bluuebunny/crossref_metadata_2025_split huggingface dataset:
Undetected Maternal Cell Contamination in Products of Conception Analysis May Mask Recurrence Risks for Future Pregnancies: A Case Report and Discussion [ID: 1377203]
Authors: Merrion Katrina , Campbell Lindsey , Hovanes Karine , Jelsema Russel , Maisenbacher Melissa 
Published: May 2023

INTRODUCTION:
Maternal cell contamination (MCC) in products of conception (POC) tissue is common; some studies report 59% of 46,XX results represent MCC.

METHODS:
Products of conception tissue and maternal blood samples were shipped to a laboratory for genotyping using Illumina CytoSNP-12b microarrays and bioinformatics (IRB E&I 19040-03A). Patient informed consent was obtained for submission of a case report.

RESULTS:
A 25-year-old woman with a family history of recurrent pregnancy loss (RPL) was first offered POC analysis after her second loss. The result was normal female; however, MCC could not be ruled out because a maternal sample was not provided. Thus, the result was presumed normal, and the patient was informed her testing did not identify a genetic cause for her loss. The patient's third miscarriage was sent for POC analysis with a parental sample, which identified a maternally derived 26.8-Mb terminal deletion and 39.3-Mb terminal duplication of chromosome 4. The submitted maternal sample allowed for reanalysis of the second loss confirming MCC. Maternal karyotype analysis revealed an abnormal result: 46,XX,inv(4)(p15.2q31.3). The patient was referred to reproductive endocrinology for discussion of options, including in vitro fertilization with preimplantation genetic testing.

CONCLUSION:
Undetected MCC can lead to erroneous normal female results, masking fetal findings that could affect recurrence risks. Since 5% of couples with RPL have a balanced chromosome rearrangement, almost six couples for every 1,000 losses are at risk for undetected MCC masking recurrence risks (calculated using a 50% expected aneuploidy rate and 59% of 46,XX results actually representing MCC).
Provider Preferences for Utilization of Video Visits for Prenatal Care During the COVID-19 Pandemic [ID: 1375554]
Authors: Hersh Alyssa , Kernberg Annessa , Rincon Monica , Sarker Minhazur , Thirunagaru Koumudi , Valent Amy 
Published: May 2023

INTRODUCTION:
The objective of this study was to assess providers' perceived advantages and disadvantages of prenatal care provision via video visits.

METHODS:
This was a cross-sectional survey of prenatal care providers in four academic institutions and their surrounding community sites across wide geographic areas of the United States in 2021–2022. Institutional review board approval was obtained by Oregon Health & Science University. The survey was distributed online via REDCap and consisted of 15 questions, which collected information about telehealth availability to patients, advantages and disadvantages of telehealth visits, and basic provider demographics. Analyses were conducted in STATA 17.

RESULTS:
There were 214 (42%) providers who completed the survey. The majority were female (82%), MD/DO (83%), older than 35 years (55%), and not trainees (61%). 155 (72%) providers reported they were conducted fewer than 10% of their visits via telehealth and 148 (69%) providers reported they had chosen not to offer a telehealth visit to a patient at least one time. The top three advantages of telehealth visits cited by providers included that patients can be located wherever is convenient for them, do not need to coordinate childcare for the appointment, and do not have to worry about exposure to infections like COVID-19. The top three disadvantages cited included inability to perform a physical exam, inability to obtain in-office urine or other point-of-care testing, and connection difficulties.

CONCLUSION:
During the pandemic, relatively few academic providers utilized telehealth visits to deliver prenatal care despite the potential advantages perceived. Addressing providers' perceived disadvantages of prenatal care provision via telehealth may combat the low utilization.
Virtual Antenatal Group Contraception Counseling: A Pilot Study [ID: 1346753]
Authors: Ereme Keemi , Akullo Kaidee , Class Quetzal A. , Hinz Erica 
Published: May 2023

INTRODUCTION:
This pilot study examines the feasibility, patient satisfaction, and knowledge after a novel virtual Group Contraception Counseling (GCC) session.

