bluuebunny/crossref_metadata_2025_split huggingface dataset:
Comparison of Bony Pelvic Dimensions and Demographic Risk Factors in Individuals With and Without Pelvic Organ Prolapse [ID: 1377653]
Authors: DeRosa Alexandra , Ablove Tova , Doyle Scott , Lewis Steven 
Published: May 2023

INTRODUCTION:
Previous studies have noted a correlation between bony pelvic measurements and the diagnosis of prolapse via musculofascial insertion points on magnetic resonance imaging. We investigated the importance of bony measurements of the lumbar spine and pelvis as risk factors in the development of prolapse via routine computed tomography (CT) imaging.

METHODS:
We sampled 171 UBMD obstetrics and gynecology clinic patients who were at least 40 years of age and had an abdominal/pelvic CT scan. Demographic and medical history was reviewed and collected. Participants were then divided into those with and without prolapse. CT images were uploaded to 3D Slicer 5.10. Each study was analyzed by a trained annotator blinded to prolapse status. The area of the anterior pelvis, interspinous diameter, pelvic outlet, ischial spine to pubic symphysis, sacrococcygeal junction to ischial spine, and lumbar and sacrococcygeal curvature were annotated. Demographic characteristics and measured annotations were compared using χ2 test.

RESULTS:
Women with prolapse were more likely to be older (P<.05) and of lower weight (mean 71.6 kg, P<.05) than controls. Patients with prolapse had a significantly larger area of their anterior pelvis (P<.05) and a significantly longer interspinous diameter (P<.05). Distance from ischial spine to pubic symphysis was significantly longer (P<.05), and pelvic outlet in women with prolapse was significantly longer than in controls (P<.05).

CONCLUSION:
In addition to known risk factors, bony measurements of the pelvis are significantly different in those with and without pelvic organ prolapse, which may be observed on routine CT imaging.
Increased Vaginal Cuff Dehiscence Among Gender-Diverse People on Testosterone [ID: 1377373]
Authors: Wong Jennifer , Ramm Olga , Vega Shayna , Weintraub Miranda , Xu Richie Houhong , Zaritsky Eve 
Published: May 2023

INTRODUCTION:
Testosterone-induced vaginal atrophy is hypothesized to increase the risk of vaginal cuff dehiscence (VCD); however, current studies are limited and conflicting. This study compares risk of VCD among gender-diverse people on testosterone (GDT) and ciswomen (CW) and evaluates factors associated with VCD.

METHODS:
An IRB-approved retrospective cohort study was conducted among adults who underwent total hysterectomy (June 1, 2014 to December 31, 2019) for benign indications at Kaiser Permanente Northern California. Patients had 6 months postoperative follow-up, and GDT had greater than 6 months testosterone use prior to hysterectomy. Differences between GDT and CW were evaluated using Wald χ2, Fisher’s exact, Student’s t test, or Kruskal–Wallis tests. Unadjusted logistic regression was conducted to estimate odds ratios (OR) for VCD.

RESULTS:
The cohort (n=22,109) included 154 (0.7%) GDT and 21,995 (99.3%) CW. GDT were younger (median 27 [interquartile range (IQR) 22–36] versus 47 [IQR 42–52] years, P<.001) and had lower proportion with Charlson Comorbidity Index (CCI) greater than or equal to 1 (18.2% versus 27.1%, P=.013) than CW. A greater proportion of GDT experienced VCD (5.8% versus 2.5%, P<.016; OR 2.42, 95% CI 1.23–4.77, P=.011). Patients with CCI greater than or equal to 1 or had hypertension were associated with 25% (95% CI 4–50%, P=.015) and 41% (95% CI 18–68%, P<.001) higher odds of VCD, respectively.

CONCLUSION:
The odds of VCD was 2.4 times higher in GDT despite being younger and healthier than CW. Charlson Comorbidity Index of 1 or higher and hypertension were also associated with higher risk of VCD. These findings support the theory of testosterone-induced vaginal atrophy as a risk factor for VCD. Additional studies are needed to better understand the pathophysiology of VCD among GDT and prevent this morbid complication.
Examining Antenatal Corticosteroid Administration at a Single Center via a New Proposed Quality Metric [ID: 1375947]
Authors: Anwer Tooba , Little Sarah , Reddy Rajesh , Reiff Emily 
Published: May 2023

INTRODUCTION:
The Society for Maternal-Fetal Medicine (SMFM) proposed a new quality metric in 2022 to increase the rate of antenatal corticosteroid (ACS) provision for early preterm deliveries and minimize ACS for pregnancies ending in term deliveries. This study evaluates compliance with this quality metric and examines which delivery indications are associated with suboptimal ACS timing.

