bluuebunny/crossref_metadata_2025_split huggingface dataset:
Race and Ethnicity and Disparities in Neonatal Outcomes in Twin Pregnancies [ID: 1375610]
Authors: Pinson Kelsey , Ballas Jerasimos , Mims Joseph , Ramos Gladys 
Published: May 2023

INTRODUCTION:
Twin pregnancies are associated with adverse neonatal outcomes. We aimed to investigate disparities in neonatal outcomes by maternal race and ethnicity.

METHODS:
This was an IRB-approved, retrospective cohort of twin deliveries at a single institution between 2001 and 2018. Pregnancies delivered less than 23 weeks’ gestational age (GA), fetal demise, or major anomaly were excluded. The primary exposure, race and ethnicity, was self-reported as follows: non-Hispanic White, Hispanic, non-Hispanic Black, Asian/Pacific Islander, and other/mixed race. The primary outcome was neonatal intensive care unit (NICU) admission of at least one twin. Secondary outcomes included 5-minute Apgar less than 7 for either twin, GA at delivery, small for GA (SGA) neonate (<10th percentile for GA), and NICU length of stay. Chi-square, ANOVA, and Student’s t test were performed for univariate analyses. Logistic regression modeling was performed to control for baseline differences.

RESULTS:
Eight hundred four twin pregnancies were identified; 48% of patients identified as non-Hispanic White, 30% as Hispanic, 10% as Asian/Pacific Islander, 5.6% as non-Hispanic Black, and 6.6% as other/mixed race. Age, parity, chorionicity, and body mass index differed between groups. The overall rate of NICU admission was 77.5% and did not differ by race and ethnicity (P=.05). Pregnancies with at least one SGA neonate varied significantly by race and ethnicity (P=.02). Gestational age at delivery, Apgar of less than 7, and ICU length of stay did not differ.

CONCLUSION:
The risk of having an SGA neonate varies by race and ethnicity in twin gestations, with highest rates among non-Hispanic Black women. Additional racial and ethnic disparities in neonatal morbidity were not found. Disparities in rate of preterm birth were not seen in this cohort.
You Matter: Elevating the Community Voice to Improve Patient Knowledge of Severe Maternal Morbidity Warning Signs Through Innovative Video Education at Postpartum Discharge [ID: 1375906]
Authors: White Kelsey , Leon-Martinez Daisy , Lipkind Heather , Senter Lindsay , Son Moeun , Tortal Danna 
Published: May 2023

INTRODUCTION:
The objective of this study was to determine whether a standardized video education campaign “You Matter” at postpartum discharge improves knowledge of warning signs for predominant causes of maternal morbidity (infection, hemorrhage, hypertensive disorders, and postpartum depression) compared to routine written instructions.

METHODS:
This was a randomized controlled trial of patients who delivered at a large, urban, tertiary care hospital. Eligible patients were enrolled and completed a baseline knowledge questionnaire. After delivery, they were randomized to written education or written plus video education, which was created with input from community stakeholders and included animated, ethnic and culturally diverse characters. After education, patients completed the same questionnaire. The primary outcome was improvement in patient knowledge, assessed by the number of correct responses. This study received IRB approval.

RESULTS:
From July to August 2022, 200 patients were enrolled (100 per group). Overall, patients were highly educated (college and/or graduate education, 82%) and most had commercial insurance (73.5%). There was no significant difference in baseline scores between the video and routine education (median 12 [11–14] versus 12 [11–13], P=.53). In the video arm, patients had significantly higher scores on posteducation questionnaires (median 14 [12–15] versus 13 [12–14], P<.01), and patients improved their scores more frequently than their written counterpart (62.4% versus 50.0%, P=.08). Patients more frequently reported that video education was “very helpful” (86.1% versus 73.2%) and were “very satisfied” with their education (86.1% versus 76.3%).

CONCLUSION:
Enhanced postpartum education through a novel video at discharge yielded statistically higher scores on posteducation questionnaires, as well as more frequently improved scores and satisfaction in their care.
Understanding the Role of Race in Doula Communities: Florida Doulas’ Perceptions of Maternal Health Disparities [ID: 1377606]
Authors: Joglekar Ria , Applequist Janelle , Louis-Jacques Adetola , Powis Richard , Wilson Ronee 
Published: May 2023

INTRODUCTION:
This study, part of a larger qualitative project, spurred significant participant feedback related to BIPOC (Black, Indigenous, people of color) clients’ needs for support from racially similar doulas. As such, this study analyzed the data to investigate how doulas navigate client perceptions of race.

