bluuebunny/crossref_metadata_2025_split huggingface dataset:
Obstetric and Allergy Providers' Attitudes Towards Penicillin Allergy Testing in Pregnancy: A Single Hospital System Survey Study [ID: 1378292]
Authors: Baird Rachael , Goje Oluwatosin , Kuder Margaret , Pien Lily 
Published: May 2023

INTRODUCTION:
Penicillin (PCN) allergy affects 10% of the U.S. population. The American College of Obstetricians and Gynecologists recommends PCN allergy testing in pregnancy when available. The objective of this study is to explore obstetric and allergy providers' knowledge and attitudes toward penicillin allergy testing and identify current barriers.

METHODS:
Single hospital system survey-based study of all obstetric and allergy providers. All obstetric and allergy providers were emailed an anonymous survey of their knowledge, current practice pattern, and perceived barriers to PCN allergy testing. Institutional review board approval was obtained for this study.

RESULTS:
From January 1, 2021 to July 31, 2022, 2,795 of 20,500 initial prenatal visits (14%) had a listed beta-lactam allergy. Of these 2,795 patients, 300 (11%) were referred for allergy testing. Fifty-four obstetric providers completed surveys. Thirty-nine percent of obstetric providers had never referred a patient for PCN allergy evaluation. Twenty-seven percent of obstetric providers self-identified lack of provider knowledge in testing process as a complete barrier to testing, and one-third of providers perceived lack of time in clinic to discuss referral as a barrier. Twenty-one allergy providers completed the survey. All allergy provider responders were willing to perform allergy testing in pregnant women, with 63% performing a direct oral challenge to confirm results. Forty-one percent of allergy providers preferred to defer testing until the third trimester.

CONCLUSION:
Allergy providers are willing and able to perform penicillin allergy testing in pregnancy, but testing is limited by obstetric provider referrals. Current barriers include obstetric provider knowledge about testing and resources to allow efficient discussion of testing benefits in clinic.
Timing of COVID-19 Vaccination and Rates of Severe COVID-19 Infection [ID: 1377384]
Authors: Kucirka Lauren , Lessler Justin , Manuck Tracy 
Published: May 2023

INTRODUCTION:
Optimal timing of COVID-19 vaccination in pregnancy is not established. We sought to characterize the relationship between vaccine timing and severe COVID-19 in pregnancy.

METHODS:
This was a retrospective cohort study of pregnant patients at a tertiary health system December 15, 2020 to June 16, 2022. Severe COVID-19 infection was defined as requiring inpatient admission and remdesivir with or without monoclonals. We compared the rate of severe COVID-19 during pregnancy between patients who were 1) never vaccinated, or were vaccinated 2) before pregnancy, 3) in the first trimester, 4) in the second trimester, or 5) in the third trimester. Infections are reported per 1,000 person-years under observation to account for differences in follow-up and length of gestation. All analyses are descriptive given small numbers of severe infections.

RESULTS:
Among 17,540 patients, 13,226 (75.2%) were unvaccinated throughout pregnancy. 1,795 (10.2%) were vaccinated before pregnancy, 566 (3.2%) first trimester, 1,126 (6.4%) second trimester, and 825 (4.7%) third trimester. There were 33 cases of severe COVID (27 among unvaccinated patients). No cases occurred among patients vaccinated in the first or second trimester (0 per 1,000 person-years). There were 2 cases among patients vaccinated in the third trimester (3.4 per 1,000 person-years) and 4 cases among patients vaccinated prior to pregnancy (3.3 per 1,000 person-years). All 4 cases among patients vaccinated before pregnancy occurred during the Omicron wave.

CONCLUSION:
There were fewer severe COVID-19 cases among patients vaccinated early in pregnancy compared to those vaccinated before pregnancy or in the third trimester, suggesting that optimal timing for boosters may be in the first or second trimester, and delaying to the third trimester may increase maternal morbidity. Larger studies are needed to better characterize the relationship between vaccine timing and severe COVID-19.
Prior History of Cholestasis Is Not Associated With Worsening Outcomes in Subsequent Pregnancy With Cholestasis [ID: 1363296]
Authors: Sarker Minhazur , DeBolt Chelsea , Ferrara Lauren 
Published: May 2023

INTRODUCTION:
Intrahepatic cholestasis of pregnancy (IHCP) is associated with adverse pregnancy outcomes including intrauterine fetal demise, spontaneous preterm labor, and meconium-stained amniotic fluid. Studies have yet to determine whether a prior pregnancy complicated by cholestasis is associated with more severe adverse outcomes in a subsequent pregnancy complicated by cholestasis.

