bluuebunny/crossref_metadata_2025_split huggingface dataset:
Patient Perception of Telehealth Prenatal Care During the Early Part of the COVID-19 Pandemic [A310]
Authors: Dayaratna Sandra , Daniel Reba , Galloway Savannah , Mercier Rebecca 
Published: June 2022

INTRODUCTION:
Routine prenatal visits were rapidly converted to telehealth (TH) visits during the beginning of the COVID-19 pandemic. Patient perceptions and experience with TH were surveyed. Demographic factors were assessed to see if there were any predictors of satisfaction.

METHODS:
Institutional Review Board approval was obtained. Electronic as well as paper surveys were distributed to 2,012 women who had experienced virtual prenatal visits from March 2020 to June 2020. Responses were stored on a password-protected computer file and analyzed using Pearson Chi-square test and Fisher’s exact test.

RESULTS:
A total of 333 (17%) women completed the survey (235 online and 98 paper). The majority of respondents agreed that TH made it easier to see their obstetrical provider during the onset of the pandemic (80%). Although 83% agreed that it is important to offer a TH program, 78% agreed that they would have been willing for in-person visits during the height of the pandemic. Only about one quarter (26%) of the patients reported that they would rather use TH versus coming in-person for a visit, and only 38% thought that TH interactions were equal to in-person visits. Medicaid patients (86%) indicated higher overall satisfaction with TH than commercially insured patients (69%; P=.009).

CONCLUSION:
Respondents were overall satisfied with TH prenatal care including ease in seeing and talking to their provider. Medicaid patients were more satisfied than commercially insured patients. In geographic areas with provider shortages, TH prenatal care may be an acceptable modality to deliver care, especially among patients insured with Medicaid.
Impact of Physician Densities on Gynecologic Cancer Outcomes in the United States [A316]
Authors: Smick Alexandra H. , Neff Robert , Holbert Michael 
Published: June 2022

INTRODUCTION:
To examine the relationship between county-level obstetrician-gynecologist (GYN) and primary care physician (PCP) densities and gynecologic cancer outcomes and whether county socioeconomic factors affect cancer prognosis.

METHODS:
An analysis of gynecologic cancers (uterine, ovarian, cervical) in the Surveillance, Epidemiology, and End Results (SEER) database was performed from 2005 to 2018. County-level demographics were abstracted from SEER, population density from the U.S. Census, and physician density (GYN and PCP per 100,000 females) from the Area Health Resources File. PCP included family, internal, and general medicine physicians. Backward stepwise regression models were used.

RESULTS:
Final analysis included 120,000 patients from the SEER database comprised of those with cervical (14.4%), uterine (60.2%), and ovarian cancers (25.4%). Initial analysis included 620 U.S. counties (41% metropolitan, 59% nonmetropolitan). Mean GYN density was 12 per 100,000 females and mean PCP density was 99 per 100,000 females. Multivariate analysis for cancer stage by primary site showed that GYN density was inversely correlated with cancer stage at diagnosis (P=.001). Analysis also showed that percent Black population was positively correlated with cancer stage (P=.001), whereas household income was negatively correlated with cancer stage (P=.01). Multivariate analysis for 5-year survival by cancer stage showed no correlation with GYN or PCP density. We found that educational attainment (P=.01) and population size (P=.001) were positively correlated with 5-year survival (P=.01).

CONCLUSION:
Lower GYN density was associated with more advanced cancer stage at time of diagnosis across the United States. Nonmetropolitan county status was also associated with worse cancer outcomes. Targeting GYN physician supply in lower-density counties may help improve population-based gynecologic cancer care.
Poor Glycemic Control Is a Risk Factor for Triple-Negative Breast Cancer in Patients With Type 2 Diabetes [A323]
Authors: Miller Madison , Bell Myah , Holland Priscella , Ibrahim Vanessa , Jacobsen Gordon , Swain Monique 
Published: June 2022

INTRODUCTION:
We sought to investigate the relationship between glycemic control, race, and the incidence of triple-negative breast cancer (TNBC) among patients with type 2 diabetes (T2D).

METHODS:
A retrospective cohort study evaluating 1,416 patients with T2D diagnosed with breast cancer between 2015 and 2020 was conducted. Tumor subtype was categorized as either hormone receptor-positive (ER+, PR+, or both) or triple-negative (ER/PR- and HER2/neu-). Based on Hgb A1c measured within 3 months of cancer diagnosis, patients were assigned to one of three categories: well-controlled (Hgb A1c less than 7.0), moderately controlled (Hgb A1c 7.0-9.4), or poorly controlled (Hgb A1c greater than or equal to 9.5) T2D.