METHODS:
Seven in-depth interviews and six focus groups were conducted with doulas serving in Florida (n=31). Transcripts were coded post-inter-coder agreement using an inductive approach to thematic analysis. Participant consent and IRB approval were obtained.

RESULTS:
1) White doulas reported Black doulas advising them to refrain from taking on Black, Brown, non-English speaking clients and instead to refer when possible. Some participants explained tendency for implicit bias and discrimination when White doulas try to step into the perspective of clients of color, specifically Black women, despite good intent in trying to support a community facing health disparities. 2) A few doulas referred to White doulas reaching out to non-White clients as a savior/virtue signaling act, while others countered that White doulas can use their racial status for advocacy in medical settings.

CONCLUSION:
Doulas shared a desire to work with underserved families and discussed that issues surrounding race must first be acknowledged in order to create safer spaces for open communication surrounding maternal health, thereby mitigating disparities. It is important to note that our study relied on convenience sampling, utilizing predominantly White doulas, limiting our data on Black doula experiences and their perceptions on the role of race in the doula–client relationship. Future directions must include diversification of participants and speaking directly with Black doulas.
The Effect of Prenatal Care on Preterm Birth in a Low-Income Minority Population in DC [ID: 1378551]
Authors: Atkins Kristin , Belgrave Briana , Everett Aviana , Smith DeAshley , Tobo Betelihem , Zhang Rui 
Published: May 2023

INTRODUCTION:
Structural and social barriers to health care affect prenatal care (PNC) utilization among underrepresented minorities in the District of Columbia (DC) and contribute to preterm birth (PTB) disparities. The PTB rate among Black people in DC was 13.1% (2018–2020), higher than the overall DC (9.8%, 2020) and United States (10.1%, 2020) rates. We evaluated the association between prenatal care utilization and preterm birth in a low-income minority population in DC.

METHODS:
As part of a collaborative effort with DC Health to reduce PTB, we designed a REDCap database to collect pregnancy and delivery data on all inpatient and outpatient patients at Howard University Hospital (HUH), between January 2020 and September 2022. Our primary exposure variable was PNC (yes or no). Our outcome was PTB (gestational age < or ≥37 weeks). Crude and adjusted logistic regression models analyzed the relationship between prenatal care and preterm birth.

RESULTS:
A total of 1,382 patient charts were evaluated, of which 11.6% had PTB and 95.1% had any PNC. Majority were Black (55.6%) or Hispanic (42.8%), and had Medicaid (92.2%). Any PNC was associated with a 54% reduced odds of PTB (adjusted odds ratio 0.46, 95% CI 0.22–0.97). Additionally, history of preeclampsia (3.75, 2.51–5.62) or spontaneous PTB (2.51, 1.50–4.18) were significantly associated with PTB.

CONCLUSION:
Prenatal care usage was associated with reduced odds of preterm birth in our population. Identifying and addressing barriers to prenatal care utilization may improve preterm birth rates among risk-entrenched patients at HUH.
The Association of Race and Ethnicity With Adverse Outcomes in Women Treated for Mild Chronic Hypertension During Pregnancy [ID: 1381420]
Authors: Moore Matthew , Sinkey Rachel 
Published: May 2023

INTRODUCTION:
The effect of race and ethnicity on outcomes in the treatment of mild chronic hypertension (cHTN) in pregnancy is unknown.

METHODS:
This was a secondary analysis of a multicenter randomized trial of pregnant patients with mild cHTN comparing antihypertensive therapy to goal blood pressure less than 140/90 mm Hg (Active) versus usual care. Log-binomial regression assessed differences in outcomes between racial and ethnic groups among Active participants. Outcomes included a composite (preeclampsia with severe features, medically indicated preterm birth [PTB]<35 weeks, abruption, fetal/neonatal death), components of the composite, intensive care unit admission, HTN with end-organ dysfunction, low birth weight (LBW), PTB less than 37 weeks, neonatal intensive care unit admission, and small for gestational age (SGA).