METHODS:
This was a retrospective cohort study of multiparous, singleton, nonanomalous live gestations complicated by IHCP at Elmhurst Hospital Center from 2005 to 2019. We compared rates of adverse outcomes in multiparous pregnancies complicated by IHCP with or without history of prior IHCP. Our primary outcome of interest was rates of spontaneous preterm labor. Our secondary outcomes included rates of iatrogenic preterm birth, meconium-stained amniotic fluid, cesarean delivery (CD) for nonreassuring fetal heart tracing, umbilical artery pH less than 7.20, and neonatal intensive care unit (NICU) admission. Chi-square and multivariate regression tests were used to determine the strength of association. In all analyses, a P value less than 0.05 and 95% CI not crossing 1.00 indicated statistical significance. Mount Sinai Icahn School of Medicine IRB approval was obtained for this project.

RESULTS:
Of the 795 multiparous pregnancies complicated by IHCP, 618 (77.7%) had no prior history of IHCP and 177 (23.3%) had prior history of IHCP. Multiparous pregnancies with prior history of IHCP had higher rates of prior preterm birth, had earlier gestational age at diagnosis and delivery, and were more likely to receive ursodeoxycholic acid therapy. In subsequent pregnancies with IHCP, history of IHCP was associated with iatrogenic preterm birth and NICU admission. After adjusting for confounders, the association with iatrogenic preterm birth and NICU admission were no longer statistically significant. There was no significant association between history of prior IHCP and other adverse obstetric outcomes.

CONCLUSION:
Findings suggest that history of prior IHCP is not associated with worsening outcomes in subsequent pregnancies complicated by cholestasis.
Long-Term Developmental Outcomes of Infants With Neonatal Abstinence Syndrome [ID: 1375900]
Authors: Heiselman Cassandra , Abuzeid Omar , Garry David , Heiligenstein Mia , Parikh Bijal , Shinder Eliane 
Published: May 2023

INTRODUCTION:
There is limited information on long-term developmental outcomes in infants with neonatal abstinence syndrome (NAS). We evaluated the infant outcomes of women with opioid use disorder based on newborn pharmacologic treatment of NAS after birth.

METHODS:
This retrospective cohort study identified opioid-exposed gestations presenting for delivery from January 2017 to July 2022. Infants were included if follow-up data was available and were divided based on pharmacologic treatment of NAS. Pregnancy information, newborn demographics, and infant care up to 4 years of age were collected. Assessments of infant outcomes included standardized developmental milestones along with any developmental delays. Statistical analysis included chi-square and Student t tests with significance levels of P<.05.

RESULTS:
There were 387 infants with 170 (44%) requiring pharmacologic treatment of NAS and 217 (56%) not requiring treatment. The gestational age at delivery, mode of delivery, birth weight, and rate of Plan of Safe Care (POSC) on discharge were similar between groups. Newborns receiving pharmacologic treatment were more likely to experience preterm birth (PTB) (22.4% versus 12.9%, P=.02), have a positive toxicology (83.4% versus 64.2%, P=.001), and a longer median length of stay with PTB removed (9.0 versus 7.0 days, P=.001). Developmental outcomes related to social-emotional delay, language-communication delay, cognitive delay, and physical-motor delay were similar between groups at 2–6 months (n=177), 9–18 months (n=138), and 2–4 years (n=94).

CONCLUSION:
Infants from opioid-exposed gestations that experienced NAS have similar long-term outcomes regardless of pharmacologic treatment for NAS after birth.
Examination of Acupuncture and Acupressure as an Integrative Treatment for Preeclampsia With Severe Features [ID: 1354672]
Authors: Kocher Zena , Castro-Pearson Sandra , Colicchia Laura , Schulte Anna , Watson David , Wunderlich Whitney 
Published: May 2023

INTRODUCTION:
This study assessed whether acupuncture (AQ) and acupressure (AP) in conjunction with routine care are associated with improved blood pressure control or obstetric outcomes in hospitalized preeclampsia patients.

METHODS:
This is a retrospective matched cohort study (2010–2020) of patients with preterm preeclampsia with severe features admitted for expectant management. Integrative medicine services including AQ or AP were offered to antepartum patients starting in 2010. Patients receiving AQ/AP were matched with controls who received only routine care. Matching criteria included gestational age on admission, maternal age, parity, multiple gestation, chronic hypertension, and other clinical features. Controls were eligible for matching if their pregnancy continued at least 12 hours after the matched case received their first AQ/AP treatment.

