bluuebunny/crossref_metadata_2025_split huggingface dataset:
Perinatal Mental Illness in Canada: Canadian Health Care Providers Do Not Feel Competent [ID: 1377412]
Authors: Cook Jocelynn 
Published: May 2023

INTRODUCTION:
Consequences of untreated perinatal mental illness (PMI) can be severe and have negative implications for mothers and children across generations. Canadian data report 33% of new mothers are concerned about PMI, which is likely a very conservative estimate. Health care providers (HCPs) play a critical role in identification, screening, and treatment of PMI, yet we regularly receive requests for practice guidance. The purpose of this study was to explore practices, needs, and perceived competencies of HCPs related to PMI.

METHODS:
An online survey was administered to perinatal HCPs. Multiple choice questions and open text responses focused on needs, screening, treatment, referrals, and barriers. Descriptive statistics were used to report findings by profession, and text comments analyzed using content analysis.

RESULTS:
Respondents (N=290) frequently encounter patients with anxiety (84%), mood disorders (63%), and psychological aspects of transition to parenthood (60%). They occasionally encounter patients with eating (74%), personality (74%), or substance use (66%) disorders. Greater than 90% wanted more information about all disorders in the prenatal period; resources were most frequently requested; information about diagnosis was least requested. Family practitioners felt very confident screening for PMI (69%), but fewer were confident counselling (54%) or treating (27%) PMI. Few obstetricians (8%), nurses (15%), and midwives (16%) felt very confident providing counseling or treatment (1–4%). Barriers included a lack of awareness of supports and resources.

CONCLUSION:
Canadian HCPs do not feel competent to manage patients with PMI and need more guidance and resources. Results will inform development of targeted education and resource initiatives, including Clinical Practice Guidelines.
A Rare Case of Biparental Placental Mesenchymal Dysplasia: A Case Report and Literature Review [ID: 1336615]
Authors: Portilla Francisco Ruiloba , Wolff Megan Barragan , Cuevas Montserrat , Chaidez Salvador Jiménez , Vázquez Yolotzin Valdespino , Alexandra van Tienhoven Ximena 
Published: May 2023

INTRODUCTION:
Placental mesenchymal dysplasia (PMD) is a rare placental anomaly associated with high perinatal mortality; it is predominantly seen in female fetuses and very few cases have been reported. The evaluation of first- and second-trimester products of conception is of the utmost importance when assessing molar pathologies such as complete hydatidiform moles, partial hydatidiform moles, and nonmolar samples.

METHODS:
We report a monochorionic 46XX,69XXY pregnancy with placental mesenchymal dysplasia (PMD) with possible androgenetic biparental mosaicism etiology (Instituto Nacional de Perinatología Isidro Espinosa de los Reyes approval number P-270-18).

RESULTS:
The patient is a 28-year-old gravida 2, para 1, female with no notable past medical history. She had a previous pregnancy resulting in an uncomplicated abdominal delivery at 39 weeks of gestation 5 years prior. The patient was transferred to our health center at 24.2 weeks of gestation with a molar component because of USG data consistent with a probable hepatic tumor, perimembranous ventricular septal defect, and probable PMD. Ultrasound at 24.3 weeks of gestation demonstrated a single intrauterine pregnancy with one-third of the placenta appearing normal, the second third showing irregular cystic masses, and the remaining third with larger cysts. Placental mesenchymal dysplasia was diagnosed retrospectively based on data from the gross, histologic, and genetic components.

CONCLUSION:
To our knowledge, this is the first reported case of PMD with a 46XX,69XXY karyotype. A radical and cautious approach to PMD cases is needed because of the lack of sufficient data and reports.
Effect of Telehealth Adaptation on the Diagnosis of Hypertensive Disorders of Pregnancy [ID: 1358276]
Authors: Abelman Sarah , Boelig Rupsa , Felder Laura , Svetec Sarah 
Published: May 2023

INTRODUCTION:
COVID-19 caused a rapid integration of telehealth into prenatal care. This study aims to assess the effect of telehealth adaptation on timing and severity of the diagnosis of hypertensive disorders of pregnancy (HDP).

METHODS:
This is an IRB-approved retrospective cohort study of patients with HDP who delivered from April to October of 2019 (pre-pandemic) and 2020 (pandemic) at one urban tertiary care center. The primary outcome was mean gestational age at diagnosis of HDP. Secondary outcomes included initial and final severity of diagnosis before delivery. Results were adjusted for baseline characteristics different at P<.10, using multivariable logistic regression and ANCOVA as appropriate.