RESULTS:
Baseline maternal characteristics of patients randomized to active treatment in the parent trial differed by race and ethnicity for age, married status, insurance, nulliparous, body mass index, tobacco use, aspirin, and prior preeclampsia. Models demonstrated increased risk of the primary composite (adjusted relative risk [aRR] 1.35 [1.05, 1.73]) among Black compared to White patients. Preeclampsia was not increased among Black (aRR 1.14 [0.87, 1.50]) or Hispanic patients (aRR 1.13 [0.82, 1.56]). Preterm birth was increased among Black (aRR 1.31 [1.02, 1.68]) and Hispanic patients (aRR 1.33 [1.00, 1.77]), and there was increased risk of LBW infants born to Black patients (aRR 1.54 [1.11, 2.14]), but not Hispanic (aRR 1.04 [0.69, 1.57]) compared to White. There was no difference in SGA between groups.

CONCLUSION:
Among women with mild cHTN treated to goal less than 140/90 mm Hg, baseline characteristics differed significantly, and Black and Hispanic women were at increased risk compared to White women for selected outcomes. Interventions to address disparities should further evaluate social determinants of health in addition to medical management.
Outcomes for Obstetrician or Midwifery Intrapartum Care of Low-Risk Hospital Births [ID: 1368407]
Authors: Agarwal Trisha , Anderson Jessica , Hurt Joseph , Lijewski Virginia , Smith Denise , Taylor Natalie 
Published: May 2023

INTRODUCTION:
The objective of this study was to compare unplanned cesarean deliveries, labor interventions, and maternal and neonatal adverse outcomes in low-risk pregnant patients receiving intrapartum care managed by obstetricians or midwives.

METHODS:
We conducted a retrospective cohort study using perinatal data from a single academic tertiary center from 2013 to 2018. The sample included healthy nulliparous and multiparous patients with a term, singleton, vertex fetus managed by obstetricians or midwives. We included both induced and spontaneous labor as well as trial of labor after cesarean. We excluded patients with planned cesarean delivery or any high-risk diagnosis requiring prelabor transfer from midwife to obstetrician care.

RESULTS:
Our cohort included 7,694 patients; 3,543 (46%) received care from an obstetrician and 4,151 (54%) from a midwife. The overall cesarean rate was 11.8%. Patients receiving midwifery care had significantly lower cesarean rates (8.9% versus 15.2%, P<.01), including when analyzed by parity. Patients receiving obstetrician care more frequently experienced induction/augmentation, neuraxial anesthesia, and operative vaginal delivery. Patients of obstetricians had a higher maternal adverse composite outcome (23% versus 18%, P<.01). Midwifery patients had higher rates of shoulder dystocia (3% versus 2%, P<.01). In logistic regression, midwifery care had lower adjusted odds of unplanned cesarean birth (adjusted odds ratio, 0.49 [0.40–0.60] 95% CI).

CONCLUSION:
Wider integration of midwifery care for low-risk labor and delivery may reduce rates of unplanned cesarean delivery and optimize effective patient-centered care. Additional studies are needed to identify the mechanisms underlying these findings and the implications for systems-based change to improve vaginal delivery rates in the U.S.
Rate of Hypertensive Disorders of Pregnancy With Monoclonal Antibody Treatment for SARS-CoV-2 Infection [ID: 1376017]
Authors: Smith Caroline , Lemon Lara , McCreary Erin , Megli Christina 
Published: May 2023

INTRODUCTION:
SARS-CoV-2 infection among pregnant patients been associated with elevated rates of hypertensive disorders of pregnancy (HDP). We have demonstrated that monoclonal antibodies did not result in significantly different rates of severe COVID-19 in pregnancy. We undertook this study to determine whether HDP was altered with monoclonal antibody (mAb) treatment for SARS-CoV-2.

METHODS:
Retrospective cohort study approved by the IRB of University of Pittsburgh of patients aged 12 or older with a pregnancy episode and positive SARS-CoV-2 test in the UPMC health system. Among 663 patients, 403 received mAb treatment and 260 did not receive mAb. Chart review was performed for diagnosis of gestational hypertension (gHTN), preeclampsia without severe features, severe preeclampsia/HELLP syndrome, and postpartum hypertensive disorder with no antepartum diagnosis (PPHTN). Student’s t test was used to compare groups, and P<.05 was considered significant.

RESULTS:
The majority of patients presented during the Omicron wave. In the mAb-treated group, 21.8% developed HDP, 13.2% gHTN, 2.5% nonsevere preeclampsia, 6.9% severe preeclampsia/HELLP, and 2.7% PPHTN. The group that received no mAb experienced rates that were not significantly different from the mAb treated: 17.3% HDP, 10.8% gHTN, 3.5% nonsevere preeclampsia, 2.3% severe preeclampsia/HELLP, and 1.9% PPHTN.

