bluuebunny/crossref_metadata_2025_split huggingface dataset:
Evaluation of Patient Cost Savings in Tailored Prenatal Pathways [ID: 1375747]
Authors: Tang Michael , Cohn Amy , Fendrick Mark , Ghrayeb Leena , Peahl Alex 
Published: May 2023

INTRODUCTION:
The Plan for Appropriate Tailored Healthcare in pregnancy (PATH) recommends tailoring prenatal visit schedules and modality (eg, telemedicine visits) to patients' risk factors and preferences. We simulated PATH recommendations to explore financial implications from the patient perspective.

METHODS:
In this IRB-exempt study, a dataset of 4,992 patients from a single academic health system was used to establish key assumptions for financial modeling. The model was constructed using several key parameters: patient risk, travel, and employment variables. We report patient-perspective cost and time savings across three models: traditional care (all patients seen for 12–14 in-person visits), tailored prenatal care (visit number tailored to patient risk), and hybrid tailored care (tailored care with telemedicine and in-person visits).

RESULTS:
Implementation of tailored care resulted in substantial cost and time savings. In the traditional model, average travel time was 26 hours and average total cost per patient was $1,374 (time off cost, $1,310; travel cost, $64). In the tailored model, patients saved on average 5 hours of travel time and $172 (total cost, $1,201; time off cost, $1,145; travel cost, $56). In the hybrid tailored model, patients saved on average 18 hours of travel and $792 (total cost, $581; time-off cost, $525; travel cost, $21; at-home supplies, $35). Extrapolated across all patients who sought prenatal care in 2020, estimated national cost savings range from approximately $0.5B and $2B annually for the in-person tailored and hybrid tailored model, respectively.

CONCLUSION:
Tailored prenatal care delivery policies, particularly those that include telemedicine, result in significant time and cost savings for patients.
Virtual Prenatal Care: The Effect of Telemedicine and Home-Ultrasound on Maternal Anxiety and Attachment During Pregnancy in Women With a History of Pregnancy Loss [ID: 1375930]
Authors: Weiner Eran , Cartun Zachary , Kleiner Ilia , Levy Michal , Marom Or , Tamayev Liliya 
Published: May 2023

INTRODUCTION:
We aimed to study the effects of twice-a-week telemedicine visits on maternal anxiety and antenatal attachment in women with a history of previous pregnancy loss by complementing routine prenatal care with home ultrasound.

METHODS:
This was a randomized controlled trial. Women with history of pregnancy loss (>20 weeks) were recruited and randomized 1:1 in the treatment arms early in their subsequent pregnancy in our high-risk clinic. The control group received routine prenatal high-risk care per protocol, while the study group received additional twice-a-week telemedicine visits with a maternal–fetal medicine specialist, which included a home ultrasound scan (for fetal heart rate, movement, and amniotic fluid) for reassurance. The scan was performed by the patient using a home ultrasound device (Pulsenmore ES) with physician authorization and guidance. Maternal anxiety was evaluated by the validated State-Trait Anxiety Inventory Scale (STAI-S) and maternal attachment was evaluated by the validated Maternal Antenatal Attachment Scale (MAAS-2) at four time points throughout pregnancy. The primary outcome was the STAI-S score at the last prenatal visit. Power analysis required 40 patients to demonstrate a 20% difference in the primary outcome. The study was approved by the local IRB, and all patients signed an informed consent upon randomization.

RESULTS:
To date, 32 patients completed follow-up, with 16 per arm. There were no differences in demographics or pregnancy outcomes between groups. The study group demonstrated lower anxiety levels at the last prenatal visit (STAI 42.2±4.7 versus 49.6±5.8, P<.001), higher differences between STAI scores at the first versus last visit (−9.9±2.7 versus −7.1±3.1, P=.011), and higher MAAS-2 scores (50.4±3.9 versus 47.2±4.5, P=.039) at last visit.

