bluuebunny/crossref_metadata_2025_split huggingface dataset:
Likelihood of Subsequent Type 2 Diabetes Diagnosis Among Patients Diagnosed With Gestational Diabetes and a 50-Gram 1-Hour Glucose Test Value of 200 mg/dL or Greater [ID: 1379006]
Authors: Harrison Rachel , Neuburg Blake , Palatnik Anna 
Published: May 2023

INTRODUCTION:
Patients with gestational diabetes mellitus (GDM) are at increased risk for lifelong type 2 diabetes mellitus (T2DM). We sought to identify whether a 1-hour 50-g glucose result of 200 mg/dL or greater increased likelihood of T2DM among individuals with GDM.

METHODS:
This was a retrospective cohort study at a single tertiary care site from 2011 to 2019. Participants were included if diagnosed and treated for GDM during pregnancy, at least 18 years of age, and had singleton pregnancy. Exclusion criteria were significant fetal anomalies or incomplete records. Participants with values of 200 mg/dL or greater were then grouped and compared to participants with a value less than 200 mg/dL. Primary outcome was diagnosis of T2DM within 5 or less years of pregnancy. T tests, χ2, Fisher’s exact, and logistic regression were utilized for statistical analyses.

RESULTS:
Seven hundred eight participants met inclusion criteria. Among these, 100 (14.1%) had a value of 200 mg/dL or greater on the 1-hour 50-g glucose test. Groups were similar, with the exception that those with a very elevated 1-hour glucose result were more likely to be publicly insured (32.0% versus 17.1%, P=.009), identify as non-Hispanic Black (19% versus 14.6%, P=.036), and likely to be married (28.0% versus 25.8%, P=.039). Of the 708 participants, 31 (31.0%) were found to have T2DM among those with 1 hour of 200 mg/dL or greater versus 93 (15.3%) of those with lower 1-hour glucose results (P<.001). After controlling for confounders, T2DM remained independently associated with 1-hour glucose of 200 mg/dL or greater (adjusted odds ratio 2.14, 95% CI 1.22–3.74).

CONCLUSION:
Elevated screening results (≥200 mg/dL) on the 1-hour 50-g glucose test predicts an increased likelihood for T2DM.
Second-Trimester Screening for Placenta Accreta in Those With Prior Cesarean Delivery [ID: 1380253]
Authors: Chasen Stephen , Suner Talia 
Published: May 2023

INTRODUCTION:
Our objective was to determine whether placental evaluation in the second trimester is sufficient to look for evidence of placenta accreta in those with prior cesarean delivery (CS).

METHODS:
Those with prior CS who underwent routine ultrasound (US) at 18–22 weeks in 2021 and delivered in our hospital were identified. Records were reviewed for history and US findings, and delivery records were reviewed to identify those with clinical or pathological evidence of accreta. Fisher’s exact test and Mann-Whitney U were used for statistical comparison.

RESULTS:
Eight hundred seventy-one patients were included, including 145 (17%) with multiple CS. There were 11 with confirmed accreta (1.3%): 7 requiring hysterectomy and 4 with myometrial fibers on placental pathology. Of 11 cases of accreta, only 4 (36%) had US findings in the second trimester, representing 57% of cases requiring hysterectomy. Cases without suspicious second-trimester findings all had other major risk factors, such as previa (n=3) or additional uterine scars such as prior B-Lynch suture (2), “T” incision (1), and Asherman syndrome (1). Overall, second-trimester US was accurate in 99.1% of cases. Of 8 inaccurate cases (7 false negative, 1 false positive) previa was noted in 4 (50%), versus 7.4% with accurate assessment (P=.002). There was no relationship between age, body mass index, or number of prior CS and accuracy of second-trimester US.

CONCLUSION:
Ultrasound findings were not identified in the second trimester in the majority of cases with accreta, although findings were noted in the majority requiring hysterectomy. All cases without second-trimester findings had previa or additional risk factors for scarring. Third-trimester US to screen for placenta accreta may not be necessary in all those with prior CS if second-trimester US is normal. Those at highest risk should undergo third-trimester imaging. If there is a selective approach to third-trimester US, a detailed history is important in identifying those with risk factors.
Intrahepatic Cholestasis of Pregnancy Complicated by COVID-19 Infection [ID: 1381429]
Authors: Gogia Soumya , Johnson Andrea , Patel Soha , Pham Amelie 
Published: May 2023

INTRODUCTION:
Recent studies show that COVID has been associated with liver injury. Our study presents a case series of pregnant patients with intrahepatic cholestasis of pregnancy (ICP) complicated by prior COVID infection.