RESULTS:
Four hundred ninety-eight patients were included, with 231 from 2019 and 267 from 2020. 17.1% had preeclampsia with severe features initially, and 29.3% met these criteria by delivery. In 2020, 80.5% of patients used telehealth (versus 0.9% in 2019), doing so for a mean of 29% of prenatal appointments. Unadjusted and adjusted analyses showed no significant difference in gestational age at diagnosis or diagnosis severity between cohorts. In the adjusted analysis, Black race was significantly associated with initial diagnosis severity (odds ratio [OR] 1.7 [1.0–2.8], P=.046); telehealth use as represented by cohort year was not (0.9 [0.5–1.3], P=.54). Black race (OR 2.6 [1.6–4.3], P<.001), non-Hispanic ethnicity (OR 0.4 [0.2–0.8], P=.04), and body mass index (OR 1.04 [1.0–1.1], P=.005) were significantly associated with final diagnosis severity; telehealth use was not (OR 1.0 [0.6–1.4], P=.87).

CONCLUSION:
The adaptation of telehealth is not associated with a change in timing or severity of diagnosis of HDP.
Regional Differences in COVID-19 Vaccination and Breakthrough Infection Rates by U.S. Census Region Using Cerner Real-World Data [ID: 1363147]
Authors: Vircks Julie , Casubhoy Imaima , Maulik Devika , Mohamed Yahia , O’Brien Devon , Sahil Suman 
Published: May 2023

INTRODUCTION:
The rate of COVID-19 infection varies across different regions in the United States. However, there are limited data evaluating the vaccination rates and subsequent infection among the pregnant population with regard to geographical location. The primary aim of the study was to determine the COVID-19 vaccination rate and subsequent infection rate among pregnant people in each U.S. census region.

METHODS:
A retrospective data collection of pregnant people from January 2020 to March 2022 was performed using the Cerner Real-World Data from 106 centers. The four census regions were defined by the U.S. Census Bureau. Breakthrough infection was defined as a positive COVID-19 test during or after pregnancy among immunized mothers. Because the database was fully de-identified, IRB approval was not required.

RESULTS:
The study included 389,764 pregnant persons, of which 44,846 were vaccinated. The rate of vaccination against COVID-19 was 14.57%, 11.80%, 11.71%, and 5.24% in the South, West, Northeast, and Midwest census regions, respectively. The COVID-19 infection rate after vaccination was 1.70%, 1.31%, 0.36%, and 0.06% in the Northeast, South, Midwest, and West census regions, respectively.

CONCLUSION:
The reported 11% vaccination rate suggests low utilization among pregnant people; that said, breakthrough infections rates appeared extremely low, suggesting robust protection. The study is limited in that it queried hospital-based vaccinations and breakthrough infections and is unable to capture larger community-based data. Further studies may compare vaccination and infection trends with nonpregnant patient populations.
Factors Associated With Surgical Intervention in Patients With Renal Colic During Pregnancy [ID: 1366267]
Authors: Abruzzese Jessica , Gurram Padmalatha , Khan Sameer , Tassone Lauren , Trivedi Kiran , White Samantha 
Published: May 2023

INTRODUCTION:
We studied clinical characteristics of patients whose renal colic and nephrolithiasis are managed surgically in pregnancy compared to patients who were managed expectantly.

METHODS:
This is a retrospective study of patients presenting with renal colic from June 2013 to May 2022. Clinical characteristics, number of admissions and length of stay, and pregnancy outcomes (preterm labor/preterm delivery or preeclampsia) of patients requiring surgical intervention (SI) were compared to patients that were managed expectantly (EM). Surgical interventions were matched to EM 1:1 based on year of SI. Patients that underwent other nonobstetric surgeries and obstetric surgeries (cerclage) within 30 days of SI were excluded. Institutional review board approval was obtained.

RESULTS:
One thousand one patients were admitted with renal colic and 40 received SI. Ureteral stents is the commonest procedure (35 patients), followed by percutaneous nephrostomy. Maternal characteristics were similar except for Black race (P=.38). Mean gestational age of presentation is 24.5 weeks in both groups (P>.05). Common indications documented for SI are intractable pain (80%) and obstructing stone with sepsis (40%). The mean pain score was 5.2 in SI versus 1.6 in EM (P=.00). Fever was seen in 15.5% of SI versus 2.5% in EM (P=.04). Computed tomography scan performed in 22.5% of SI versus 2.5% in EM. Number of admissions were 1.75 versus 1.08 in EM (P=.03). Length of stay was 5.34 versus 1.38 days in EM (P=.00). Pregnancy outcomes were similar (P>.05).