CONCLUSION:
Routine prenatal telemedicine visits with home ultrasound can lower maternal anxiety and improve attachment in women with previous pregnancy loss.
A Pilot Randomized Control Trial of Topical Capsaicin as Adjunctive Therapy for Nausea and Vomiting of Pregnancy [ID: 1376219]
Authors: Murphy Lauren , Griffin Laurie , Hamel Maureen , Smith Megan , Whelan Anna 
Published: May 2023

INTRODUCTION:
Nausea and vomiting is one of the most common complications of pregnancy affecting 50–80% of pregnant persons and despite its prevalence remains a challenging condition to treat. Therapy often involves oral and IV medications with potential side effects, particularly when taken in combination. Capsaicin cream is proven to decrease nausea and vomiting in cyclic vomiting syndrome, however has not been well studied among pregnant patients. We conducted a pilot randomized controlled trial (RCT) to test the acceptability and feasibility of the off-label use of capsaicin for treatment of nausea and vomiting in pregnancy.

METHODS:
Patients were recruited during triage evaluation for nausea and vomiting. Institutional review board approval was obtained prior to enrollment. Consenting participants were randomized to abdominal application of topical capsaicin versus placebo. All participants received intravenous hydration and metoclopramide. The primary outcome, total treatment time, was recorded for all participants. Additionally, symptom severity was assessed every 30 minutes using a visual analogue scale.

RESULTS:
Of the 38 eligible individuals approached, 30 were randomized. There was a trend towards decreased mean treatment time in the capsaicin group compared to placebo (79.9 versus 97.3 minutes, P=.1). There were no significant differences in VAS scores at any time point between groups. Furthermore, capsaicin was well tolerated, with only one individual requesting the medication be removed.

CONCLUSION:
This study demonstrates that capsaicin is an acceptable treatment for nausea and vomiting in pregnancy and additional explorations of its use as therapy are feasible. A larger RCT is needed to determine the efficacy of capsaicin in this population.
Effect of U.S. Region on the Incidence of In-Hospital Pregnancy Terminations Over Two Decades [ID: 1376691]
Authors: Desposorio Jonathan , Ramsey Patrick , Seifi Ali 
Published: May 2023

INTRODUCTION:
The overturning of Roe v Wade will result in a patchwork of abortion laws that vary based on where a person lives; however, the current association between geographical region in the United States and abortion is poorly understood. Our objective was to define the effect geographic location has on the incidence of in-hospital pregnancy terminations in the United States.

METHODS:
The U.S. Nationwide Inpatient Sample (NIS) database was queried for all patients who underwent an in-hospital abortion (termination of pregnancy) from 1997 to 2014. The cohort was divided based on what region in the United States the procedure was performed: Northeast, Midwest, South, and West. ANOVA statistical analysis was used to compare the four groups across the study period.

RESULTS:
We identified a total of 37,600 patients who underwent an in-hospital pregnancy termination with a significant decrease from 4,113 abortions in 1997 to 1,059 in 2014 (P<.001). Compared to the rest of the United States, the Northeast region experienced a significantly higher incidence of abortions (P<.01), with a mean of 878 abortions per year, and the Midwest experienced a significantly lower incidence of abortions (P<.01), with a mean of 261 abortions per year.

CONCLUSION:
Our study found that the Northeast and Midwest regions of the United States experience the highest and lowest rates of abortion, respectively. With Roe v Wade overturned, an even higher discrepancy between abortion rate and U.S. region might ensue; however, further study is needed to investigate the etiology of these differences.
Fetal Monitoring mHealth Apps: A Mixed-Methods Study of Users' Perceptions of App Effects [ID: 1377502]
Authors: Baker Elizabeth , Bedia Enrique , Buckingham-Schutt Lyndi , Duffy Pamela , Ferguson Emma 
Published: May 2023

INTRODUCTION:
Little is known about users' perceptions of fetal monitoring mHealth apps (FMAs). mHealth guidelines for developing behavior change interventions, like FMAs, recommend consistent evaluation of these apps to examine users' perceptions of app effects and to identify unintended consequences or harms to app users. The objective of this secondary, mixed-methods study was to explore app users' perceptions of the interventions' effects.

METHODS:
A convenience sample of 806 pregnant individuals aged 18+ who voluntarily downloaded a free, proprietary FMA completed a survey, including open- and closed-ended items in four survey sections: app engagement, perceived efficacy of the app raising awareness of fetal movements, health behaviors and diagnoses, and pregnancy and birth outcomes. We conducted a thematic analysis of the responses of the 299 participants who answered open-ended questions and triangulated themes with app user data (DMU IRB-2021-17).