METHODS:
This is a single-center retrospective cohort of patients receiving ACS from January 2017 to September 2022. The primary outcome, measuring compliance with the SMFM ACS quality metric, is the proportion of all early preterm deliveries that received optimally timed ACS (one dose of ACS within 6 hours–7 days before birth). The secondary outcome is the proportion of term deliveries that had previously received ACS compared to all patients who received ACS. A sample of convenience of 500 patients was investigated to determine the indication for ACS.

RESULTS:
Of the 36,080 deliveries between 2017 and 2022, 2,022 patients received ACS (initial or rescue) and delivered at this center. There were 3,720 early preterm deliveries. Of early preterm deliveries, 14.67% received ACS in the optimal window. Of all the patients that received ACS, 20.9% delivered at term. ACS were more optimally dosed for hypertension relative risk (RR) 1.71 (95% CI 1.36–2.14) and preterm prelabor rupture of membranes RR 2.08 (95% CI 1.67–2.59).

CONCLUSION:
Based on the SMFM quality metric, rates of optimal ACS administration remain lower than minimum realistic benchmarks. Continuing efforts are needed to optimize ACS administration for preterm deliveries. In order to meet these goals, institutions may examine which clinical situations lead to suboptimal ACS.
Pregnancy Outcomes Before and After the Emergence of the SARS-CoV-2 B.1.1.529 (Omicron) Variant [ID: 1365953]
Authors: Seif Karl , Desai Andrea , Mangione Mary , Tadbiri Hooman , Turan Shifa , Wolfe Alexa 
Published: May 2023

INTRODUCTION:
Starting December 15, 2021, the SARS-CoV-2 B.1.1.529 (Omicron) variant became the predominant strain in the United States. Preliminary data suggest that the Omicron variant causes less severe COVID-19 than earlier variants. We hypothesize that adverse maternal and neonatal outcomes are less likely if infection occurred during the Omicron epoch compared to pre-Omicron.

METHODS:
This IRB-approved retrospective cohort study was conducted at a major university health system in Maryland from March 2020 to May 2022. We identified patients who were SARS-CoV-2 positive before and after December 15, 2021. Demographics and maternal, obstetric, and neonatal outcomes were collected and compared. Wilcoxon rank-sum and Fisher’s exact tests were used to compare continuous and categorical data, respectively. Adjusted odds ratios (aORs) were calculated using vaccination status.

RESULTS:
A total of 742 SARS-CoV-2–positive pregnant patients were identified. Of those, 548 (74%) tested positive pre-Omicron and 194 (26%) tested positive during the Omicron wave. Tobacco and illicit drug use were higher among patients in the Omicron epoch. Patients were also older and more likely to have received at least one vaccine dose (3% versus 35%, P<.001). Omicron epoch patients had less severe disease as evidenced by higher rates of asymptomatic infection (72% versus 44%) as well as lower rates of hospital admission due to COVID-19, supplemental oxygenation, and intensive care unit (ICU) admission. However, the odds of ICU admission were not significantly decreased in Omicron epoch patients after adjusting for vaccination (aOR 0.15, 95% CI 0.02–1.14). The odds of preeclampsia and preterm birth less than 34 weeks were lower in Omicron epoch patients after adjusting for vaccination (aOR, 0.61 and 0.38, respectively). Neonatal outcomes were not statistically different between the two groups.

CONCLUSION:
Pregnant patients infected with SARS-CoV-2 during the Omicron epoch have a less severe disease course than those infected pre-Omicron. Lower ICU admissions during the Omicron epoch may be due to higher vaccination rates.
Disproportionate Fetal Abdominal Growth in Patients With Diabetes Does Not Increase the Risk of Neonatal Hypoglycemia [ID: 1369330]
Authors: Soehl John , Esposito Matthew , Lord Megan , Murphy Lauren , Whelan Anna 
Published: May 2023

INTRODUCTION:
Neonates of pregnant persons with diabetes are at increased risk of hypoglycemia. The Fetal Abdominal Adiposity Score (FAAS) is a measure of disproportionate fetal abdominal growth theorized to serve as a proxy for fetal exposure to excess glucose in utero. We sought to characterize the relationship between FAAS and neonatal hypoglycemia in this population.

