bluuebunny/crossref_metadata_2025_split huggingface dataset:
Associations Between Emotional Resilience and Mental Health Problems in Underserved Pregnant Women [A325]
Authors: Guo Yuqing , Jimah Tamara , Borg Holly , Pimentel Pamela , Kehoe Priscilla 
Published: June 2022

INTRODUCTION:
Prenatal distress (ie, depression and anxiety) is associated with adverse maternal and infant outcomes. Importantly, emotional resilience has been found to protect women from mental health conditions. The goals of this research were to identify the prevalence of depression and anxiety and to examine relationships between emotional resilience and depression/anxiety in low socioeconomic (LSE) prenatal women during the COVID-19 pandemic.

METHODS:
The study adopted a cross-sectional design. We recruited 15 underserved Hispanic women who were aged 18-40 years and had a singleton pregnancy through WIC in California. The validated surveys were used to collect participants' demographics, mental health, and emotional resilience, including Patient Health Questionnaire (PHQ-8), Generalized Anxiety Disorder (GAD-7), Freiburg Mindfulness Inventory, and Coping Self-Efficacy. The Cronbach's alpha of these surveys ranged from 0.77 to 0.93. Descriptive statistics and partial correlations were conducted using SPSS.

RESULTS:
Maternal mean age was 26.8 (SD=3.73). Approximately one half of pregnant women (46.7%) had a Bachelor's degree or higher, 20% did not live with the baby's father, and 33.3% indicated having an at-risk pregnancy (e.g., anemia). Appropriately 13.3% of Hispanic pregnant women experienced prenatal depression and/or anxiety. After controlling for maternal education, higher mindfulness was significantly associated with a lower level of anxiety (r= −0.67, P=.009), and greater coping self-efficacy was significantly associated with a lower level of depression (r= −0.54, P=.049).

CONCLUSION:
It would be critical to improve pregnant women's mental health by increasing their ability to practice mindfulness and confidence to cope with distress.
Characteristics of Patients Most Likely to Use Postpartum Text-Based Breastfeeding Support Platform [A267]
Authors: Bender Whitney , Durnwald Celeste 
Published: June 2022

INTRODUCTION:
The aim was to describe the patient population most likely to utilize a postpartum text-based breastfeeding support platform.

METHODS:
This is a secondary analysis of an IRB-approved randomized controlled trial (RCT) at an urban tertiary care center from January 2020 to January 2021 comparing (1) a control group receiving weekly text messages inquiring about infant feeding method versus (2) an intervention group receiving educational texts and personalized text-based breastfeeding support as needed in addition to a weekly feeding question. Only patients randomized to the intervention arm were analyzed. The primary outcome was utilization of text-based support as defined by asking ≥1 feeding-related question in the first 6 weeks postpartum.

RESULTS:
Of the 216 subjects in the RCT, 106 were randomized to the intervention arm. Within this cohort, mean age was 31.4 years, 50% self-identified as Black, 51.9% were nulliparous, and 54.7% had commercial insurance. Overall, nulliparous patients were more likely than multiparous patients to utilize the text-based support platform (65.5% vs. 34.6%, P=.004). Patients with commercial insurance were also more likely to engage with the text-based support platform (65.5% vs. 34.6%, P=.02). Platform usage did not differ based on other clinical characteristics analyzed.

CONCLUSION:
Nulliparous and commercially insured patients were more likely to utilize a postpartum text-based breastfeeding support platform than their multiparous or publicly insured counterparts. Understanding the patient populations most likely to engage with a text-based health platform is critical to advancing health care delivery in the future.
Addressing Racial Disparities in Cesarean Delivery Rates Using A Digital Program: Preliminary Findings [A271]
Authors: Pickover Alison , Moss Christa , Shah Neel 
Published: June 2022

INTRODUCTION:
Current U.S. data indicate racial disparities in cesarean delivery rates, with Black mothers most likely to deliver via cesarean. We examined the association between use of a digital health program with virtual education appointments and cesarean delivery rates, overall and by race and ethnicity.

METHODS:
Participants were 524 women with singleton pregnancies who enrolled in a digital health program in 2020 and completed self-report questionnaires on race/ethnicity, medical history, and pregnancy outcomes. We used logistic regression to test associations between program engagement (operationalized as total virtual appointments) and cesarean delivery, controlling for age, trimester at program enrollment, and history of cesarean delivery.