RESULTS:
Four major app effects were reported by users: reduced prenatal anxiety and increased parent/family–fetal bonding, awareness of fetal movement, and health-seeking behavior in the presence of decreased fetal movement. Moreover, app user data suggested that these benefits were amplified by more consistent app use.

CONCLUSION:
Collectively, FMA users in this study associated app use with clinically significant prenatal outcomes and did not report that app use led to consequences or harm. From an institutional perspective, these findings may support health systems and prenatal providers who are investigating whether and how to integrate digital patient support modalities into prenatal care and are seeking evidence to support decision-making.
The Natural History of Fetal Triploidy in an Era of Limited Abortion Access: A Case Series [ID: 1380133]
Authors: Moustafa Ahmed Zaki , Araji Sarah , Clericuzio Natalie , Frieson Danielle , Hendon Laura 
Published: May 2023

INTRODUCTION:
Triploidy is a chromosomal abnormality that occurs in 1–3% of all conceptions and often results in early spontaneous miscarriage. It is exceedingly rare for a triploid fetus to survive to birth. Neonates usually die within hours to days after delivery. After the Dobbs v Jackson Women's Health Organization ruling in July 2022, access to abortion is becoming increasingly limited, and therefore providers should consider the adverse maternal health outcomes that can be associated with triploidy.

METHODS:
In this case series, we describe three cases of confirmed fetal triploidy that we encountered in our center within 1 year (2021–2022). All three cases were referred to us after House Bill 1259 was passed on July 1, 2020, in Mississippi banning termination of pregnancy based on race, sex, or genetic abnormality.

RESULTS:
Our first case is a 21-year-old patient referred at 19 weeks 2 days for abnormal second-trimester serum screen. Ultrasound showed an enlarged multicystic placenta and multiple fetal anomalies. Amniocentesis showed a 69,XXY karyotype. Patient was managed expectantly. At 21 week 5 days, patient was diagnosed with superimposed preeclampsia with severe features. Patient underwent medical termination of pregnancy. The second case is a 25-year-old referred at 30 weeks 0 days for concerns of fetal anomalies. Ultrasound confirmed multiple fetal anomalies. Amniocentesis showed a 69,XXY karyotype. Patient was diagnosed with preeclampsia and pulmonary edema and was delivered at 30 weeks 1 day. The neonate passed away at 22 days of life. Our third case is a 20-year-old referred at 24 weeks 0 days for abnormal aneuploidy screening. Ultrasound showed a major cardiac defect and severe fetal growth restriction. Amniocentesis showed a 69,XXY karyotype. Patient was managed expectantly. At 29 weeks 0 days, intrauterine fetal demise was diagnosed. Patient was diagnosed with peripartum depression.

CONCLUSION:
Women with pregnancies affected by fetal triploidy are at risk of developing preeclampsia. Restricting access to abortion will lead to increased maternal morbidity and mortality rates.
Stigma, Confidentiality, and Blame: Qualitative Focus Groups of Ghanaian Obstetric Providers After Maternal and Perinatal Losses [ID: 1377293]
Authors: Russell Colin , Beyuo Titus , Lawrence Emma , Oppong Samuel , Owusu-Antwi Ruth 
Published: May 2023

INTRODUCTION:
Despite maternal and perinatal mortality disproportionately occurring in low- and middle-income countries, there are limited data on the emotional toll these losses have on obstetric providers. In a series of focus groups discussions (FGDs), this study delves into the experiences of physicians and midwives in Ghana after maternal and perinatal losses.

METHODS:
Participants were obstetrician/gynecologists and midwives at the two largest tertiary hospitals in Ghana. Five FGDs were conducted by a trained facilitator, using a semi-structured guide. Questions explored experiences after patient deaths and perspectives on supportive interventions for providers. FGDs were audio-recorded and transcribed verbatim. Using an iteratively developed codebook, transcripts were thematically analyzed with NVivo. Written informed consent and IRB approvals were obtained.

RESULTS:
Twenty obstetricians and 32 midwives participated in five FGDs in Accra and Kumasi, Ghana. Most providers (84%) had completed training, and almost half (46%) had been in practice for above 10 years. Three major themes emerged: 1) pervasive stigma about seeking mental health services, especially from psychiatrists, rooted in cultural norms; 2) skepticism about departmental and peer confidentiality if providers seek support after poor outcomes; 3) profound sense of blame, both from self and peers, that resulted in poor mortality audit attendance and effects on workplace performance. Despite numerous barriers, providers expressed a strong need for improved departmental and institutional support systems.

