bluuebunny/crossref_metadata_2025_split huggingface dataset:
Buprenorphine Decreases Fetal Breathing Movements in Fetal Biophysical Profile Assessment [ID 2683456]
Authors: Bulger Caroline , Olsen Martin , Lewis Nicole 
Published: May 2024

INTRODUCTION:
Ten percent of pregnant patients in our community receive medication-assisted therapy with buprenorphine during their prenatal course. The American College of Obstetricians and Gynecologists (ACOG) recommends antenatal testing for conditions when risk of stillbirth is greater than 0.8/1,000. Opioid use in pregnancy is associated with modest increased odds of stillbirth (odds ratio 1.3). Our hypothesis was that biophysical profile (BPP) in buprenorphine patients might be different than a control group of high-risk patients due to the effects of buprenorphine.

METHODS:
This retrospective chart review analyzed the BPP assessments of patients receiving buprenorphine compared to patients followed for chronic hypertension. Patients seen between July 1, 2016, and June 30, 2020, were evaluated. 131 patients were in the buprenorphine group and 46 patients were in the chronic hypertension control group.

RESULTS:
Patients receiving buprenorphine were more likely to have a fetal breathing score of zero than patients undergoing BPP for hypertension. There is a significant relationship between buprenorphine dosage and breathing motion assessment. Chi-squared test yielded a value of P=.04269. Patients on high-dose buprenorphine are more likely to have values of 0 on fetal breathing motion assessment than low-dose patients.

CONCLUSION:
This is the first study to show a dose-related effect of buprenorphine on fetal breathing movements. Previous research has shown buprenorphine effects on fetal brain structure. Current guidelines minimize the effects of maternal buprenorphine administration on fetal development. This study adds to prior research; further study on the dose-related long-term and short-term effects of buprenorphine on fetal development is encouraged.
Frequency of Cannabis Use and Female Infertility: A Cross-Sectional Analysis [ID 2683566]
Authors: Dzubay Sarah , Arora Megha , Prewitt Kristin C. , Hernandez Arielle G. , Andrea Sarah B. 
Published: May 2024

INTRODUCTION:
With expanding cannabis legalization in the United States, the prevalence of cannabis use is growing. Literature describing the effect of cannabis use on fertility is limited. The purpose of this study is to investigate the association between frequency of cannabis use and infertility.

METHODS:
This study utilized cross-sectional data from the 2013–2018 cycles of the National Health and Nutrition Examination Study (NHANES) for women aged 20–49. We used multivariable logistic regression models to examine the association between frequency of cannabis use (never used, irregular use, regular use) and infertility (inability to conceive within 1 year), adjusting for self-reported sociodemographics and use of other substances. Regular cannabis use was defined as monthly use or more for at least a year. All analyses were conducted using R, version 2022.07.2.

RESULTS:
Of the 3,166 women included, 12.5% reported infertility, with the prevalence of infertility ranging from 10.8% among irregular cannabis users to 15.4% among regular cannabis users. Compared to women who reported never using cannabis, women who reported regular use had 47% greater odds of infertility (adjusted odds ratio [aOR] 1.47; 95% CI, 0.88, 2.45) and women who reported irregular use had 17% lower odds of infertility (aOR 0.83; 95% CI, 0.54, 1.30).

CONCLUSION:
Our results contribute to a small, but growing body of evidence that regular cannabis use could have a small to moderate association with infertility, signaling that further research is necessary to better characterize the risk to prospective parents.
Patient Understanding of Carrier Screening With an Educational Video Intervention [ID 2683583]
Authors: Legro Nicole , Mccullough Corinne , Kumnick Allison , Mokhtari Neggin , Haizler-Cohen Lylach 
Published: May 2024

INTRODUCTION:
Carrier screening allows patients to understand their risk of passing on a recessive genetic disease. Clinical visits have limited time to explain concepts behind carrier screening and access to genetic counseling may not be available. We sought to understand patient's baseline knowledge of carrier screening and whether an educational video intervention can improve understanding of this test.