RESULTS:
Overall, 29% delivered via cesarean section in their current pregnancy; 12% reported cesarean delivery in a past pregnancy. History of cesarean delivery was higher among Black mothers (29%). In the full sample, appointments and type of delivery were unrelated. When inspecting this association separately for different racial and ethnic groups of sufficient sample size (Asian, Black, Hispanic, Multiracial, White), a significant, inverse relationship between appointments and likelihood of cesarean delivery was observed specifically among Black mothers (P=.043). Providers most popularly sought by Black mothers included doulas (27%) and obstetricians (21%), and Black mothers had higher rates of birth-planning appointments (14%) than other groups.

CONCLUSION:
These preliminary data suggest that access to virtual appointments may help reduce racial disparities in cesarean delivery rates. Research is needed to clarify the mechanisms by which digital health engagement addresses these disparities.
Autoimmune Diseases and Rates of Thromboembolism in Pregnancy [A278]
Authors: Brewerton Charles , Thomas Jacob , Harrison Rachel , Holmgren Calla 
Published: June 2022

INTRODUCTION:
Antiphospholipid syndrome (APLS) is associated with an increased risk of thromboembolism during pregnancy. Other autoimmune diseases are less well-studied. Given the pro-inflammatory state associated with these conditions, we sought to identify the risk of thromboembolic disease in pregnant patients with autoimmune conditions.

METHODS:
This is a retrospective cohort study utilizing the National Inpatient Sample (Healthcare Cost and Utilization Project) for the year 2018. Subjects were excluded if they had a history of thrombosis, inherited thrombophilia, or APLS. Patients with at least one autoimmune condition (rheumatoid arthritis, Type 1 diabetes, systemic lupus erythematosus, myositis, ulcerative colitis, Crohn's, Sjogren's, scleroderma, and Hashimoto's thyroiditis) were compared to unaffected pregnancies. The primary outcome was a composite of thrombotic events. Secondary outcomes included individual components of the composite including deep vein thrombosis, PE, arterial embolism, and cerebrovascular thrombosis. The groups were compared via Student's t-tests, Chi-square, and logistic regression analyses.

RESULTS:
The control cohort comprised 750,743 pregnancies. The study cohort had 8,605 patients with≥1 autoimmune condition. The patients with autoimmune conditions were more likely to be older, White, obese, chronic hypertensive, tobacco users, privately insured, and in the upper quartile of household income (all P<.001). After controlling for confounders that differed between groups with P<.05, presence of an autoimmune disease was independently associated with higher rates of thrombosis and embolic events, with rates of 0.6% compared to 0.2% in controls (aOR 2.40, 95%CI 1.75–3.28).

CONCLUSION:
Autoimmune disease is associated with an increased risk of thromboembolic disease in pregnancy.
Trauma-Informed Pelvic Examination Practices Among Clinicians [A286]
Authors: Terrell Stephanie , Mehari Kathleen , Oshman Lauren , Otto Alana K. , Ruff Allison , Owens Lauren 
Published: June 2022

INTRODUCTION:
Most people have experienced assault, an adverse childhood event, or other trauma. Trauma adversely impacts reproductive health outcomes and patients' experiences of health care. Survivors' preferences for trauma-informed pelvic care are established in the literature, but there are scant data on clinicians' adherence to these practices. This study assessed clinicians' knowledge, attitudes, and practices regarding trauma-informed care (TIC) and pelvic examinations.

METHODS:
The study team distributed an anonymous Qualtrics survey to 1,017 clinicians across 12 departments at a large academic medical center in June 2021. Clinicians who had performed at least one pelvic examination in the last year were eligible. Descriptive statistics are reported.

RESULTS:
Of 1,017 clinicians contacted, 362 responded, for a response rate of 35.6%. Overall, 81 (22.4%) reported no familiarity with TIC, and 106 (29.3%) had no training in TIC. Although 203 (56.1%) thought it was extremely important to use a trauma-informed approach to the pelvic examination when patients had a known history of trauma, only 88 (24.3%) thought it was extremely important to use a trauma-informed approach when no trauma history was known. Ninety-seven clinicians (26.8%) endorsed using trauma-informed practices during pelvic examinations “often” or “always.”