CONCLUSION:
The use of mAbs in pregnant patients infected with SARS-CoV-2 is not associated with a change in the rate of HDP with the Omicron variant. Patients treated with mAbs had a trend toward increased severe preeclampsia, although this was not statistically significant. An understanding of which populations benefit maximally from mAb treatment will assist in managing the most effective and efficient allocation of resources.
Effect of Tranexamic Acid in a Cohort of Placenta Accreta Spectrum Patients [ID: 1380346]
Authors: Hussein Nada , Harrison Rachel , Holmgren Calla , Phelps Alexandra , Steinberg Guy , Steinberg Guy 
Published: May 2023

INTRODUCTION:
Use of tranexamic acid (TXA) is beneficial in the setting of obstetric hemorrhage. We sought to understand whether patients with placenta accreta spectrum disorder benefit from TXA administration during cesarean hysterectomy.

METHODS:
This is an IRB-approved retrospective cohort study of participants with suspected placenta accreta spectrum undergoing cesarean hysterectomy in a single hospital system. Those who received TXA were compared to those who did not. The primary outcome was the rate of blood transfusion. Secondary outcomes included maternal intensive care unit (ICU) admission, massive transfusion, length of postoperative stay, operative time, and a composite of adverse maternal outcomes. Chi-square, t tests, and Fisher’s exact test were used to compare baseline characteristics, and a logistic regression was performed with possible confounders.

RESULTS:
A total of 87 participants met criteria for the study; among those were 35 (40.2%) who received TXA. Baseline characteristics between groups were similar. Although not statistically significant in univariable analysis, there was a trend for those who received TXA to have lower blood loss overall (∼2,000 mL versus ∼2,300 mL, P=.483) and be less likely to require transfusion (48.6% versus 69.2%, P=.053). Further, they were statistically less likely to undergo ICU admission (22.9% versus 60.4%, P=.001). There was no difference in the other secondary outcomes including the combined adverse maternal outcome (40.0% versus 44.2%, P=.695). After controlling for confounders, TXA administration was independently associated with decreased rates of blood transfusion (adjusted odds ratio [aOR] 0.23, 95% CI 0.08–0.68) and ICU admission (aOR 0.16, 95% CI 0.05–0.48).

CONCLUSION:
Tranexamic acid use in the setting of cesarean hysterectomy for PAS was associated with decreased risks of transfusion and ICU admission.
Profile and Outcomes of Women With Amniotic Fluid Embolism in the United States [ID: 1375935]
Authors: Akinyemi Oluwasegun , Guoyang Luo , Kuffour Gabriella , Welborn Lyvia Karoline , Weldeslase Terhas Asfiha 
Published: May 2023

INTRODUCTION:
Amniotic fluid embolism (AFE) is one of the most catastrophic pregnancy complications and a significant cause of maternal mortality in the United States. The estimated incidence of AFE is 1:15,200 in North America. However, unanswered questions remain about its etiology, risk factors, perinatal morbidity, mortality, and treatment options. In the present study, we described the profile and outcomes of women who develop AFEs in the United States.

METHODS:
We collated data from the National Inpatient Sample Database from January 2010 to December 2017 to conduct a retrospective analysis of women who developed AFEs. We conducted a multivariate analysis to determine the risk of the development of AFE and the outcomes after its development. We included covariates such as women’s age, race and ethnicity, preexisting comorbidities, pregnancy-associated risk factors, and region of the country in the multivariate analysis. Samples were weighed to generate nationally representative estimates.

RESULTS:
There were 1,659 cases of AFE in the NIS during the study period. The median age of these women was 31 years (interquartile range of 26–36 years). 57.8% of the women underwent cesarean section, 48.2% developed disseminated intravascular coagulation, and 37.0% developed acute respiratory distress syndrome. The overall mortality rate was 12.9%. On univariate analysis, women between the ages of 31 and 40 years have a twofold incidence of developing AFE (odds ratio [OR] 2.51, 95% CI 1.45–4.35), while women between 41 and 50 years have a lower risk (OR 0.41, 95% CI 0.19–0.88) compared to the reference (women ≤20 years). Other risk factors include electrolyte abnormalities (OR 5.23, 95% CI 3.72–7.35) and cesarean section (OR 8.2, 95% CI 6.35–10.61). On multivariate analysis, only cesarean section and electrolyte abnormalities have a statistically significant association with the development of AFE.

