bluuebunny/crossref_metadata_2025_split huggingface dataset:
Does Longer Second-Trimester Cervical Length Increase Likelihood of Labor Induction? [ID 2683543]
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 associated with increased rates of spontaneous preterm birth; however, little is known about the effect of increasing TVCLs on spontaneous labor rates. We aimed to determine if longer TVCL is associated with increased risk of induction of labor (IOL).

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. Rates of IOL 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 controlled for potential confounders. Institutional review board approval was obtained.

RESULTS:
Of 1,027 eligible deliveries, 594 (58%) underwent IOL. Patients with TVCLs in T2 and T3 were significantly more likely to undergo IOL than patients with TVCL in T1 (T2 59.6% versus T1 49.4%, P=.02; T3 56.5%, P=.04). Patients in T2 had increased odds of IOL compared to those in T1 (OR 1.5 [CI, 1.1–2.1]). This relationship did not remain significant after adjusting for potential confounders including term delivery, delivery mode, race/ethnicity, age, and body mass index. The odds of IOL with TVCL in T3 were not significantly different than for those in T1, before and after adjusting for confounders.

CONCLUSION:
Within a cohort of patients with normal mid-trimester TVCL, increasing TVCLs were not associated with higher rates of IOL after adjusting for confounding variables. These results can be used to guide patient counseling surrounding birth plans and expectations for labor and delivery.
Relationship Between Vaginal and Gut Microbiome on Stress and Depression in Pregnancy [ID 2683607]
Authors: Worly Brett Lawrence , Gur Tamar L. , Rajasekera Therese 
Published: May 2024

INTRODUCTION:
Pregnancy is a period of significant stress and weight gain; however, the effect of the vaginal and gut microbiome on pregnancy, depression, stress, and the neonate is not completely understood.

METHODS:
An IRB-approved prospective cohort study was performed for pregnant individuals and their neonates. The Perceived Stress Scale (PSS) and Center for Epidemiologic Studies Depression Scale (CES-D) surveys were administered in the antepartum and postpartum patient, vaginal and fecal microbiome samples were collected, and neonate umbilical cord blood and fecal specimens were also collected. Using full-length 16S rRNA sequencing, fecal and vaginal community composition was characterized. Additionally, possible covariates such as body mass index, cohabitation status, educational attainment, dietary intake, public/private insurance status, chronic health conditions, and pregnancy complications were captured.

RESULTS:
The study sample consisted of 35 pregnant individuals, average age 30 years, and half primiparous. Increased early pregnancy stress (PSS greater than or equal to 14) was associated with increased abundance of fecal taxa, and increased stress from late pregnancy through postpartum was associated with increased abundance of fecal microbial pathogens. Depressed participants (CES-D greater than or equal to 16) experienced steeper decreases in prenatal vaginal microbiome diversity. In late pregnancy, maternal stress and depression scores were associated with elevated maternal inflammatory markers (CCL2). At delivery, neonatal umbilical CCL2 concentration was negatively correlated with relative abundance of maternal fecal lactobacilli.

CONCLUSION:
These findings highlight the relationship between stress and depression in pregnancy, the microbiome of the pregnant patient, and inflammatory markers in the pregnant patient and the neonate.
Is Preeclampsia With Low Sodium Levels Associated With Increased Need for Antihypertensives? [ID 2683464]
Authors: Band Isabelle C. , Goldberger Cody , Wang Kelly Z. , Cohen Rebecca M. , Zachem Alexis L. , DeBolt Chelsea A. 
Published: May 2024

INTRODUCTION:
Preeclampsia (PEC) complicates 5–10% of pregnancies. Preeclampsia and low sodium (PALS) has been reported, but risks of low sodium are not well understood. We hypothesize that PALS is associated with increased need for antihypertensives.

METHODS:
This was an IRB-approved retrospective cohort study of 521 PEC patients with a documented sodium level during delivery or postpartum admission at Mount Sinai Hospital (2013–2021). Primary outcomes were need for emergency antihypertensives during admission and long-acting antihypertensives at discharge. Secondary outcomes were maternal length of stay (LOS), ICU admission, and readmission for PEC.

