Pub Date : 2023-05-01DOI: 10.1097/01.aog.0000931180.57371.d4
C. Johnson, E. Oliver, F. Ramsey, Marisa Rose
INTRODUCTION: Within obstetrics care, it can be difficult to discuss death and advances directives (AD). Recent maternal illnesses and deaths secondary to COVID-19 highlight the importance of these conversations. There is little available research regarding AD in obstetrics, especially within medical education. This study aimed to establish a baseline of obstetric provider comfort and knowledge with this material, provide education, and then reassess comfort and knowledge. METHODS: Institutional review board committee approval was waived for this study. A pre-intervention survey, including a unique identifier to allow for pairing of pre/post-surveys, was emailed to residents of a large university obstetrics and gynecology department with questions assessing comfort and knowledge of AD. The intervention was a 45-minute lecture covering definitions and local state laws relating to AD. A postsurvey, with identical questions to the presurvey, was sent 2 weeks after the intervention. Only paired responses were analyzed, using paired t test. RESULTS: Twenty-three residents (96% of program) participated in the presurvey; 17 (71%) participated in the postsurvey. All were matched to presurvey responses and analyzed. In the presurvey, 41% of respondents were usually or always comfortable identifying surrogate decision makers, which increased to 82% in the postsurvey, a 41% difference (P=.01). With regards to the knowledge-based questions, the mean correct response was 56% in the presurvey and 87% in the postsurvey, a 31% difference (P<.001). CONCLUSION: A simple didactic intervention showed improvement in comfort and knowledge surrounding topics of AD for ob-gyn residents. Additional research relating to patient awareness of AD during pregnancy could be explored.
{"title":"Advance Care Planning in Obstetrics: Effectiveness of a Didactic Intervention on Provider Comfort and Knowledge [ID: 1373348]","authors":"C. Johnson, E. Oliver, F. Ramsey, Marisa Rose","doi":"10.1097/01.aog.0000931180.57371.d4","DOIUrl":"https://doi.org/10.1097/01.aog.0000931180.57371.d4","url":null,"abstract":"INTRODUCTION: Within obstetrics care, it can be difficult to discuss death and advances directives (AD). Recent maternal illnesses and deaths secondary to COVID-19 highlight the importance of these conversations. There is little available research regarding AD in obstetrics, especially within medical education. This study aimed to establish a baseline of obstetric provider comfort and knowledge with this material, provide education, and then reassess comfort and knowledge. METHODS: Institutional review board committee approval was waived for this study. A pre-intervention survey, including a unique identifier to allow for pairing of pre/post-surveys, was emailed to residents of a large university obstetrics and gynecology department with questions assessing comfort and knowledge of AD. The intervention was a 45-minute lecture covering definitions and local state laws relating to AD. A postsurvey, with identical questions to the presurvey, was sent 2 weeks after the intervention. Only paired responses were analyzed, using paired t test. RESULTS: Twenty-three residents (96% of program) participated in the presurvey; 17 (71%) participated in the postsurvey. All were matched to presurvey responses and analyzed. In the presurvey, 41% of respondents were usually or always comfortable identifying surrogate decision makers, which increased to 82% in the postsurvey, a 41% difference (P=.01). With regards to the knowledge-based questions, the mean correct response was 56% in the presurvey and 87% in the postsurvey, a 31% difference (P<.001). CONCLUSION: A simple didactic intervention showed improvement in comfort and knowledge surrounding topics of AD for ob-gyn residents. Additional research relating to patient awareness of AD during pregnancy could be explored.","PeriodicalId":19405,"journal":{"name":"Obstetrics & Gynecology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79339833","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-05-01DOI: 10.1097/01.aog.0000930196.23819.99
Joyce H. Xu, E. Defranco, Aaron W Murnan, N. Nidey, M. Terplan, C. Wilder
INTRODUCTION: Experiences of discrimination among pregnant and postpartum people with opioid use disorder (OUD) are common and likely affect utilization of medication for OUD (MOUD), which is associated with reduced risk of overdose and death. We aimed to examine experiences of discrimination by prenatal care (PNC) and substance use disorder (SUD) treatment settings and estimate its effect on the risk of various MOUD utilization outcomes. METHODS: Patient-stakeholders co-designed survey questions to measure self-reported outcomes related to MOUD treatment utilization, return to substance use, and overdose. First, we examined the proportion of participants who endorsed items on a modified Healthcare Discrimination Scale and summed the total scores. Next, we quantified the effect of discrimination experienced by health care setting on postpartum MOUD utilization, return to use, and overdose using log-binomial models to calculate relative risk (RR) and 95% CIs. RESULTS: Among the 100 participants enrolled in the study, 57 reported experiencing discrimination, 56 within PNC and 33 within SUD treatment settings. Discrimination within PNC (RR 2.6, CI 1.06–6.40) and SUD treatment (RR 3.26, CI 1.59–6.70) were associated with increased risk of not using MOUD as prescribed. Discrimination within SUD treatment settings correlated with an increased risk of MOUD discontinuation (RR 2.56, CI 1.19–5.54) and return to use (RR 2.36, CI 1.18–4.73). CONCLUSION: Experiences of discrimination were common, especially within prenatal care settings, and discrimination was associated with poor MOUD treatment outcomes and risk of return to use. Interventions to address discrimination within health care settings can improve outcomes for pregnant and postpartum people with OUD.