CONCLUSION:
Clinicians reported a lack of training in TIC. They did not see the need for universal application of TIC, and they reported inconsistent usage of trauma-informed practices during pelvic examinations. These data demonstrate a pressing need to improve training for clinicians and appropriate care for patients.
Prevalence of Alcohol Use, Screening, and Counseling Among Postpartum Persons: Six U.S. States, 2019 [A290]
Authors: Board Amy , Park Youngjoo , Denny Clark H. , Salveson von Essen Beatriz , Miele Kathryn , D'Angelo Denise V. 
Published: June 2022

INTRODUCTION:
The postpartum period presents an opportunity to engage patients in discussions on alcohol use and associated risks for the mother and infant. This study examined the prevalence of postpartum alcohol use, screening, and counseling.

METHODS:
We analyzed 2019 data from a telephone follow-up survey (10 months postpartum) among individuals with a recent live birth who responded to the Pregnancy Risk Assessment Monitoring System in six U.S. states with high rates of opioid overdose. Weighted prevalence estimates were calculated for alcohol use, screening, and counseling since birth, overall and among subgroups at risk of future alcohol-exposed pregnancies.

RESULTS:
Among 1,790 respondents (response rate=67.1%), 51.5% reported consuming alcohol and 15.6% reported binge drinking. Among those who drank postpartum, 70.5% reported being asked about alcohol use by a health care provider; prevalence was lower for those trying to get pregnant (55.2%) and those not using birth control (60.8%) at the time of the survey. Approximately 1 in 4 respondents who drank alcohol postpartum reported being advised about risky alcohol levels by a health care provider during the postpartum period. Of individuals who drank alcohol postpartum and were currently pregnant, 11% had been advised to reduce or quit drinking. Only 1.6% of individuals who drank alcohol postpartum and were trying to get pregnant were advised to reduce or quit drinking.

CONCLUSION:
Postpartum alcohol screening and counseling was lower among individuals not currently using birth control and respondents trying to get pregnant who drank postpartum, indicating missed opportunities to promote patient health and reduce alcohol-exposed pregnancies.
Attitudes and Perceptions of Prenatal Aneuploidy Screening Among Hispanic Women [A291]
Authors: Hoeppner Catherine G. , Durojaye Oluwaseun T. , Petersen Scott 
Published: June 2022

INTRODUCTION:
Universal prenatal aneuploidy screening should be offered in pregnancy; however, patients may encounter various barriers. The goal of the study is to better understand the attitudes and perceptions of aneuploidy screening among Hispanic patients at an uninsured community clinic.

METHODS:
This survey was IRB-exempt. Patients who were>18 year old, <23 weeks pregnant, and identified as Hispanic were offered the survey in English or Spanish. The survey included demographics, baseline genetic testing knowledge, and reasons for accepting or declining screening. Data were added to a secure research database (REDCap). All statistical analyses, including Fisher's exact test, were performed with a P value<.05.

RESULTS:
A total of 55 patients completed the survey. The majority were 25–35 year old (58%), 49% had less than a high school education, and 61% were unemployed. The majority did not know what genetic conditions would be tested (55%), nor did they know options available if testing was abnormal (71%). Overall, 77% stated they would undergo genetic screening. Patients from Guatemala were statistically less likely to get screening (44% vs. 85%, P<.02). Decision to accept screening was influenced by “none of the above” (40%) followed by health care providers (24%), whereas those who declined were influenced by religion (41%).

CONCLUSION:
Although patients may be unfamiliar with aneuploidy testing, this survey highlights what influences patients regarding prenatal genetic screening, particularly health care providers and religion in this specific patient population. Targeting baseline knowledge, attitudes, and perceptions of unique patient populations may shift the acceptance rates of those offered genetic testing.
The Advent of Home-Based STI Testing: A Scoping Review to Assess if Programs Address Barriers to STI Testing for Youth [A117]
Authors: Sao Saumya , Wang Runzhi , Coleman Jenell 
Published: June 2022

INTRODUCTION:
Barriers to sexually transmitted infection (STI) testing for youth include a lack of privacy and confidentiality, limited access to affordable testing, and discomfort with providers. Home-STI testing has high acceptability in the U.S., particularly for youth who are at highest risk for STIs. This review sought to identify home-based STI programs that could overcome barriers to testing for youth.

METHODS:
A scoping review of home-based STI testing programs was conducted. Data on STI test validation, cost, age restrictions, and provider access were collected.