CONCLUSION:
This study uncovers key barriers for providers to access mental health care and support after experiencing maternal and perinatal mortalities. Findings should inform interventions to better support struggling providers.
Initiation of Oral Agents Versus Insulin as First-Line Therapy for Gestational Diabetes Mellitus [ID: 1360154]
Authors: Edwards Kayla , DeFranco Emily , Griffith Taylor , Masters Heather 
Published: May 2023

INTRODUCTION:
Although the American College of Obstetricians and Gynecologists recommends insulin as first-line pharmacologic treatment for gestational diabetes mellitus (GDM) since 2017, use of oral agents as first-line remains common. This study aims to identify patient-level factors associated with choice of initial pharmacologic treatment of GDM with oral agents compared to insulin.

METHODS:
Case–control study of 617 patients with White's class A2 GDM treated at a single academic center in a comprehensive GDM treatment program, 2011–2018. Pregestational diabetes and GDM not requiring medication (A1 GDM) were excluded. Case group was GDM pregnancies treated with any oral agent first-line and control group was treated with insulin as first-line treatment. Logistic regression was performed to identify patient factors associated with oral agents as first-line pharmacologic treatment. Receiver-operator characteristic (ROC) curve estimated the ability of these factors to predict initial medication choice.

RESULTS:
Among those with GDMA2, 80% were started on an oral agent and 20% were started on insulin. Those started initially on oral agents were more likely to be Hispanic or non-Hispanic White, be non-English speakers, have private insurance, and have normal body mass index (BMI). Factors strongly associated with starting on an oral agent rather than insulin were Hispanic ethnicity, treatment initiated later in pregnancy (>28 weeks), normal BMI, and 1-hour glucose challenge test (GCT) greater than 200. The ROC derived from the adjusted logistic regression model found a predictive value of these variables for initiating oral agents of 79% (area under the curve 0.79).

CONCLUSION:
Patient-level factors are predictive of pharmacological agent chosen for first-line treatment of GDM. Factors that are typically associated with more difficult to control GDM, such as obesity, high values on the GCT screening test and earlier gestational age at diagnosis are more common in patients treated initially with insulin. However, some demographic factors such as Hispanic ethnicity and non-English primary language are more common among patients initiated on oral agents for treatment of GDM.
Timing of Fetal Growth Restriction Development in Patients With Preeclampsia [ID: 1363469]
Authors: Francis Matilda , Kawakita Tetsuya , Martins Juliana 
Published: May 2023

INTRODUCTION:
Preeclampsia (PEC) and fetal growth restriction (FGR) share common pathophysiology of placental insufficiency. In pregnancies complicated by PEC, the incidence of FGR increases significantly. We sought to examine the timing of FGR development in patients with PEC.

METHODS:
This was a retrospective cohort study of patients with PEC and singleton pregnancy who delivered at 23 weeks or greater. Patients who had been diagnosed with FGR prior to PEC diagnosis, those who were diagnosed with FGR at the same time as PEC, and those who delivered immediately after PEC diagnosis were excluded. Demographics were compared between patients with FGR and those without FGR. We plotted Kaplan-Meier curves for the interval from the diagnosis of PEC to the development of FGR. A Cox proportional hazards model was used to estimate the adjusted hazard ratios (HRs) for FGR. Our IRB approved this analysis.

RESULTS:
Of 392 patients with PEC, 31 (7.9%) developed FGR. Compared to patients who did not develop FGR, patients who developed FGR were more likely to have early-onset PEC and lower maternal weight and were less likely to have gestational diabetes (P<.05). The incidence rate of FGR increased by 11.6% each week from the PEC diagnosis. Compared to patients with late-onset PEC, those with early-onset PEC had a significantly higher cumulative incidence of FGR (P<.01). The Cox proportional hazards model showed that early-onset PEC was associated with FGR (adjusted HR 4.12, 95% CI 1.19–14.33) compared to late-onset PEC.

CONCLUSION:
Patients with early-onset PEC had a significantly higher incidence of FGR compared to those with late-onset PEC. There was a high cumulative incidence rate of FGR in patients with early-onset PEC. Patients with PEC should be followed by serial fetal growth ultrasound.
Adverse Pregnancy Outcomes of Cervical Cerclage According to the Indications [ID: 1363547]
Authors: Kawakita Tetsuya , Nehme Lea 
Published: May 2023

INTRODUCTION:
The objective of this study was to examine pregnancy outcomes of patients who underwent cervical cerclage according to cerclage indications.

