bluuebunny/crossref_metadata_2025_split huggingface dataset:
Evaluating Ob-Gyn Resident Beliefs Toward COVID-19 Vaccine and Its Safety and Efficacy in Pregnancy: A National Survey [ID: 1375473]
Authors: Weinstein Anna , Desai Chandani , Francis Antonia , Yacoel Tamar 
Published: May 2023

INTRODUCTION:
Vaccination beliefs vary across the United States. The American College of Obstetricians and Gynecologists (ACOG) recently published formal recommendations for COVID-19 vaccination in pregnancy. Outlooks regarding maternal vaccination among obstetrician–gynecologists have important implications for maternal morbidity and mortality. Resident perception of COVID-19 vaccination has yet to be studied. Our national survey sought to evaluate ob-gyn resident views regarding COVID-19 vaccine safety and efficacy in pregnancy.

METHODS:
In April 2022, a national survey was sent to all Accreditation Council for Graduate Medical Education-accredited obstetrics and gynecology residency programs in the United States. Responses were obtained and descriptive analysis was performed. Institutional review board approval was obtained.

RESULTS:
The majority of ob-gyn residents believed that pregnant patients should be vaccinated against COVID-19 (96.1%, n=73). In the outpatient setting, most resident physicians reported that they strongly recommend the COVID-19 vaccine to pregnant patients (89.5%, n=68). The majority of respondents believed the COVID-19 vaccine is effective in reducing maternal morbidity and mortality (98.7%, n=75). Of that subgroup, a minority of respondents felt the safety profile of COVID-19 vaccine in pregnancy is unknown (10.7%, n=8). Geographic distribution of respondents, as defined by Centers for Disease Control and Prevention Census designations, were as follows: Midwest (34.3%, n=26); Northeast (40.8%, n=31); South (10.5%, n=8); West (14.4%, n=11).

CONCLUSION:
The majority of ob-gyn residents believed the COVID-19 vaccine to be effective in reducing maternal morbidity and mortality. Although a minority were uncertain regarding its safety profile, they continued to recommend vaccination per ACOG guidelines. While descriptive responses were homogenous, a paucity of respondents from the South and West regions made geographic distribution uneven.
Effect of Policies Aiming to Restrict Ultrasound Use [ID: 1375832]
Authors: Hemminger Anna , Louis Judette , Price Corley Rachelle 
Published: May 2023

INTRODUCTION:
During the early months of the COVID-19 pandemic, policies were implemented that sought to reduce in-person prenatal visits and ultrasounds. We sought to evaluate the effect of those policies on the rate of diagnosed fetal growth restriction and infant low birth weight.

METHODS:
We performed a cohort study of patients delivered at an academic center. Participants who received prenatal care during the time period of restricted visits were matched in a 1:1 ratio to patients receiving care during an equivalent time period when there were no such restrictions (group I: July 1, 2019, to December 31, 2019; and group II: March 23, 2020, to September 23, 2020). Medical records were reviewed for clinical and demographic characteristics. Neonatal morbidity was defined as any of the following: stillbirth, neonatal death, preterm birth, neonatal intensive care unit admission, low birth weight. Data were analyzed using chi-square and Mann-Whitney U test where appropriate. P<.05 was significant.

RESULTS:
Our cohort included 580 patients. Overall, the group had a 13% preterm birth rate, 8.2% were diagnosed with fetal growth restriction, and 26% had the composite neonatal morbidity. All patients in the cohort had at least one ultrasound. Compared to group I, group II had more individuals who had only one ultrasound during the pregnancy (3.1 versus 0%, P=.004), but overall the group had more total ultrasounds performed (1.5 [1–3] versus 1 [1–2], P=.02) and had more patients who required fetal surveillance for maternal and fetal conditions (56 versus 44, P=.014). Group II was more likely to have a neonatal demise (1.4 versus 0.3%, P<.01), but there was no difference in the rate of prenatal diagnosis of fetal growth restriction or low birth weight.

CONCLUSION:
Policies to reduce prenatal ultrasounds were not effective in reducing ultrasounds performed, and there was no difference in the diagnosis of fetal growth restriction despite an increase in comorbidity.
Intrauterine Insemination (IUI) Pregnancy Rates After COVID-19 Vaccination [ID: 1376042]
Authors: Groves Savannah , Hsu Albert 
Published: May 2023

INTRODUCTION:
Public concern over the potential negative effect of COVID-19 vaccines on fertility has persisted, as confidence in COVID-19 vaccines remains low, especially in certain Midwestern populations. We evaluated the success of intrauterine inseminations (IUIs) in achieving pregnancy in women who self-report receiving at least one dose of the vaccine against SARS-CoV-2, compared with women who self-report declining the vaccine.

