bluuebunny/crossref_metadata_2025_split huggingface dataset:
Validation of a New Calculator for Predicting Success of Vaginal Birth After Cesarean Delivery at a Tertiary Center [A194]
Authors: Nittur Nandini , Cansino Catherine , Reyes Carolyn , Ponzini Matthew D. , Wilson Machelle D. , Marshall Maya 
Published: June 2022

INTRODUCTION:
Race as a variable in a predictive model for successful trial of labor after cesarean delivery (TOLAC) has been questioned as contributing to health inequities. The Society for Maternal–Fetal Medicine has just released a modified calculator removing race as a variable. To our knowledge, the new calculator has not been validated in any U.S. population outside the cohort from which it was derived.

METHODS:
We reviewed all patients who underwent a TOLAC in 2019–2020 at a tertiary academic center. Institutional review board approval was either obtained for the study. The probability of successful TOLAC was calculated for each patient using both predictive calculators and compared to birth outcomes. The area under the curve (AUC) was calculated for each model.

RESULTS:
From the cohort of 134 patients, 42% identified as African American (AA) or Hispanic. The success rate for vaginal birth after cesarean delivery was 80% for the entire population, and 82% among AA and/or Hispanic patients. The AUC of the original calculator was 0.715, compared to 0.748 for the new calculator. For AA and/or Hispanic patients, the average predicted success rates between the models rose from 62% to 71%.

CONCLUSION:
Our results suggest that AA and Hispanic patients were previously predicted to have a poorer chance of successful TOLAC based on the original calculator. The higher AUC associated with the new model implies improved predictability for AA and Hispanic populations. Informed by using the new calculator, AA and Hispanic patients may begin to have better birth experiences based on more accurate counseling of their success rates.
Tobacco and Marijuana Use and Effect on Gestational Weight Gain [A195]
Authors: Mirsky Elizabeth , Paudel Alissa M. , Maples Jill M. , Mastronardi Alicia , Young Megan Lacy , Zite Nikki 
Published: June 2022

INTRODUCTION:
Previous work has addressed the effect of marijuana and tobacco use in pregnancy on infant birth weight; however, there is a paucity of data reporting the potential impact of marijuana and tobacco use on maternal gestational weight gain (GWG). This study sought to determine an association between marijuana and/or tobacco use and meeting GWG recommendations.

METHODS:
This retrospective study included patients who delivered at a single academic institution between January 2019 and June 2021. Institutional review board approval was obtained. Data collected included prepregnancy weight, BMI, and gestational weight gain (GWG), as well as tobacco and marijuana use. GWG was categorized according to Institute of Medicine and American College of Obstetricians and Gynecologists recommendations as adequate, inadequate, or excessive.

RESULTS:
A total of 7,653 patients were included in the study. Polysubstance use was excluded. Overall, 52% of patients experienced excessive GWG, 28% adequate GWG, and 19% inadequate GWG. Former tobacco users were more likely to have excessive GWG than non-smokers and current tobacco users (61% versus 51% and 51%; P<.001), while current tobacco users were more likely to have inadequate GWG than non-users and former tobacco users (24% versus 19% and 15%; P<.001). Marijuana users were more likely to have excessive GWG than non-users (57% versus 52%; P=.007). Marijuana use remained a significant predictor of excessive GWG, even when controlling for tobacco use (P<.035).

CONCLUSION:
It appears that tobacco and marijuana use may play a role in GWG. Further research is needed in order to fully understand and appropriately counsel on the potential effects of marijuana and tobacco use on GWG and pregnancy outcomes.
Investigating Below the County Level to Reveal Poverty-Related Disparity in Poor Birth Outcomes [A204]
Authors: Hall Jaclyn , Smith Erica , Wen Tony , Reeder Callie , Layton Claire , Lemas Dominick 
Published: June 2022

INTRODUCTION:
Birth outcome disparity associated with communities of rurality and socioeconomic vulnerability within the state of Florida was examined. Specific challenges suffered by poor communities may be overlooked when reporting standards for health outcomes are at the county level. We hypothesized that birth outcome disparities are more related to neighborhood socioeconomic vulnerability than rurality.

METHODS:
Data for Florida births from 2013 to 2017 were obtained from FLHealthcharts.com. Maternal counties of residence were identified as rural or non-rural by the population density measure used by the Florida Department of Health. The Centers for Disease Control and Prevention’s index for socioeconomic status vulnerability (SEV) was incorporated for residential census tracts, which were divided into higher and lower vulnerability halves. The prevalence of preterm (PTB) and low-weight birth (LBW) was calculated for each outcome. Statistical significance of birth outcome disparity was tested using rate ratio statistical test.

