bluuebunny/crossref_metadata_2025_split huggingface dataset:
Early Indicators That Universal Screening for Social Risk Factors Is Essential in the Perinatal Period [ID: 1381099]
Authors: Rogovin Hayley , Arem Hannah , Auguste Tamika , Laccay Christine , Patchen Loral , Thomas Angela 
Published: May 2023

INTRODUCTION:
The District of Columbia has one of the highest maternal mortality rates in the United States. It is estimated that clinical factors account for 20% of health outcomes; the remaining 80% are attributable to other factors including social determinants of health (SDOH). This quality improvement project aims to examine the effectiveness of utilizing screening tools to identify social risk factors during the perinatal period.

METHODS:
We conducted a retrospective analysis of birthing individuals who completed our SDOH screening tool between April 1, 2021, and March 31, 2022. There were 1,106 birthing individuals screened. Social determinants of health were divided into seven risk categories: food insecurity, housing conditions, transportation, safety, legal, finance, and social support. Occurrences of each risk category were analyzed and compared for those who screened at both the pregnancy and postpartum stages.

RESULTS:
Of the 1,106 patients screened, 72% of the patients screened positive by reporting at least one social risk factor. Of those who screened positive, 81% requested general support. The primary needs identified were transportation (42%) and housing conditions (27%). Of 216 patients who were seen during pregnancy and postpartum, 24% had a decrease in the number of positive social risk categories from pregnancy to postpartum; 24% had the same; and 52% had an increase. There was a decrease in the number of patients with housing conditions; transportation needs increased.

CONCLUSION:
A majority of our perinatal patients report at least one social risk factor. The next step is to strengthen our ability to respond to resource needs identified by routine screening.
The Effect of Remdesivir on Liver Function Test Trends in Pregnant People With COVID-19 [ID: 1356660]
Authors: Kraus Alexandria , Kucirka Lauren , Sakai Nozomi , Weddendorf Elizabeth , Young Omar 
Published: May 2023

INTRODUCTION:
The purpose of this study is to describe the effect of remdesivir on liver function test (LFT) trends when used in the treatment of COVID-19 in pregnant people.

METHODS:
This was a retrospective cohort study examining pregnant people with COVID-19 admitted to an academic medical center between October 1, 2020 and December 31, 2021. Patient data were obtained by querying the Data Warehouse for Health, a data repository sourced from the Epic EHR. Patient charts were reviewed to abstract missing data and to ensure accuracy of key variables. Demographics, clinical characteristics, and pregnancy outcomes were compared between those who received remdesivir and those who did not.

RESULTS:
The study cohort comprised 102 pregnant individuals, of whom 21 received remdesivir. Mean length of stay for patients who received remdesivir was 11.4 versus 4.2 days, and they were more likely to require intensive care unit admission (57.1% versus 2.5%) and intubation (9.5% versus 0%). Those who received remdesivir were more likely to deliver by cesarean section (62.5% versus 38.2%) and had a lower mean gestational age at delivery (35.5 weeks versus 37.8 weeks). Ten patients had a LFT doubling after treatment, and two were diagnosed with preterm preeclampsia. Patients with LFT doubling were more likely to be delivered by cesarean section (87.5% versus 16.8%) and had a lower mean gestational age at delivery (33.2 weeks versus 38.2 weeks).

CONCLUSION:
Thirty-three percent of patients treated with remdesivir had a doubling in LFTs. Two had increases attributed to preterm preeclampsia. Further research is essential to elucidate the autonomous effects of remdesivir, COVID-19, and preeclampsia, on liver function.
Obstetrical and Neonatal Outcomes in Women With Gestational Lyme Disease [ID: 1354384]
Authors: Courville Julien , Abenhaim Haim Arie , Czuzoj-Shulman Nicholas , Spence Andrea 
Published: May 2023

INTRODUCTION:
The incidence of Lyme disease (LD) infections has risen in recent decades. Gestational LD has been associated with adverse pregnancy outcomes; however, the results have been contradictory. The objective of this study was to examine the effects of gestational LD on obstetrical and neonatal outcomes.