RESULTS:
Patients with PALS (sodium <135 mmol/L; n=111) were more likely to be nulliparous (P=.004), have lower body mass index (P=.03), and have a history of PEC (P=.047). In a multivariable logistic regression adjusting for history of PEC, chronic hypertension, aspirin use in pregnancy, multiple gestations, and PEC subtypes, patients with PALS were more likely to require long-acting antihypertensives at discharge (adjusted odds ratio [aOR] 1.79; 95% CI [1.13, 2.83]; P=.01) compared to PEC with normal sodium. Need for emergency antihypertensives, rates of maternal ICU admission and maternal readmission did not differ between groups. However, the distribution of maternal LOS differed between groups (median [interquartile range (IQR)]: 4.0 [3.0, 5.0] for normal sodium, 4.0 [4.0, 6.0] for low sodium; P<.0001).

CONCLUSION:
Preeclampsia and low sodium is associated with increased need for long-acting antihypertensives at discharge. Preeclampsia and low sodium may represent a more severe PEC presentation, warranting closer attention to sodium levels in the management of PEC patients. Future studies with larger sample sizes are needed to assess the effects of lower sodium levels.
Prevalence of Large for Gestational Age and Polyhydramnios on Late Third-Trimester Ultrasound and Associated Adverse Pregnancy Outcomes [ID 2683531]
Authors: Moss Heather , Riley William L. , Mastronardi Alicia , Brechtel Leanne E. , Patel Mithil D. , Reeder Callie 
Published: May 2024

INTRODUCTION:
The objective of this study was to evaluate the prevalence of large for gestational age (LGA) and polyhydramnios found on ultrasound performed between 34 and 38 weeks of gestation and investigate the prevalence of gestational diabetes and delivery outcomes in this population.

METHODS:
A retrospective cross-sectional study (IRB #4869) was performed including chart review of late third-trimester ultrasounds performed on singleton pregnancies between 34 and 38 weeks of gestation from April 2020 to April 2022 at a hospital-owned private practice. Patients were grouped as no LGA (estimated fetal weight >90%) or polyhydramnios (amniotic fluid index ≥25 or maximum vertical pocket ≥8) or LGA and/or polyhydramnios. Differences in cesarean delivery (CD), gestational diabetes diagnosis, and macrosomia between groups were assessed via χ2 and Fisher's exact tests.

RESULTS:
Of 1,510 pregnancies, 15.0% (227/1,510) were diagnosed with LGA and/or polyhydramnios on late third-trimester ultrasound. The overall prevalence of CD in the group without LGA and/or polyhydramnios was 25.5%, whereas the rate of CD in patients having LGA and/or polyhydramnios was 44.1% (P<.001). The overall prevalence of macrosomia in the group without LGA and/or polyhydramnios was 8.8%, whereas the rate of macrosomia in patients having LGA and/or polyhydramnios was 17.2% (P<.001). The prevalence of diabetes in pregnancy was not significantly different between groups (without LGA and/or polyhydramnios 12.2% versus having LGA and/or polyhydramnios 16.7%; P=.081).

CONCLUSION:
Patients with LGA and/or polyhydramnios on late third-trimester ultrasound had significantly higher rates of CD and macrosomia. They were not more likely to have a diagnosis of diabetes during pregnancy. Late third-trimester ultrasound findings of LGA and/or polyhydramnios could be useful in detecting undiagnosed and/or missed diabetes. Future work will evaluate the timing of gestational diabetes screening and subsequent testing for diabetes if findings suggest LGA and/or polyhydramnios.
Obstetric Outcomes After Chemotherapy in Pregnancy [ID 2683556]
Authors: Nambiar Anjali , Mulder Isabelle , Rodriguez Aldeboran N. , Duryea Elaine L. , Lea Jayanthi , Spong Catherine Y. 
Published: May 2024

INTRODUCTION:
Cancer affects approximately 1 in 1,000 pregnancies; limited data exist to guide clinical decision making and counseling regarding chemotherapy. We investigated the obstetric outcomes of patients who received chemotherapy for cancer in pregnancy at a large county hospital.

METHODS:
In this retrospective IRB-approved study, patients diagnosed with cancer prior to or during pregnancy from May 2009 to May 2023 were identified. Those who received chemotherapy in pregnancy were included. Type of cancer, chemotherapeutic agents, and obstetric outcomes were obtained from the electronic medical record.

