bluuebunny/crossref_metadata_2025_split huggingface dataset:
Intrinsic and Extrinsic Apoptotic Pathways May Dictate In Vitro Fertilization Outcomes in Women of Advanced Maternal Age [ID 2683425]
Authors: Archer Hannah C. , Nguyen Dieu Thao , Petyak Eleanor , Chosed Renee J. , Green Lisa , Chang T. Arthur 
Published: May 2024

INTRODUCTION:
Women of advanced maternal age (AMA) (≥35 years) are at an increased risk for a decline in ovarian reserve and have a decreased rate of live birth after one cycle of in vitro fertilization (IVF). Current practice recommends preimplantation genetic testing for aneuploidy (PGT-A) to women of AMA to increase live birth outcomes. However, recent studies have found that conventional IVF was non-inferior to PGT-A. Identifying additional biomarkers may provide another metric for selecting the most viable embryo.

METHODS:
Blastocoel fluid-conditioned media was collected from day 5 IVF embryos that underwent PGT-A. RNA was purified from pooled blastocoel fluid samples from four groups based on implantation status and maternal age, and then cDNA was synthesized. RT-qPCR was used to assess expression of CASP3, CASP7, CASP8, and BCL2L12 levels in a total of 64 embryos.

RESULTS:
CASP3 and CASP7 expression were higher in the media from IVF embryos with positive implantation outcomes from patients aged less than 35 years. There was increased CASP8 expression in media from IVF embryos from AMA patients regardless of implantation status.

CONCLUSION:
Preliminary analysis suggests increased CASP8 expression is associated with successful implantation outcomes in AMA patients. This suggests that CASP8 could be activated in preimplantation embryos as an aging response as found in AMA media samples. One explanation is that CASP8 is associated with aneuploidy in the AMA samples. Further research will determine whether expression and activation of CASP8 are required for positive implantation outcomes and be used as an additional embryo selection tool for other AMA patients utilizing IVF.
Addiction-Centered Pregnancy Care: Bridging the Gap Between Addiction Treatment and Prenatal Care to Improve Outcomes for Pregnant People and Infants [ID 2683418]
Authors: Morgan Alexandra , Saunders Elizabeth , Goodman Daisy J. 
Published: May 2024

INTRODUCTION:
Opioid use disorder (OUD) is a leading cause of maternal mortality. This study evaluated a new model of care for pregnant people with OUD, addiction-centered pregnancy care (ACPC), which provides assessment and support for the social, economic, and personal challenges linked to OUD within prenatal care. Unlike integrated models of care providing medication for OUD, ACPC is easier to implement and rapidly scalable. This study compared risk of preterm delivery and infant length of stay for patients receiving ACPC versus standard prenatal care.

METHODS:
In this retrospective cohort study approved by the Dartmouth Hitchcock IRB, data were abstracted from charts of patients with OUD who received ACPC (n=53) or standard prenatal care (n=41) and delivered at an academic medical center in the Northeast between 2018 and 2021. Risk of preterm delivery was examined using multivariate logistic regressions, and infant length of stay was assessed with negative binomial models.

RESULTS:
Women in the ACPC cohort had reduced odds of preterm delivery (n=3, 5.7%) compared to the standard prenatal cohort (n=11, 26.8%; odds ratio [OR] 0.40; 95% CI, 0.21, 0.80). Compared to standard prenatal care, infants of patients receiving ACPC stayed in the hospital fewer days after delivery (incidence risk ratio, 0.77; 95% CI, 0.61, 0.97).

CONCLUSION:
Among a cohort of pregnant patients with OUD in the Northeast, receiving ACPC was associated with reduced risk for preterm delivery and shorter length of infant hospitalization compared to standard prenatal care. Future research should assess if these differences are due to this model’s focus on supporting psychosocial and socioeconomic challenges linked to OUD.
ChatGPT Compared With Google Bard: Which Large Language Model Responds Best to Commonly Asked Pregnancy Questions? [ID 2683501]
Authors: Khromchenko Keren , Shaikh Sameeha S. , Singh Meghana , Vurture Gregory , Rana Rima , Baum Jonathan 
Published: May 2024

INTRODUCTION:
Large language models (LLMs) have proven themselves in a variety of settings and shown the ability to provide information on a variety of topics in obstetrics and gynecology. Which platform performs best in regard to its ability to respond to commonly asked pregnancy questions is unknown.