METHODS:
A retrospective review of singleton pregnancies delivered in an academic center between January 2020 and April 2022 identified patients with ICP (bile acids [BA]>10 mmol/L) with prior COVID infection in pregnancy. Maternal demographics, clinical/laboratory findings, medication use, and perinatal outcomes were collected. Secondary outcomes included BA greater than 40 mmol/L, BA trends in pregnancy, use of ursodiol, and rate of adverse perinatal outcomes (maternal/neonatal death). Institutional review board approval was exempted for this study.

RESULTS:
Of 138 cases of ICP and 743 cases of COVID during our study period, 14 patients were evaluated, 9 of whom met inclusion criteria. All cases of COVID resolved prior to delivery except one. Most cases (77.8%, 7/9) used ursodiol for treatment of ICP with mean duration of 6.9 weeks (±4.7). Six cases (66.7%) had BA greater than 40 mmol/L. One reported BA as high as 153 mmol/L at 23.5 weeks after COVID was diagnosed at 23.2 weeks. In this case, BA levels resolved by 26 weeks to less than 10 mmol/L and remained normal until delivery at 37 weeks. No adverse perinatal outcomes were reported.

CONCLUSION:
ICP cases in the setting of prior COVID in pregnancy are rare, but liver injury related to COVID may increase BA levels in pregnancy. Further studies are needed to evaluate possible associations between elevated BA due to COVID-19 and adverse perinatal outcomes.
Outcomes of Diabetic Intervention With One Abnormal Value on the 3-Hour 100-Gram Glucose Tolerance Test [ID: 1381570]
Authors: Foy Melissa , O’Reilly Geralyn 
Published: May 2023

INTRODUCTION:
Recent studies identified an increased risk of adverse perinatal outcomes in women who have one abnormal value on the 3-hour 100-g glucose tolerance test (GTT) compared to women without gestational diabetes (GDM). Limited data are available on the benefit of diabetic intervention with these patients. We examined outcomes of pregnancies diagnosed and managed with GDM based on one abnormal value compared to those receiving routine care.

METHODS:
We performed a retrospective cohort study of all women with one abnormal value, comparing outcomes for those patients who received routine prenatal care (January 2016 to February 2018) versus those treated for gestational diabetes (March 2018 to July 2021). The primary outcome was birth weight greater than 4,000 g. Secondary outcomes included large for gestational age and cesarean delivery secondary to labor dystocia. Nonparametric tests were used to compare outcomes between groups. Study was IRB exempt.

RESULTS:
One hundred twenty-six women had one abnormal value on the 3-hour GTT. 76 (55.88%) were diagnosed with GDM and managed accordingly, while 50 (36.76%) were followed with routine care. Of the women diagnosed with GDM, 27 (35.52%) required pharmacologic treatment. Diagnosis of GDM and intervention were associated with a significant reduction in birth weight greater than 4,000 g (5.26% versus 20%, odds ratio 0.22, 95% CI 0.07–0.75). There were no significant differences for secondary outcomes.

CONCLUSION:
Pregnancies with one abnormal value on 3-hour GTT who received diabetic intervention were less likely to have birth weights greater than 4,000 g. Although further studies with larger cohorts are needed, this supports the use of one abnormal value for the diagnosis of GDM.
The Contribution of Neighborhood Context to the Association of Race With Anemia [ID: 1369542]
Authors: Hacker Francis , Lemon Lara , Phillips Jaclyn , Simhan Hyagriv , Simhan Jayanthi , Simhan Uma 
Published: May 2023

INTRODUCTION:
Anemia on delivery admission is a risk factor for severe maternal morbidity (SMM). SMM occurs more often in racial minorities and those of socioeconomic disadvantage. We sought to explore the relationship between anemia on delivery admission, race, and a composite measure of neighborhood socioeconomic disadvantage.

METHODS:
We performed an IRB-approved retrospective cohort analysis of delivery admissions in a single health care network from 2015 to 2020. Area deprivation index (ADI) was used to represent neighborhood socioeconomic disadvantage and is a composite index of neighborhood that spans income, education, household characteristics, and housing. The index ranges from 1 to 100 with higher values indicating higher disadvantage. Anemia was defined as hemoglobin less than 11.0 mg/dL. Multivariable binomial regression models were used to estimate the effect that ADI has on the relationship between race and anemia.

RESULTS:
People in disadvantaged neighborhoods and those of Black race had the highest unadjusted incidence of anemia (23% and 29%, respectively). Across all ADI values, people of Black race had higher rates of anemia than all other races. In the multivariable model, Black race had a 2.7 times odds anemia when compared to White race (95% CI 2.6–2.9). This relationship persisted in an adjusted model (adjusted odds ratio 1.9, 95% CI 1.8–2.0). The relationship between ADI and anemia did not depend upon or vary by race.