METHODS:
This is a retrospective cohort study of 109 IUI procedures in women receiving fertility treatment at the University of Missouri Reproductive Endocrinology and Infertility clinic from October 2021 through September 2022. Participants were grouped based on self-reported COVID-19 vaccination status, prior to their IUI. The primary outcome was pregnancy after IUI, as verified by a serum pregnancy test. This study was performed under University of Missouri IRB approval (IRB #MU2062683).

RESULTS:
In comparing women self-reporting COVID-19 vaccination versus nonvaccination, no statistical differences were found for positive serum pregnancy tests after IUI (17.3% among vaccinated; 21.7% among nonvaccinated). Although these IUI success rates are higher than the national average, there was no significant difference in pregnancy rates (P=.6331).

CONCLUSION:
In this limited sample, self-reported COVID-19 vaccination status does not appear to have a significant negative effect on the ability to conceive a pregnancy with IUI. Further prospective studies should evaluate the effect of male partner or sperm donor vaccination, the number and type of COVID-19 vaccines received, pregnancy outcomes, and confounders. This study may help address the ongoing questions of whether the COVID-19 vaccines have a significant negative effect on fertility and pregnancy outcomes.
Trust in Health Care Providers After 2 Years of COVID: Perceptions From a Missouri Birthing Population [ID: 1380219]
Authors: Williams Emily , Chrans K. Mariah , Lewis Elizabeth , Otto Ashlie , Ramaeker Devon , Smith Martha 
Published: May 2023

INTRODUCTION:
Distrust in the medical system is rooted in American history and exacerbated after the rapid dissemination of COVID-19 vaccinations. Pregnant women were the lowest group to receive vaccinations. We sought to understand vaccine uptake and perceptions of provider credibility in the Missouri birthing population.

METHODS:
The Perinatal Quality Collaborative (PQC) of Missouri developed a questionnaire assessing perceived trustworthiness of medical providers. Further questions assessed willingness to receive a COVID-19 vaccination. A mailing list racially representative of the birthing population was purchased (Dynata) with grant support. Thirty-nine questions were distributed from March to August 2022 to birthing persons 18 or more years of age. Those without a Missouri zip code or who identified as male were excluded.

RESULTS:
One thousand seven hundred thirty-eight people met inclusion criteria with a response rate of 89%. Of those, 74.5% identified as White, 14% as Black, 3.5% as Hispanic, 3.6% as Native American, 2.5% as Asian, 0.3% as Hawaiian Native or Pacific Islander, and 1.6% as other/unknown. Eighty-five people who responded were currently pregnant. Trust in provider recommendations was high at 83% with 80.9% stating they look to their physicians for reliable medical advice. The majority of respondents were aware that pregnancy is a risk factor for COVID-related complications, but only 39.6% stated they would be willing to receive a vaccine while pregnant.

CONCLUSION:
Despite low willingness to accept a COVID vaccine while pregnant, the Missouri birthing population overall trusts and seeks medical advice from their providers. Time allocated for more targeted counseling from all health care workers could increase vaccine uptake in the pregnant population.
Hypertensive Disorders of Pregnancy During the COVID-19 Pandemic: A Population-Based Study [ID: 1380265]
Authors: Gulersen Moti , Bornstein Eran , Chervenak Frank , Grunebaum Amos , Lenchner Erez 
Published: May 2023

INTRODUCTION:
We previously reported that the prevalence of hypertensive disorders of pregnancy (HDP) increased during the COVID-19 pandemic. We aimed to ascertain potential sociodemographic factors contributing to this association.

METHODS:
This was a retrospective analysis of the U.S. Centers for Disease Control and Prevention Natality Live Birth database (2016–2020). The prevalence of HDP, defined as a composite of gestational hypertension, preeclampsia, and eclampsia, was compared between the COVID-19 pandemic group (births from April 1, 2020, to December 31, 2020; n=2,728,674) and the pre-pandemic group (births from January 1, 2016, to February 29, 2020; n=15,967,803). A comparison of the prevalence of HDP among maternal sociodemographic factors and pregnancy characteristics between the two groups was also performed using χ2 test. Multivariable logistic regression was used to adjust for potential confounders. Statistical significance was set at P<.05.