METHODS:
Pregnancies complicated by gestational diabetes (GDM), or preexisting diabetes type 1 (T1DM) or type 2 (T2DM), resulting in delivery of a live singleton nonanomalous fetus were identified within an existing NIH-funded database. Corresponding third-trimester ultrasounds (US) were identified. The FAAS was calculated as follows for each pregnancy, using measurements from the last US prior to delivery: fetal biparietal diameter minus fetal abdominal diameter (calculated as abdominal circumference/π). Results were expressed as a percentile for the gestational age at measurement relative to a reference population. Clinically significant neonatal hypoglycemia was defined as a hypoglycemia that either required treatment or resulted in a blood glucose level of 25 mg/dL or lower in the first 24 hours of life.

RESULTS:
Clinically significant hypoglycemia occurred in 58/1,299 neonates (4.5%), including 0/39 (0%) with FAAS at the 10th centile and 11/229 (4.8%) with FAAS at the 90th centile. There was no statistically significant difference in risk of hypoglycemia between various FAAS categories (P=.133). FAAS was weakly associated with the lowest postnatal blood sugar (R=0.098).

CONCLUSION:
Among pregnancies complicated by diabetes, FAAS was not associated with risk of neonatal hypoglycemia even for those at the extremes of abdominal growth.
Progesterone After Cerclage Does Not Improve the Preterm Birth Rate [ID: 1372160]
Authors: Sayres Lauren , Lijewski Virginia , Reeves Shane , Sheeder Jeanelle , Taylor Natalie 
Published: May 2023

INTRODUCTION:
Preterm birth represents a leading cause of neonatal morbidity and mortality. Cerclage and progesterone supplementation are the two most frequently employed interventions to reduce the risk of prematurity. Guidelines for cerclage and progesterone have evolved as conflicting evidence for their use mounts, and combination therapy remains poorly understood. Our objective is to determine whether there is benefit to adjunct progesterone supplementation after cerclage placement.

METHODS:
This is a retrospective cohort review of all individuals who underwent transvaginal cerclage placement at a tertiary medical center between 2005 and 2021. The rate of delivery prior to 37 weeks was compared between participants with and without progesterone supplementation after cerclage. Several secondary maternal and neonatal outcomes were evaluated. Multivariate regression analysis accounted for cerclage indication, use of progesterone prior to cerclage, and other factors that affect prematurity risk.

RESULTS:
Of 451 participants, there were 160 history-indicated, 134 ultrasound-indicated, and 157 examination-indicated cerclages. Overall, 285 (63.2%) received postcerclage progesterone. Progesterone after cerclage did not decrease the rate of preterm delivery (adjusted odds ratio 1.1, 95% CI 0.4–2.6) for any indication of cerclage. Moreover, adjunct progesterone was associated with decreased latency between cerclage placement and delivery (P=<.01).

CONCLUSION:
Prescribing patterns for progesterone after cerclage suggest clinical equipoise. We have found that adjunct progesterone does not decrease the preterm delivery rate and may in fact cause harm by decreasing latency from cerclage to delivery. These data do not support the use of progesterone after cerclage for any indication.
Early Treatment of Gestational Diabetes Mellitus and Prediabetes: A Systematic Review and Meta-Analysis of Randomized Clinical Trials [ID: 1377137]
Authors: Hessami Kamran , Harper Lorie M. , Shamshirsaz Alireza A. , Werner Erika F. 
Published: May 2023

INTRODUCTION:
This meta-analysis aims to determine whether early treatment of hyperglycemia in gestational diabetes mellitus (GDM) and prediabetic pregnancies improve perinatal outcomes.

METHODS:
PubMed/Medline, EMBASE, ClinicalTrials.gov and Web of Science were systematically searched up to June 30, 2022. Randomized clinical trials (RCTs) of early treatment for gestational diabetes mellitus (International Association of the Diabetes and Pregnancy Study Groups [IADPSG] or Carpenter and Coustan [C&C] criteria) and prediabetes (HbA1c 5.7–6.4%) before 20 weeks of gestation were considered eligible. Random-effects model meta-analysis was used to pool the odds ratios (OR) and/or mean differences (MD) with 95% CI. Furthermore, subgroup analysis was performed stratifying by indication for intervention (GDM versus prediabetic).