CONCLUSION:
Rates of anemia increase as neighborhood disadvantage increases, but this relationship does not depend on or vary by race. Exploration of specific factors in the built environment that contribute to anemia deserves future study for possible remediation.
Effect of Race and Insurance on Outcomes in Women With Placenta Accreta Spectrum [ID: 1374697]
Authors: Parikh Bijal , Garretto Diana , Heiselman Cassandra , Herrera Kimberly , Kohli Harmehar , Korgaonkar-Cherala Chaitali 
Published: May 2023

INTRODUCTION:
We evaluated whether maternal race and insurance status affect outcomes in pregnancies diagnosed with placenta accreta spectrum (PAS).

METHODS:
This was an IRB-approved retrospective cohort study including women diagnosed with PAS from January 2013 to December 2021 at a single academic institution. Women were grouped based on race and insurance status. Primary outcome was intraoperative complications including PPH, uterine rupture, cystotomy, and ureteral injury. Secondary outcomes included total blood products, length of stay, and postdischarge complications (readmission, infection, disseminated intravascular coagulation, and venous thromboembolism). Statistical analysis was performed using χ2 tests, Student t tests, and logistic regression modeling, with statistical significance defined as P<.05.

RESULTS:
A total of 72 pregnancies with PAS were included. The majority of patients were Caucasian (69.0%), followed by Hispanic (14.1%), African American (11.3%), Asian/Pacific Islander (2.8%), and other (2.8%). 27 women (37.5%) had government-assisted insurance. There was no association between race and preoperative multidisciplinary planning (P=.223), planned hysterectomy (P=.926), or composite of any intraoperative complications (P=.141). Race did not predict receiving greater than five blood products (P=.623), ICU admission (P=.447), or composite of any postdischarge complication (P=.103). Similarly, there was no association with the above outcomes based on insurance status. Government-assisted insurance did predict length of stay greater than 7 days (85.7% versus 14.3%, P=.010).

CONCLUSION:
At our institution, maternal race and health insurance status did not affect preoperative planning, perioperative resuscitation, and delivery outcomes in women with PAS.
Association of Gestational Diabetes Mellitus Recurrence With Race and Ethnicity [ID: 1375479]
Authors: Hersh Alyssa , Caughey Aaron , Doshi Uma , Garg Bharti 
Published: May 2023

INTRODUCTION:
To assess whether there is an association between race and ethnicity with recurrence of gestational diabetes mellitus (GDM) among pregnant persons with a history of GDM in a prior pregnancy.

METHODS:
This was a retrospective cohort study of births between 2000 and 2012 to pregnant persons in California with a history of GDM in a prior pregnancy. We included singleton, nonanomalous births at gestational ages 23–42 weeks and excluded those who developed preexisting diabetes mellitus between pregnancies or with missing data for race and ethnicity. We adjusted for body mass index, age, educational attainment, and insurance type. Statistical analyses were performed using chi-square and multivariable logistic regression with a P value of .05.

RESULTS:
We included 26,903 births in this analysis. There were significant differences for all sociodemographic characteristics by recurrence of GDM. The highest proportion of pregnant persons with GDM recurrence were non-Hispanic Asian (55%), followed by Hispanic (51%). We found that the adjusted odds of GDM recurrence was higher among Hispanic (odds ratio [OR] 1.24, 95% CI 1.14–1.35) and non-Hispanic Asian (OR 1.93, 95% CI 1.76–2.11) individuals than the referent, while there was no difference in the adjusted odds of GDM recurrence for non-Hispanic Black (OR 0.99, 95% CI 0.83–1.18) or non-Hispanic American Native (OR 0.99, 95% CI 0.58–1.69) individuals.

CONCLUSION:
We found that among pregnant persons with a history of GDM, there was a higher adjusted odds of GDM recurrence among certain racial and ethnic groups. Future studies should assess this disparity with targeted interventions to mitigate this increased risk among these specific populations.
Mental Health Care Disparities After Implementation of a Perinatal Depression Intervention [ID: 1377829]
Authors: Spalding Hannah , Byatt Nancy , Leung Katherine , Simas Tiffany Moore , Yeboah Tracy 
Published: May 2023

INTRODUCTION:
Perinatal depression affects upward of 1:7 childbearing individuals and is associated with significant negative intergenerational outcomes, especially when unrecognized and untreated. Our study examined provider perinatal depression screening, assessment, treatment, and follow-up by race and ethnicity, as a proxy for implicit bias or systemic racism, after a perinatal depression intervention was implemented.