RESULTS:
Residing in a rural area was associated with a significant disparity of 7% higher rate for PTB and 2% higher rate for LBW. Residing in a community with high SEV was associated with a larger disparity. High SEV is associated with 18% higher PTB and 28% higher LBW risk than residing in low SEV.

CONCLUSION:
The health burden related to socioeconomic vulnerability is higher than the disparity related to rurality. Public health studies involving social determinants of health, like birth outcomes, require statistical investigations below the county level. By moving beyond the county as the standard for public health reporting and reporting at the community level, we uncover the burden of health concerns as related to SEV.
Immediate Versus Delayed Admission in Early Labor [A214]
Authors: Iovino Nicole , Chappelle Joseph 
Published: June 2022

INTRODUCTION:
There is no clear consensus on when to admit patients in early labor. The purpose of this study is to evaluate whether early labor admission increases rate of cesarean delivery compared to delayed admission, and additionally, to explore differences in neonatal outcomes and length of hospital stay among these groups.

METHODS:
A retrospective cohort study comparing immediate versus delayed admission in full-term patients presenting in early labor at a university-based tertiary-care center and found to be 1–4 cm dilated.

RESULTS:
Of 432 patients who presented to our hospital for labor evaluation, 131 were admitted on initial presentation and 301 experienced delayed admission. There was no statistically significant difference in rate of cesarean delivery in the immediate admission group versus delayed admission (6.1% versus 10.3%, P=.2), Apgar<7 (5.3% versus 4.9%, P=.811), meconium (26% versus 28.1%, P=.377), infection (5.3% versus 49.7%, P=.41) or NICU admissions (11.5% versus 16.4%, P=.187). Time from admission to delivery was statistically similar among these groups (10.9 versus 12.5 h, P=177).

CONCLUSION:
There was no evidence of increased risk of cesarean delivery or harm in patients who underwent immediate admission. Interestingly, both patients who were admitted initially and those who had their admission delayed had similar lengths of time until to delivery once they were admitted, suggesting that providers likely have a good clinical sense of when a patient should be admitted, or at a minimum are consistent. There is no clear answer on optimal timing for admissions; thus we should continue to use clinical judgment, talk to our patients, and make joint decisions.
Implementation of Guideline for Transthoracic Echocardiography Screening for Pregnant Women With Risk for Cardiac Disease [A221]
Authors: Abelman Sarah , Burd Julia , Muir Molly , Smith Jessica M. , McCurdy Rebekah J. 
Published: June 2022

INTRODUCTION:
Adverse maternal outcomes from cardiac disease may be mitigated by pregnancy screening guidelines as proposed by the California Maternal Quality Care Collaborative.

METHODS:
Prior to guideline implementation (January 2020), provider discretion determined echocardiography recommendations. Post-guideline, echocardiography was recommended to pregnant women with ≥4 risk factors OR, history of cardiac disease. Risk factors included: age ≥40, BMI ≥35, Black race, chronic hypertension, prepregnancy diabetes, and substance use (opiates, cocaine, alcohol, or other substance). Underlying heart disease included history of endocarditis, congenital heart disease, cardiotoxic chemotherapy, or other cardiac disease. All outpatient maternal–fetal medicine consultations from December 2017 to August 2021 were reviewed, and patient demographics and echocardiography recommendations were recorded.

RESULTS:
Pre-guideline, 1,318 consultations (93 high-risk for cardiac disease) were completed. Post-guideline, 1,697 consultations (69 high-risk) were completed. Risk factors for the 162 high-risk patients included age (20.4%), race (60.5%), BMI (48.7%), diabetes (29.6%), hypertension (46.3%), opioids (5.6%), cocaine (1.2%), alcohol (1.2%), other substance use (5.6%), cardiotoxic chemotherapy (8.1%), endocarditis (3.1%), congenital heart disease (20.4%), and other cardiac disease (35.8%). Of the 162 high-risk patients, 100 (61.7%) received recommendations for echocardiography. Post-guideline, echocardiography was recommended for high-risk patients more often than pre-guideline (n=62 [89.9%] versus n=38 [40.9%], P<.001). When echocardiography was recommended, it was more likely to be completed (87.0%) than if not recommended (17.7%, P<.001). Delivery mode for 133 completed pregnancies was via cesarean delivery (51.9%), operative vaginal delivery (4.5%), and spontaneous vaginal delivery (43.6%).