METHODS:
This was a retrospective cohort study of patients with a singleton pregnancy who underwent cervical cerclage from 2014 to 2020 at a single academic institution. Patients were categorized according to cervical cerclage indications (history-indicated, ultrasound-indicated [cervical length 1–2.4 cm versus less than 1 cm], and physical exam indicated cerclage). Our primary outcome was spontaneous preterm delivery before 37 weeks of gestation. Outcomes were compared according to cervical cerclage indications. Multivariable logistic regression models were used to calculate adjusted odds ratios (aORs) and 95% CI, adjusting for a history of preterm delivery. Our IRB approved this analysis.

RESULTS:
Of 501 patients, 240 (47.9%), 115 (23.0%), 50 (10.0%), and 96 (19.2%) had a history-indicated, ultrasound-indicated (1–2.4 cm), ultrasound-indicated (<1 cm), and physical exam-indicated cerclage, respectively. Rates of preterm delivery were statistically different according to the indications. Compared to history-indicated cerclage, physical exam-indicated cerclage was associated with spontaneous preterm delivery (adjusted odds ratio [aOR] 3.97, 95% CI 2.27–6.97), preterm delivery (aOR 3.48, 95% CI 2.23–5.96), spontaneous preterm delivery less than 34 weeks (aOR 5.60, 95% CI 2.92–10.74), and neonatal demise or stillbirth (aOR 3.18, 95% CI 1.35–7.50). Compared to history-indicated cerclage, ultrasound-indicated cerclage (1–2.4 cm) was associated with preterm delivery (aOR 1.70, 95% CI 1.07–2.72) and neonatal intensive care unit (NICU) admission (aOR 1.81, 95% CI 1.11–2.96). Compared to history-indicated cerclage, ultrasound-indicated cerclage (<1 cm) was associated with spontaneous preterm delivery less than 34 weeks (aOR 2.46, 95% CI 1.02–5.94) and NICU admission (aOR 2.51, 95% CI 1.23–3.36).

CONCLUSION:
Compared to history-indicated cerclage, other cerclage indications were associated with increased odds of adverse pregnancy outcomes.
Neonatal Outcomes Associated With Personalized Text Messages for Diabetes Self-Management in Pregnancy [ID: 1373396]
Authors: Lester Lauren , Boerrigter Ashley , Gavard Jeffrey , Mostello Dorothea , Sakach Julia 
Published: May 2023

INTRODUCTION:
The objective was to determine whether providing individualized text messages regarding diabetes management improved compliance with care and pregnancy outcomes.

METHODS:
Institutional review board committee approval was obtained for the study. Pregnant women with type 2 (T2) and gestational diabetes (GDM) were randomized into two groups. The “contact-control” group was enrolled in the Text4baby program, which provides nonpersonalized educational text messages throughout pregnancy. The intervention group (Text4diabetes) received individualized text messages regarding upcoming appointments, current insulin regimen, and encouragement to keep and submit glucose logs for review. The primary outcome is compliance (data not yet analyzed). This analysis assesses neonatal outcomes, including perinatal loss (>24 weeks), delivery gestational age (GA), arterial cord pH less than 7.1, 5-minute Apgar less than 7, large-for-gestational-age (LGA) status, need for glucose supplementation, intubation, and surfactant administration.

RESULTS:
One hundred forty-four women with T2 or GDM were randomized. Both groups had similar numbers of women with T2 diabetes (33% and 31%) and history of GDM in prior pregnancy (21% and 19%). The Text4diabetes group had fewer deliveries less than 35 weeks, fewer LGA infants, and fewer surfactant administrations. A composite of adverse neonatal outcomes, including LGA status, delivery less than 35 weeks GA, arterial cord pH less than 7.1, and need for surfactant administration, showed fewer adverse outcomes in the Text4diabetes group. No findings, however, reached statistical significance.

CONCLUSION:
Text messages aimed at improving compliance with diabetes care in pregnancy did not significantly affect neonatal outcomes. Correlation with compliance results is needed to see whether improved compliance improved neonatal outcomes.