METHODS:
Using the Healthcare Cost and Utilization Project–National Inpatient Sample database from the United States, we conducted a retrospective cohort study of pregnant women who were admitted to hospital between 2016 and 2019. The exposed group consisted of pregnant women with gestational LD infection (ICD-10 code of A692x), whereas the comparison group consisted of pregnant women without gestational LD. Descriptive statistics and multivariate logistic regression models, adjusted for baseline maternal characteristics, were used to determine the associations between gestational LD and obstetrical and neonatal outcomes.

RESULTS:
Our cohort included 2,943,575 women, 226 of whom were diagnosed with LD during pregnancy. The overall incidence of gestational LD was 7.67 per 100,000 pregnancy admissions. The incidence of gestational LD was stable during the study period. Women with gestational LD were more likely to be Caucasian, older, have private health insurance, and earn higher incomes than the comparison group. Gestational LD was associated with an increased risk of placental abruption (adjusted odds ratio [aOR] 3.45, 95% CI 1.53–7.80) and preterm birth (aOR 1.58, 95% CI 1.03–2.42).

CONCLUSION:
Gestational LD is associated with a higher risk of placental abruption and preterm birth. Pregnancies complicated by LD may benefit from being closely monitored in tertiary care settings.
Fetal Gastroschisis: Does Fetal Growth Restriction Correlate With Small for Gestational Age at Birth? [ID: 1375594]
Authors: Brawley Amalia , Pauli Jaimey , Stetter Christy 
Published: May 2023

INTRODUCTION:
Conflicting data exist regarding the optimal formula for calculating estimated fetal weight (EFW) in fetuses with gastroschisis. The widely used Hadlock formula includes abdominal circumference (AC) and may underestimate EFW, as fetuses with gastroschisis tend to have a smaller AC. We evaluated 1) correlation between EFW and birth weight (BW) and 2) agreement between fetal growth restriction (FGR) and small for gestational age (SGA) in fetuses/neonates with gastroschisis.

METHODS:
This was an IRB-approved single-center retrospective cohort study at a tertiary care center. Data were obtained from 2012 to 2021 and included singleton pregnancies with at least one growth ultrasound (US) performed by our center and neonate born at our center with confirmed gastroschisis. Pearson correlation was used to examine association between EFW and BW. Kappa statistic was used to examine agreement between FGR and SGA.

RESULTS:
Thirty-five maternal–neonatal pairs were included. There was a strong correlation between EFW on last growth US and BW (r=0.70, 95% CI [0.48, 0.84], P<.001). There was disagreement between FGR on last US and SGA at birth (Kappa coefficient=0.11, 95% CI [0.00, 0.22], P<.001) with 26 (74.3%) FGR fetuses, 5 (14.3%) of which were SGA neonates.

CONCLUSION:
Although EFW and BW were strongly correlated, less than one-fifth of fetuses diagnosed with FGR became neonates classified as SGA, suggesting that an EFW formula including AC overestimates FGR in fetuses with gastroschisis. Accurate estimation of EFW is necessary for antenatal testing, delivery planning, and avoiding unnecessary interventions. An alternative EFW formula could be considered for fetuses with gastroschisis.
Effect of SARS-CoV-2 Infection on Hypertensive Disease of Pregnancy [ID: 1381283]
Authors: Jessel Rebecca , Dubois Bethany , Janevic Teresa , Kaplowitz Elianna , Lesseur Corina , Mills Alexandra 
Published: May 2023

INTRODUCTION:
Antenatal SARS-CoV-2 infection causes significant maternal morbidity and mortality. Preeclampsia and SARS-CoV-2 infection share common pathophysiology that may worsen pregnancy outcomes when both coexist. The purpose of this study was to investigate the effect of gestational SARS-CoV-2 infection on the risk of developing hypertensive disease of pregnancy (pregnancy-induced hypertension [PIH]).

METHODS:
We performed a study of 307 participants from the IRB-approved Generation C prospective cohort study in New York City designed to examine the effect of SARS-CoV-2 infection on maternal, fetal, and neonatal outcomes. SARS-CoV-2 infection during pregnancy was ascertained using a combination of PCR, spike and nucleocapsid IgG antibodies, and chart review. Maternal symptoms were assessed in the original Generation C study. Pregnancy-induced hypertension status was defined using the American College of Obstetricians and Gynecologists diagnostic criteria and excluded participants with chronic hypertension. Logistic regression was used to estimate associations between SARS-CoV-2 infection and PIH after adjusting for age, body mass index, race, history of diabetes including gestational, chronic hypertension, and history of PIH.