RESULTS:
Seventeen home-based STI testing programs were identified: 16 were restricted to age ≥18 years, three accepted insurance, four included clinician fees in test cost, and one included medication costs in test cost. Validated self-collected samples (urine, vaginal swab, dried blood spot) were offered for Chlamydia trachomatis, Neisseria gonorrhoeae, Trichomonas vaginalis, syphilis, hepatitis B, and HIV. Only one program had free testing; the remaining programs charged $45–178 for chlamydia/gonorrhea tests alone and charged more to add other STIs/HIV. Additionally, five did not connect users to providers. No information was documented on prompts to improve test-kit return rates.

CONCLUSION:
Home-STI testing programs did not address the barriers to STI testing for youth. None were tailored to youth, and the majority had age restrictions. There were expensive out-of-pocket costs, and some programs did not link users who test positive to providers. Home-based STI testing at significantly subsidized costs and home-testing programs customized for youth are needed to help reduce their increasing STI incidence rates and decrease long-term risks of STI-related morbidity.
Perceptions and Acceptance of COVID-19 Vaccine in Pregnancy Using a Health Belief Model in an Inner-City Population [A127]
Authors: Knypinski Julia , Doulaveris Georgios , Rabin-Havt Sara , Igel Catherine , Dar Peer , Klugman Susan 
Published: June 2022

INTRODUCTION:
COVID-19 vaccination is safe in pregnancy and has been recommended to reduce severe maternal and fetal morbidity; however, hesitancy still exists. We sought to investigate perceptions and acceptance of vaccination among pregnant patients.

METHODS:
Pregnant patients were recruited during telehealth visits in a prospective, cross-sectional manner. Participants received an online survey using a health belief model framework to understand factors that predict COVID-19 vaccination acceptance in pregnancy. Perceptions of barriers to and benefits of vaccination as well as susceptibility to and severity of COVID-19 disease during pregnancy were sought. The primary outcome was vaccine acceptance rate pre- and post-recommendations from the American College of Obstetricians (ACOG) and Gynecologists and Society for Maternal–Fetal Medicine (SMFM). Secondary outcomes were perceptions of barriers to and benefits of vaccination.

RESULTS:
We received 238 responses out of 1,291 (18.4%) from May to November 2021. Among unvaccinated patients, 92.5% stated they would not accept vaccination during pregnancy. There was no difference when ACOG/SMFM recommendations were considered (94.1% pre versus 89.1% post, P=.4). During this period, more patients were fully vaccinated prior to pregnancy post recommendations (46.7% versus 18.8%, P<.01). Post recommendations, study participants had more confidence in the personal and fetal protective effects of vaccination (personal, 53.5% versus 33.7%, P<.01; fetal, 46.5% versus 23.5%, P<.01). However, there was no change in perception of vaccine harm to the pregnancy (30.7% versus 39.8%, P=.1).

CONCLUSION:
COVID-19 vaccination acceptance rates remained unchanged among unvaccinated pregnant patients following national recommendations. Approximately one third of patients consider the vaccine harmful to their pregnancy. Counseling regarding vaccine safety prior to and during pregnancy is crucial to improve acceptance rates.
Predictors of COVID-19 Vaccine Hesitancy and Top Concerns in Pregnant Women at a South Texas Clinic [A128]
Authors: Sutanto Michelle , Hosek Meredith G. , Stumpff Sierra , Ramsey Patrick S. , Boyd Angela , Neuhoff Barbara K. 
Published: June 2022

INTRODUCTION:
COVID-19 vaccination rates among pregnant women remain low, despite increased risk of COVID-19-related illness and death and demonstrated vaccine safety and efficacy in this population. Continued research is needed to better understand and characterize the vaccine-hesitant pregnant population.

METHODS:
Following institutional review board approval, a cross-sectional cohort study was conducted from August to September 2021 surveying pregnant women at an urban South Texas clinic to identify predictors of COVID-19 vaccine hesitancy. Variables collected included: demographics, COVID-19 beliefs, Tdap/influenza vaccine hesitancy, and primary vaccine concerns. Fisher’s exact test and Mann-Whitney U test were used to identify variables predicting vaccine hesitancy. A multinomial logistic regression model was used to analyze sub-cohorts of unvaccinated participants.