RESULTS:
Among 416 patients admitted for preeclampsia, 146 had AQ/AP treatment, of which 104 were matched to controls for a final sample of 208 patients. Mean gestational age at admission was 30.6 weeks. Mean latency period from admission to delivery was 9.6 days (±7.6) in the treatment group and 7.3 days (±7.5) in the control group (P=.006). Changes in mean arterial pressure (MAP) from 12, 8, and 6 hours before and after the first treatment were not significantly different between the matched pairs.

CONCLUSION:
Among patients hospitalized for preeclampsia with severe features, AQ/AP treatment was associated with significant prolongation of the latency period from admission to delivery, but was not associated with changes in MAP over the 12–24 hours surrounding the first treatment.
The Effect of Antibiotics on Latency When Given at the Time of Membrane Rupture Prior to Viability [ID: 1357946]
Authors: Lambert Katherine , Cate Jennifer , Dotters-Katz Sarah , Grace Matthew , Honart Anne West 
Published: May 2023

INTRODUCTION:
Antibiotics administered when membranes rupture (ROM) after viability increase latency to delivery. This may also be true in previable prelabor preterm rupture of membranes (pPPROM). This study assesses the effect of prophylactic antibiotics on latency in individuals with pPPROM.

METHODS:
Retrospective cohort of pregnancies with pPPROM less than 23 weeks 0 days in a single health system (2013–2022). Patients opting for termination or with contraindication to expectant management were excluded. Prophylactic antibiotic administration (48 hours IV azithromycin/ampicillin followed by 5 days oral amoxicillin) was at clinician discretion. The primary outcome was latency (weeks) from diagnosed pPPROM to delivery. Secondary outcomes included maternal and neonatal morbidity and mortality. Bivariate statistics compared patients who did and did not receive antibiotics. Kaplan-Meier/Cox proportional hazards ratio using significant covariates (P<.1) in bivariate analysis models antibiotic effect on latency.

RESULTS:
Ninety-three patients had pPPROM; 46 (49%) met inclusion criteria. Thirty-four (74%) received prophylactic antibiotics. Median gestational age (GA) at ROM trended later among those who received antibiotics (22.0 weeks [20.6, 22.4] versus 20.9 weeks [19.6, 21.7], P=.09). Median latency (interquartile range) did not differ with antibiotic receipt (1 week [0.4, 2.6] versus 0.6 weeks [0.3, 0.9], P=.27). When adjusted for GA at ROM, antibiotics were not associated with longer latency (hazard ratio 1.33 [0.91, 1.93]). Antibiotic receipt was associated with lower rates of previable delivery (23.0 weeks [22.7, 24.0] versus 21.3 weeks [20.5, 23.1], P=.006). After controlling for GA at ROM, adjusted odds of previable delivery remained lower with receipt of antibiotics (adjusted odds ratio 0.20 [0.04, 0.90]).

CONCLUSION:
Antibiotics at the time of pPPROM were not associated with longer latency but, after controlling for confounders, did increase the odds of delivering after viability. Further study should address optimal antibiotics strategies for this unique population.
Up to Date in Pregnancy: Assessing Vaccination Status in Hepatitis C-Positive Pregnant Persons [ID: 1372896]
Authors: Angelides Mary , Murone Julie , Venkat Divya , Vij Ruchika 
Published: May 2023

INTRODUCTION:
Hepatitis C virus (HCV) is the most commonly reported bloodborne infection in the United States. Over 65% of infections are among people of childbearing age leading to increased perinatal transmission. The American College of Obstetricians and Gynecologists recommends HCV screening for all pregnant persons. Prior to HCV treatment, the hepatitis B (HBV) vaccination series is recommended. Per recommendations from the Centers for Disease Control and Prevention, the HBV vaccination series should be given to unvaccinated pregnant persons. This study aims to assess the frequency of HCV-positive pregnant persons who are screened for HBV immunity.

METHODS:
A quality improvement project through retrospective chart review was performed at a single institution from October 2020 to October 2022. Patients identified as HCV positive in pregnancy were included. Data collected included patient demographics and infectious variables such as HCV viral load, HBV antigen/antibody testing, and whether patients underwent HCV treatment.

RESULTS:
From October 11, 2020, to October 11, 2022, 113 pregnant patients were noted to be HCV positive. Of this population, 95% were also screened with HBV antigen. Only 13 patients had a HBV surface antibody checked to assess vaccination or previous infection status, of whom 9 were previously immunized. In total, only 74% of patients had a HCV viral load checked, half of whom had a viral load present. Of the patients with a positive viral load, only 51% had planned or participated in HCV treatment.