RESULTS:
We detected an overall increase in odds of HDP during the COVID-19 pandemic period (8.7% versus 7.1%, adjusted odds ratio 1.25, 95% CI 1.24–1.26). The highest prevalence of HDP during the pandemic was seen in similar sociodemographic subgroups as in the pre-pandemic group, such as older maternal age, patients with some college credit, private insurance, and non-Hispanic Black race. A marked increase in HDP prevalence was noted during the pandemic in most maternal characteristic subgroups evaluated, with the greatest noted in Asian individuals and tobacco users. Interestingly, chronic hypertension, which was more prevalent during the pandemic period (1.2% versus 0.9%, P≤.001), was associated with a lower prevalence of HDP during that time.

CONCLUSION:
The prevalence of HDP increased in the United States during the COVID-19 pandemic among all sociodemographic factors evaluated. Although chronic hypertension was more prevalent during the pandemic period, it had a lower effect on the development of HDP during that time.
Breast/Chestfeeding and HIV: Shared Decision-Making and the Needs of Women [ID: 1372281]
Authors: Covin Ciarra , Conley Jenna , Ford Olivia , Levison Judy , Martel Krista , Picou Bridgette 
Published: May 2023

INTRODUCTION:
Breast/chestfeeding is considered both the healthiest infant-feeding option for the general population and the standard of care for birthing parents living with human immunodeficiency virus (HIV) in resource-limited settings. Inadequate research on breastfeeding and HIV in high-resource settings has resulted in a lack of clinical guidance for providers to support informed decision-making among women living with HIV in these areas.

METHODS:
The Well Project, a nonprofit working to change the course of the HIV pandemic through a unique and comprehensive focus on women, conducted a survey in 2021 that included questions about breastfeeding experiences. Among 200 self-identified women living with HIV surveyed via Survey Monkey, 33 women reported experiences around breastfeeding.

RESULTS:
Forty-nine percent of women reported discussing breastfeeding with their provider—60% with ID providers and 57% with obstetrician–gynecologists. Half of respondents reported their provider initiated the discussion. Sixty-nine percent said their provider told them they could not breastfeed; 19% said they received incomplete/inaccurate breastfeeding information; and 13% reported their provider supported them in making the best decision for their families.

CONCLUSION:
These numbers, although small, supplement anecdotal evidence suggesting that most U.S. women living with HIV are not counseled according to the Perinatal HIV Guidelines, which recommend people living with HIV who are interested in breastfeeding receive patient-centered, evidence-based counseling on their options and those who choose to breastfeed be supported in order to minimize transmission risk. Education is greatly needed to ensure providers support their patients through this decision-making process.
Effect of the COVID-19 Pandemic on Substance Use in Pregnancy and Associated Neonatal Outcomes [ID: 1342912]
Authors: Moncada Kea Alexa , Beckerman Karen , Chacko Jerel , Fruhman Gary , Izard Stephanie 
Published: May 2023

INTRODUCTION:
We sought to determine whether the COVID-19 pandemic resulted in an increase in positive urine drug screens (UDSs) in labor and delivery and whether the effect of drug use on neonatal outcomes differed before versus during the pandemic.

METHODS:
In this retrospective chart review, we identified patients from February 4, 2018, to May 11, 2022, with a completed UDS test and classified them into time periods: pre-COVID-19 and COVID-19. Pearson's χ2 test or Fisher's exact test was used to assess whether the proportion of positive tests and the presence of each drug type differed between the periods. A logistic regression was used to explore the effect of time period and test result on neonatal outcomes.

RESULTS:
We identified 7,648 UDS results; 3.6% were positive in the pre-COVID-19 period and 1.6% were positive in the COVID-19 period (P<.001). We found higher proportions of benzodiazepine and cannabinoid detection in the pre-COVID-19 period (P=.045 and P=.005, respectively). In the COVID-19 period, we found higher proportions of buprenorphine detection (P=.004). In the COVID-19 period, there was a stronger association between positive UDS results and neonatal intensive care unit (NICU) admission compared to the pre-COVID-19 period (odds ratio [OR] 16.78 [95% CI: 9.9, 28.6], 6.2 [95% CI: 3.8, 10.0], respectively). During the COVID-19 period, drug use was found to be a risk factor for small for gestational age (SGA) (OR 4.1 [95% CI: 2.3, 7.4]).