CONCLUSION:
Black race, pain score greater than 5, and fever are more likely to have SI. Surgical intervention can be safely performed in pregnancy without increase in adverse outcomes.
Can We Predict Isolated Fasting Hyperglycemia in Patients With GDM? [ID: 1368593]
Authors: Strauss Tirtza Spiegel , Al-Ibraheemi Zainab , Brustman Lois , Grubman Olivia , Owens Thomas , Scarpelli-Shchur Sophia 
Published: May 2023

INTRODUCTION:
One-third of patients with gestational diabetes mellitus (GDM) require hypoglycemic agents. There is a subset of patients who control their postprandial values with diet, yet they have persistent fasting hyperglycemia requiring bedtime hypoglycemic agents (GDMHS). As fasting hyperglycemia is an independent risk factor for adverse pregnancy outcomes, we aimed to identify risk factors to predict (and subsequently counsel) GDM patients with a risk of isolated fasting hyperglycemia requiring treatment with bedtime hypoglycemic agents.

METHODS:
This was an IRB-approved retrospective cohort study of patients diagnosed with GDM after 24 weeks from 2016 to 2020. Patients monitored glucose four times daily (fasting and 2 hours postprandial); fasting hyperglycemia was defined as more than 50% fasting values greater than 90 mg/dL. Patients completely controlled with diet (GDMA1) were compared to those with GDMHS. A multivariate analysis assessed whether age, body mass index (BMI), fasting glucose tolerance test (GTT) value, HbA1c at diagnosis, history of polycystic ovarian syndrome or previous GDM, Asian race, or family history of diabetes predicted isolated fasting hyperglycemia.

RESULTS:
Four hundred five patients had GDM. 57% had GDMA1, and 28% had GDMHS. Compared to GDMA1, patients with GDMHS were older, had higher BMI, higher fasting GTT value, higher HbA1c, and higher incidence of previous GDM or family history of diabetes. After adjusting for confounders, higher HbA1c at GDM diagnosis (odds ratio [OR] 3.55), older age (OR 1.08), and higher fasting GTT value (OR 1.06) were significantly associated with an increased probability of persistent fasting hyperglycemia. Asian race was associated with decreased probability of fasting hyperglycemia but was confounded by lower fasting GTT and lower BMI.

CONCLUSION:
Our data suggest that elevated HbA1c, higher fasting GTT value, and older age may predict persistent isolated fasting hyperglycemia in GDM patients who are otherwise controlled with diet. These data can be used to educate and counsel patients to alleviate frustration encountered with persistent fasting hyperglycemia despite postprandial diet control.
Delivery Outcomes in Pregnant Women With Third-Trimester Vaginal Bleeding [ID: 1376165]
Authors: Kalyanpur Nisha , Byrne John , Cheng CeCe , Neuhoff Barbara , Rowley Justin , Sundjaja Claire 
Published: May 2023

INTRODUCTION:
We sought to determine delivery-related morbidity outcomes in patients presenting with third-trimester vaginal bleeding in the absence of placenta previa or placenta accreta spectrum (PAS).

METHODS:
A retrospective cohort study was conducted among women presenting with third-trimester vaginal bleeding at our tertiary center from July 2020 to June 2022 with exclusion of placenta previa or PAS. Bleeding was categorized by amount documented on provider examination as follows: “light,” less than 50 mL; “heavy,” 50 mL or more. The primary outcome was postpartum hemorrhage (PPH; ≥1,000 mL). Secondary outcomes included relevant maternal and neonatal morbidity measures.