孕妇和产后阿片类药物使用障碍(OUD)患者的歧视经历是常见的，并且可能影响OUD (mod)药物的使用，这与过量使用和死亡风险降低有关。我们的目的是检查产前护理(PNC)和物质使用障碍(SUD)治疗设置的歧视经历，并估计其对各种mod使用结果风险的影响。方法:患者与利益相关者共同设计调查问题，测量与mod治疗利用、药物使用和过量相关的自我报告结果。首先，我们检查了在修订的医疗歧视量表上认可项目的参与者比例，并总结总分。接下来，我们使用对数二项模型来计算相对风险(RR)和95% ci，量化医疗环境对产后mod使用、返回使用和过量使用的影响。结果:在参加研究的100名参与者中，57人报告遭受歧视，56人在PNC治疗环境中，33人在SUD治疗环境中。PNC (RR 2.6, CI 1.06-6.40)和SUD治疗(RR 3.26, CI 1.59-6.70)中的歧视与未按规定使用mod的风险增加相关。SUD治疗设置中的歧视与mod停药(RR 2.56, CI 1.19-5.54)和重新使用(RR 2.36, CI 1.18-4.73)的风险增加相关。结论:歧视的经历是常见的，特别是在产前护理环境中，歧视与不良的mod治疗结果和再次使用的风险有关。解决卫生保健机构内歧视问题的干预措施可以改善孕妇和产后OUD患者的结局。
{"title":"Experiences of Discrimination and Treatment Outcomes Among Pregnant and Postpartum People With Opioid Use Disorder [ID: 1376917]","authors":"Joyce H. Xu, E. Defranco, Aaron W Murnan, N. Nidey, M. Terplan, C. Wilder","doi":"10.1097/01.aog.0000930196.23819.99","DOIUrl":"https://doi.org/10.1097/01.aog.0000930196.23819.99","url":null,"abstract":"INTRODUCTION: Experiences of discrimination among pregnant and postpartum people with opioid use disorder (OUD) are common and likely affect utilization of medication for OUD (MOUD), which is associated with reduced risk of overdose and death. We aimed to examine experiences of discrimination by prenatal care (PNC) and substance use disorder (SUD) treatment settings and estimate its effect on the risk of various MOUD utilization outcomes. METHODS: Patient-stakeholders co-designed survey questions to measure self-reported outcomes related to MOUD treatment utilization, return to substance use, and overdose. First, we examined the proportion of participants who endorsed items on a modified Healthcare Discrimination Scale and summed the total scores. Next, we quantified the effect of discrimination experienced by health care setting on postpartum MOUD utilization, return to use, and overdose using log-binomial models to calculate relative risk (RR) and 95% CIs. RESULTS: Among the 100 participants enrolled in the study, 57 reported experiencing discrimination, 56 within PNC and 33 within SUD treatment settings. Discrimination within PNC (RR 2.6, CI 1.06–6.40) and SUD treatment (RR 3.26, CI 1.59–6.70) were associated with increased risk of not using MOUD as prescribed. Discrimination within SUD treatment settings correlated with an increased risk of MOUD discontinuation (RR 2.56, CI 1.19–5.54) and return to use (RR 2.36, CI 1.18–4.73). CONCLUSION: Experiences of discrimination were common, especially within prenatal care settings, and discrimination was associated with poor MOUD treatment outcomes and risk of return to use. Interventions to address discrimination within health care settings can improve outcomes for pregnant and postpartum people with OUD.","PeriodicalId":19405,"journal":{"name":"Obstetrics & Gynecology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84463820","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-05-01DOI: 10.1097/01.AOG.0000930084.97027.73
Karl E. Seif, A. Desai, M. Mangione, H. Tadbiri, S. Turan, A. Wolfe
INTRODUCTION: Starting December 15, 2021, the SARS-CoV-2 B.1.1.529 (Omicron) variant became the predominant strain in the United States. Preliminary data suggest that the Omicron variant causes less severe COVID-19 than earlier variants. We hypothesize that adverse maternal and neonatal outcomes are less likely if infection occurred during the Omicron epoch compared to pre-Omicron. METHODS: This IRB-approved retrospective cohort study was conducted at a major university health system in Maryland from March 2020 to May 2022. We identified patients who were SARS-CoV-2 positive before and after December 15, 2021. Demographics and maternal, obstetric, and neonatal outcomes were collected and compared. Wilcoxon rank-sum and Fisher’s exact tests were used to compare continuous and categorical data, respectively. Adjusted odds ratios (aORs) were calculated using vaccination status. RESULTS: A total of 742 SARS-CoV-2–positive pregnant patients were identified. Of those, 548 (74%) tested positive pre-Omicron and 194 (26%) tested positive during the Omicron wave. Tobacco and illicit drug use were higher among patients in the Omicron epoch. Patients were also older and more likely to have received at least one vaccine dose (3% versus 35%, P<.001). Omicron epoch patients had less severe disease as evidenced by higher rates of asymptomatic infection (72% versus 44%) as well as lower rates of hospital admission due to COVID-19, supplemental oxygenation, and intensive care unit (ICU) admission. However, the odds of ICU admission were not significantly decreased in Omicron epoch patients after adjusting for vaccination (aOR 0.15, 95% CI 0.02–1.14). The odds of preeclampsia and preterm birth less than 34 weeks were lower in Omicron epoch patients after adjusting for vaccination (aOR, 0.61 and 0.38, respectively). Neonatal outcomes were not statistically different between the two groups. CONCLUSION: Pregnant patients infected with SARS-CoV-2 during the Omicron epoch have a less severe disease course than those infected pre-Omicron. Lower ICU admissions during the Omicron epoch may be due to higher vaccination rates.