METHODS:
At an urban academic hospital, we recruited English-speaking pregnant women aged 15–49 who had access to a video-enabled electronic device. Participants engaged in a standardized 45-minute educational session about contraceptive methods in groups of two to five persons conducted over a video conferencing platform. The primary outcome was patient satisfaction measured by the Person-Centered Contraception Counseling (PCCC) scale. The secondary outcome was knowledge change before and after counseling. We used a nonparametric test of ranks to analyze satisfaction scores. A paired-sample t test and independent t tests were used to compare knowledge scores.

RESULTS:
Nineteen participants completed the study. Participants identified primarily as Black (47%), in a partnership (52%), having completed college (61%), and having an annual income of less than $50,000 (78%). The mean PCCC score was 19.21 out of 20 (SD 1.12, range 13–20) with no difference in satisfaction based on demographics or knowledge change score (r−0.296, P=.218). There was a significant difference between knowledge test scores pre- and post-GCC sessions (t
18=−3.229, P<.01), with post scores being 12% higher than pre scores (range 16–40%). Age, race, partnership status, and employment did not differentiate scores, whereas education was predictive of mean change of score after the GCC session (t
15=−2.93, P<.01).

CONCLUSION:
Our preliminary findings suggest antenatal contraception counseling in small virtual groups is a feasible option with high satisfaction and increased contraceptive knowledge for postpartum contraception choices.
Universal Transvaginal Ultrasounds: Does It Really Make a Difference? [ID: 1369458]
Authors: Grubman Olivia , Hussain Farrah , Mitchell Mackenzie , Owens Thomas , Strauss Tirtza 
Published: May 2023

INTRODUCTION:
There are no universal guidelines for transvaginal ultrasound (TVUS) at time of anatomy scan. TVUS can provide valuable information on placental location and cervical length (CL). As a quality assurance initiative, universal TVUS (UTVUS) protocol was started. The aim of this study was to evaluate differences in diagnoses and interventions in the 6 months prior to UTVUS protocol to 6 months after implementation.

METHODS:
This was an institutional review board-approved retrospective cohort study performed on singleton gestations from February 2021 to January 2022. The pre-group underwent TVUS for history of preterm birth, if the cervix appeared short or if the placenta appeared low lying on transabdominal scan. In the post-group, all patients underwent TVUS.

RESULTS:
Of the 1,197 patients, 148 underwent TVUS in the pre-group and 1,049 received UTVUS in the post-group. A greater proportion of patients had short CL identified in the post-group compared to the pre-group (2.2% versus 0.9%, P<.01). Additionally, CL was shorter in the post-group compared to the pre-group (median 1.6 versus 2.2 cm, P=.03). A greater proportion of patients in the post-group received vaginal progesterone (3.1% versus 0.7%, P<.01) and cerclage (2.3% versus 0.7%, P<.01) compared to those in the pre-group, and had a later gestational age at cerclage placement (median 17 weeks 2 days versus 13 weeks 6 days, P=.04). Patients in the pre-group had a higher rate of prior preterm birth (P<.01), delivered at an earlier gestational age (P<.01), and were more likely to have neonatal intensive care unit admission compared to patients in the post-group (P=.02). The overall preterm birth rate in both time periods was not significantly different (11.4% versus 11.2%, P=.82).

CONCLUSION:
UTVUS identifies shorter CL, which leads to increased use of vaginal progesterone and cerclage as compared to abdominal ultrasound with targeted TVUS. UTVUS may lead to increased intervention. However, the cost-effectiveness and clinical significance need to be further evaluated.
Application of Hematologic Indices for Diagnosis of Iron Deficiency Anemia in Pregnancy [ID: 1378030]
Authors: Vigh Richard , Gray Celia , Mackeen A. Dhanya , Paglia Michael , Young Amanda 
Published: May 2023

INTRODUCTION:
Prenatal care providers may omit iron studies if the complete blood count is suggestive of mild or moderate iron deficiency anemia (MMIDA). We investigated how sensitive the mean corpuscular volume (MCV) or red blood cell distribution width (RDW) are in identifying MMIDA that is diagnosed by ferritin measurement.