RESULTS:
Of 22 patients who initiated or continued chemotherapy, seven had a cancer diagnosis prior to pregnancy. Fifteen were diagnosed in pregnancy, at an average gestational age of 15.5 weeks. Average maternal age was 30.5 years. Hematologic (36%) and breast (32%) cancers were most common. Four terminated pregnancy and 18 continued pregnancy. Chemotherapy initiation occurred at an average of 21.2 weeks. Most patients received alkylating agents or antitumor antibiotics, and only one required antepartum admission for chemotherapy-related complications. Patients delivered at an average of 35.6±3.0 (29–41) weeks and 9/18 (50%) patients delivered prior to 37 weeks. Severe fetal growth restriction (less than third percentile) occurred in 6/18 (33%) patients; one had a history of fetal growth restriction in a prior pregnancy. There were no neonatal deaths or congenital malformations.

CONCLUSION:
While high rates of fetal growth restriction and preterm birth were observed, chemotherapy was well tolerated in pregnancy and all non-terminated pregnancies delivered viable infants in the third trimester. Chemotherapy can be administered in pregnancy with counseling regarding neonatal risks.
Cardiovascular Risk Assessment in Pregnancy: Findings From a Large Urban Academic Medical Center [ID 2683572]
Authors: Flatley Kevin , Hameed Afshan , Wolfe Diana S. , Thiel de Bocanegra Heike 
Published: May 2024

INTRODUCTION:
The goal of this study is to describe patients who screened positive and had true cardiovascular disease (CVD) identified using a risk assessment tool in pregnancy or postpartum.

METHODS:
This is a prospective validation study of the CVD screening algorithm proposed by the California Maternal Quality Care Collaborative (CMQCC). The CVD risk assessment tool was embedded in the electronic medical record for use by all prenatal care providers with a goal of at least one CVD risk assessment during pregnancy and/or postpartum period. Patients identified with increased risk of CVD received an echocardiogram, electrocardiogram, and cardiology consultation. We describe the assessment tool responses, timing of assessment, cardiac findings, and subsequent interventions. This study was approved by the IRB at Albert Einstein College of Medicine.

RESULTS:
A total of 1,877 patients were screened as of September 1, 2023, with 148 screening positive for at risk of CVD. Thirty-two patients were found to be true positives including 2 (6.25%) with systolic and/or diastolic dysfunction, 10 (31.3%) with ventricular dilation or hypertrophy, and 23 (71.9%) with a valvular abnormality.

CONCLUSION:
All 32 true-positive cases were seen by a multidisciplinary cardio-obstetrics team at least once. Ten patients had multiple visits with the cardio-obstetrics team. Three patients were deemed to be of higher risk for decompensation during labor by modified World Health Organization classification and required detailed plans for intrapartum and postpartum management. Seven patients were started on cardiovascular medications. The cardiovascular risk assessment tool proved valuable for identifying and providing individualized care for cardio-obstetric patients.
Preeclampsia Risk in Pregnant Patients With Preexisting Ischemic Heart Disease [ID 2683588]
Authors: Azar Michelle , Bailey Beth A. 
Published: May 2024

INTRODUCTION:
Preeclampsia (PreE) affects 1 in 25 U.S. pregnancies. Recognized risk factors include obesity, chronic hypertension, and diabetes, and PreE may elevate risk of cardiovascular disease (CVD) later in life. Despite shared vascular integrity concerns with known risk factors, there is no clear link between preexisting CVD, particularly ischemic heart disease (IHD), and increased risk of PreE during pregnancy. This study investigates whether preexisting IHD heightens risk of PreE in pregnant patients, and if this relationship can be explained by elevated rates of hypertension, diabetes, and obesity.

METHODS:
Data were obtained from the Healthcare Cost and Utilization Project (HCUP) national database, containing comprehensive de-identified patient data on U.S. hospital encounters. ICD-10 codes for IHD, chronic hypertension, gestational and preexisting diabetes, obesity, and PreE were used to identify relevant cases among delivery admissions. Data were analyzed using logistic regression, controlling for confounders.