CONCLUSION:
We found a decrease in drug use during the COVID-19 pandemic. However, drug use during the pandemic was more strongly associated with NICU admission and was a risk factor for SGA.
Comparison of Weaning and Nonweaning of Medication-Assisted Treatments in Pregnant and Postpartum Women With Opioid Use Disorder: A Systematic Review [ID: 1376658]
Authors: Adelli Rakesh , Olsen Martin , Ramirez Andrea , Shah Darshan , Subbanna Maya , Walker McKenzie 
Published: May 2023

INTRODUCTION:
The objective of this study was to perform a systematic review of studies reporting the maternal and infant outcomes associated with weaning (W) and nonweaning (NW) of medication-assisted treatments (MATs) in pregnant and postpartum women with opioid use disorder.

METHODS:
Studies done between the years 2000 and 2022 were extracted from PubMed using MeSH terms (neonatal abstinence syndrome, pregnancy, opioid disorder, and outcomes). Studies that reported maternal and infant outcomes associated with W and NW of MATs and done in English language were included. Thirty-eight studies out of 329 met the criteria. Data included study design, number of participants, and maternal and infant outcomes. SPSS was used to perform the analysis.

RESULTS:
Among the 38 studies included in this review, 8 were W studies, which included 1,214 participants, and 30 were NW, which included 5,727 participants. The average birth weight of infants was 3.07 kg (W group), 3.03 kg (NW group) (P=.01), and 3.3 kg (national average 2020); preterm deliveries were 13.6% (W group), 15.2% (NW group) (P=<.0001), and 10.1% (national rate 2020). Babies needing abstinence treatment was lower in W group (43.6% versus 51.6%, P=<.0001). Five in 286 deliveries in W group and 5 in 3,478 deliveries in NW group were recorded as pregnancy loss (P=<.0001).

CONCLUSION:
A statistically significant difference was observed between the preterm rates in MAT groups and the national average (P<.0001) and between pregnancy loss, average birth weight, and infants needing abstinence treatment of both groups. The W group had lower numbers of preterm babies, and babies needing abstinence treatment, and the average birth weight in W group was closer to the national average.
Cannabis Use in Pregnancy: Effects of a Hospital Policy on Toxicology Screening Practices [ID: 1377573]
Authors: DiBiase Florence , Brousseau Erin , Pileika Lindsey , Reddy Neha 
Published: May 2023

INTRODUCTION:
Guidelines for toxicology screening in pregnancy are lacking. Studies suggest provider bias in implementation and potential serious consequences for patients. We examined the effect of a novel hospital policy.

METHODS:
A protocol was outlined for verbal screening, counseling, and toxicology screening by a hospital task force on cannabis use in pregnancy. Institutional review board approval was obtained for study. A retrospective chart review and analysis of practices on admission for delivery was performed 6 months pre- and post-policy implementation in resident low-risk and maternal–fetal medicine clinics.

RESULTS:
There were 2,373 deliveries during the study period and 129 mother–infant dyads underwent toxicology screening. The rate of maternal screening did not significantly differ pre- and post-policy implementation (2.6% versus 3.4%, P=.23). In those screened, the rate of maternal cannabinoid positivity increased significantly post-policy (13.8–42.9%, P=.005). Similarly, the rate of neonatal screening did not significantly differ pre- and post-policy implementation (3.4% versus 3.6%, P=.88), while the neonatal cannabinoid positivity rate increased significantly post-policy (7.7–31.8%, P=.005). There were no significant differences in demographics of those screened pre- versus post-policy.

CONCLUSION:
Implementing a hospital policy did not change the rate or demographics of screening but did correlate with an increased cannabinoid detection rate. The effects of the policy should be cautiously considered. The benefit of standardized verbal screening and discussion of risks is clear, but potential harm from toxicology screening remains.
Emergency Contraception Deserts in the New Orleans Metropolitan Area Post-Dobbs v Jackson Women's Health Organization [ID: 1369505]
Authors: Sisk Charles , Bergeron Lauren , Rault Lule , Ulrich Nicole , Williams Frank 
Published: May 2023

INTRODUCTION:
Recent legal changes limit access to abortion in Louisiana. Ensuring access to over-the-counter (OTC) emergency contraception (EC) is essential in the current environment. Building on the idea of “food deserts,” we aimed to identify EC deserts, or places where urban residents would need to travel more than 1 mile to acquire OTC EC.

METHODS:
During the months of August and September 2022, secret shoppers surveyed all retail pharmacies in Jefferson, Orleans, and Terrebonne parishes (counties) to ascertain the availability of OTC EC. Distance from such pharmacies was calculated for each of the 348 census tract centroids (CTCs) in the survey region. Chi-square analysis was used to compare the number of CTCs with a distance greater than 1 mile to OTC EC relative to the number of pharmacies stocking OTC EC in a given parish (county).