RESULTS:
Twenty-seven percent (n=84) of the 307 pregnant persons were infected with SARS-CoV-2 during pregnancy. No participants developed even moderate symptoms nor required hospitalization. Twelve percent (n=10) of those exposed developed any hypertensive disease of pregnancy. In participants without SARS-CoV-2 infection (n=223), 36 (16%) developed PIH. In adjusted multivariable models, gestational SARS-CoV-2 infection was not associated with PIH (odds ratio 0.53, 95% CI [0.22, 1.16], P=.13).

CONCLUSION:
Despite recent publications suggesting an increased risk of PIH in pregnancies complicated by antenatal SARS-CoV-2 infection, our study fails to reveal an increased risk of PIH associated with asymptomatic or mild infection in a diverse prospective New York City pregnant cohort.
COVID-19 Vaccination Coverage Among Pregnant Women by Race and Ethnicity: National Immunization Survey Adult COVID Module, United States, December 2020 to July 2022 [ID: 1375059]
Authors: Razzaghi Hilda , Black Carla , Hung Mei-Chuan , Jatlaoui Tara , Lu Peng-Jun , Srivastav Anup 
Published: May 2023

INTRODUCTION:
Pregnant and postpartum women are at increased risk for severe illness from COVID-19.

METHODS:
Data from the National Immunization Survey Adult COVID Module collected April 22, 2021 to August 27, 2022, were analyzed to assess COVID-19 vaccinations (receipt of ≥1 dose) received from December 2020 to July 2022 among women aged 18–49 years who were pregnant at the time of the survey using Kaplan-Meier survival analysis. The NIS-ACM is a random-digit–dialed cellular telephone survey of adults aged 18 years or older. Data are weighted to represent the noninstitutionalized U.S. adult population and calibrated to state-level vaccine administration data.

RESULTS:
By the end of April 2021, national COVID-19 vaccination coverage was highest among Asian and non-Hispanic White (White) pregnant women (56.4% and 42.5%, respectively) and lower among multiple or other race (38.2%), Hispanic (34.5%), American Indian or Alaska Native (AI/AN) (34.3%), Native Hawaiian or other Pacific Islander (NH/OPI) (32.4%), and non-Hispanic Black (Black) (25.2%) pregnant women. By the end of July 2022, coverage had increased in all racial and ethnic groups and was highest among Asian (98.6%) and Hispanic (79.0%) pregnant women. Coverage was similar for multiple or other race (67.8%), White (66.2%), NH/OPI (64.6%), and Black (64.2%) pregnant women; however, coverage remained lower for AI/AN (49.1%) pregnant women.

CONCLUSION:
Although COVID-19 vaccination coverage among pregnant women has increased and racial and ethnic disparities have narrowed over time, approximately 1 in 3 remain unvaccinated. A strong recommendation for COVID-19 vaccination is critical for all women of reproductive age to increase coverage and help achieve vaccine equity.
Evaluation of a Youth-Led Intervention to Improve Adolescent Sexual and Reproductive Health Knowledge, Efficacy, and Autonomy [ID: 1377919]
Authors: Sao Saumya , Coleman Jenell , Izadi Lillee , Wang Runzhi , Yu Ruoxi 
Published: May 2023

INTRODUCTION:
Youth bear a disproportionate burden of sexually transmitted infections (STIs) and unintended pregnancy. Knowledge about sexual and reproductive health (SRH) is low among this population, and youth face numerous barriers to care. We sought to develop and assess a youth-led intervention to increase youth SRH knowledge, self-efficacy, and autonomy, which are key indicators in developing positive sexual health behaviors and skills to feel confident in accessing health services.