METHODS:
This was a pilot randomized controlled trial administered between July 1, 2023 and July 31, 2023, where participants were recruited at their first obstetrics visit. They were randomized in 1:1 ratio to watch a short video on carrier screening versus routine care. A 10-question true/false questionnaire on basic concepts of carrier screening was administered to all participants. Demographic data including race, age, ethnicity, gravity, and parity were collected. Two-tailed t-test and Fisher's exact test were used for continuous and categorical variables, respectively.

RESULTS:
In total, 40 participants were recruited and 20 were randomized to view an educational video. The cohort identified as 60% Black or African American; average age, 30.2; and 32.5% completed a graduate degree. There were no significant demographic differences between the groups. The average knowledge score in the video and nonvideo groups was similar (61% versus 63%; P=.69). However, most participants felt that an educational video was helpful (84.6%).

CONCLUSION:
This pilot study did not find a significance in knowledge score after the video intervention. Our results highlight the need for additional patient resources and face-to-face interventions to improve patient education on carrier screening.
Oh My GAD: Evaluating Anxiety in Current Pregnant Patients Who Have Had a Prior Termination Abortion [ID 2683438]
Authors: Or Maya , Kazma Jamil , Alpern Rebecca R. , Folarin-Amode Faridat , Jamshidi Roxanne 
Published: May 2024

INTRODUCTION:
An estimated 31.1% of U.S. adults experience anxiety disorders at some point in their lives. Studies have shown that prior pregnancy loss such as miscarriage is associated with increased anxiety in future pregnancies. We aim to look at the effect of abortion on anxiety in future pregnancies carried to term.

METHODS:
This is a cross-sectional study in which current pregnant patients seeking obstetric care at the George Washington Medical Faculty Associates were surveyed via the BabyScripts application. The survey was sent out via the application and text message and included demographics, obstetric history, and the Generalized Anxiety Disorder-7 (GAD-7). The primary outcome was anxiety levels in patients who are currently pregnant and have previously undergone abortion.

RESULTS:
One hundred seventy-nine patients completed the survey thus far; the study is ongoing. Of these, 72 patients reported a history of anxiety. Race distribution between those with a history of anxiety versus those without were similar. Of those who have had a prior pregnancy, those with a history of abortion were more likely to have severe anxiety with a GAD-7 score greater than 15 in this current pregnancy (18.2% versus 4.5%; P=.01).

CONCLUSION:
Our study shows that multiparous patients who have had a prior abortion and are currently pregnant are more likely to have severe anxiety as compared to patients without a history of abortion. Patients who have experienced abortion therefore have specific needs for prenatal care that are currently unmet. Furthermore, as GAD-7 is not routinely administered in pregnancy, these patients may be underdiagnosed with anxiety that then goes untreated.
Trends in Substance Use and Prenatal Care in Pregnant Patients in a Delaware Hospital [ID 2683484]
Authors: Bishop Erin E. , Hoffman Matthew K. 
Published: May 2024

INTRODUCTION:
8.2% of pregnancy-associated deaths are attributable to opioid use. In Delaware, the rate of overdose deaths is 60% higher than nationally, and 12/14 pregnancy-associated deaths in 2021 were opioid related. This study examines demographic trends to identify targets for population-level interventions to decrease opioid abuse in pregnancy.

METHODS:
The data for this retrospective study were obtained via chart review, de-identified, and included all women with a positive drug screen who delivered in a Delaware community hospital between January 2018 and December 2021, examined for trends by half year.

RESULTS:
The majority of 677 women identified as White (70.9%), non-Hispanic/Latino (93.6%), and had government-issued insurance (86.6%). We saw high rates of emergency department (ED) utilization, with 66.6% of patients being seen in ED on at least one occasion prior to delivery. 33% of patients had less than five prenatal visits and 11.1% had no prenatal care. Women with government-issued insurance were significantly more likely to have insufficient prenatal care (P<.001). A trend was present showing that women taking medication for opioid use disorder (MOUD) were more likely to have sufficient prenatal care, although this value was not significant (P=.10).