CONCLUSION:
Amniotic fluid embolism remains a rare but catastrophic emergency with high morbidity and mortality in the United States.
Influence of Maternal Body Mass Index on Severe Maternal Morbidity in the United States [ID: 1383260]
Authors: Patel Priya , DeFranco Emily , Roulette Gregory 
Published: May 2023

INTRODUCTION:
Rates of severe maternal morbidity (SMM) and maternal obesity are increasing in the United States. We aimed to quantify the influence of increasing maternal body mass index (BMI) on SMM at a population level among U.S. births.

METHODS:
This was a population-based retrospective cohort study of all singleton live births using U.S.-linked birth–death data from 2013 to 2017. The exposure variable, maternal BMI, was categorized as BMI less than 18, 18–24 (referent), 25–29.9, 30–34.9, 35–39.9, 40–49.9, 50–59.9, and 60–69.9. The primary outcome, SMM, was defined as a composite variable of any blood transfusion, uterine rupture, unplanned hysterectomy, eclampsia, or maternal intensive care unit admission during the delivery hospitalization of the parturient. Generalized linear modeling quantified the association between maternal prepregnancy BMI and SMM while adjusting for maternal race and low socioeconomic status (SES) (Medicaid). Rates of SMM per 10,000 live births and relative risks (95% CI) are reported stratified by BMI.

RESULTS:
The study population included 19,844,580 live births. The numbers of births stratified by maternal BMI are shown in the table. The lowest rate of SMM was among the normal BMI group (0.57%), with 57 cases per 10,000 live births. The rate and risk of SMM increased with each increasing class of maternal BMI, with the highest rate in the BMI 60–69 category (2.2%), 217 cases per 10,000 live births. Maternal BMI 60–69 experienced the highest risk of SMM, over a threefold increase, even after accounting for the confounding influence of maternal race and low SES.

CONCLUSION:
Very high maternal BMIs are associated with a high rate and risk of SMM. These findings highlight the importance of addressing this modifiable risk factor on a population basis. Public health initiatives aimed to educate women with obesity of childbearing age about weight loss before pursuing pregnancy could help to mitigate maternal mortality in the United States.
The Effect of Advanced Maternal Age on Adverse Outcomes Among Forceps-Assisted Vaginal Deliveries [ID: 1355950]
Authors: Cochrane Elizabeth , Bianco Angela , DeBolt Chelsea , Doctor Tahera , Roger Sarah , Wang Kelly 
Published: May 2023

INTRODUCTION:
Delivery rates among patients of advanced maternal age (AMA) are increasing. Prior studies have shown that AMA is associated with increased pregnancy risks and adverse outcomes. This study’s objective was to evaluate whether AMA is associated with an increase in obstetric anal sphincter injury (OASIS) rates among patients who undergo forceps-assisted vaginal deliveries (FAVDs).

METHODS:
This was an IRB-approved, retrospective cohort study of singleton gestations with FAVD at a single institution between 2017 and 2021. Primary outcome was rate of OASIS among patients with and without AMA. Secondary outcomes included quantitative blood loss (QBL), neonatal composite of subgaleal and cephalohematoma (adverse neonatal composite), and neonatal intensive care unit (NICU) admission. Quantitative blood loss was assessed using Mann-Whitney U test. Remaining outcomes were assessed using multivariate logistic regression models while adjusting for provider clustering and confounding patient characteristics including episiotomy and birth weight.

RESULTS:
Nine hundred eighty-three records were included, 704 non-AMA and 279 AMA. Patients of AMA were more likely to be Caucasian and were less likely to be Hispanic, nulliparous, experience spontaneous labor, and undergo episiotomy. Patients of AMA did not demonstrate increased odds of OASIS compared to non-AMA patients (odds ratio [OR] 1.21 [0.78, 1.89]). When age was assessed continuously, there was no association between increasing age and rates of OASIS (OR 1.02 [0.98, 1.06]). There was no statistically significant difference in QBL among the two groups (357.0 versus 350.0 cc, P=.20), NICU admission or adverse neonatal composite.

CONCLUSION:
Advanced maternal age does not appear to be a risk factor for OASIS or other adverse outcomes in patients undergoing FAVD.