METHODS:
The Program In Support of Moms (PRISM), an obstetric practice intervention, was implemented in November 2017 at the UMass ob-gyn resident clinic. PRISM aims to improve the detection, assessment, treatment, and follow-up of patients with perinatal depression. With IRB approval, we abstracted data from charts of patients having one or greater prenatal or postpartum visits with an Edinburgh Postnatal Depression Screen (EPDS) score equal to or greater than 10 between October 2017 and May 2020. Descriptive statistics were used for comparisons.

RESULTS:
Seven hundred ninety individuals were included (White n=369, Black n=84, Hispanic n=264, other n=73). There were significant differences by race and ethnicity in the assessment of prior mental health history, interest in treatment engagement, therapy referrals, and medication treatment offered (all P≤.001) with White patients having significantly higher rates than patients who were Black or another race. There were no differences by race and ethnicity in provider positive screen acknowledgement, provision of psychoeducation, or repeat screening after a positive screen.

CONCLUSION:
Racial disparities in assessment, referral, and medication treatment offerings exist after a perinatal depression intervention. Implementation of PRISM intervention with an anti-racist lens is needed to improve equitable access to mental health care for those marginalized by racism.
Racial Disparities in Cervical Length Surveillance in Patients With a History of Spontaneous Preterm Birth [ID: 1378309]
Authors: Chornock Rebecca , Alzamora Maria , Anders Jacqueline , Kumnick Allison , Mokhtari Neggin 
Published: May 2023

INTRODUCTION:
Racial disparities in preterm birth are well established. We sought to identify racial disparities in cervical length surveillance in patients with a history of spontaneous preterm birth.

METHODS:
This was a subgroup analysis performed on data collected from a multi-institutional retrospective cohort study of pregnant patients with a history of early (<34 weeks) and late (≥34 weeks) spontaneous preterm birth (PTB) that underwent transvaginal cervical length surveillance between November 2016 and March 2022. MedStar Health Research Institute IRB approval was obtained. Twin pregnancies were excluded. Data was compared between Black patients and non-Black patients using χ2 tests, t tests, and ANOVA analyses, as appropriate (α=0.05).

RESULTS:
Of 324 patients, 231 (71.3%) were Black and 93 (28.7%) were non-Black. When comparing patients who had early PTB to late PTB, Black patients were more likely than non-Black patients to have early PTB (76.3 versus 61.3%, P=.005). Average gestational age at time of last spontaneous PTB was significantly earlier in Black patients compared to non-Black patients (28 weeks 3 days versus 30 weeks 4 days, P=.008). Black patients were further along in current gestation at the time of cerclage placement than non-Black patients (16 weeks 6 days versus 14 weeks 1 day, P=.041).

CONCLUSION:
Black patients are more likely to have later cerclage placement compared to non-Black patients despite a predisposition to earlier gestational age at time of prior preterm birth.
Use of an NTSV Checklist to Identify the Cause of Racial Disparities in Cesarean Birth Rates [ID: 1380461]
Authors: Vandyck Rhoda , Hayes Natalie , Jones Monica , Karpman Mitchell , Suess Jennifer 
Published: May 2023

INTRODUCTION:
Despite reductions in our overall nulliparous, term, singleton, vertex (NTSV) cesarean birth rates with targeted initiatives, nationally recognized racial disparities also exist at our institution. Implementation of an NTSV checklist in February 2022 enabled evaluation for racial disparities in NTSV care implementation.

METHODS:
In this IRB-approved, single-institution, retrospective cohort study of NTSV deliveries between July 2021 and June 2022, data were abstracted using EMR reports, customized queries, and manual chart reviews. We analyzed the effect of race, comorbidities, and use of specified interventions on delivery method. The primary aim was to assess for racial disparities in implementation of institutional NTSV initiatives. Secondary aims were to assess the effect of comorbidities and checklist implementation on NTSV cesarean birth rates.

RESULTS:
Before February 2022, Black NTSV patients were 76% more likely than White counterparts to have cesarean births (odds ratio [OR] 1.76, CI 1.28–2.41). Post-intervention, Black NTSV patients were 6% more likely to have cesarean births (OR 1.06, CI 0.70–1.60). Comparing Black NTSV patients with completed checklists to White counterparts showed no statistically significant difference in likelihood of cesarean birth (OR 1.36, CI 0.49–3.74) or having no NTSV intervention utilized (OR 1.10, CI 0.30–4.03). Black NTSV patients were more likely than White counterparts to have gestational hypertension (OR 1.47, CI 1.05–2.06) or intrauterine growth restriction (OR 2.3, CI 1.24–4.27).