CONCLUSION:
A standardized guideline prompted more recommendations for and subsequent completion of transthoracic echocardiography among pregnant patients at high risk for underlying cardiac disease.
Evaluating the Frequency of Postpartum Depression in Marijuana Users With and Without a History of Depression [A226]
Authors: Richards Ria , Benedict Jason , Lynch Courtney , Schaffir Jonathan 
Published: June 2022

INTRODUCTION:
Existing literature suggests an association between marijuana use in pregnancy and postpartum depression (PPD). We looked closer at this association by examining the role of depression history.

METHODS:
Institutional review board approval was attained. We conducted a retrospective cohort study of patients receiving perinatal care at an academic medical center between January 2017 and December 2019. Inclusion criteria included: delivery of a live-born infant at ≥24 weeks, no history of or current opioid dependence, and available Edinburgh Postnatal Depression Scale (EPDS). Marijuana use was self-reported. Screen positive for PPD was defined as scoring 10 or higher on the EPDS. Modified Poisson regression was used to calculate the relative risk (RR) of screening positive for depression.

RESULTS:
A total of 250 women were included in this analysis. Most were non-Hispanic Black (52%) or White (28%); 61 (24%) reported marijuana use during pregnancy; 102 (41%) had a history of depression and 148 (59%) did not; 39 (16%) screened positive for PPD. With a history of depression, the risk of PPD for those who reported marijuana use was 2.67 times (95% CI, 1.46–4.88) that of those who did not report use. Without a depression history, there was no statistically significant elevation in risk (RR, 1.81; 95% CI, 0.39–8.48). Multivariable analyses are ongoing to assess whether the finding is robust to adjustment for confounding.

CONCLUSION:
Those with a depression history who report using marijuana during pregnancy may have an increased risk of PPD compared to those who do not report use.
A Feasibility Study of Isolation of Circulating Fetal Trophoblast for Prenatal Aneuploidy Screening [A227]
Authors: Liu Zitao , Hou Shuang , Liu Lian 
Published: June 2022

INTRODUCTION:
We are exploring the feasibility of isolating circulating fetal trophoblast (CFT) from maternal whole peripheral blood (MWPB) in the first trimester for prenatal aneuploidy screening (24 chromosomes) by a platform based on our in-house-developed enrichment technology.

METHODS:
The research was approved by institutional review board and consents were obtained. MWPB (5–7 mL) and chorionic villi were collected upon dilation and curettage (D&C) from seven patients with missed abortion (MAB; five from in vitro fertilization, one from intrauterine insemination, and one from natural conception). CFT was enriched by our in-house enrichment platform. We compared CFT with the chorionic villous trophoblast (CVT) and maternal white blood cell in their karyotype and DNA fingerprints, as well as the aneuploidy screening results from CFT, with conventional noninvasive prenatal testing (NIPT).

RESULTS:
The average gestational age upon D&C was 58.4±4.9 days of gestation. CFTs (3.4±1.7 cells/mL MWPB) were consistently enriched and successfully karyotyped. The karyotype and fingerprint between CFT and CVT were completely matched in all the cases. For the MAB from aneuploidy blastocyst transfer, the Preimplantation Genetic Testing for Aneuploidy result matched the karyotype of CFT and CVT. Sample identification was proved for the embryos created from autologous oocytes, but not from donor oocytes, by DNA fingerprints. The two cases of trisomy (47,XX+2 and 47,XX+4) detected by aneuploidy screening from CFT were not reported by conventional NIPT.

CONCLUSION:
The rare CFT could be successfully and efficiently isolated from MWPB in the first trimester by our enrichment platform, which makes prenatal aneuploidy screening feasible from<3 mL of MWPB in the first trimester.
Neighborhood Deprivation Index and Postpartum Depression: Association Varies by Race and Ethnicity [A244]
Authors: Onyewuenyi Ticara L. , Peterman Kelli , Tutwiler Ameisha , Weintraub Miranda Ritterman , Pettway Bria L. , Avalos Lyndsay A. 
Published: June 2022

INTRODUCTION:
Little research has evaluated the influence of neighborhood deprivation index (NDI) on postpartum depression (PPD). This study evaluated the effects of NDI and race/ethnicity independently and jointly.

