bluuebunny/crossref_metadata_2025_split huggingface dataset:
Urine Drug Screening for a History of Isolated Marijuana Use: Is Our Help Hurting? [A224]
Authors: Rubin Alexandra , Zhong Lydia , Nacke Lauren , Raghuraman Nandini , Carter Ebony B. , Kelly Jeannie 
Published: June 2022

INTRODUCTION:
Despite being widely legalized, marijuana use commonly triggers urine drug screening (UDS) in obstetric practice, mainly to identify other substance exposures that could require intervention. We sought to identify frequency of concomitant nonprescribed substance use in patients who underwent UDS for isolated marijuana use (IMU) at delivery.

METHODS:
We performed a retrospective cohort study of all patients admitted for delivery from January 1 to July 31, 2020, at an urban academic center where UDS are sent based on specific criteria, including IMU. Demographic data were compared between those with IMU versus those not meeting UDS criteria. UDS results for patients with IMU are described.

RESULTS:
Of 2,045 deliveries, 484 (23.7%) had UDS performed. Reported IMU represented the most common reason for UDS (43.2%). Compared to patients who did not meet UDS criteria, those undergoing UDS for IMU were more likely Black (78.5% versus 43.1%, P<.001), younger (median age 25 versus 29 years, P<.001), and publicly insured (60.9% versus 37.0%, P<.001). Of 209 UDS sent for IMU, 4 (1.9%) were positive for nonprescribed substances other than marijuana. Of 125 UDS positive for marijuana only, 117 (93.6%) were mandatorily reported to the state Child Abuse/Neglect hotline. All 209 (100%) patients with IMU were discharged home with their infant.

CONCLUSION:
Over 40% of UDS were sent due to IMU on a labor unit, but ultimately identified a minority of other substance exposures. IMU as an indication for UDS disproportionately targets young, Black, publicly insured patients by triggering a downstream cascade of stigmatized legal consequences, and should be carefully examined for necessity.
Prevalence of Postpartum Depression Following the COVID-19 Pandemic at an Urban Academic Institution [A235]
Authors: Green Danetta , Southern Clayton , Sessions Kayle , Chen Judy , Ragonetti-Zebell Georgia , Green Lisa 
Published: June 2022

INTRODUCTION:
Postpartum depression (PPD) is a complication of pregnancy commonly occurring within the first month of delivery. Numerous risk factors are associated with PPD, including financial stressors, inadequate emotional support, and perceived social isolation. This study evaluated the impact of the implemented social restrictions to mitigate the spread of the COVID-19 virus on the overall prevalence of PPD at an urban academic center.

METHODS:
Following institutional review board approval, a retrospective cohort study was performed of 1,097 subjects between 1 and 8 weeks postpartum. Group 1, the control group, included 420 women with routine PPD screening prior to the COVID-19 pandemic (April 1–December 31, 2019). Group 2, our case group, included 677 women with routine PPD screening during the pandemic (April 1–December 31, 2020). Both groups completed the Edinburgh Postnatal Depression Scale (EPDS), and the prevalence of PPD (defined as having an EPDS score greater than 11) was determined. Postpartum patients following fetal demise were excluded.

RESULTS:
The prevalence of PPD was higher in postpartum women before the COVID-19 pandemic (13.10%) when compared to postpartum women screened during the pandemic (10.78%). This increased prevalence, however, was not found to be statistically significant (P=.2474).

CONCLUSION:
Our study revealed no statistically significant difference in the prevalence of PPD before or during the COVID-19 pandemic. Nevertheless, the downward trend of PPD during the pandemic may be due to quarantine recommendations allowing families/spouses to work from home. The association of PPD and specific social support systems should be evaluated further.
“It Just Feels Useless”: Views of Economically Marginalized Women of Color on Prenatal Telehealth [A236]
Authors: Dickens Molly , Franck Linda , Scott Karen , Dy Eric 
Published: June 2022

INTRODUCTION:
Virtual prenatal care has spiked during the COVID-19 pandemic, yet most research has neglected to consider care satisfaction from individuals at highest risk for poor health care experiences and outcomes.

METHODS:
We recruited economically marginalized, pregnant individuals of color to share their experiences with telehealth prenatal care for a survey- and text-message-based study. A pre-study survey assessed level of trust in providers (1–5 score) and overall care satisfaction (CSAT score; 1–10). After individual appointments, participants assigned appointment-based CSAT scores alongside narrative feedback. Quantitative data were analyzed using descriptive statistics. Qualitative data were analyzed using directed thematic analysis.