CONCLUSION:
Because of frequent visits in the antepartum period, pregnancy is a time where women may have increased interaction with the health care system, providing an important opportunity for intervention and care. Encounters in the ED may provide an important occasion to help connect patients to prenatal care resources, and clinics providing substance use-related care and prenatal care in one location would further decrease barriers to access care.
Evaluating the Effect of Intimate Partner Violence on Hypertensive Disorders of Pregnancy [ID 2683517]
Authors: de Pins Agathe M. , DeBolt Chelsea A. 
Published: May 2024

INTRODUCTION:
Approximately 5% of pregnant individuals in the United States will experience intimate partner violence (IPV) during their pregnancy. Studies have linked IPV during pregnancy to adverse pregnancy outcomes, but most were either conducted in small datasets, low/middle-income countries, or are outdated. Hypertensive disorders of pregnancy (HDP) have been linked to maternal stress and adverse pregnancy outcomes, but no study to date has looked at the effect of IPV during pregnancy on HDP.

METHODS:
Data from the 2016–2021 Pregnancy Risk Assessment Monitoring System were used to conduct univariate and multivariate logistic regression analyses to assess the relationship between IPV (physical, sexual, and emotional) and HDP, adjusting for maternal age, education, insurance, preexisting hypertension or diabetes, smoking, and no previous live births.

RESULTS:
Of the 41,075 participants, 2,762 (6.7%) reported IPV during pregnancy and were younger with higher rates of public insurance, tobacco use, preexisting hypertension/diabetes, and less likely to have a bachelors degree. Incidence of HDP among individuals reporting IPV was 20.8%. Those who reported IPV had increased odds of HDP compared to those who did not (adjusted odds ratio [OR] 1.13 [1.02–1.26]). This association remained significant in individuals reporting physical abuse (N=863) during pregnancy (adjusted OR, 1.25 [1.05–1.50]) and reporting emotional abuse (N=2,607) during pregnancy (adjusted OR, 1.13 [1.01–1.25]). There was no association between IPV and HDP for individuals reporting sexual (N=490) abuse.

CONCLUSION:
This study provides a current understanding of the effect of IPV during pregnancy on HDP. Its findings provide ground for greater advocacy against IPV and towards IPV screening and support during pregnancy.
Stakeholder Implementation Considerations for PATH (Plan for Appropriate Tailored Healthcare in Pregnancy) Social Needs Recommendations [ID 2683568]
Authors: Rajpurkar Asavari , Zahn Christopher M. , Daniel Yannet , Lott Lauren , Ahmed Lamiya , Peahl Alex 
Published: May 2024

INTRODUCTION:
Unmet social needs negatively affect health care access and outcomes, and are disproportionately experienced by groups marginalized by racism, socioeconomic status, and geography. 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 social needs: 1) early screening for medical and social determinants of health; and 2) management of social needs in prenatal care. A national listening tour was conducted to capture stakeholder feedback for implementing social needs 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, and analyzed with matrix coding across patient, clinic, and policy level implementation considerations.

RESULTS:
Focus groups included 110 participants. Patient-level considerations for implementation included the importance of relationship building, shared decision-making, resources-first screening, and delivery of trauma-informed, culturally concordant care. On the clinic level, participants stressed robust clinic-level processes for providing effective social needs care, including multidisciplinary care navigation, social needs toolkit utilization, dynamic patient needs assessments, and provision of closed-loop referrals. Policy-level considerations included the need for improved provider incentives, interprofessional group collaboration, evidence-based research, and social needs infrastructure.