METHODS:
This IRB-approved retrospective cohort study from October 15, 2007 to October 14, 2021, included singleton pregnancies diagnosed with MMIDA and treated with iron for at least 4 weeks prior to delivery. Patients with comorbidities that predispose to anemia (eg, thalassemia) were excluded. The primary outcome was the percentage of patients whose MMIDA could be identified by low MCV or elevated RDW. Secondary outcomes included changes in hemoglobin, MCV, and RDW, and were assessed by persistence versus correction of MMIDA by delivery.

RESULTS:
Eight thousand eight hundred thirty-three patients met criteria; 1,141 (12.9%) had MMIDA diagnosed by low ferritin. The MCV or RDW was concordant with MMIDA diagnosis in 259 (22.7%). Hemoglobin significantly improved from 10.6 to 11.8 g/dL in the corrected group and did not change in the persistent group. Treatment with concurrent oral and IV iron resulted in greater hemoglobin increase (persistent, +0.4, versus corrected, +1.9 g/dL) versus oral iron alone (−0.1 versus +1.3 g/dL). The MCV decreased and RDW increased in both persistent (−2.7 fL, +1.0%) and corrected groups (−0.8 fL, +0.7%).

CONCLUSION:
Thirteen percent of providers ordered iron studies when MMIDA was suspected. Low MCV or elevated RDW are insensitive surrogates of ferritin. Iron studies remain the gold standard for diagnosis. Concurrent IV iron results in superior improvement of hemoglobin versus oral iron alone.
Maternal and Neonatal Outcomes After Monoclonal Antibody Use [ID: 1376620]
Authors: Storm Andrew , Gilley Annemarie , Greiner Andrea 
Published: May 2023

INTRODUCTION:
The study aimed to evaluate whether the administration of monoclonal antibodies (MABs) in mildly symptomatic unvaccinated COVID-19-positive pregnant patients reduced the need for maternal hospitalization and to evaluate whether this medication affected the rate of adverse neonatal outcomes and severe maternal disease. We hypothesized that MAB use would reduce the need for hospitalization.

METHODS:
This retrospective cohort study was completed by obtaining electronic medical record data of all pregnant patients between August 2020 and January 2022 who met criteria for MAB therapy. The two comparison groups were patients who received outpatient MAB therapy during pregnancy and those who were eligible for therapy but declined. Demographic and hospitalization data were obtained. Exclusion criteria included severe illness upon diagnosis requiring hospitalization, or patients for whom delivery and neonatal data were not available.

RESULTS:
During the study period, 49 patients qualified for MAB therapy, of which delivery data were available for 39 patients. Twenty patients (51%) elected to receive MAB therapy and 19 (49%) declined. Among those who received MAB therapy, 10 (26% of the population) were vaccinated, and among those who declined, 6 (15% of the population) were vaccinated. The two groups were similar in gestational age at delivery (38 weeks 4 days versus 37 weeks 5 days) and gestational age at diagnosis (19 weeks 0 days versus 22 weeks 6 days). Among patients who did not receive MABs, both absolute and relative maternal hospitalization rate was higher (26.3% versus 5%, 12.8% versus 3%, P>.05). When stratified by vaccination status, those who were vaccinated had a 5% probability of hospitalization regardless of MAB therapy. The probability of hospitalization was highest among unvaccinated women who did not receive MAB therapy (67%) and lowest among unvaccinated women who received MAB therapy (0%).

CONCLUSION:
Unvaccinated patients who declined MAB therapy had a higher rate of hospitalization, although not statistically significant. These preliminary findings warrant further study with a larger cohort.
Effect of Residency Training in Treating Maternal Opioid Use Disorder [ID: 1376984]
Authors: Herbosa Christina , Dickison Shelby , Kelly Jeannie , Lawlor Megan , Russell Sharman , Strand Eric 
Published: May 2023

INTRODUCTION:
Buprenorphine treatment for opioid use disorder (OUD) remains substantially underutilized, reflecting a systemic deficit in medical education. Our study assesses the effect of residency training in a prenatal OUD-specific clinic (CARE) on postgraduate ob-gyn physician attitudes, self-perceived competence, and treatment of maternal OUD.