RESULTS:
A significant increase in the percentage of non-Hispanic White patients with TNBC across the three levels of glycemic control was observed (P=.037). When racial comparisons of cancer subtype within categories of glycemic control were performed, a significant (P=.001) increase in the percentage of Black patients with TNBC compared with non-Hispanic White patients was only observed among those with well-controlled T2D.

CONCLUSION:
Although previous studies have shown that Black patients are 2 to 3 times more likely to develop TNBC than their non-Hispanic White counterparts, a statistically significant racial difference was only noted among our patients with well-controlled T2D. Thus, our data not only suggest that T2D may serve as a modifiable risk factor for the development of TNBC but also that the risk conferred by poor glycemic control may bear more significance for non-Hispanic White patients than Black patients.
Racial Disparity in Neonatal Outcomes in Pregnancies Conceived Via In Vitro Fertilization [A277]
Authors: Bar-El Liron , Yeshua Arielle , Eliner Yael , Chervenak Frank , Bornstein Eran 
Published: June 2022

INTRODUCTION:
Increased adverse maternal and neonatal outcomes are seen in Black compared to White U.S. women. Pregnancies conceived via in vitro fertilization (IVF) represent a unique population, often with appropriate pre-pregnancy medical care, access to prenatal care, and overall higher socioeconomic status. Thus, we set out to assess whether similar racial disparities exist in pregnancies following IVF.

METHODS:
We performed a retrospective analysis of the CDC's natality database (2016–2018) of births conceived via IVF in women who self-identified as non-Hispanic Black and non-Hispanic White. Pearson's Chi-square test was used to compare several pregnancy and neonatal outcomes among women of both races. Multivariate logistic regression adjusted the outcomes for potential confounders. Results are presented as adjusted odds ratios (aORs) with a 95% confidence interval (CI). Statistical significance was set as P-value less than .05.

RESULTS:
Non-Hispanic Black women had a lower risk for gestational diabetes (aOR 0.8, CI 0.7–0.9), hypertensive disorders of pregnancy (aOR 0.8, CI 0.7–0.9), eclampsia (aOR 0.9, CI 0.9–1), and neonatal immediate and prolonged ventilation (aOR 0.7, CI 0.7–0.8; aOR 0.75, CI 0.6–0.8; respectively) than non-Hispanic White women. No difference was found in the rate of preterm deliveries, maternal intensive care unit admissions, gravid hysterectomies, neonatal intensive care unit admissions, and newborn antibiotics (P>.05).

CONCLUSION:
Based on this extensive U.S. database, maternal and neonatal complications that are generally seen more frequently in Black women are, in fact, lower in Black compared to White women in the IVF population. These findings may indicate that different socioeconomic factors, rather than race per se, are at play. Further research is needed to explore the causes of this disparity.
Postpartum Depression Rates and Breastfeeding Outcomes Among Physicians [A280]
Authors: Eischen Emily , Awomolo Adeola , Crowe Susan , Braden Andrea L. , Lehman Kristina , Louis-Jacques Adetola 
Published: June 2022

INTRODUCTION:
There are limited data on postpartum depression (PPD) rates in physicians. Physicians are vulnerable due to unique stressors such as strenuous work hours, limited maternity leave, and other work-related barriers. Our objectives were to assess the rates of PPD in physicians as well as the relationship between PPD and breastfeeding outcomes.

METHODS:
We conducted a cross-sectional survey of physicians with a singleton pregnancy during the most challenging time of their career. Survey questions were adapted from the CDC's Infant Feeding Practices Study and Pregnancy Risk Assessment Monitoring System, along with investigator-developed questions. Analyses were completed via STATA version 17.

RESULTS:
A total of 637 respondents met eligibility. Most were non-Hispanic White (77%). A majority surpassed national breastfeeding initiation (99%) and exclusive duration rates (72%), and most met personal breastfeeding goals (78%). There were associations between race (P=.04), birth year (P=.001), and medical specialty (P=.02) and meeting breastfeeding goals. Twenty-five percent of participants experienced PPD. PPD rates were higher in White than non-White respondents (25% vs. 18%, P=.03). Asians had the lowest rates of PPD (15%), whereas Hispanics/Latinx physicians had the highest rate (31%). Most commonly selected reasons for PPD were sleep deprivation (80%), infant feeding (44%), lack of adequate maternity leave (41%), and lack of support at work (33%). There was an association between meeting breastfeeding goals and exhibiting PPD (P=.003).