METHODS:
This is a retrospective cohort study of Kaiser Permanente Northern California members aged >15 years who delivered a live-born infant between October 7, 2012, and May 31, 2017. PPD was identified using depression diagnoses obtained the day after delivery through 12 months postpartum. NDI was categorized into quartiles; the top quartile represented the highest deprivation. Multivariable logistic regression was conducted to assess the association between NDI and PPD. We performed analyses stratified by race/ethnicity to assess for effect modification.

RESULTS:
Among 177,511 live births, 122,995 were to unique mothers; among those, 18,510 (12.5%) had PPD. PPD ranged from 20.8% in the lowest NDI quartile to 27.8% in the highest. Higher NDI was associated with greater odds of PPD (Q4, referent Q1: adjusted odds ratio [aOR], 1.16; 95% CI, 1.10–1.23). Associations between NDI and PPD varied by race/ethnicity. NDI was not associated with PPD among Hispanic women. Black women had the highest odds of PPD for all NDI quartiles (Q2: aOR, 1.50, 95% CI, 1.17–1.91; Q3: aOR, 1.64, 95% CI, 1.30–2.07; Q4: aOR, 1.78, 95% CI, 1.42–2.22; referent for all comparisons Q1).

CONCLUSION:
There were significant variations in PPD rates according to race and ethnicity that persisted regardless of NDI. Findings from this study suggest that while geographic targeting of mental health services may be informative, the role of systemic racism should be considered.
Fetal Abdominal Circumference and Risk of Neonatal Morbidity in Pregnancies Complicated by Diabetes [A246]
Authors: Lord Megan G. , Rasiah Stephen , Has Phinnara , Stoever Kara , Savitz David A. , Esposito Matthew A. 
Published: June 2022

INTRODUCTION:
We aimed to characterize the relationship between fetal abdominal circumference and neonatal morbidity in pregnancies complicated by diabetes.

METHODS:
After institutional review board approval, patients with gestational diabetes (GDM) or preexisting diabetes type 1 or type 2 (T1DM, T2DM) who delivered a live, singleton, non-anomalous infant at a single center 2002–2013 were identified within a large, National Institutes of Health-funded database of detailed pregnancy and delivery information extracted by trained research nurses. Neonatal morbidity (NM) was defined as one or more of the following: 5-minute Apgar <7, arterial cord pH <7.0, sepsis, neonatal death, or need for respiratory support, chest compressions, phototherapy, exchange transfusion, or hypoglycemia treatment. Rates of morbidity were calculated for the following groups stratified by fetal abdominal circumference (AC) percentile for gestational age: below the 20th percentile, 20th–39th percentile, 40th–59th percentile, 60th–79th percentile, and 80th percentile or greater. Unadjusted relative risk (RR) of neonatal morbidity was calculated for each group, with AC 40th–59th percentile as the reference.

RESULTS:
A total of 721 eligible pregnancies were identified (643 GDM, 35 T1DM, 43 T2DM). Neonatal morbidity occurred in 261 (36%). The lowest rate of neonatal morbidity (22%) occurred in pregnancies with a fetal AC below the 20th percentile (RR, 0.55; 95% CI, 0.31–0.98). The highest rate of neonatal morbidity (42%) occurred in those with an AC at or above the 80th percentile, but this was not a statistically significant increase in risk compared to the reference group (RR, 1.05; 95% CI, 0.82–1.33).

CONCLUSION:
Among pregnancies complicated by diabetes, fetal abdominal circumference below the 20th percentile was associated with decreased risk of neonatal morbidity.
Pregnancy-Related Hypertension: Adherence to a New Type of Monitoring (PHANTOM) [A247]
Authors: Arkerson Brittany J. , Finneran Matthew , Harris Solita R. , McElwee Eliza R. , Demosthenes Lauren , Sawyer Renata 
Published: June 2022

INTRODUCTION:
The majority of hypertension-related postpartum morbidity occurs in the early postpartum period. Due to this, current guidelines recommend that patients with hypertensive disorders of pregnancy present for a blood pressure check within 7–10 days postpartum. However, in-office assessment of blood pressure has a relatively low adherence rate, and remote monitoring may be a safe and feasible alternative.

METHODS:
This was an institutional review board‒approved prospective multi-site randomized controlled trial of postpartum patients diagnosed with a hypertensive disorder of pregnancy prior to discharge between April 2021 and August 2021. Patients were randomized to either an in-office blood pressure check or remote monitoring through a web-enabled smartphone platform. The primary outcome was the rate of blood pressure ascertainment within 10 days of discharge. Secondary outcomes include rates of initiation of anti-hypertensive medication, readmission, and additional office/triage visits for hypertension.