METHODS:
2013–2022 graduates from a single obstetrics and gynecology residency program were invited to participate in an online anonymous survey, which collected information on demographics, attitudes, self-perceived competency, and current practice. Answers from participants who graduated before the establishment of CARE in 2018 were compared to those who trained after the establishment of CARE using Fisher's exact, χ2, and Student t tests. A value of P<.05 was considered statistically significant.

RESULTS:
55/86 (64%) physicians completed the survey. Compared to graduates without CARE experience (N=30), those with residency experience in CARE (N=25) were significantly more likely to be actively prescribing buprenorphine (24% versus 3%, P=.02) or planning to obtain an X-waiver (24% versus 3%, P=.03). The majority with CARE experience reported feeling comfortable prescribing buprenorphine during pregnancy (92.0% versus 13.3%, P<.001), confident to treat maternal OUD (84% versus 26.7%, P<.001), and able to manage buprenorphine treatment during pregnancy (88% versus 30%, P<.001). Those with experience in CARE reported that residency provided sufficient training to manage maternal OUD without additional X-waiver training (84% versus 10%, P<.001). Institutional review board approval was obtained.

CONCLUSION:
Prenatal OUD-specific clinics are known to be associated with improved patient outcomes, and may also significantly expand the ability of ob-gyn residents to treat maternal OUD after graduation.
Racial Differences in Activity Restriction Recommendations in Pregnancy [ID: 1379637]
Authors: Ha Laura , Bairey Merz C. Noel , Bello Natalie , Hirsch Anna , Kilpatrick Sarah , Naqvi Mariam 
Published: May 2023

INTRODUCTION:
Activity restriction (AR) is commonly recommended to pregnant patients despite lack of evidence demonstrating benefit to this practice. We describe AR recommendation patterns and identify factors associated with a higher likelihood of recommendation for AR.

METHODS:
This was a secondary analysis of the Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-Be (nuMoM2b) prospective cohort. Data were collected on nulliparous singletons at eight sites from September 2010 to September 2013. Patients were surveyed about AR recommendations at 22 weeks 0 days–29 weeks 6 days and delivery. We excluded patients missing data on AR and age. Patients were grouped by history of AR in pregnancy. We assessed characteristics between groups using χ2 and Wilcoxon rank sum tests. Associations between AR and demographic and clinical factors were examined with univariable and multivariable logistic regression.

RESULTS:
Of 9,312 women, 1,386 (14.9%) were recommended AR. In unadjusted analysis, prevalence of race and ethnicity, obesity, chronic hypertension, renal disease, and short cervix were significantly different between groups. After adjustment for covariates, Black and Hispanic patients were less likely to be placed on AR when compared to White patients (adjusted odds ratio [aOR] 0.81 [95% CI 0.68–0.98], and aOR 0.73 [95% CI 0.61–0.87], respectively).

CONCLUSION:
Activity restriction was more likely to be recommended in patients with obesity, chronic medical conditions, and short cervix. After adjustment for baseline differences, Black and Hispanic patients were significantly less likely to be recommended AR compared to White patients. While AR is not an evidence-based practice, these findings suggest implicit bias may affect which patients receive advice to limit activity in pregnancy.
Prenatal Care Utilization Among Pregnant Women With Substance Use Disorder: A Drug-Free Moms and Babies Project Study [ID: 1377131]
Authors: Dawley Denise , Breyel Janine , Lilly Christa , Umer Amna 
Published: May 2023

INTRODUCTION:
Pregnant people with substance use disorder (SUD) are more likely to have inadequate prenatal care quality/utilization. The rate of stimulants and opioids use continues to increase nationwide with significantly higher rates observed in rural and socioeconomically disadvantaged pregnant populations. The objective of this study was to quantify the association between substance use and the quality of prenatal care in the rural Appalachian pregnant population of West Virginia.

METHODS:
Drug-Free Moms and Babies Project is a multicenter program in West Virginia that offers coordinated care for pregnant and postpartum individuals with SUD. Secondary data analysis for this study (2018–2022) was limited to only those patients who entered the program during pregnancy (N=1,555). Kessner Index was used to categorize prenatal care quality as inadequate, intermediate, and adequate. Substance use included stimulants alone, opioids/narcotics alone, opioids/narcotics and stimulants concurrent use, and all other substances but not opioid/narcotic or stimulant use.