CONCLUSION:
Key considerations for implementing social needs care at the individual, clinic, and policy levels must be operationalized for successful integration into routine prenatal care. Further evidence is needed to identify and test the best approaches to addressing unmet social needs across practice settings.
Exploring Hybrid Prenatal Care: A Qualitative Analysis of Accessibility, Quality of Care, Attitude, and Preference Among Low-Risk Obstetric Patients [ID 2683577]
Authors: Stelmak Daria , Rasmussen Chloe , Azar Michelle , Maben-Feaster Rosalyn E. , Wu Justine P. , Peahl Alex 
Published: May 2024

INTRODUCTION:
Patients' experiences with virtual prenatal care options outside of the acute COVID-19 pandemic remain relatively uncharacterized. Our study qualitatively describes obstetric patients’ experiences and general attitudes regarding hybrid care models (in-person and virtual visits) to evaluate strategies for patient-centered care.

METHODS:
At an academic institution, patients consented to this IRB-exempt survey during their postpartum hospitalization. A qualitative content analysis followed by matrix coding of free-responses was used to evaluate patients’ perceptions of hybrid prenatal care.

RESULTS:
Among the 200 patients who participated in the survey, 78 received hybrid prenatal care. Regarding access, patients highlighted the enhanced general access afforded by hybrid care, emphasizing flexibility and reduced travel time and time off work; however, negative aspects included unreliable internet, insurance coverage issues, and availability of home monitoring devices. For quality, virtual care was sometimes viewed favorably, but some respondents expressed concern for impersonal virtual care experiences or missing the fetal heartbeat. One patient stated, “I really needed to be able to hear the heartbeat every visit, so opted out of virtual visits….” Although many participants had a positive attitude towards hybrid care as an option, others stated a preference for in-person visits, driven largely by the desire to hear the fetal heartbeat.

CONCLUSION:
Patients expressed positive attitudes and experiences regarding improved access with virtual prenatal care. Participants stressed hearing the fetal heartbeat when citing concern for virtual care quality and preference for in-person visits. Future studies should explore patient-centric approaches to virtual care, such as incorporating home-based fetal heartbeat assessment.
Letrozole and Clomiphene Compared With Letrozole Alone for Ovulation Induction in Women With Polycystic Ovary Syndrome: A Systematic Review and Meta-analysis [ID 2683666]
Authors: Eskandar Karine , Queiroz Almeida Juliana Vieira , Chavez Matheus P. , Meirelles Dias Yasmin Jardim , Isabela de Araujo Zotti Ana , Mora de Marco Novellino Andrea 
Published: May 2024

INTRODUCTION:
Nearly 70% of patients with polycystic ovary syndrome (PCOS) have anovulatory infertility. One therapeutic option is letrozole; however, its comparative efficacy and safety when compared with the association of letrozole and clomiphene citrate are unclear. Therefore, we aimed to compare letrozole and the combined use of letrozole and clomiphene citrate for ovulation induction in PCOS.

METHODS:
We systematically searched EMBASE, PubMed, and Cochrane databases for randomized controlled trials (RCTs) and observational studies comparing letrozole and clomiphene citrate versus letrozole alone in patients with PCOS. The primary endpoints rate of mature follicles and ovulation were calculated via a random-effects meta-analysis. Statistical analysis was performed using RevMan 5.4.1. Heterogeneity was assessed with I2 statistics and random-risk effect was used.

RESULTS:
Two RCTs and one observational study comprising 223 patients (mean age, 28.7 years; 49.3% combined therapy) were included. The combined therapy was associated with a higher number of women with mature follicles (>15 mm) (odds ratio [OR] 2.94; 95% CI, 1.66–5.21; P=.0002; I2=0) and ovulations (OR 3.31; 95% CI, 1.91–5.73; P<.0001; I2=0). There was no significant difference between groups in the number of pregnancies and thickness of the endometrial lining. Adverse events, including headache, abdominal bloating, fatigue, back pain, breast discomfort, and night sweats, were similar between groups.