RESULTS:
Seven RCTs including 2,757 pregnant individuals, of whom 647 had positive screening before 20 weeks of gestation, were included. Of 647 individuals, 346 were allocated to early treatment and 301 to the routine treatment. There was no significant difference in terms of gestational age at delivery (MD –0.21 [95% CI: −0.44, 0.02], P=.089), rate of cesarean delivery (OR 0.93 [95% CI: 0.64, 1.34], P=.394), hypertensive disorder of pregnancy (OR 1.19 [95% CI: 0.59, 2.39], P=.341), any diabetic medication use (OR 1.31 [95% CI: 0.89, 1.93], P=.177), and neonatal hypoglycemia (OR 1.02 [95% CI: 0.50, 2.08], P=.952). However, there was a decreased risk of macrosomia (OR 0.42 [95% CI: 0.19, 0.92], P=.031) and increased need for insulin use (OR 2.23 [95% CI: 1.30, 3.84], P=.004) for early treatment group. After separate analyses on GDM and prediabetics as distinct groups, the risk of macrosomia was not decreased for GDM and prediabetic subgroups after early treatment.

CONCLUSION:
Treatment in early pregnancy for GDM or prediabetes does not appear to improve the maternal or neonatal outcomes.
Late-Onset Severe Fetal Growth Restriction and Isolated Severely Small Abdominal Circumference: Do Neonatal Outcomes Differ? [ID: 1377666]
Authors: Hirsch Anna , Ha Laura , Naqvi Mariam 
Published: May 2023

INTRODUCTION:
Updated guidelines from the Society for Maternal-Fetal Medicine (SMFM) define severe fetal growth restriction (sFGR), or an estimated fetal weight (EFW) less than 3rd percentile, as a distinct entity due to higher perinatal morbidity in this group. Whether an isolated abdominal circumference (AC) less than 3rd percentile similarly portends adverse outcomes remains unclear.

METHODS:
This is a single-institution, retrospective cohort study of singleton gestations with late-onset FGR and normal Doppler studies from 2012 to 2022. Pregnancies affected by AC less than 3rd percentile (but EFW≥3rd percentile) and EFW less than 3rd percentile were compared using univariable analysis and multivariable logistic regression. The primary outcome was neonatal intensive care unit (NICU) admission.

RESULTS:
Among eligible participants, 78 (63%) had an isolated AC less than 3rd percentile and 45 (37%) had sFGR. Neonates prenatally diagnosed with sFGR were more likely to be admitted to the NICU than those with isolated AC less than 3rd percentile (68.9% versus 23.1%, P<.001). After adjusting for gestational age, birth weight, race, maternal age, and medical comorbidities, sFGR was still associated with an increased odds of NICU admission (adjusted odds ratio 4.9, 95% CI 1.37–17.48, P=.014). Rates of cesarean delivery (46.7% versus 26.9%; P=.03), small for gestational age (86.7% versus 67.9%, P=.02), and 5-minute Apgar score less than 7 (6.7% versus 0.0%, P=.02) were also higher in the sFGR group. There were no significant differences in NICU length of stay or perinatal death between groups.

CONCLUSION:
Adverse neonatal outcomes were more prevalent in pregnancies affected by sFGR compared with isolated AC less than 3rd percentile, providing support for the updated SMFM guidelines.
Risk of Adverse Perinatal Outcomes in Hispanic Women With Pregestational Type 1 Diabetes Mellitus [ID: 1379155]
Authors: Echeverria Milady Banegas , Arce Lidia , Robles Claudia Flores , Cruz Nayeli Martínez , Muñoz Enrique Reyes 
Published: May 2023

INTRODUCTION:
Type 1 diabetes mellitus (T1DM) during pregnancy is associated with increased risk of maternal and fetal complications. We aimed to compare the risk of adverse perinatal outcomes in women with pregestational T1DM to those of background population.

METHODS:
In this historical cohort study, we included Mexican pregnant women who attended from 2016 to 2021 a tertiary-level hospital in Mexico City. Group 1: Pregnant women with T1DM; group 2: pregnant women without diabetes, matched 1:2 by maternal age, pregestational body mass index (BMI), gestational age at admission and parity with women of group 1. Relative risk (RR) with a 95% CI was calculated using logistic regression. We had IRB approval.