CONCLUSION:
Although the physicians in our study were highly successful at breastfeeding compared to the national rates, the postpartum depression rates were higher than the national rates.
Acupuncture as Treatment for Pelvic Girdle Pain in Pregnancy: A Literature Review [A282]
Authors: Fang Jennifer , Balica Adrian 
Published: June 2022

INTRODUCTION:
Pelvic girdle pain (PGP) is often regarded as a normal result of physiologic changes during pregnancy, but it may also cause significant disability that cannot be ameliorated by standard conservative measures such as analgesics and physical therapy. This review seeks to explore the recent literature regarding the efficacy of acupuncture as an alternative treatment for PGP.

METHODS:
References were obtained through a search of PubMed and Google Scholar databases using the keywords “pelvic girdle pain,” “pregnancy,” and “acupuncture.” Nine papers published within the past 10 years were selected that studied acupuncture use for PGP during pregnancy.

RESULTS:
Six of the selected studies were randomized controlled trials (RCTs), and the remaining three papers were surveys/qualitative studies. All RCTs comparing acupuncture to standard treatment demonstrated a statistically significant improvement in pain intensity, disability, and quality of life. Two RCTs also demonstrated that adjuvant acupuncture therapy was superior to other modalities such as manipulation and stabilizing exercises alone. The qualitative studies showed that 21% of women sought out acupuncture during pregnancy, and all patients reported a subjective improvement in pain. However, 66% of providers hesitate to perform acupuncture on pregnant patients, citing unfounded concerns that acupuncture can cause miscarriages, despite no reported major adverse effects.

CONCLUSION:
Though higher powered studies still need to be conducted, current literature shows that acupuncture use in pregnancy is safe and effective at reducing PGP and is more efficacious than standard treatments alone. Physicians should consider promoting acupuncture for pregnant patients with PGP whose pain is refractory to other conservative measures.
Effects of Antiretroviral Therapy on Weight Gain and Hypertensive Disorders of Pregnancy in Persons With HIV [A118]
Authors: Nissim Oriel , Haney Ashley , Lazenby Gweneth 
Published: June 2022

INTRODUCTION:
Recent evidence suggests an association of increased weight gain when switching to a tenofovir-based antiretroviral therapy (ART). Given the potential for medical complications of obesity, we sought to determine if persons with HIV prescribed tenofovir alafenamide (TAF) during pregnancy were more likely to experience excessive weight gain, diabetes, and hypertensive disorders.

METHODS:
This is a retrospective cohort study of pregnant persons with HIV who delivered a live infant during the study period (January 1, 2009, to December 31, 2020). ART was classified as including TAF or no TAF. Median weight gain was compared using Wilcoxon rank sum tests (WRST). A Friedman test was used to compare median weights measured at antenatal visits. We compared the proportion of persons with gestational diabetes (GDM) and hypertensive disorders (HDP) by ART groups using chi-square and Fischer’s exact tests.

RESULTS:
We observed 189 persons who were prescribed ART during pregnancy: 30 with TAF and 159 without TAF. Median weight gain was similar between groups: TAF, 7.8 kg (95% CI, 3.4–13.6 kg); no TAF, 6.8 kg (95% CI, 2–10.8 kg), WRST P=.41. Repeated measures of median weight at antenatal visits were similar between groups (Friedman test P=.72). GDM was an infrequent outcome (TAF, 0; no TAF, 5 [3%]; P=1.0). HDP were common but similar between groups (TAF, 11/28 [39%]; no TAF, 58/156 [24%]; P=.89].

CONCLUSION:
Use of TAF during pregnancy did not result in significant weight gain or increased risk of GDM or HDP. Pregnant persons should not be counseled to avoid TAF during pregnancy to avoid these outcomes.
Impact of COVID-19 Knowledge on COVID-19 Vaccination Rates During Pregnancy [A125]
Authors: Vilarino Valerie , Agasse Eva , Rodriguez Gabriella , Galli Johnny , Shafazand Shirin , Potter JoNell 
Published: June 2022

INTRODUCTION:
Immunization against SARS-COV-2 protects pregnant persons from severe COVID-19 illness. Pregnant individuals are less likely (19.2%) to be vaccinated against COVID-19 than their non-gravidas counterparts (69.6%). This disparity may be attributed to a lack of knowledge regarding the risks of SARS-COV-2 infection in pregnancy and the benefits and safety of vaccination. This study aims to determine the impact of patients’ self-reported COVID-19 knowledge on COVID-19 vaccination rates during pregnancy.