RESULTS:
Pregnant people with opioids use alone (odds ratio [OR] 2.11 [1.43–3.12]), stimulants use alone (OR, 3.27 [1.69–6.32]), and concurrent use of opioids and stimulants (OR 4.69 [2.52–8.73]) were more likely to have inadequate versus adequate prenatal care compared to those who used only other substances after adjusting for maternal income, education, medical conditions, prior children, planned/unplanned pregnancy, alcohol use, or smoking during pregnancy.

CONCLUSION:
Opioids/narcotics and stimulants use is associated with inadequate prenatal care utilization that becomes more pronounced with polysubstance use. Improving quality of prenatal care is critical for this population to improve the health of parent and child.
Psychological Trauma of COVID-19 in Pregnancy: Diagnosis, Treatment, and Recovery [ID: 1378016]
Authors: Drexler Kathleen , Tully Kristin , Young Omar 
Published: May 2023

INTRODUCTION:
The objective of this study was to delineate birthing persons' accounts of COVID-19 diagnosis, inpatient treatment, and recovery from infection and the effect on mental health.

METHODS:
This is a prospective qualitative study of English-speaking birthing people hospitalized for treatment of COVID-19 during pregnancy at a single quaternary care center from August 2021 to March 2022. Semistructured interviews were conducted to examine emotional reactions to developing COVID-19 during pregnancy, experiences with hospital admission and inpatient care, and effect on mental health after recovery. All interviews were audio-recorded, professionally transcribed, and iteratively coded for inductive narrative analysis.

RESULTS:
Eight birthing people participated in interviews. Universally, participants experienced feelings of fear, panic, and frustration with the diagnosis of COVID-19 infection and their need to be hospitalized. Inpatient care engendered feelings of isolation and disconnection due to separation from family and limited interaction with health care team members. Compared to non-Hispanic White participants, non-Hispanic Black participants were more likely to express feelings of discrimination and disrespectful care. After discharge, participants described intentionally avoiding people to minimize risk of reinfection, further increasing fears of anxiety and isolation even months after diagnosis. Postdischarge recovery also included ongoing recovery from physical symptoms, including breathing and activities of daily living.

CONCLUSION:
Birthing people reported significant psychological trauma after their diagnosis, treatment, and recovery from COVID-19 infection in pregnancy. These experiences highlight the importance of focusing on mental health as part of recovery and outline opportunities to improve the provision of respectful, equitable care.
Maternal Adverse Childhood Experiences (ACEs) Increase Opioid Use During Pregnancy [ID: 1368263]
Authors: Jacobs Benjamin , Ganson Kyle , Jackson Dylan , Nagata Jason , Testa Alexander , Zhang Lixia 
Published: May 2023

INTRODUCTION:
Adverse childhood experiences (ACEs) are linked with a myriad of adverse health outcomes and problematic health behaviors including depression, tobacco use, alcohol use, and illicit drug use. Although studies have drawn a connection between ACEs and substance use in adulthood, there is limited research on whether ACEs are associated with prescription opioids during pregnancy. The current study examines the relationship between ACEs and prescription opioid use during pregnancy using representative data from live births from two states.

METHODS:
This study uses data on 2,999 individuals from the 2019 and 2020 Pregnancy Risk Assessment Monitoring System (PRAMS) from North Dakota and South Dakota. Multiple logistic regression is used to assess the relationship between ACEs and prescription opioid use during pregnancy.

RESULTS:
The prevalence of prescription opioid use increases alongside accumulating ACEs. Compared to those with no ACEs, recent mothers with three or more ACEs have approximately a 2.4 greater odds of prescription opioid use during pregnancy (adjusted odds ratio 2.437, 95% CI: 1.319, 4.503).

CONCLUSION:
Given the potential harms of prescription opioid use during pregnancy, the findings suggest the need for additional research to better understand the mechanisms that link ACEs and prescription opioid use during pregnancy, as well as how to best support those with ACEs exposure in a trauma-informed manner to reduce the risk of substance use.