RESULTS:
A total of 13 participants engaged in the study from May to July 2020. Most participants identified as Black/African American, with reported household income below $50,000/year. Most participants rated trust in providers positively. For care satisfaction, telehealth delivery was generally viewed negatively within the scope of overall care. For individual appointments, CSAT scores for in-office visits were higher (median, 9; IQR, 1; n=35) than for telehealth visits (median, 6; IQR, 4; n=11). Participants’ narratives reflected three themes: relationship/trust with provider, information sharing/support, and maternal/fetal assessment. In-person appointment narratives contained more positive language, while telehealth narratives contained more negative language.

CONCLUSION:
Most participants report feeling negative and less satisfied with telehealth with dissatisfaction centered on level of information provided and inability to physically evaluate their health and their baby’s health. As remote prenatal care expands, there is an urgent need to engage patients as partners in the design and evaluation of its use and to augment telehealth with technology to objectively measure maternal and fetal health.
The Effect of the COVID-19 Pandemic on EPDS Scores and Maternal Quality of Life [A239]
Authors: Twichell Elizabeth , Zofkie Amanda , Mathisen Danielle , Lafferty Ashlyn , McIntire Donald D. , Morgan Jamie 
Published: June 2022

INTRODUCTION:
The COVID-19 pandemic has impacted mental health. We evaluated the impact on pregnant women and compared the Edinburgh Postpartum Depression Scale (EPDS) and a Maternal Postpartum Quality of Life Questionnaire (mPQOL) before and during the pandemic to evaluate the effect of the pandemic on maternal mental health and quality of life.

METHODS:
After institutional review board approval, EPDS screening exams and mPQOL surveys were collected postpartum on all pregnant women during six 12-week epochs prior to and during the pandemic (Epoch 1: December 16, 2019, to March 8, 2020; Epoch 2: March 9, 2020, to May 31, 2020; Epoch 3: June 1, 2020, to August 23, 2020; Epoch 4: August 24, 2020, to November 15, 2020; Epoch 5: November 16, 2020, to January 31, 2021; Epoch 6: February 1, 2021, to May 2, 2021). Scores were compared among the epochs. A score of 13 or higher indicated screening positive for depression. The mPQOL survey was evaluated by sub-categories: Psychological/Baby, Socioeconomic, Relational/Partner, Relationships/Family, and Health/Functioning. Satisfaction was ranked on a scale from 1 to 6 (1=very dissatisfied, 6=very satisfied). EPDS scores and mPQOL scores were compared among the epochs to determine contributors that impacted quality of life during the pandemic.

RESULTS:
Out of 2,011 women, an EPDS score of 13 or higher increased from 3% to 9% from Epoch 1 to Epoch 2 and peaked at 11% in Epoch 5 (P=0.007). mPQOL Socioeconomic and Relational/Partner sub-category scores decreased significantly from 5.8 to 5.5 (P=0.014) and 5.5 to 5.4 (P=0.041), respectively, from Epoch 2 to Epoch 3.

CONCLUSION:
There was a significant increase in positive EPDS screens in pregnant women during the COVID-19 pandemic. Sub-scores obtained from the mPQOL survey suggest that increasing socioeconomic concerns and relational partner issues may have driven these trends.
Neonatal Outcomes Among Patients Taking Medication for Opioid Use Disorder [A248]
Authors: Keer Emma , Irani Sanaya , Boggan Jordyn , Townsel Courtney 
Published: June 2022

INTRODUCTION:
Our multidisciplinary “Partnering for the Future” (PFF) clinic cares for birthing people with a mood or substance use disorder, including patients receiving medications for opioid use disorder (MOUD). The purpose of this study was to summarize the neonatal outcomes among infants born to patients receiving MOUD.

METHODS:
We conducted a retrospective analysis of all patients receiving care in our PFF clinic from January 2019 to August 2021. We excluded patients who were not maintained on MOUD and those only seen for consultation. Neonatal characteristics were abstracted from the medical record. Descriptive statistics were computed in SPSS v27. This study was deemed exempt by the institutional review board

RESULTS:
A total of 92 maternal-infant pairs were identified, of whom 49 patients were taking MOUD, resulting in 51 (54.3%) opioid-exposed infants (two twin pregnancies). Methadone exposure occurred in 21 (43%) pregnancies and buprenorphine exposure in 28 (57%). Neonatal intensive care unit (NICU) admission occurred in 45% (23/51) of infants. Neonatal opioid withdrawal syndrome (NOWS) was diagnosed in 26 (51.0%) infants, with 69% (18/26) infants developing severe NOWS meeting criteria for treatment. Severe NOWS occurred in 57% (12/21) of methadone-exposed pregnancies and 21% (6/28) of buprenorphine-exposed pregnancies. Among the 18 neonates diagnosed with severe NOWS, the average time to initial NOWS diagnosis was 22.35 (±0.86) hours compared to 40.4 (±0.70) hours for neonates diagnosed with non-severe NOWS.