METHODS:
Nine interactive, youth-led, 2-hour sessions were held virtually or in-person over 9 months. Session topics included human immunodeficiency virus and STIs, contraception, reproductive anatomy, menstrual health, healthy relationships, sexual decision-making, sexual violence, substance use, goal setting, gender identity and sexuality, and navigating health care services as an adolescent. Monetary compensation and transportation were provided. Sexual and reproductive health knowledge, self-efficacy, and autonomy were assessed using validated scales via an electronic questionnaire before and after implementing the intervention (IRB approved). Paired t tests were used to assess intervention effect.

RESULTS:
Thirty-seven participants with a mean age of 15.8 years (SD 1.13) were enrolled. All lived in the greater Baltimore area, and the majority self-identified as female. 52% were Black/African American, 28% Asian/Asian American, 12% White, and 8% Hispanic/Latino. Average attendance across sessions was 88%. Participants showed improvement in SRH knowledge (P=.02), advocacy and self-efficacy (P<.001), and personal safety and autonomy (P<.01). They reported increased comfort using trusted sites to procure SRH information (P<.01).

CONCLUSION:
A youth-led SRH intervention effectively increased SRH knowledge, self-efficacy, and autonomy. Further work should be done to explore the effects and expansion of peer-to-peer SRH education.
Developing an Obstetrics and Gynecology Residency Curriculum for the Care of Gender-Diverse Patients [ID: 1380351]
Authors: Lee Alice , Rajagopalan Supraja , Rowland Ayresleigh , Viloria Rebekah 
Published: May 2023

INTRODUCTION:
Standardized training across obstetrics and gynecology residency programs to care for LGBTQIA+ and gender-diverse individuals is lacking. A pilot simulation session for ob-gyn residents was developed to educate, increase comfort, and assess clinical competency in providing reproductive and sexual health care for this population.

METHODS:
A simulation session with standardized patients was developed for ob-gyn residents at a university teaching hospital (n=16). The session focused on the gynecologic exam, counseling for gender-affirming therapies and surgeries, as well as contraception and family building options in this population. Presession and postsession surveys of knowledge, attitudes, and behaviors were analyzed. The initial simulation session was conducted in May 2021. After a repeat simulation in March 2023, 2 years of data will be included in the final analysis.

RESULTS:
Posttest attitude analyses demonstrated that among residents with lower pretest scores, the majority endorsed increased comfort with explaining and eliciting gender identity. All residents agreed or strongly agreed that the simulation was effective in improving their communication with transgender and gender-diverse patients, and similarly agreed or strongly agreed that they desired a similar training session in the future.

CONCLUSION:
Advancing sexual, reproductive, and gender-affirming care for LGBTQIA+ individuals requires institutional investment in standardized educational opportunities for ob-gyn residents. This initiative to develop a longitudinal patient simulation session for ob-gyn residents offers a unique and effective model for other residency programs.
Lessons Learned From the Integration of Reproductive Health Specialists in the Multidisciplinary Care of Women With Locally Advanced Breast Cancers [ID: 1347982]
Authors: Miller Madison , Bensenhaver Jessica , Cannella Cara , Petersen Lindsay , Swain Monique 
Published: May 2023

INTRODUCTION:
The objective of this study was to investigate whether a multidisciplinary approach to breast cancer care with the inclusion of a reproductive health specialist improves referral rates for fertility counseling and/or preservation.

METHODS:
An IRB-approved retrospective study including women of reproductive age diagnosed with locally advanced breast cancer and treated at a health system before and after the advent of a comprehensive, multidisciplinary tumor board (cMTB) with a reproductive health specialist was conducted. Rates of referral for fertility counseling and utilization of fertility preservation methods were compared between the cMTB and non-cMTB groups using t tests. Secondary analyses comparing baseline group characteristics and rates of referral/fertility preservation by age, insurance type, and race were performed using χ2 tests.

RESULTS:
Of 306 study participants, 117 were cared for by a non-cMTB and 189 by a cMTB. The groups did not differ in average age, parity, breast cancer subtype, insurance type (public versus private), or treatment site (urban versus suburban); however, the distribution of race was significantly different (P=.003). Overall, a greater percentage of women in the cMTB group received referrals for fertility counseling compared to those in the non-cMTB group (23.3% versus 0.9%, P<.001). Of the patients in the cMTB group who were referred for counseling, 20.5% underwent fertility preservation. Within the cMTB group, women younger than 30 were significantly more likely to be referred for fertility counseling (41.7% versus 20.6%, P=.043) and undergo a fertility preservation procedure (16.7% versus 3.0%, P=.016) than those aged 31–40. No significant differences in rates of referral or fertility preservation by race or insurance type were noted within each group.