RESULTS:
The sample included 1,670,527 patients who delivered between 2016 and 2019. Although no differences by race were observed, patients with IHD were significantly older and more likely to qualify for Medicaid. After controlling for age and insurance status, pregnant patients with IHD were nearly three times more likely to develop PreE than those without IHD (OR 2.75 [1.93–3.39]). With adjustment for possible mediators including chronic hypertension, preexisting and gestational diabetes, and obesity, IHD was still associated with a twofold increased risk of PreE (OR 2.07 [1.44–2.99]).

CONCLUSION:
Pregnant women with preexisting IHD face significantly higher risk of developing PreE, even when considering comorbidities including obesity, diabetes, and hypertension. Preeclampsia is a leading cause of maternal morbidity and mortality worldwide. As the incidence of IHD rises, understanding the potential interactions between these conditions becomes crucial. Further research is needed to clarify connections between IHD and PreE, especially in identifying IHD and its risk factors to improve PreE prophylaxis and management.
Inflammatory Bowel Disease and Associated Placental Histopathology [ID 2683599]
Authors: Schneider Emily , Kantorowska Agata , Akerman Meredith , Khullar Poonam , Kinzler Wendy L. , Rekawek Patricia 
Published: May 2024

INTRODUCTION:
Inflammatory bowel disease (IBD) has been associated with adverse obstetric outcomes, but its effect on placental histopathology is not well studied. We sought to determine the placental histopathology findings associated with maternal IBD.

METHODS:
This is an IRB-approved retrospective cohort study of patients with IBD who delivered singleton live births at a single institution from October 2019 to April 2023 and had placental pathology available. Participants were identified using an ultrasound query for “Crohn’s” or “ulcerative colitis” (UC). Cases with fetal aneuploidy or major anomalies were excluded. Controls were matched 2:1 for maternal age, gestational age at delivery, and medical comorbidities. Demographics, pregnancy outcomes, and pathology findings were obtained from the electronic medical record. Mann–Whitney and Fisher's exact tests were used with significance set at P<.05.

RESULTS:
Placental pathology was compared between 18 IBD participants (11 Crohn's, seven UC) and 36 controls. Of 18 IBD participants, three were treated with sulfasalazine, seven with TNF-α inhibitors, and eight used no medication. Baseline demographics and cesarean delivery rates were similar between groups. Five participants per group had histologic evidence of acute chorioamnionitis and/or funisitis (27.8% versus 13.9%; P=.27). Three IBD participants demonstrated maternal vascular malperfusion (MVM) versus 15 controls (16.7% versus 41.7%; P=.07). There were no differences in placental weight, meconium, or fetal vascular malperfusion.

CONCLUSION:
Inflammatory bowel disease was not associated with adverse placental histopathology. Decreased incidence of MVM may result from IBD medications reducing systemic inflammation. Larger studies are warranted to further evaluate the effect of IBD on placental pathology.
Questioning the Value of Urine Protein for the Diagnosis of Hypertensive Disorders of Pregnancy [ID 2683605]
Authors: Hopman Clarice , Class Quetzal A. , Wheatley Catherine N. , Thiyagarajan Dhanalakshmi 
Published: May 2024

INTRODUCTION:
Preeclampsia with severe features (PreE w/SF) is often preceded with a diagnosis of gestational hypertension (gHTN) or preeclampsia without severe features (PreE w/o SF). These diagnoses remain differentiated via a 24-hour urine protein (24 UP) or a urine–protein creatinine ratio (PCR). We examine the utility of the 24 UP/PCR in differentiating the progression of gHTN or PreE w/o SF to PreE w/SF.

METHODS:
We created a retrospective cohort study of 1,687 patients who delivered a live-born neonate at our urban, academic hospital between September 2011 and September 2021. All patients had an initial diagnosis of either gHTN or PreE w/o SF. Patients with chronic hypertension or an initial diagnosis of PreE w/SF were excluded. We performed descriptive and inferential statistics including chi-square.

RESULTS:
We identified 910 (54%) patients initially diagnosed with gHTN and 777 (46%) PreE w/o SF. A total of 972 (57.7%) reported to be Black and 518 (30.1%) Hispanic. The rate of progression to PreE w/SF did not differ across those with an initial diagnosis of gHTN (n=147 [16%]) or PreE w/o SF (n=153 [19%]; X2 (1)=3.55, P>.05). Timing of initial diagnosis being antenatal or postnatal was not predictive of disease progression.