RESULTS:
Among 6,584 singleton pregnancies, 76 (1.2%) presented with third-trimester vaginal bleeding without evidence of placenta previa or PAS; 68 of patients had light and 8 had heavy bleeding. Bleeding was frequently accompanied by contractions (62%) and cervical change (74%). Bleeding on admission was not associated with increased risk of PPH (light: relative risk [RR] 0.7, 95% CI [0.3, 1.4], P=.14; heavy: RR 1.7, 95% CI [0.5, 5.5], P=.2) or need for blood transfusion. Cesarean delivery (CD), general anesthesia, preterm birth (PTB), and neonatal intensive care unit admissions were more common in patients with heavy bleeding (all P<.05). Light bleeding did not increase the risk of PTB or CD and was associated with a higher rate of spontaneous vaginal delivery (RR 1.24, 95% CI [1.1, 1.4], P=.0003). No patients with bleeding required intensive care unit admission, hysterectomy, or had neonatal demise. Seventy-five percent of patients with heavy bleeding (n=8) and 16% of patients with light bleeding (n=11) had clinical or pathological evidence of abruption.

CONCLUSION:
Third-trimester vaginal bleeding, without placenta previa or PAS, is not associated with increased risk for PPH. Heavy bleeding, however, is associated with increased risk of preterm delivery and cesarean section, with abruption evident in 75% of these patients. Light bleeding on admission is usually not associated with an abruption or an increase in adverse maternal or neonatal outcomes.
Differences in Ultrasonographic Predictors of Fetal and Maternal Morbidity and Mortality Between Gestational and Pregestational Diabetics [ID: 1376398]
Authors: Kucirka Lauren , Boggess Kim , Kraus Alexandria 
Published: May 2023

INTRODUCTION:
We sought to estimate the association between polyhydramnios and/or large for gestational age (LGA) and perinatal outcomes in pregestational (PreDM) compared to gestational diabetic (GDM) patients.

METHODS:
This was a secondary analysis of an observational study at a large academic center between 2014 and 2021, excluding congenital anomalies. Using modified Poisson regression, we measured the relationship between polyhydramnios (mild or moderate/severe) and/or LGA, and risk of stillbirth, neonatal intensive care unit (NICU) admission, cesarean delivery, and postpartum hemorrhage. We adjusted for potential confounders and stratified by diabetes group (PreDM versus GDM). We also created a model including interaction terms between diabetes type and presence of 1) polyhydramnios or 2) LGA, to test for interactions on outcomes.

RESULTS:
Among 2,533 pregnancies, 2,298 (91%) had GDM and 235 (9%) had PreDM. Four hundred seventy-two (18.6%) had LGA and 41 (1.6%) had moderate/severe polyhydramnios, and both were more common in PreDM versus GDM (34% versus 17%, P<.001, and 3.8% versus 1.4%, P<.05, respectively). LGA was associated with a significantly increased risk for cesarean section and NICU admission in both groups; however, moderate/severe polyhydramnios was associated with higher risk of stillbirth in PreDM (RR 14.7 [95% CI 1.3–163], P<.05), but not GDM. In those with moderate/severe polyhydramnios, PreDM had a significantly greater risk of stillbirth compared to GDM (P<.05). There was no statistically significant interaction between diabetes type, LGA, and risk of stillbirth.

CONCLUSION:
Moderate/severe polyhydramnios portends a higher risk of stillbirth in PreDM versus GDM. The presence of moderate/severe polyhydramnios should be considered in determining antenatal surveillance and delivery timing in patients with PreDM.
Hypertensive Disorders of Pregnancy and the Risk of Developing Hypertension Outside of Pregnancy Based on Updated Hypertension Guidelines [ID: 1377015]
Authors: Tucker Tonya , Branche-James Lauren , Cooper Shontreal , Kuo Chia-Ling , Shields Andrea 
Published: May 2023

INTRODUCTION:
The purpose of this study is to determine whether hypertensive disorders of pregnancy (HDP) affect the development of chronic hypertension (HTN) within 5 years postdelivery based on updated guidelines by the American Heart Association (AHA).

METHODS:
This IRB-approved study evaluated women who delivered at one hospital from 2014 to 2016. Participants were determined to be normotensive or with HDP. Inclusion criteria for the HDP group was diagnosis of gestational HTN or preeclampsia at 20 weeks of gestation or greater. Exclusion criteria were previous diagnosis of HTN and age over 40. Women were followed up to 5 years postdelivery to assess development of chronic HTN, defined by the 2017 AHA guidelines as systolic greater than 130 mm Hg or diastolic greater than 80 mm Hg.

RESULTS:
Sixty-four participants (30.9%) developed chronic HTN within 5 years of delivery. Of these participants, 6.25% were from the normotensive pregnancy group, while 84.4% were from the preeclampsia with severe features group, with adjusted odds ratio of 11.38 (CI 4.67–22.46). Compared to the 5-year normotensive group, the 5-year chronic HTN group was associated with higher maternal body mass index (BMI) (P=.0146), preterm delivery (P=.0231), and neonatal intensive care unit (NICU) admission (P=.04).