CONCLUSION:
Pregnancy offers a unique opportunity to complete complex vaccination series for previously unimmunized individuals who are positive for HCV. This quality improvement project indicates a lack of screening and assessment for further HBV immunization in a vulnerable population.
Comparative Risks of Electronic Versus Tobacco Cigarette Use During Pregnancy: Findings From a Low-Risk Sample [ID: 1374893]
Authors: Azar Michelle , Bailey Beth , Oatey Elena 
Published: May 2023

INTRODUCTION:
Harms of tobacco use in pregnancy are well studied and include low birth weight, decreased newborn well-being, and need for medical interventions after birth. Less understood is the effect of noncombustible alternatives, including electronic cigarettes (ECs). We examined whether EC use during pregnancy also increases risk of adverse birth outcomes.

METHODS:
Data were from the Michigan Obstetrics Initiative (OBI), a quality improvement effort involving 75 maternity hospitals, focused on safely reducing cesarean delivery rates. Our participants were nulliparous, singleton pregnancy, term delivery, and vertex fetal positioning. Data were from medical records, entered locally, and compiled centrally by OBI.

RESULTS:
Participants delivered since January 1, 2021, with no known pregnancy alcohol and opioid use: controls (no EC/tobacco use [n=26,394], EC only [n=493], and tobacco only [n=2,126]). After control for confounding and comparison to controls, the EC group had significantly lower birth weight; the tobacco group had reduced birth weight, and greater rates of arterial cord pH less than 7.1, 5-minute Apgar scores less than 8, and neonatal intensive care unit admission.

CONCLUSION:
While EC use in pregnancy reduced birth weight, most newborn risks linked to tobacco exposure were not predicted by EC use. Additional study is needed, as nonsignificant trends toward poorer outcomes for EC users were evident, and potentially significant with larger samples or when amount/timing of EC exposure is considered. Further, given this sample was low risk, cases for whom EC use led to adverse outcomes were potentially eliminated. Growing evidence suggests pregnant patients should be counseled to avoid EC use.
Operational Effects of Implementing Hybrid Prenatal Care Models: A Retrospective Analysis [ID: 1374984]
Authors: Ghrayeb Leena , Bryan Timothy , Cohn Amy , Peahl Alex , Zhang Yuanbo 
Published: May 2023

INTRODUCTION:
Telemedicine is promising for improving prenatal care access but may generate unscheduled prenatal care utilization including phone calls and portal messages. We describe differences in care utilization between pregnant people receiving in-person only versus hybrid (in-person and telemedicine) models of prenatal care.

METHODS:
In this IRB-exempt electronic health record-based study, we identified patients who received prenatal care and gave birth at our academic institution between March 1, 2021 and March 31, 2022. We classified patients into four groups based on medical and social risk factors: A) completely low risk; B) high social risk only; C) high medical risk only; and D) completely high risk. We compared visit number, portal messages, and phone calls between patients who received hybrid versus in-person only care. We report medians for all measures.

RESULTS:
Of the 4,992 included patients, 48% received hybrid care. Patients in all groups had one additional visit if they received hybrid versus in-person care (A: 9 versus 8; B: 8 versus 7; C: 9 versus 8; D: 9 versus 8). Patients receiving hybrid care used more portal messages than patients in the same group who received in-person care: A: 8 versus 6; B: 9 versus 5; C: 10 versus 9; D: 12 versus 8. There was no significant difference in phone call utilization between the in-person and hybrid patient groups.

CONCLUSION:
Patients who received hybrid prenatal care tended to utilize prenatal care including both planned and unplanned services more frequently than exclusively in-person patients.
Prenatal Sleep Linked to Postpartum Mental Health Outcomes [ID: 1375042]
Authors: Sinow Carolyn , Avalos Lyndsay , Beck Arne , Felder Jennifer , Stark Joanna , Sujan Ayesha 
Published: May 2023

INTRODUCTION:
Sleep disturbances commonly occur in pregnancy; and the postpartum state confers elevated risk for mental health disorders. In nonpregnant populations, sleep problems have been linked to mental health problems. The scant research on the association between prenatal sleep disturbances and postpartum mental health has produced mixed results. The goal of this project was to evaluate the association between prenatal sleep and postpartum mental health.

