment is a modifiable risk factor, and as women's health providers, it is important to address all social drivers of health, including food insecurity.
Epidemiologic Look at Teen Birth [ID 2683394]
Authors: Russo-Sikes Heather R. , Amin Raid W. , Leiro Alberto , Decesare Julie 
Published: May 2024

INTRODUCTION:
To take an epidemiologic look at the most up-to-date geographical variation in the average teenage birth rates by county in the United States.

METHODS:
Data from the National Center for Health Statistics were used in this retrospective cohort to count the total number of live births to females aged 15–19 years by county between 2003 and 2020. Software for disease surveillance and spatial cluster analysis was used to identify clusters of high or low birth rates in counties or areas of greater than 100,000 teenage females. The data were then further analyzed by unemployment rate, no high school diploma rate, Hispanic rate, African American rate, and poverty rate per county as influence on the prediction of teenage birth rate.

RESULTS:
Spatial analysis identified 94 significant spatial clusters of teenage births. When adjusted for time and space, there were three significant clusters within Texas, all within 2013–2020, showing a steep increase in teenage birth rates. The top cluster with a 60% higher chance of teenage birth than the remainder of the country. Individual covariates examined showed the best predicter of teenage birth is unemployment followed by low education.

CONCLUSION:
Nationally, teenage births have declined over the last 30 years; however, clusters of elevated teenage birth rates remain predominantly in the southeastern United States and Texas. When adjusting for covariates of social determinants of health, some of these clusters remained, indicating other factors with influence on teenage birth rate.
Limited Access to Obstetric Services for the American Indian and Alaska Native Population [ID 2683412]
Authors: Baker Hailey A. , Calac Alec , Interrante Julia 
Published: May 2024

INTRODUCTION:
American Indian and Alaska Native (AI/AN) people face one of the highest rates of maternal mortality in the United States. Access to maternity care is correlated with health outcomes; however, research on availability of maternity care in areas largely composed of AI/AN populations is limited.

METHODS:
We identified the 69 counties and county-equivalents in the United States with greater than or equal to 25% of the population self-identifying as AI/AN. Counties and county-equivalents were further classified as rural (micropolitan and non-core) or urban (metropolitan). We then determined the availability of hospitals with obstetric care, obstetric providers (obstetricians and certified nurse-midwives), and the number of live births in counties and county-equivalents. Maternity care deserts were defined as counties and county-equivalents having no hospitals providing obstetric care nor obstetric providers. Limited access to maternity care services was defined as counties and county-equivalents having one or less hospital offering obstetric services and fewer than 60 obstetric providers per 10,000 births.

RESULTS:
These counties and county-equivalents spanned 13 states, and 65 (94.2%) were classified as rural. 39 counties and county-equivalents (56.5%) were classified as maternity care deserts, and 10 were classified as having limited access to maternity care (14.5%).

CONCLUSION:
The findings of this study suggest that access to maternity care is limited for AI/AN populations. Increasing access to care in counties and county-equivalents largely composed of AI/AN populations is a potential avenue to improve maternal health outcomes.
Obtaining Patients' Perspective for Advancing Health Equity in Maternal Depression Screening for Black Women in a Federally Qualified Health Center [ID 2683414]
Authors: Zeeshan Quratulain , Ascher Amanda F. 
Published: May 2024

INTRODUCTION:
One in eight women experience symptoms of postpartum depression. At Sun River Health, efforts to improve postpartum depression screening rates led to an increase from 76% in January 2022 to 80% in January 2023. However, we continue to see a persistent racial disparity in postpartum depression screening: For Black/African American women, postpartum depression screening rates are 77.4%, whereas White women have screening rates of 88%.

METHODS:
A focus group of English-speaking Black/African American women (n=7) who were not screened for postpartum depression was conducted in May 2023. We administered a series of questions aimed at gathering insight into patients' understanding of and beliefs around postpartum depression, patients' experiences, and barriers to care. The responses were recorded and interpreted using qualitative data analysis.

RESULTS:
Eighty-three percent of group participants reported that they experienced postpartum depression. Fifty-seven percent reported not receiving depression screening, and 71% reported no discussion on mental health with their clinicians. Among the barriers to care the participants described, social stigma was a common influence and the majority described clinicians as dismissive of their symptoms. Only 14% of patients voiced comfort in discussing mental health with their clinician.

CONCLUSION:
Further work is needed to better educate clinicians on mental health conditions in pregnancy and postpartum and the importance of engaging patients in discussion on mental health issues. The organization should propagate the survey to obtain additional patients’ feedback and further our understanding of barriers to screening and treatment of depression in Black/African American pregnant women.
The Effects of Acknowledgment of Paternity and Marital Status on Infant Morbidity and Mortality [ID 2683463]
Authors: Wells Brittney , Hennessy Elizabeth , Salamanca Ghajarieh Alyssa P. , Townson Lauren , Halfar Matthew A. 
Published: May 2024

INTRODUCTION:
Research shows that maternal behavior during the perinatal period has a significant effect on neonatal outcomes and that instability in the social support structure can cause undue perinatal stress. With unmarried women accounting for nearly one in three births in the United States, this analysis reviewed how marital status and paternity acknowledgment (AOP) affected infant morbidity and mortality utilizing national 2017–2019 data from the CDC-WONDER databases.

METHODS:
A series of chi-squared analysis and logistic regressions were performed to assess for differences in infant outcomes between married women, unmarried women with AOP, and unmarried women without AOP, as well as assess the effect of socioeconomic covariates.

RESULTS:
Results demonstrated that marital and AOP status had significant correlation on frequency of preterm birth, low birth weight, newborn need for assisted ventilation, antibiotics for suspected sepsis, and neonatal intensive care unit admission (P<.0001). Additionally, there were significant differences in Apgar scores found at 5 and 10 minutes for AOP and at 5 minutes for marital status. Furthermore, significant differences in rate of prenatal complication related infant mortality, as well as overall infant mortality up to 1 year of age were seen. These trends persisted when accounting for mother's age, race, nativity, education, insurance status, and select maternal health risk factors.

CONCLUSION:
It is evident that infants born to unmarried women and women without AOP are at increased risk for development of complex infant morbidity and mortality. This suggests that increased monitoring, precautions, and social support may be indicated. Further studies are needed to evaluate the role of paternal and other support during pregnancy.