METHODS:
A total of 359 postpartum patients consented to participate in an institutional review board‒approved cross-sectional survey at an urban academic medical center in Miami, Florida between July and September 2021. Participants self-reported their COVID-19 vaccination status and answered questions to assess their general knowledge regarding COVID-19 infection and its impact on pregnancy, as well as knowledge of current guidelines for vaccination in pregnancy and safety of vaccination in pregnancy and breastfeeding. Correct responses to each item earned 1 point, while incorrect responses detracted 1 point, yielding knowledge scores ranging from –5 to +5.

RESULTS:
The mean knowledge score across participants was 1.7±1.77. Controlling for age and education, a 1-point increase in knowledge score was associated with a 1.6-times increase in the odds of vaccination. There was a monotonic increase in vaccination rates as knowledge score rose (P<.001).

CONCLUSION:
The strongly positive correlation between knowledge scores and vaccination emphasizes the vital role that knowledge plays in the decision to be vaccinated for gravida individuals. This elucidates the importance of empowering pregnant persons with reputable and accurate information to increase the likelihood of vaccination in this at-risk population.
Association of GDF15-GFRAL-RET Pathway With Hyperemesis Gravidarum Confirmed by Sequencing Families [A163]
Authors: Fejzo Marlena , Wang Xinran , Mancuso Nick , MacGibbon Kimber , Mullin Patrick 
Published: June 2022

INTRODUCTION:
The placenta hormone gene GDF15 is the greatest genetic risk factor for hyperemesis gravidarum (HG), shifting the field away from human chorionic gonadotropin as the most likely causal factor. In maternal serum, GDF15 levels are increased in hospitalized patients, patients with second-trimester vomiting, and in those prescribed antiemetics. Variants in GDF15 are associated with familial and recurrent HG. GDF15 signals through the brainstem receptor GFRAL and co-receptor RET to cause taste aversion, appetite loss, vomiting, cachexia, and chemotherapy-induced nausea. Herein we set out to determine whether rare variants in this pathway occur in families affected by HG.

METHODS:
Whole-exome sequencing was performed on 16 families with >3 individuals affected by HG to identify potentially causal variants. Institutional review board approval was obtained.

RESULTS:
Two of 16 families had rare/novel missense variants at the RET-BMS1 locus segregating with HG. The variants were not detected in unaffected family members nor in 660 unaffected individuals.

CONCLUSION:
This study adds evidence the GDF15-GFRAL-RET complex is involved in the etiology of HG. HG is associated with increased risk of adverse outcomes, including maternal suicidal ideation, post-traumatic stress disorder, preterm birth, and neurodevelopmental delay in offspring. Current antiemetic treatments are often ineffective in reversing pregnancy weight loss caused by HG, so novel approaches are needed. This pathway is under intense investigation by pharmaceutical companies to treat disorders of weight loss and, conversely, weight gain, and may lead to novel treatments for HG. The study has implications for genetic testing and counseling of patients with a family history of HG.
Effects of the COVID-19 Pandemic on Routine Maternal Vaccine Uptake [A176]
Authors: Cotter Savannah B. , Taylor Lauren L. , Grace Rebecca , Miao Di , Coleman Maame Aba , Ratan Bani M. 
Published: June 2022

INTRODUCTION:
This study examines the impact of the COVID-19 pandemic on influenza and Tdap (tetanus, diphtheria, pertussis) vaccine uptake in a pregnant, low-income population.

METHODS:
This retrospective cohort study included women initiating prenatal care before (May–November 2019) or during the COVID-19 pandemic (May–November 2020) at two large Medicaid clinics. All patients entered prenatal care before 20 weeks of gestation and delivered full-term. Medical records were reviewed for vaccine uptake and demographic data. Multivariate logistic regression analysis was used to compare vaccination rates prior to and during the COVID-19 pandemic. Additional analysis was performed to identify association of demographic factors with vaccine uptake. Institutional review board‒ approval was obtained for this study.