CONCLUSION:
We found no clinical significance of a 24 UP/PCR in predicting progression to PreE w/SF from gHTN or PreE w/o SF. Performing a 24 UP or PCR takes health care dollars and patients' time, which has economic and social effects. Although further investigation is needed, our findings support eliminating 24 UP/PCR as a diagnostic criterion.
How Patients Seeking Abortion in a Surge State Use Their Stories to Support Each Other [ID 2683411]
Authors: Banwarth-Kuhn Brenna , McQuade Miriam M. , Truehart Amber , Trujillo Victoria 
Published: May 2024

INTRODUCTION:
A changing legal landscape after Texas Senate Bill 8 and the Dobbs decision resulted in a surge of out-of-state patients accessing abortion care in New Mexico. In one health center, patients undergoing procedural abortion can write entries in a recovery room journal titled, “Tell your story; it may help someone else.” Journals were not developed for research but with the goal of invoking community. Patients can read and anonymously share their abortion experience. We analyzed the themes from journal entries to understand how patients share their experiences to foster community during a time of increasing restrictions.

METHODS:
We reviewed 74 anonymous narrative journal entries from a single health center in Albuquerque, New Mexico, from 2020 to 2023, identifying overarching themes using inductive content.

RESULTS:
Journal entries described complex decisions and emotions. Themes included solidarity, autonomy, gratitude, and difficulty of accessing care. People invoked comradeship with words of encouragement and reassured others that restrictive abortion laws should not define their decisions or interfere with their autonomy.

CONCLUSION:
This study highlights the importance of patient storytelling in improving health outcomes. Developed with the goal of invoking community and shared experience for normalization of abortion care, these stories can help us understand how patients frame the context of their decision to help others. The challenges they present and real-time emotional processing help frame the complexity of this decision and the accessibility of abortion care during the time period of increasing restrictions on abortion care.
Racial and Ethnic Disparities in Adverse Neonatal Outcomes Persist With Use of Fertility Treatment [ID 2683455]
Authors: Phillips Sara , Kornfield Molly , Garg Bharti , Krieg Sacha A. 
Published: May 2024

INTRODUCTION:
Racial/ethnic health disparities are well documented, yet little is known about the effect of fertility treatment on disparities. This study assesses the relationship between fertility treatment and adverse neonatal outcomes by race/ethnicity.

METHODS:
A secondary data analysis was performed using National Vital Statistics (2012–2020) including singleton, non-anomalous births from 23 to 42 weeks of gestation. The primary outcome was an adverse neonatal composite outcome (ANCO) encompassing neonatal intensive care unit admission, assisted ventilation, seizures, and Apgar scores less than 7 at 5 minutes. Multivariable logistic regression assessed whether fertility treatment was associated with ANCO by race/ethnicity after adjusting for maternal age, gestational age at delivery, maternal body mass index, education status, insurance, and delivery year.

RESULTS:
Of 31,975,746 births meeting inclusion criteria, 414,716 (1.3%) were conceived with fertility treatment. Across the entire cohort, fertility treatment was associated with significantly increased odds of ANCO (adjusted odds ratio [aOR] 1.44; 95% CI, 1.43–1.46). Prevalence of ANCO was highest for the non-Hispanic Black (NHB) and American Indian/Alaska Native (AIAN) populations in both nonfertility and fertility treatment groups. Without fertility treatment, the Asian/Pacific Islander (API) and Hispanic groups had the lowest rates of ANCO at 8.3% and 8.9%, respectively. With fertility treatment, ANCO odds increased the most in API (aOR 1.61; 1.56–1.66) and Hispanic populations (aOR 1.60; 1.54–1.65).

CONCLUSION:
Fertility treatment is associated with approximately 1.5 times the odds of adverse neonatal outcomes across all racial/ethnic groups, with the greatest increase among the API and Hispanic populations. The NHB and AIAN groups experienced the highest overall rates of ANCO, supporting the need for targeted interventions for historically marginalized populations.