RESULTS:
A total of 197 patients were randomized (101 in-office, 96 remote). Patients with remote monitoring had higher rates of postpartum blood pressure ascertainment compared to in-office surveillance (92.7% versus 59.0%, P<.001). However, patients in the remote monitoring group had additional unscheduled hypertension-related visits in the office or triage (21.7% versus 8.2%, P=.008), but there was no difference in readmission rate (4.4% versus 5.1%, P=.807) or rate of initiation of antihypertensives after discharge (9.8% versus 7.1%, P=.499).

CONCLUSION:
Remote monitoring can increase postpartum blood pressure ascertainment within 10 days of discharge for patients with hypertensive disorders of pregnancy. Additional research is needed to develop safe protocols that promote cost-effective health care utilization.
Socioeconomic Status and Excessive Gestational Weight Gain Among Full-Term, Normal-BMI Parturients [A256]
Authors: Del Pozzo Jaclyn A. , Kouba Insaf , Blitz Matthew J. , Bracero Luis A. 
Published: June 2022

INTRODUCTION:
The Institute of Medicine (IOM) recommends a weight gain of 25–35-pounds for pregnant patients with a body mass index (BMI) of 18.5–24.9. The purpose of this study is to assess socioeconomic and clinical factors that affect excessive gestational weight gain (eGWG) in women with normal prepregnancy BMI (pBMI).

METHODS:
Retrospective cohort study of term patients with normal BMI from seven hospitals within a large integrated health system between January 2018 and February 2020. eGWG was defined as >35 pounds for those with normal BMIs. Twin pregnancies and overweight and obese patients were excluded. Data collected included demographics, medical comorbidities, and ZIP codes, which were linked to neighborhood data from the U.S. Census Bureau’s American Community Survey. Patients with eGWG were compared to those without eGWG.

RESULTS:
A total of 23,691 patients were included: 13,940 (59%) met IOM guidelines and 9,751 (41%) had eGWG. When comparing patients with and without eGWG, significant differences were observed in race, preferred language, marital status, parity, pBMI, mood disorders, and neighborhood socioeconomic characteristics (educational attainment, households receiving supplemental income, single parent households, and owner-occupied housing). Patients who met IOM guidelines were less likely to have gestational diabetes (6% versus 3%). Maternal age, ethnicity, gestational age, medical comorbidities (chronic hypertension and diabetes mellitus), type of health insurance, and neighborhood characteristics (median annual household income, unemployment rate, mean persons per household) were not associated with eGWG.

CONCLUSION:
Neighborhood socioeconomic conditions contribute to eGWG and subsequent maternal and fetal complications.
Black Women With Low Numeracy Fare Worse in Diabetic Pregnancies [A257]
Authors: Jacobson Jennifer M. , Godecker Amy , Janik Jennifer , Eddy April , Adams Jacquelyn 
Published: June 2022

INTRODUCTION:
Numeracy is the ability to understand and use numbers in daily life. Low diabetes (DM) numeracy is associated with poor knowledge of DM, lower perceived efficacy in managing DM, and worse glycemic control. Numeracy score (NS) is obtained using a validated diabetes screening tool assessing use of numbers in diabetes management.

METHODS:
Retrospective cohort study of 345 women with pregestational diabetes (preDM, n=166) or gestational diabetes (GDM, n=179) between January 1, 2018, and December 31, 2020. Patients were identified using our clinic diabetes database. Pregnancy data were obtained from a statewide QI database and medical records. Chi-square test was used for categorical variables and unpaired t test for continuous variables. For adjusted estimates, logistic regressions were used for binary outcomes and least squared regressions for continuous outcomes.

RESULTS:
No difference was observed between preDM and GDM groups in low NS (19.3% versus 20.1%, P=.846). Demographics were similar between groups, except for low NS by race (Asian 34.2%, Black-NH 58.1%, LatinX 20.0%, multiethnic 41.7%, and White-NH 10.4%, P<.01). When controlled for DM type, women with low and high NS had similar third-trimester hemoglobin A1c values (5.89% versus 5.68%, P=.059), except among Black women with low NS, who had significantly higher A1c in the third trimester (OR, 0.53; 95% CI, 0.28–0.81; P<.01).

CONCLUSION:
Low NS did not impact A1c values in the third trimester, except in Black women. Black women with low NS had worse glycemic control in the third trimester regardless of DM type. Additional studies are warranted to investigate the role of numeracy in glycemic control and develop interventions, particularly in Black women.