METHODS:
This IRB-approved prospective cohort study included 336 individuals receiving prenatal care at a single institution between August 2020 and April 2021. Participants completed a baseline questionnaire upon recruitment, in the first or early second trimester, and a follow-up questionnaire at 4–8 weeks postpartum. Individuals completed surveys for sleep (Pittsburgh Sleep Quality Index [PSQI]), depression (Patient Health Questionnaire depression scale [PHQ-8]), and anxiety (General Anxiety Disorder scale [GAD-7]).

RESULTS:
After adjusting for baseline depression and potential confounders, prenatal global sleep quality (PSQI, >5) was associated with development of postpartum depression (PHQ-8, ≥10) (relative risk [RR] 1.12: 95% CI 1.01–1.25). Specifically, sleep quality (RR 2.18: 95% CI 1.22–3.91) and sleep latency (RR 1.52: 95% CI 1.06–2.17) were associated with postpartum depression. Prenatal sleep problems were associated with higher postpartum anxiety scores (RR 1.09: 95% CI 0.99–1.20), but findings did not reach statistical significance.

CONCLUSION:
Prenatal sleep problems are associated with the development of postpartum depression. Research suggests that treating prenatal insomnia may prevent postpartum depression. Screening for sleep disorders in pregnancy could potentially be used to target screening and prevention measures for postpartum depression.
Association of Above-Average Healthy Eating Index and Pregnancy Outcomes [ID: 1375493]
Authors: Tuel Kierstyn , Hersh Alyssa , Purnell Jonathan , Ryan Kimberly , Valent Amy , Vesco Kimberly 
Published: May 2023

INTRODUCTION:
Nutritional health plays an important role in the intrauterine environment's effect on the developmental origins of disease. The Healthy Eating Index (HEI), a measure of dietary quality scaled 0–100 with 100 being ideal, has been shown to be poor on average in Americans. In a prospective cohort study of healthy pregnant individuals with a singleton gestation, we assessed dietary quality and its association with pregnancy outcomes.

METHODS:
Individuals completed their first study visit at a mean gestational age of 15 weeks, and three, 24-hour dietary recalls were obtained. Participants were dichotomized by HEI scores as above and at or below the U.S. average (>58 and ≤58). We assessed outcomes including gestational diabetes (GDM), hypertensive disorders of pregnancy (HDP), and large for gestational age (LGA >90th percentile). Statistical analysis was completed using two-sample t tests and Fisher's exact tests (P=.05). The study was IRB approved.

RESULTS:
Of the 67 participants included in the analysis, 45 (67%) had above average and 22 (33%) had below average HEI scores. The incidence of HDP was significantly lower among individuals with higher dietary quality (22.8% versus 4.4%, P=.03). Although the rates of GDM were not different between the two groups (15.6% versus 9.1%, P=.71), the proportion of LGA infants trended lower in those with higher HEI (4% versus 22%, P=.19).

CONCLUSION:
Our data suggest that higher dietary quality may lead to improved pregnancy outcomes and support the potential role of the HEI for further exploring these relationships in future research.
Access and Barriers to Home Device Use in Pregnancy [ID: 1375585]
Authors: Azar Michelle , Maben-Feaster Rosalyn , Moniz Michelle , Pangori Andrea , Peahl Alex , Wu Justine 
Published: May 2023

INTRODUCTION:
Virtual prenatal visits are promising for removing barriers to care; however, prior work suggests pregnant people who may benefit most might lack access to tools like home blood pressure (BP) monitors. We assessed drivers of pregnant patients' access to and use of home BP monitors.

METHODS:
We conducted an IRB-exempt cross-sectional survey of postpartum patients admitted for childbirth at an academic institution. After obtaining consent, we assessed patients' barriers to accessing home devices during pregnancy. Data were summarized using descriptive statistics and between-group comparisons.

RESULTS:
78/200 (39%) patients surveyed completed at least one virtual visit, of whom 76.92% were White and 23.08% were publicly insured. Patients who completed at least one virtual visit were more likely to report having a home BP monitor (73.08%) than those who had none (44.26%) (P<.001). More patients who had no virtual visits reported their provider did not recommend a BP monitor (41.80%) (P<.001), and not knowing how to check their BP (13.93%) (P=.048). Patients with public insurance (15.6%) and Black patients (17.4%) were more likely to report inability to obtain a BP monitor than commercially insured (4.5%) and White patients (3.1%) (P<.05).

CONCLUSION:
Access to BP monitors was limited in obstetrics patients who selected in-person care, were Black, and publicly insured. Policy change is needed to ensure patients who face the greatest barriers to care can access necessary tools for virtual visits.