METHODS:
A qualitative analysis of ChatGPT and Google Bard was performed in August of 2023. We queried each LLM on 12 commonly asked pregnancy questions and asked for their references. Query responses were graded as “acceptable” or “not acceptable” based on correctness and completeness in comparison to American College of Obstetricians and Gynecologists (ACOG) publications, PubMed-indexed evidence, and clinical experience. References were classified as “verified,” “broken,” “irrelevant,” “non-existent,” and “no references.” Review and grading of the responses and references for both LLMs were performed by the co-authors individually and then as a group to formulate a consensus.

RESULTS:
A grade of acceptable was given to 58% of ChatGPT’s responses (7 out of 12) and 83% of Google Bard’s responses (10 out of 12). A grade of not acceptable was assigned to 42% of ChatGPT’s responses (2 were incomplete and 3 were incorrect) and 17% of Google Bard’s responses (2 incomplete). In regard to references, ChatGPT had reference issues in 100% of its references (12 out of 12). No references were provided for 10 answers, one answer had a non-existent reference, and another answer had two broken references and two verified references. Google Bard had discrepancies in 8.3% of its references (1 out of 12): 11 answers had verified references, and 1 answer had a broken reference.

CONCLUSION:
Google Bard has superior response performance regarding content and references when queried on commonly asked pregnancy questions. Both LLMs must be carefully evaluated and vetted prior to being accepted as accurate and reliable for this purpose.
Trimester-Specific SARS-CoV-2 Infection and the Association With Preeclampsia [ID 2683535]
Authors: Leftwich Heidi K. , Hillman Michelle , Khan Lyba , Patel Jenna , Dmello Monalisa , Chernick Rebecca 
Published: May 2024

INTRODUCTION:
With COVID-19 becoming more endemic, trimester-specific infection risks are important to study. Here, we examine the effect of SARS-CoV-2 positivity by trimester on development of preeclampsia.

METHODS:
This was an IRB-approved, retrospective cohort study of patients receiving prenatal care and delivering at a single academic hospital from January 1, 2019, to December 30, 2022. Primary outcomes were rate and severity of preeclampsia. Secondary outcomes were characteristics of placental pathology.

RESULTS:
6,174 patients met inclusion criteria, 649 of whom were SARS-CoV-2-positive during pregnancy. Of SARS-CoV-2-positive patients, 19.4%, 40.8%, and 39.8% tested positive in the first, second, and third trimesters, respectively. Preeclampsia rates were higher in first (19.2%) and second (18.2%) but not third (11.2%) trimester compared to no infection (11.7%; P=.001). After adjusting for confounding factors, second-trimester SARS-CoV-2-positive patients were 48% more likely to develop preeclampsia than uninfected (95% CI, 1.04–2.11; P=.005). Severity was increased in all trimester infections versus no infection (P=.008), but adjusted analyses showed this difference remained only in first-trimester infections (odds ratio 6.55 [1.90–22.55]; P=.003). SARS-CoV-2 infection in the second trimester was also associated with 63% increase in meconium-stained placenta (95% CI, 1.01–2.61; P=.044), but no other studied placental pathology.

CONCLUSION:
Consistent with timing of pathogenesis of preeclampsia in late first/early second trimester, patients infected with SARS-CoV-2 in the first and second trimester had higher rates of preeclampsia and severity. This finding helps clarify conflicting studies versus the risk of preeclampsia with SARS-CoV-2 infection in that this risk may be trimester specific and can help aid in our counseling and proposed future research.
The Association of Second-Trimester Cervical Length and Gestational Age at Delivery [ID 2683538]
Authors: Pember Nicolette G. , Thayer Sydney M. , Zofkie Amanda C. 
Published: May 2024

INTRODUCTION:
Second-trimester transvaginal cervical length (TVCL) under 2.5 cm is a well-established risk factor for preterm birth, although few studies have evaluated delivery outcomes in “normal” cervical length groups. We aimed to evaluate the association of normal TVCL (2.5 cm or greater) tertiles on gestational age (GA) at delivery.