CONCLUSION:
The rate of chronic HTN development 5 years postdelivery was significantly higher in participants with HDP, notably preeclampsia with severe features. Participants with development of chronic HTN had increased BMI during pregnancy, preterm delivery, and NICU admission rates as compared to participants with 5-year normotensive pressures. Awareness of the prevalence and risk factors for development of chronic hypertension provides areas of focus for future investigations.
Investigating the Relationship Between Maternal Obesity and Disorders of Amniotic Fluid [ID: 1377151]
Authors: Yan Xiteng , Bentley Beth , Dinglas Cheryl , El-Kady Dina , Rosner Jonathan , Schmidt-Swartz Jordana 
Published: May 2023

INTRODUCTION:
Prior studies show conflicting evidence as to whether obesity in the absence of other medical or pregnancy-related conditions contributes to amniotic fluid disorders. The purpose of this study is to determine the association between late-pregnancy obesity with oligohydramnios (amniotic fluid index [AFI]<5 or maximum vertical pocket [MVP]<2) and/or polyhydramnios (AFI>24 or MVP>8).

METHODS:
This is a retrospective cohort study of 966 women with singleton gestations who had one or more obstetrical ultrasounds at Mount Sinai South Nassau at 36 0/7 weeks of gestation or beyond between August 1, 2015, and May 1, 2020. Patients were included if they had valid pregnancy dating and a documented AFI and/or MVP. Patients were categorized based on body mass index (BMI) (eg, normal, overweight, class I obesity, class II obesity, or class III obesity). Chi-square analyses were performed to evaluate whether there was a relationship between BMI and AFI. A logistic regression analysis was then performed for any confounding variables.

RESULTS:
There was no significant association between oligohydramnios and increasing BMI, whether patients had overweight (P=.17), class I (P=.46), class II (P=.49), or class III obesity (P=.99). The same was true for polyhydramnios and increasing BMI, whether patients had overweight (P=.68), class I (P=.74), class II (P=.94), or class III obesity (P=.99).

CONCLUSION:
Elevated maternal BMI was not significantly associated with disorders of amniotic fluid, regardless of the severity of obesity.
The Role of Fetal MRI in Management of Polyhydramnios: Findings From a Fetal Care Center [ID: 1378023]
Authors: Bank Rachel , Cass Darrell , Hopkins Maeve , Kalan Amanda , Kalan Amanda , Robertson Jason , Wang Sarah 
Published: May 2023

INTRODUCTION:
Polyhydramnios, affecting 1–2% of pregnancies, is frequently associated with congenital anomalies. Prenatal ultrasound may identify potential etiologies for polyhydramnios and associated anomalies but has limitations particularly with regard to gastrointestinal imaging. There are no guidelines for use of fetal MRI (fMRI) in the setting of polyhydramnios.

METHODS:
The medical records of all patients referred to Cleveland Clinic’s Fetal Care Center between 2015 and 2021 were reviewed. Singleton pregnancies with amniotic fluid index (AFI)≥24 cm who underwent fMRI were included. Prenatal diagnoses made by ultrasound and fMRI were compared to postnatal diagnosis and potential etiologies for polyhydramnios.

RESULTS:
Fifty-eight patients with polyhydramnios received an fMRI, of which 26.6% (16/58) had a new diagnosis not detected by prior prenatal ultrasounds. Among cases where fMRI resulted in a new diagnosis, the majority were neurological 25% (4/16) or genitourinary anomalies 25% (4/16); 12.5% (2/16) were considered causative of polyhydramnios. Among patients with a new diagnosis on fMRI, 25% (4/16) had no abnormalities identified by prenatal ultrasound. Fetal MRI confirmed ultrasound diagnoses in 76.2% (32/42) of cases. There was no difference in average AFI between patients who were and were not found to have a new diagnosis on fMRI (33.1 versus 33.0, P=.47).

CONCLUSION:
In patients presenting to a fetal care center with polyhydramnios, addition of fMRI to prenatal ultrasound identified new anomalies in 26.6% of cases. Fetal MRI should be considered an adjunct to prenatal ultrasound in evaluation of pregnancies complicated by polyhydramnios to improve prenatal diagnosis of structural anomalies, prenatal counseling, and perinatal management.