RESULTS:
Of 212 eligible pharmacies, 97 (46%) offered EC for sale OTC and had it in stock: 46% in Jefferson Parish, 46% in Orleans Parish, and 45% in Terrebonne Parish. Mean distance from CTC to a pharmacy stocking EC OTC was 1.45 miles, and median distance was 0.66 miles. Overall, 26% of CTCs met the above criteria for emergency contraception deserts; 21% of pharmacies in Jefferson and Orleans parishes met criteria compared to 69% of pharmacies in Terrebonne Parish (P<.001).

CONCLUSION:
Fewer than half of surveyed Louisiana retail pharmacies have immediately available OTC emergency contraception, with nearly 70% of census tracts located in Terrebonne Parish defined as EC deserts.
Immediate Postpartum Long-Acting Reversible Contraception Uptake and Outcomes [ID: 1371558]
Authors: Holland Kelsey , Mastronardi Alicia , Young Megan , Zite Nikki 
Published: May 2023

INTRODUCTION:
Tennessee Medicaid began covering immediate postpartum (IPP) long-acting reversible contraception (LARC) in November 2017 with the goal of reducing the rate of short-interval births (SIBs) (defined as less than 24 months after a previous birth). In 2014, 22.7% of births in Tennessee were SIBs. We sought to determine IPP LARC uptake and SIB outcomes for women who received IPP LARC after this policy was implemented.

METHODS:
A retrospective chart review of women who delivered from March to December 2018 and received IPP LARC was conducted. LARC receipt and SIB outcomes were determined utilizing local, regional, and state records (IRB: 4768, 2021-0303).

RESULTS:
Among the 406 IPP LARC recipients, the average age was 25.9 (15–42), and the average number of living children was 1.28 (0–6). LARC type elected was 4.7% copper intrauterine system (Cu-IUS), 39.9% levonorgestrel-releasing intrauterine system (LNG-IUS), and 55.4% contraceptive implant. Subsequent SIB was identified in only 5.4% (22). Of these, 2 received Cu-IUS, 10 received LNG-IUS, and 10 received contraceptive arm implants. Timing and reason for removal were documented for 7 of these. Expulsion was identified in 1 copper and 1 hormonal IUD. Removals due to side effects were reported in 3 implant and 2 hormonal IUD users.

CONCLUSION:
The rate of SIB among the IPP LARC recipients was much lower than the general rate among Tennessee women, highlighting the benefit of IPP LARC provision. Additionally, the high preference for contraceptive implants may reflect provider counseling on the increased risk of IUD expulsion when placed IPP or other factors that may be elucidated by future studies.
Trends in Contraceptive Choices Among Patients Delayed in Receiving Bilateral Tubal Ligation Because of the COVID-19 Pandemic [ID: 1371694]
Authors: Conrad Sarah , Bohac Sarah , Carranco Sara , Casey Sarah 
Published: May 2023

INTRODUCTION:
The COVID-19 pandemic led to a decline in access to elective surgeries and contraceptive care. Today, there remains a backlog of patients awaiting elective female sterilization. The use of alternative contraception during delays has yet to be explored. To address this gap, patients awaiting sterilization were surveyed to evaluate trends in contraception usage.

METHODS:
Patients at Ben Taub Hospital who desired tubal ligation between March 2020 and July 2022 were called and asked to complete a 23-question survey, which assessed obstetric history, current contraceptive usage, and demographics. Patients were called up to three times, and descriptive statistics were analyzed.

RESULTS:
Of 217 patients, 123 consented to the survey (56%). Respondents almost entirely identified as Black, Indigenous, and people of color (BIPOC), with 83% of surveys administered in Spanish. The average age was 36. While awaiting sterilization, 85% used an alternative form of contraception, with Depo-Provera (Depo) and oral contraceptive pills (OCPs) being the most common. 28.5% of Depo users endorsed missing injections. Thirty-eight percent of patients using OCPs reported missing doses. Thirty-two percent reported undesirable side effects of their contraceptive, such as pain or irregular bleeding. Overall, 58% were satisfied with their current contraceptive method with 89% still desiring tubal ligation. In total, there were six unplanned pregnancies.

CONCLUSION:
Despite extensive COVID-19-related delays in sterilization, most patients still desired the procedure. Patients most commonly chose Depo and OCPs for contraception to bridge the delay, as opposed to long-acting reversible contraceptives.