RESULTS:
Group 1, n=203; group 2, n=406; there were no differences in maternal age, pregestational BMI, gestational age, and parity. The mean glycated hemoglobin A1C and gestational age at admission to prenatal care in T1DM women were 8.0±2.0 and 19.1±6.6, respectively. The risk of adverse perinatal outcomes was increased in women with T1DM and were expressed as RR (95% IC); preterm birth, 4.03 (3.0–5.3); preeclampsia, 5.2 (3.3–8.3); cesarean birth, 1.5 (1.3–1.7); miscarriage, 34 (4.5–253); congenital malformations, 8.5 (3.8–19.1); neonatal hypoglycemia, 15 (3.4–64); hyperbilirubinemia, 2.8 (1.6–4.9); respiratory distress syndrome, 8.6 (3.6–20); and large for gestational age, 6.8 (3.7–12.4).

CONCLUSION:
The risk of adverse perinatal outcomes was increased in Hispanic women with T1DM compared with general population. These adverse outcomes show the critical importance to prioritize education to patients and resources for glucose control to improve outcomes before and during pregnancy.
Combatting Food Insecurity Through Implementing Food Pantry Amenities in Clinical Settings [ID: 1375662]
Authors: Neal Amber , Frazier La-Tisha , Hawthorne Jenci , Miller Edward , Root Emily 
Published: May 2023

INTRODUCTION:
The SARS-CoV-2 pandemic has brought renewed public attention to food insecurity and other social determinants of health. According to the United States Department of Agriculture (USDA), food insecurity affects 10.5% of households nationwide. Our study sought to determine the prevalence of food insecurity at the University of Louisville and the effect that implementing food pantry amenities within the clinic has on pregnancy outcomes.

METHODS:
Institutional review board approval was obtained. We screened pregnant women presenting to our outpatient clinic for prenatal care each trimester. Food security was determined using a modified version of the USDA Adult Food Security Survey over the past 12 months. Women that were determined to be food insecure were provided access to food pantry amenities at each prenatal visit. Screening data were entered in REDCap, then exported into Stata for statistical analysis.

RESULTS:
Survey data demonstrated that 38% of our patients screened positive for food insecurity. As a result, a total of 5,829 lb of food have been distributed. Secondary outcomes including prenatal care adherence rates, weight gain during pregnancy, pregnancy complications, and birth outcomes will be displayed graphically.

CONCLUSION:
Rates of food insecurity in our clinic population were three times higher compared to the national average. Formal screening allows providers to better identify families experiencing food insecurity and connect them to food pantry amenities. Importantly, our initiative can serve as a guide for other institutions considering food security interventions. Implementing food pantries in academic institutions nationwide will enhance and inform these innovations to target at-risk populations and provide health equity.
Effect of Race on Obstetric Ultrasound Keepsakes [ID: 1376924]
Authors: Stoddard Rachel , Duffy Cassandra , Kim Hyunseo , Modest Anna , Quesnelle Georgia , Wylie Blair 
Published: May 2023

INTRODUCTION:
Differences in treatment and health outcomes by race are well-documented. Ultrasound photos represent important keepsakes and may affect patient experience and care. We examined whether race and other factors affected the number of keepsakes given during obstetric ultrasound. A secondary outcome was patient satisfaction.

METHODS:
From October 2021 to September 2022, we distributed a survey after outpatient obstetric ultrasounds at a tertiary care hospital, including questions on demographics, number of photos received, and overall satisfaction. Exclusion criteria included inability to complete the survey in one of four available languages or carrying a multifetal gestation. Ultrasound staff and faculty were blinded to the research question. This study was approved by the Beth Israel Deaconess Medical Center IRB.

RESULTS:
Of 405 individuals approached, 251 completed the survey (response rate of 62.0%). Of these, 53.4% identified as White, 16.3% Asian, 10.4% Black, 7.2% as multiple races, 6.8% other race, and 6.0% preferred not to say. In total, 81.3% of patients received photos (median, 4; interquartile range [IQR], 3–6), with no difference in number by race, ethnicity, primary language, or body mass index. Most patients expected to receive photos, with no appreciable differences by race. Ratings for visits were high (IQR, 8–10/10) with no difference between patients who did or did not receive photos or by number of photos.

CONCLUSION:
We found no difference in number of photos patients received by race. Overall ratings of ultrasound visits were high and not associated with number of keepsakes received. While reassuring, further research is needed into equitable treatment in obstetric ultrasound.