CONCLUSION:
Severe NOWS was more prevalent among infants exposed to methadone and diagnosed sooner than non-severe NOWS cases. Strategies are needed to reduce NICU admissions and identify infants at highest risk for severe NOWS.
The Economic Impact of Preconception Fibroid Treatment With Myomectomy on Neonatal Outcomes [A261]
Authors: Colson-Fearon Darien N. , Drabo Emmanuel F. , Coleman Jenell 
Published: June 2022

INTRODUCTION:
Fibroids during pregnancy have been associated with premature birth. However, there is no recommendation to guide counseling. We aimed to assess the cost-effectiveness of treating prevalent fibroids prior to pregnancy and universal screening for fibroids with treatment of incident and prevalent cases.

METHODS:
A decision tree model was used to compare (1) preconception myomectomy for prevalent fibroids with no treatment and (2) universal ultrasound screening and subsequent myomectomy. Probabilities and costs from the U.S. health care sector’s perspective were derived from the literature. Effectiveness was measured in incident premature births, and a lifetime horizon following birth was used. Incremental cost-effectiveness ratio (ICER) was used and measured in incremental cost per premature birth averted. ICERs were compared to a societal willingness-to-pay threshold of USD $100,000 per premature birth. One-way sensitivity analyses were conducted to identify influential parameters.

RESULTS:
Treating known fibroids prior to pregnancy yielded an ICER of USD $25,678 per premature birth averted. Universal fibroid screening with treatment of incident and prevalent cases yielded an ICER of USD $307,173 per premature birth averted. Sensitivity analyses showed cost-effectiveness improved with decreased cost of myomectomy, increased proportion of prevalent cases, and increased proportion of incident cases detected. Additional analysis assessing cost-effectiveness of universal screening among Black women yielded an ICER of USD $87,944 per premature birth averted.

CONCLUSION:
Preconception myomectomy to prevent preterm birth is cost-effective, but treating prevalent cases plus ultrasound screening followed by myomectomy for incident cases in all populations is not a cost-effective strategy. However, evidence supports universal screening intervention for African American women, in whom fibroid prevalence and diagnosis is higher than national averages.
Too Much of a Good Thing? The Impact of Initial Prescription Size in Post-Cesarean-Delivery Pain Management [A265]
Authors: Goodrich Robyn N. , Nunziato James Jaclyn D. , Hagerdorn Meghan K. , Spivey Cara N. , Tegge Allison , Locklear Tonja M. 
Published: June 2022

INTRODUCTION:
Abuse of prescription opioids has reached epidemic proportions, and research demonstrates that prescription opioids used in post-cesarean-delivery pain management contribute significantly to this epidemic. Research in other surgical specialties demonstrated that patients consume about half of their initial prescription dose; however, this theory has yet to be applied to the field of obstetrics and gynecology. The objective of this research is to determine if initial prescription size influences patient consumption of opioids for post-cesarean-delivery pain management.

METHODS:
This randomized controlled trial involves 170 opioid-naive women ages 19–40 years undergoing scheduled cesarean deliveries at Carilion Roanoke Memorial Hospital. Patients were randomized to receive either 10 or 20 tabs of oxycodone 5 mg as an initial postoperative prescription in a double-blinded, parallel trial design. Outcome metrics regarding opioid consumption patterns and pain control were collected at three different time points postoperatively: 2–3 days, 10–14 days, and 6 weeks.

RESULTS:
Preliminary data (n=62) demonstrates that an average of 5 (±3.73) opioid tablets were consumed postoperatively in the 10-tablet group, compared to 8.4 (±8.87) tablets in the 20-tablet group (P=.05). Moreover, no participant requested additional refills of opioids.

CONCLUSION:
We observed that the average number of opioids consumed for adequate postoperative pain management was about half of the initial prescription size in both groups. Preliminary data supports the idea that initial prescription size influences patient opioid consumption. This study has direct implications to support a standard reduction of opioid prescriptions for post-cesarean pain management and the potential to directly impact millions of women every year.
Contraceptive Efficacy and Safety of 52 mg Levonorgestrel-Releasing Intrauterine Systems During Years 6–8 of Use: Data From the Mirena Extension Trial [A13]
Authors: Jensen Jeffrey T. , Lukkari-Lax Eeva , Schulze Andrea , Baisden Kristie W. , Serrani Marco , Kroll Robin 
Published: June 2022

INTRODUCTION:
The Mirena Extension Trial (MET) evaluated efficacy and safety of 52 mg levonorgestrel-releasing intrauterine systems (LNG-IUS, Mirena) during extended use.