METHODS:
This is a retrospective cohort study of patients eligible for vaginal birth with singleton term gestations and normal TVCL (at 16–24 weeks of gestation) delivering at a tertiary care center June 2022 to June 2023. Mean GA at delivery and rates of term deliveries were compared by TVCL tertiles (T1: 2.5–3.49 cm, T2: 3.5–4.49 cm, and T3: 4.5 cm or greater). Multivariable logistic regression was used to control for potential confounders. Institutional review board approval was obtained.

RESULTS:
Of 1,034 eligible deliveries, 984 (95.2%) were term (37 0/7 weeks or greater). Patients with TVCLs in T2 and T3 were significantly more likely to have a term delivery than patients with TVCL in T1 (T2 96.0% versus T1 90.9%, P=.007; T3 96.2%, P=.03). Compared to T1, those with TVCLs in T2 and T3 also had increased odds ratio (OR) of a term birth (OR 2.4 [CI, 1.2–4.8] and OR 2.55 [CI, 1.03–6.7], respectively). After adjusting for confounders, this relationship remained statistically significant (T2 adjusted OR 3.05 [CI, 1.4–6.6]; T3 3.91 [CI, 1.3–11.4]).

CONCLUSION:
Patients with longer TVCL measured at anatomy ultrasound are significantly more likely to have a term delivery, even after adjusting for confounders. These results can be used to guide patient counseling and expectations for labor and delivery outcomes.
Stakeholder Perspectives of PATH (Plan for Appropriate Tailored Healthcare in Pregnancy) Telemedicine Recommendations [ID 2683565]
Authors: Rajpurkar Asavari , Zahn Christopher M. , Daniel Yannet , Lott Lauren , Ahmed Lamiya , Peahl Alex 
Published: May 2024

INTRODUCTION:
The COVID-19 pandemic has propelled innovation in prenatal care delivery including use of telemedicine for routine prenatal visits. The Plan for Appropriate Tailored Healthcare in Pregnancy (PATH), a consensus-based prenatal care recommendation developed by a multidisciplinary panel of prenatal care experts, includes two recommendations regarding telemedicine: 1) telemedicine should be an option for all visits aside from four key in-person contacts requiring in-person visits; and 2) home monitoring is an appropriate option for most routine parameters during pregnancy. A national listening tour was conducted to elicit stakeholder feedback for incorporating telemedicine recommendations into practice.

METHODS:
We conducted nine, 120-minute virtual focus groups with more than 25 organizations including professional (8), patient advocacy (8), public health (5), and payer groups (4). Focus groups were transcribed, coded by recommendation. Data were next analyzed with matrix coding across positive attitudes, negative attitudes, and implementation considerations.

RESULTS:
Focus groups included 110 participants. Most participants supported telemedicine use as a care modality for routine prenatal care. Positive attitudes included the belief that telemedicine increased care flexibility, care access, and patients' health agency. Negative attitudes included concerns that poor digital literacy, insufficient access to devices, and high cost could perpetuate existing health disparities. Implementation considerations included the importance of relationship building with patients, technical support staff use, home monitoring device validation, and patient education on telehealth best practices. Participants also emphasized needed improvements to telehealth infrastructure and funding.

CONCLUSION:
Interprofessional stakeholders broadly support telemedicine use in routine prenatal care. Improvements in existing advocacy efforts, research, and infrastructure in underserved communities are needed to facilitate increased access to telemedicine.
Stakeholder Perspectives of the PATH (Plan for Appropriate Tailored Healthcare in Pregnancy) Targeted Visit Schedule Recommendation [ID 2683601]
Authors: Rajpurkar Asavari , Zahn Christopher M. , Daniel Yannet , Lott Lauren , Ahmed Lamiya , Peahl Alex 
Published: May 2024

INTRODUCTION:
Traditional prenatal care delivery guidelines recommend 12–14 in-person visits for all patients, although care can be safely delivered to average-risk patients with 8–9 targeted visits. These additional visits may result in oversurveillance and unnecessary interventions. The Plan for Appropriate Tailored Healthcare in Pregnancy (PATH), a consensus-based prenatal care recommendation developed by a multidisciplinary team of prenatal care experts, recommends tailoring care delivery to patients' needs by using targeted visit schedules for average-risk patients. A national listening tour was conducted to obtain stakeholder feedback for incorporating this care delivery model into practice.