CONCLUSION:
The inclusion of a reproductive health specialist in a multidisciplinary breast cancer tumor board increased rates of referral for fertility counseling for women of reproductive age. A similar, comprehensive approach to the care of reproductive-aged women with gynecologic malignancies should be considered.
Does Bundling Matter? The Effect of Providing HPV Vaccination Before Tdap Vaccination on Timely Completion of the HPV Vaccine Series [ID: 1381348]
Authors: Kajtezovic Sidika , Fiascone Stephen , Morgan Jake , Perkins Rebecca 
Published: May 2023

INTRODUCTION:
The American Academy of Pediatrics and American Cancer Society promote vaccine initiation at age 9 as one way to improve human papillomavirus (HPV) vaccination rates. Studies have noted increased HPV vaccine series completion rates when the series was begun before age 11. We used a national sample to assess the effect of initiating the HPV vaccine series initiation prior to the adolescent platform on timely series completion.

METHODS:
To explore the effect of initiating the HPV vaccine series prior to other vaccines in the adolescent platform (unbundling) on timely series completion, we created a cohort of children aged 9 in 2015 who were continuously enrolled through the age of 13 (2019) from a national administrative database of employee-sponsored insurance (MarketScan). Logistic regressions were used to predict the odds of HPV vaccine series completion among those who started the series prior to, concurrent with, or after receiving tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccination. The cohort included 100,857 eligible children.

RESULTS:
Compared with adolescents who received their HPV and Tdap vaccinations concurrently, those who received HPV prior to Tdap had higher completion (adjusted odds ratio [aOR], 1.38), whereas those who received their HPV vaccination after Tdap had lower odds of HPV vaccine series completion (aOR 0.68). Other factors associated with series completion included female sex, residing in an urban (versus rural) area, residing in the Northeast, and receiving primary care from a pediatrician (versus family medicine physician).

CONCLUSION:
These data indicate that beginning the HPV vaccine series prior to the adolescent platform (unbundling) may improve on-time series completion.
Integrating Obstetric Point-of-Care-Ultrasonography (POCUS) Simulation Curriculum [ID: 1363619]
Authors: Lee Emily , Rubio Xiomara Brioso , Chang Yifan , Crabtree Janice , Ding Jia Jennifer , Pathy Shefali 
Published: May 2023

INTRODUCTION:
Point-of-care ultrasonography (POCUS) is increasingly used in medicine and is widely integrated into training. While obstetric (OB) ultrasound (US) is prevalent, its formal use and curriculum is often overlooked in POCUS training.

METHODS:
We performed a prospective comparative study of medical students who underwent formal obstetrics POCUS training and simulation. Students participated in a pre- and post-knowledge assessment of basic (presentation, placentation, fluid) and advanced (biometry and basic anatomy) knowledge. Scores were compared via Wilcoxon signed-ranks test. In addition to formal didactics, students participated in hands-on simulation training. The simulation provided one-on-one biometry training with a high-fidelity CIRS model 065-20 fetal model. Participants were evaluated on their ability to perform a complete fetal biometry.

RESULTS:
There were 58 participants in formal POCUS simulation training. Prior to training, only 29.7% were comfortable with a basic OB US and 8.1% were comfortable with performing biometry. Afterwards, 83.8% and 78.4% were comfortable performing basic and biometry US. Students had significantly higher basic OB US knowledge comparing before (Mdn=50.0) to after training (Mdn=83.3) (Z=5.27, P<.01). Similarly, there was a significant increase in advanced OB US knowledge comparing before (Mdn=56.3) to after (Mdn=100.0) (Z=4.99, P<.01). All participants were able to complete biometry measurements on the CIRS model. 91.9% of participants recommended this training to others.

CONCLUSION:
Obstetric ultrasound provides invaluable opportunity for learners to gain POCUS skills. Formal training and simulation significantly improves learning knowledge, confidence, and practical OB POCUS skills that can be used during clinical care.