CONCLUSION:
The NTSV checklist did not reveal statistically significant racial disparities in use of institutional initiatives. NTSV checklist implementation may have contributed to a decreased racial disparity in NTSV cesarean birth rates. A larger sample size would strengthen analysis of the effect of comorbidities, institutional initiatives, and checklist implementation on delivery mode.
Effect of Anemia on Adverse Perinatal Outcomes Is Greater in Black Women at Varying Hemoglobin Concentrations [ID: 1380962]
Authors: Ladella Subhashini , Gomes Cintia , Shaver Amber 
Published: May 2023

INTRODUCTION:
Maternal anemia affects 40% of pregnancies worldwide. It is associated with adverse birth outcomes, including preterm birth (PTB), which disproportionally affects Black women. We compared adverse perinatal outcomes and anemia as defined by World Health Organization/Centers for Disease Control and Prevention (hemoglobin [Hb]<11 g/dL) and institutional guidelines (Hb<12 g/dL), among Black women.

METHODS:
Institutional review board-approved retrospective cohort study was performed on patients delivered at Community Regional Medical Center, Fresno, California, from 2015 to 2016. Data abstraction included gestational age, first- and third-trimester Hb, race and ethnicity, parity, maternal age, mode of delivery, and neonatal outcomes. Exclusion criteria included hemoglobinopathies, tobacco use, uterine abnormalities, multiple gestation, and prior PTB or cervical surgery.

RESULTS:
Birth outcomes of 1,305 term and 990 PTB were analyzed for anemia at Hb less than 11 g/dL and less than 12 g/dL. Black women with PTB (83.8%) had significantly higher rates of anemia compared to term (68.8%) at Hb less than 12 g/dL (P<.05) versus Hb less than 11 g/dL (P>.05). Compared with other ethnicities (n=2,104), Black women (n=193) showed significantly higher rate of first- (47.60% versus 24.3%; P<.01) and third-trimester anemia (75.10% versus 59.50%, P<.01), low birth weight (LBW) neonates (38.70% versus 26.20% not-AA, P<.1), and lower 1- and 5-minute Apgar scores (32.30% and 15.30% versus 22.90% and 8.70% not-AA, respectively; P<.05) at Hb less than 12 g/dL.

CONCLUSION:
Significant association of anemia with PTB, LBW, and lower Apgar scores was noted in Black women at HB less than 12 g/dL. Further studies with larger sample sizes are needed to evaluate the need for redefining anemia Hb concentration for Black women, which may help initiate early treatment and prevent adverse perinatal outcomes.
Maternal Morbidity Rates Relative to Length of Labor in a Multiethnic Patient Population [ID: 1337798]
Authors: Lee Daniel , Kwan Lorna , Nguyen Emily , Pluym Ilina , Tandel Megha 
Published: May 2023

INTRODUCTION:
Prolonged induction of labor is associated with increased morbid maternal outcomes. Induction of labor length varies by institution and labor management. The objective of this study was to determine the risk of morbid outcomes increasing hours of labor induction in a multiethnic tertiary care center.

METHODS:
We conducted a retrospective cohort study on patients undergoing scheduled induction of labor from June 2020 to May 2021 at a tertiary care center. Nulliparous singleton term pregnancies with intact membranes who had an initial cervical dilation less than 3 were included. Length of labor induction was defined as first intervention to birth. Morbid outcomes included suspected intraamniotic infection (IAI), postpartum hemorrhage (PPH), and cesarean birth. Multivariable logistic regressions were performed relative to the length of labor.

RESULTS:
Two hundred sixty-seven patients were included in our study, with 18.0% Asian American/Pacific Islander, 6.4% Black/non-Hispanic, 20.2% Hispanic, 32.6% White/non-Hispanic, 17.6% multiracial/other, and 5.2% unknown. The median labor length was 28.5 hours (interquartile range 21.2–38.5). The rates of IAI was 22%, PPH 12%, and cesarean birth 22%. For every hour of labor, there was 1.04 increased odds of IAI, 1.08 odds of cesarean birth, and 1.05 odds of PPH after adjusting for confounders (P<.01). When comparing White versus non-White patients, there were no differences in labor length (28.4 hours versus 28.6 hours, P=.46) and no differences in IAI, PPH, and cesarean.

CONCLUSION:
For each hour of labor, the risk of IAI, PPH, and cesarean birth increased by 4%, 8%, and 5%, respectively. Characteristics contributing to this association may be multifactorial and suggest labor management should aim for an expedient birth.