METHODS:
We conducted nine, 120-minute virtual focus groups with more than 25 organizations including professional (8), patient advocacy (8), public health (5), and payer groups (4). Focus groups were transcribed and coded by recommendation, and analyzed with matrix coding across positive attitudes, negative attitudes, and implementation considerations.

RESULTS:
Focus groups included 110 participants. Positive attitudes included the belief that targeted visit schedules would improve visit attendance, care flexibility, and resource equity. Negative attitudes included concerns for inappropriate targeted visit schedule application, inadequate safety net systems for missed services, and reduced payer reimbursement. Providers were also concerned about decreased opportunities for relationship building and counseling in targeted visit schedules. Implementation considerations included the importance of shared decision-making, serial needs assessments, and clear risk stratification guidelines. Participants emphasized the need for multidisciplinary safety net processes to ensure timely, adequate care.

CONCLUSION:
Participants were receptive to incorporating targeted visit schedules for average-risk individuals into routine prenatal care. Greater infrastructure investment is needed to implement more flexible care models successfully.
Starting Conversations About Gestational Weight Gain: How Weight and Weight Gain Communication Is Initiated in the First Prenatal Visit [ID 2683652]
Authors: Harinath Malini , Smith Alaina M. , Binstock Anna Berlyn. , Pollak Kathryn I. , Levine Michele D. , Chang Judy C. 
Published: May 2024

INTRODUCTION:
The American College of Obstetricians and Gynecologists (ACOG) recommends that obstetric (OB) providers discuss appropriate weight gain and body mass index (BMI) with their patients at initial prenatal care visits. Few studies have examined how obstetric care providers initiate and discuss this topic. The aim of this study is to describe weight conversations during initial prenatal visits.

METHODS:
We analyzed data from an IRB-approved, larger prospective observational study. Patient–provider conversations at initial prenatal visits were audio-recorded with patient consent. Transcripts of 70 visits were coded for discussions of diet, exercise, and weight discussions, including who initiated weight conversations.

RESULTS:
Thirty-four out of 70 visits (49%) included weight discussions. Out of these 34 visits, the OB provider brought up weight 71% of the time. Providers gave weight recommendations by generally speaking about how much weight gain can be expected (55%). In 12% of the visits, providers specifically cited organizational guidelines. There were no visits during which providers mentioned patients' BMI. Patients expressed concern over their weight at 29% of the visits. Providers reassured patients during weight discussions in 32% of the visits. Providers made potentially judgmental comments about their patients’ bodies regarding weight on 9% of visits (eg, “if anything you are a little twig of a woman”).

CONCLUSION:
Although providers usually initiated weight discussions, these discussions occurred in only half of initial prenatal visits; this does not meet ACOG recommendations. Providers mostly reassured patients but occasionally expressed comments that could be interpreted as judgmental or stigmatizing. Communication strategies to invite patients’ weight/weight gain concerns may be helpful to improve these conversations.
Association of Low Levels of Placental Growth Factor With Abnormal Fetal Doppler Assessment [ID 2683423]
Authors: Figueiro-Filho Ernesto A. , Versteeg Kathryn , Vinken Jamie , Orieux Alyx , Grzyb Karolina 
Published: May 2024

INTRODUCTION:
Placental growth factor (PlGF) is involved in placental angiogenesis and maturation. Low maternal serum PlGF levels predict placental dysfunction and associated conditions, such as preeclampsia, and fetal growth restriction. These pregnancy complications can lead to abnormal fetal Doppler assessment, indicating progressive fetal deterioration prompting preterm delivery.

METHODS:
We collected retrospective data from laboratory results of PlGF levels and fetal Dopplers (umbilical artery [UA], middle cerebral artery [MCA], and ductus venosus [DV]) from patients who had clinical indication for PlGF testing. Over 100 patients were identified to have results of all assessments between 2021 and 2023. Levels of PlGF were stratified in five categories according to gestational age and compared with normal and abnormal doppler results. For comparisons, the values were aggregated in normal and low PlGF.

RESULTS:
There were statistically significant associations between PlGF levels and Dopplers. Patients with low PlGF (less than 5th percentile for gestational age) were more likely to have abnormal dopplers than patients with normal PlGF (UA, P<.001; MCA, P<.001; DV, P<.001). A normal PlGF had a high negative predictive value (NPV) for normal dopplers (UA, 88%; MCA, 94.3%; DV, 98.6%).