METHODS:
MET was a multicenter, single-arm US study enrolling women aged 18–35 years who were current users of 52 mg LNG-IUS for 4.5–5 years. Institutional review board approval was obtained for all centers. Contraceptive efficacy (Pearl Index, PI) of 52 mg LNG-IUS beyond 5 years up to 8 years of use was assessed.

RESULTS:
Of 362 participants starting year 6, 243 entered year 8, with 346 included in the year 8 primary analysis set (PAS, all participants aged 36 years or less at end of year 8). Mean (standard deviation) age for the year 8 PAS was 29.2 (±2.9) years and 50.9% were parous. Two pregnancies occurred (both with device in situ): one of undetermined location that spontaneously resolved in year 6 and one ectopic in year 7. For years 6–8, the 3-year PI (95% confidence interval) was 0.28 (0.03–1.00), with an estimated pregnancy probability of 0.68% (0.17–2.71). PIs for years 6, 7, and 8 were 0.34 (0.01–1.88), 0.40 (0.01–2.25), and 0.00 (0.00–1.90), respectively. Treatment-emergent adverse events were reported in 249/362 participants (68.8%) and were related to 52 mg LNG-IUS in 65 (18.0%). The discontinuation rate was 38.4% (139/362), most commonly due to wish for pregnancy (12.2%, 44/362). At end of year 8, 220/223 (98.7%) were satisfied with 52 mg LNG-IUS.

CONCLUSION:
52 mg LNG-IUS, initially approved for 5 years, maintains high contraceptive efficacy, user satisfaction, and a favorable safety profile through 8 years of use.
Medication Abortion Experiences Before and During the COVID-19 Pandemic: A Content Analysis of Online Reddit Posts [A19]
Authors: Reissner Hana , Ponzio Madeline R. , Nagatani-Short Lindsay , Hurtado Alondra , Nguyen Brian 
Published: June 2022

INTRODUCTION:
The COVID-19 pandemic impacted abortion access, prompting initiatives to improve medication abortion access. We examined self-reported experiences and inquiries about medication abortion before and during the pandemic, using the anonymous platform Reddit.

METHODS:
We identified medication abortion-related Reddit posts across seven subreddits (e.g., r/Askwomen, r/abortion) using keywords linked to medication abortion (e.g., “abortion pill,” “misoprostol”). We restricted our search to pre-pandemic (September-November 2019) and during pandemic (April-June 2020) and filtered posts for experiences with or questions about medication abortion. We analyzed posts via inductive and iterative coding to characterize salient themes. We examined the prevalence of themes before and during the pandemic using chi-square tests. Institutional review board approval was obtained.

RESULTS:
Medication abortion-related posts increased by 134% during the pandemic (70 prior vs. 164 during). Frequent themes included sharing anxieties (34%), geographic barriers (22%), privacy/secrecy surrounding abortion (21%), post-abortion relief (19%), concerns about pain/bleeding (18%), and medication seeking (12%). For posts during the pandemic, 56 (24%) mentioned COVID-19 as a barrier; more posts expressed concerns about efficacy during than prior to COVID-19 (17% vs. 3%, P<.05). We did not detect a statistically significant change in posts specifying self-managed abortion (23% vs. 27%), teleabortion (9% vs. 16%), or clinic abortion (46% vs. 32%) before versus during COVID-19. Nine posts (7%) specified interest in medication abortion above 11 weeks.

CONCLUSION:
Individuals share abortion experiences and seek support and advice on Reddit. Nearly a quarter of posts reported COVID-19 being a barrier to abortion access. However, concerns about abortion access, emotions surrounding abortion, and advice-seeking were prevalent across time periods.
Giving a Voice to the Unheard: Latinx Attitudes, Decision-Making, and Experiences With Abortion [A25]
Authors: Urbina Josephine , Rivas Mercedes Posadas , Kerns Jennifer , Steinauer Jody 
Published: June 2022

INTRODUCTION:
While Latinas make up 25% of abortion patients in the US, they are poorly represented in abortion studies. This gap in information has contributed to an inadequate understanding of Latinx pregnancy-related decision making. The goal of this ethnically and language-concordant study was to qualitatively examine how Latinx women feel about abortion and their decision-making path in order to provide the community with equitable and quality care, outcomes, and experiences.