RESULTS:
A total of 939 patients were included, with 462 initiating care prior to and 477 initiating care during the COVID-19 pandemic. Influenza vaccination uptake was 78% (362/462) in the pre-pandemic group, significantly decreasing to 61% (291/477) in the pandemic group (P<.01; OR, 0.38; 95% CI, 0.26–0.53). Tdap vaccination uptake was 85% (392/462) in the pre-pandemic group, significantly decreasing to 76% (361/477) in the pandemic group (P<.01; OR, 0.56; 95% CI, 0.40–0.79). Unvaccinated patients were significantly more likely to be non-Hispanic Black patients when compared to Hispanic patients both pre-pandemic (P<.01; OR, 0.34; 95% CI, 0.21–0.56) and during the pandemic (P<.01; OR, 0.24; 95% CI, 0.15–0.38), while there was no significant difference in age or parity in relation to vaccination status.

CONCLUSION:
Routine vaccination uptake significantly decreased during the COVID-19 pandemic in a low-income population of pregnant women, with decrease more pronounced on influenza vaccine than on Tdap vaccine uptake.
Is Maternal Anemia Associated With Hypotension During a Scheduled Cesarean Delivery? [A180]
Authors: Bharucha Jinai , Rimsza Rebecca , Palanisamy Arvind , Raghuraman Nandini , Bligard Katherine H. 
Published: June 2022

INTRODUCTION:
Hypotension is the most common complication of anesthesia during cesarean delivery (CD) and is associated with both maternal and neonatal morbidity. Maternal anemia presents additional cardiovascular stress, which could compromise the reserve available to overcome the vasodilation associated with spinal anesthesia. We investigated whether maternal anemia predisposes patients to spinal-related hypotension.

METHODS:
We performed an institutional review board‒approved retrospective cohort study including all women delivering non-anomalous, term singletons via scheduled CD under spinal anesthesia from 2004 to 2014 at a tertiary-care center. Anemia was defined as admission hemoglobin <11 g/dL. The primary outcome was intraoperative hypotension, defined as 30% decrease in systolic blood pressure (SBP) from baseline or SBP<90 mmHg, and was compared between anemic and non-anemic patients. Multivariable logistic regression was used to adjust for confounders. Prophylactic vasopressor infusion was not a standard of care during the study period.

RESULTS:
Of 1,988 patients included, 742 (37%) had anemia. Anemic patients were younger and less likely to be nulliparous or to have gestational diabetes (P<.01 for all). Incidence of intraoperative hypotension was greater in non-anemic patients (52.0% versus 45.8%; P<.01). However, after adjusting for known risk factors for spinal-related hypotension, the risk of hypotension in anemic patients was similar to that in non-anemia patients (aOR, 0.79; 95% CI, 0.59–1.05).

CONCLUSION:
Maternal anemia is not associated with hypotension during scheduled CD. These findings argue against the need for additional measures to prevent intraoperative hypotension in anemic patients.
Implementation of Trauma-Informed Care Strategies in a Multidisciplinary Maternal-Fetal Care Center [A186]
Authors: Cole Joanna CM , Zajac Lindsay , Budney Alexandra , Spinner Susan , Schindewolf Erica , Teefey Christina Paidas 
Published: June 2022

INTRODUCTION:
Little is known about traumatic stress among expectant parents who receive a prenatal diagnosis of a birth defect. The current study aimed to identify traumatic stress symptoms among expectant parents carrying fetuses with confirmed fetal anomalies and describe the ways in which a fetal care center, with an embedded psychosocial support team, provides trauma-informed strategies to mitigate the effects of trauma throughout the pregnancy via collaborative prenatal care visits.

METHODS:
A retrospective analysis of 4,391 pregnant patients and 3,570 partners in a fetal center was performed with institutional review board approval. Traumatic stress symptoms in response to the confirmed fetal diagnosis were assessed using the Impact of Events Scale–Revised (IES-R). Exploratory descriptive analyses examined rates of overall traumatic stress symptoms and elevated subscale scores.

RESULTS:
In total, 28.7% of mothers and 24.2% of fathers reported elevated traumatic stress symptoms in response to their confirmed fetal diagnosis, with clinically significant risk endorsed among 16.2% and 13.4% respectively. Symptoms of intrusion and avoidance were most notable among parents. Trauma-informed care strategies provided by a multidisciplinary care team, in collaboration with the psychosocial support team to identify, support, and intervene with high-risk parents, were implemented.

CONCLUSION:
Recognizing that expectant parents who receive a fetal anomaly diagnosis are at heightened risk for experiencing traumatic stress symptoms, maternal–fetal care teams should implement trauma-informed care into daily prenatal clinical practice and incorporate psychosocial support services, including parental mental health screening, psychosocial assessment, and clinical interventions, to reduce the negative effects of trauma for parents prior to birth.