RESULTS:
A total of 109 participants completed the survey, 35 vaccinated and 74 unvaccinated, with a response rate of 91.6%. Patients in the vaccine-hesitant cohort had greater odds of being younger (28.0 versus 31.0 years; OR, 0.90; P<.004) and further along in pregnancy (210 versus 140 days; OR, 1.01; P=.001). They also were more likely to report vaccine hesitancy for influenza (OR, 0.1, P<.001; OR, 0.11, P<.001) and Tdap (OR, 0.13, P<.001; OR, 0.29, P<.03). Furthermore, they had greater odds of believing they did not have enough information to confidently make their decision (OR, 0.15, P<.01; OR, 0.23, P<.01). Primary concerns with COVID-19 vaccines included short- and long-term side effects on the pregnancy, personal long-term side effects, and harmful ingredients in the vaccine.

CONCLUSION:
Results suggest that public health strategies aimed at increasing COVID-19 vaccine acceptance in pregnant women should focus on younger women, addressing broader hesitancy with vaccines in general and COVID-19 vaccine safety concerns.
Improving Provision of Expedited Partner Therapy in the Obstetrics and Gynecology Office [A131]
Authors: Vasudeva Isha , Hartnett Janice M. , Bondi Laura , Newmark Alexis , Lindsay Sarah 
Published: June 2022

INTRODUCTION:
Expedited partner therapy (EPT) provides an opportunity to treat partners of patients diagnosed with gonorrhea or chlamydia without an examination, a practice supported by the American College of Obstetricians and Gynecologists and the Centers for Disease Control and Prevention (CDC), to decrease the risk of reinfection. However, EPT is not consistently offered by all providers. We performed a quality improvement project to increase the rate at which EPT is offered and prescribed at our clinic in line with Department of Public Health (DPH) regulations.

METHODS:
We completed quality improvement interventions at the Women’s Ambulatory Health Services, an urban hospital-based outpatient clinic in Hartford, CT, to improve appropriate provision of EPT to 70% of eligible patients. We defined appropriate provision of EPT by infection type (gonorrhea or chlamydia only, per CDC guidelines) and method of EPT prescription per DPH regulations (paper prescription or in-clinic dispensing to a patient for EPT). Interventions included education sessions regarding state EPT policies, implementation of a standard clinic workflow, and pre-completed written prescriptions. We gathered data from the electronic health record over 18 months to assess our quality improvement outcome.

RESULTS:
Rates of appropriate provision of EPT improved with our interventions (22% versus 75%). We found an unexpected decrease in EPT acceptance by patients after initiation of our interventions (81% versus 50%).

CONCLUSION:
Our quality improvement intervention increased appropriate provision of EPT. However future work should investigate potential barriers to EPT acceptance, including the impact of DPH regulation of prescribing options and standard workflow in patient counseling.
Real-World Treatment for Menopausal Symptoms in the U.S. by Practitioner Type [A133]
Authors: DePree Barbara , Houghton Katherine , Shiozawa Aki , Esterberg Elizabeth , Kim Janet , Mancuso Shayna 
Published: June 2022

INTRODUCTION:
Vasomotor symptoms are the most common menopausal symptoms for which women seek treatment. We describe current treatment use by practitioner type (gynecologists versus primary care providers [PCPs]) and U.S. geographic region.

METHODS:
This subgroup analysis of a noninterventional, observational study used a convenience sample of 283 practitioners (131 gynecologists, 152 PCPs) who abstracted data on menopause-specific therapy from medical records of women aged 40‒60 years who initially presented with menopausal symptoms between January 1, 2016, and December 31, 2019. Data were summarized descriptively.

RESULTS:
Practitioners provided data for 1,016 women (from gynecologists: 512; PCPs: 504). About half the women overall experienced symptoms for ≥6 months before consultation. Patients of gynecologists had more vaginal and sexual symptoms recorded than patients of PCPs. Gynecologists’ patients more commonly had prescription medications (63% versus 57%) but less commonly had nonprescription therapies/interventions (59% versus 66%) documented than PCPs’ patients. They more often received hormone therapy (HT; 76% versus 64% of patients with any prescription) and compounded HT (17% versus 7%) and less often received selective serotonin reuptake inhibitors (SSRIs; 11% versus 19%) and serotonin-norepinephrine reuptake inhibitors (2% versus 12%) than PCPs’ patients. Black cohosh was the most frequently documented nonprescription therapy by gynecologists (24%) and PCPs (35%); gynecologists more commonly documented Estroven (16% versus 10%). Compounded HT use was more common in the U.S. Southeast and Southwest (∼20%), and SSRI use was more common in the Northeast (22%) than other regions.

CONCLUSION:
Prescribing patterns for menopausal symptoms vary by practitioner type and U.S. region.