METHODS:
We recruited English- and Spanish-speaking Latinx women from the five US cities with the largest Latinx populations. After screening participants online, we invited a diverse pool to participate in one-on-one interviews to examine their attitudes, decision-making, and experiences with abortion. We utilized a community advisory board of Latinx women to provide insight into the development of the interview guide. Using thematic analysis, we analyzed transcripts iteratively, identifying themes from interviews; we stopped recruitment when we reached thematic saturation.

RESULTS:
We conducted 30 interviews, and participants described mixed experiences. Three overarching themes from the qualitative interviews were: shame and/or stigma, cultural humility, and access to abortion. Most participants described providers not understanding their culture as a larger barrier than providers not speaking their language. In addition, participants identified family and culture as the most influential factors on their beliefs about abortion. Religion was mentioned less frequently.

CONCLUSION:
Latinx attitudes and decision-making surrounding abortion is not monolithic. Abortion care delivery should be individualized and efforts should continue to assess the cultural and linguistic relevance of how services are delivered to the Latinx community.
Continuation Rates of the Etonogestrel Implant and Factors Associated With Early Discontinuation [A32]
Authors: Hines Genesis V. , Quinones Joanne N. , Walker Treasure N. , Waxman Andrea 
Published: June 2022

INTRODUCTION:
The etonogestrel implant is a highly effective, 3-year, long acting reversible contraceptive (LARC) device. Studies report a 1-year continuation rate of 80%, with 10% of patients reporting abnormal uterine bleeding (AUB) leading to discontinuation. Our primary objective was to describe the continuation rates of the implant in our population. Secondarily, we aimed to identify factors associated with early discontinuation.

METHODS:
Single center retrospective cohort study of women with placement of the etonogestrel implant at Lehigh Valley Health Network Obstetrics and Gynecology department between January 1, 2015 and December 31, 2017. Institutional review board (IRB) approval was obtained. A sample size calculation was performed to guide a subanalysis of the implant side effect profile.

RESULTS:
From 2015-2017, 774 women had the etonogestrel implant inserted. The 1-year continuation rate was significantly less than the literature reported value (62% vs 80%, P<.001). A subanalysis of 216 women revealed that 82% reported side effects (n=177) and 73% discontinued use due to side effects. Side effects were more common in women who discontinued use at 1 year compared to women who continued use (93% vs 71%, P<.001). The most common side effect, AUB (n=115), was not associated with early discontinuation. Neurologic and psychiatric complaints were reported by 16.7% of patients (n=18), and associated with early discontinuation (P=.02).

CONCLUSION:
The 1-year continuation rate of the etonogestrel implant may be significantly lower than that reported in the literature. Side effects are common, and patients with psychiatric or neurologic side effects are more likely to discontinue. Future studies should examine this relationship.
Reasons for Early Removal of the Etonogestrel Subdermal Implant in Obese Women [A35]
Authors: Hatch Cherise , Brouse Brynne , Young Amanda , Gray Celia M. , Paglia Michael J. , Howard Denise 
Published: June 2022

INTRODUCTION:
To evaluate women's reasons for electing early removal of the etonogestrel subdermal implant (EI) across body mass index (BMI) classes.

METHODS:
This is a retrospective chart review between January 2010 and December 2019 in a large health system which evaluated women’s reasons for early removal of the EI. Early removal was defined as removal less than 2.5 years after insertion. The reasons for removal as documented by providers were manually abstracted from the electronic health record. Listed reasons included abnormal uterine bleeding (AUB), desire to conceive (DTC), perceived weight gain, and implant complications. The subjects were grouped by BMI class and a test of trend analysis was performed for each of the reasons for removal.

RESULTS:
The cohort included 1,433 women, of whom 36% were normal/underweight, 25% were overweight, and 39% were obese. The trend for early removal secondary to AUB decreased with increasing BMI class: 64.0% in the normal/underweight group, 60.6% in overweight, 45.9% in class I obese, 41.7% in class II obese, and 40.5% in class III obese group (P<.0001). The trend for early removal secondary to perceived weight gain, desire to conceive, and implant complications increased with increasing BMI.

CONCLUSION:
Women with obesity were less likely to have the EI removed early due to AUB, but they were more likely to have it removed early because of the desire to conceive, perceived weight gain, and implant complications. This information will be helpful in counseling women with obesity regarding the use of the EI for long-acting reversible contraception.