CONCLUSION:
In women with PCOS and anovulatory infertility, letrozole and clomiphene citrate combined therapy promoted a significant benefit for the maturation of follicles and ovulation, with a similar safety profile compared to letrozole alone.
Risks of Vaginally and Sexually Transmitted Infections With Contraceptive Vaginal Rings Compared to Oral Contraceptives [ID 2683643]
Authors: Arceneaux Amy , Karam Kathleen , Vincent Kathleen L. , Pyles Richard , Villarreal Elvia L. , Mansingka Nandika 
Published: May 2024

INTRODUCTION:
Use of combined contraceptive vaginal ring (CCVR) has been found to upregulate immune-related genes in the endocervix and mediators within the cervicovaginal fluid. Attachment and infection rates of certain pathogens within this tract can vary based on hormones within the local environment. Rat studies have shown treatment with estrogen prior to chlamydial infections was protective. Continued clinical safety analyses are critical as CCVR use continues to increase. We calculated risk of vaginal infections associated with CCVR compared to oral contraceptive pills (OCPs) via retrospective chart review.

METHODS:
De-identified data was collected from TriNetX. Using ICD-10 and RxNorm codes, study cohorts included women receiving etonogestrel and ethinyl estradiol CCVRs without segesterone, versus women on OCPs without vaginal hormones. Cohorts (n=30,796 each) were matched for age, race, and ethnicity. Statistical analysis within 1 year of CCVR placement used risk ratios (RRs); P<.05 was considered significant.

RESULTS:
Combined contraceptive vaginal rings showed increased risk of HSV-2 (RR 1.790; P<.0005), acute vaginitis (RR 1.722; P<.0005), subacute/chronic vaginitis (RR 1.904; P<.0005), subacute/chronic vulvitis (RR 1.969; P<.0005), acute vulvitis (RR 1.894; P<.0005), candidiasis (RR 1.464; P<.0005), trichomoniasis (RR 2.162; P<.0005), and pelvic inflammatory disease (PID) (RR 2.984; P<.0005). Combined contraceptive vaginal rings showed a decreased risk of chlamydia (RR 0.760; P=.047). There were no differences in risk of gonorrhea, syphilis, HIV, or anogenital warts between the CCVR and OCP cohorts

CONCLUSION:
In this chart review, women using CCVRs had increased risks for HSV-2, vaginitis, vulvitis, PID, trichomoniasis, and candidiasis and decreased risk of chlamydia compared to OCPs. Further study of local hormone delivery on the vaginal mucosa is warranted.
Transgender and Gender Nonbinary Individuals' Assigned Female at Birth Experiences and Preferences With Gendered Advertisement and Packaging of Contraception [ID 2683586]
Authors: Costley Lauren K. , Maguire Karla , Cook Jake , Abern Lauren , Harris Miles 
Published: May 2024

INTRODUCTION:
Transgender and gender nonbinary individuals assigned female at birth (TGNB-AFAB) use contraceptives for a variety of reasons including menstrual suppression or pregnancy prevention. However, the use of contraceptives could trigger gender dysphoria and deter use. Our goal is to determine the effect of gendered advertisement on the use of contraceptives in this population.

METHODS:
TGNB-AFAB individuals, ages 18 and older, participated in an online anonymous survey about their experiences with sexual and reproductive health care. The study was IRB approved by Emory University.

RESULTS:
Ninety-two TGNB-AFAB individuals responded. The mean age was 34 (SD 7.8). The majority of respondents identified as White (89.3%) and non-Hispanic (94.0%). 66 (78.6%) were college educated. 33 (38.4%) respondents currently use contraception. Primary forms of contraception include oral contraceptives (15.6%), condoms (21.9%), intrauterine devices, and implants (21.9%). 38 (45.2%) reported gendered advertisement or packaging makes them less likely to use contraceptives and 62 (73.8%) believed gendered advertisement makes other TGNB-AFAB individuals less likely to use contraceptives. 36 (42.9%) respondents said they would be more likely to use contraceptives if the packaging were gender neutral or gender inclusive and 33 (39.3%) if it was marketed specifically for trangender and gender-diverse individuals. The data from this study are preliminary.

CONCLUSION:
Contraceptive use is common in TGNB-AFAB; however, gendered advertising and packaging can be a deterrent for these individuals. Gender-neutral and/or gender-inclusive advertisement could potentially increase the use of contraceptives in this population.