CONCLUSION:
The results show that normal PlGF is highly associated with normal Dopplers. Additional data will be required to account for confounding factors; however, our preliminary data suggest that PlGF could be a useful tool for patients in rural and remote locations, as normal PlGF has a statistically and clinically significant negative predictive value for normal Doppler assessment.
Autoimmune Condition Diagnosis After Recurrent Pregnancy Loss [ID 2683458]
Authors: Imbroane Marisa R. , LeMoine Felicia V. , Gibson Kelly S. 
Published: May 2024

INTRODUCTION:
Research has suggested a link between recurrent pregnancy loss (RPL) and cell-mediated immunity dysregulation. We aim to determine whether a history of RPL is associated with development of cell-mediated autoimmune condition (AIC) diagnosis.

METHODS:
This was a retrospective cohort study using the TriNetX network database. The RPL group had greater than or equal to three spontaneous abortions (SABs), whereas controls had at least one pregnancy but did not have the diagnosis of RPL (ICD-10 N96). The rate of new AIC diagnosis was measured from diagnosis of the third SAB or first pregnancy for the RPL and control groups, respectively. Propensity score matching was used for age, race, and ethnicity. Logistic regression analyses investigated the relationship between RPL and AIC diagnoses.

RESULTS:
113,118 patients were included in each arm. Recurrent pregnancy loss was associated with an increased risk for systemic lupus erythematosus (relative risk [RR] 2.22; 95% CI, 1.88–2.63), rheumatoid arthritis (1.52 [1.30–1.78]), multiple sclerosis (1.57 [1.36–1.82]), Crohn’s disease (1.40 [1.12–1.74]), ulcerative colitis (1.42 [1.17–1.73]), Hashimoto’s thyroiditis (1.74 [1.57–1.91]), Graves’ disease (1.61 [1.37–1.90]), and Sjogren syndrome (1.81 [1.53–2.15]), but not psoriatic arthritis.

CONCLUSION:
Patients with a history of RPL are at nearly double the risk for development of AIC when compared to those without a history of RPL.
No-Show Rates in a Perinatal Practice: Telemedicine Compared With In-Person Visits [ID 2683494]
Authors: Ruma Michael S. 
Published: May 2024

INTRODUCTION:
The objective of this study was to determine the effect of telemedicine on no-show rates in a perinatal practice before, during, and after the COVID-19 pandemic.

METHODS:
A retrospective study was conducted among pregnant patients receiving care at a private maternal–fetal medicine (MFM) practice in New Mexico from January 2020 to June 2023. The primary outcome was attendance for telemedicine versus in-person visit evaluated by visit type including MFM consultation, diabetes management, and mental health.

RESULTS:
Maternal–fetal medicine visits showed no difference in no-show rates between telemedicine versus in-person visits for 2020, 2022, and 2023. More no-show visits occurred in 2021 with 118/1,800 (6.56%) for telemedicine versus 632/15,608 (4.05%) for in-person visits (P<.0001) and for all years combined with 352/7,144 (4.93%) for telemedicine versus 1,952/49,363 (3.95%) for in-person visits (P=.0001). The odds ratio for no-show visits for all years was 1.26 (1.12, 1.41) for telemedicine versus in-person visits. Diabetes management visits showed higher no-show rates for telemedicine versus in-person visits each year and overall. For all years combined, more diabetes management no-show visits (1,454/12,232 [11.89%]) occurred for telemedicine versus 15/310 (4.84%) for in-person visits with an odds ratio for telemedicine no-show visits of 2.65 (1.57, 4.47) (P=.002). For all years combined, fewer mental health no-show visits (362/1,823 [19.86%]) occurred for telemedicine versus 76/224 (33.93%) for in-person visits with an odds ratio for telemedicine no-show visits of 0.48 [0.36, 0.65] (P<.001).

CONCLUSION:
Telemedicine use expanded greatly during the COVID-19 pandemic in all areas of health care including maternal–fetal medicine. In this large private practice-based cohort, different outcomes were noted in areas unique to perinatal care. Patients undergoing MFM consultation with ultrasound had comparably low no-show rates for telemedicine versus in-person visits. Opposite effects were noted for diabetes management and mental health visits with higher no-show rates for telemedicine diabetes management visits and lower no-show rates for telemedicine mental health visits.