{"title":"Pregnancy Outcomes Before and After the Emergence of the SARS-CoV-2 B.1.1.529 (Omicron) Variant [ID: 1365953]","authors":"Karl E. Seif, A. Desai, M. Mangione, H. Tadbiri, S. Turan, A. Wolfe","doi":"10.1097/01.AOG.0000930084.97027.73","DOIUrl":"https://doi.org/10.1097/01.AOG.0000930084.97027.73","url":null,"abstract":"INTRODUCTION: Starting December 15, 2021, the SARS-CoV-2 B.1.1.529 (Omicron) variant became the predominant strain in the United States. Preliminary data suggest that the Omicron variant causes less severe COVID-19 than earlier variants. We hypothesize that adverse maternal and neonatal outcomes are less likely if infection occurred during the Omicron epoch compared to pre-Omicron. METHODS: This IRB-approved retrospective cohort study was conducted at a major university health system in Maryland from March 2020 to May 2022. We identified patients who were SARS-CoV-2 positive before and after December 15, 2021. Demographics and maternal, obstetric, and neonatal outcomes were collected and compared. Wilcoxon rank-sum and Fisher’s exact tests were used to compare continuous and categorical data, respectively. Adjusted odds ratios (aORs) were calculated using vaccination status. RESULTS: A total of 742 SARS-CoV-2–positive pregnant patients were identified. Of those, 548 (74%) tested positive pre-Omicron and 194 (26%) tested positive during the Omicron wave. Tobacco and illicit drug use were higher among patients in the Omicron epoch. Patients were also older and more likely to have received at least one vaccine dose (3% versus 35%, P<.001). Omicron epoch patients had less severe disease as evidenced by higher rates of asymptomatic infection (72% versus 44%) as well as lower rates of hospital admission due to COVID-19, supplemental oxygenation, and intensive care unit (ICU) admission. However, the odds of ICU admission were not significantly decreased in Omicron epoch patients after adjusting for vaccination (aOR 0.15, 95% CI 0.02–1.14). The odds of preeclampsia and preterm birth less than 34 weeks were lower in Omicron epoch patients after adjusting for vaccination (aOR, 0.61 and 0.38, respectively). Neonatal outcomes were not statistically different between the two groups. CONCLUSION: Pregnant patients infected with SARS-CoV-2 during the Omicron epoch have a less severe disease course than those infected pre-Omicron. Lower ICU admissions during the Omicron epoch may be due to higher vaccination rates.","PeriodicalId":19405,"journal":{"name":"Obstetrics & Gynecology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84874834","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-05-01DOI: 10.1097/01.AOG.0000930392.60389.a5
S. Hamilton, Shari Lawson, Sarah Olson, K. Voegtline
INTRODUCTION: In Maryland, 81% of pregnancy-related deaths occurred in the postpartum period. We sought to compare postpartum readmission by race and ethnicity to better understand disparities in maternal mortality. METHODS: In this retrospective study (2016–2019), childbirth hospitalizations from the Maryland State Inpatient Database for childbearing age patients were analyzed. Indication for readmission was described. Multivariable logistic regression models were employed to determine race and ethnicity differences in postpartum readmissions, adjusting for maternal and obstetric characteristics (Johns Hopkins IRB00320807). RESULTS: Among total deliveries (n=260,778), 3,914 patients (1.5%) were readmitted within 60 days of delivery. The most common primary diagnoses at readmission were hypertension and infection. The prevalence of readmission was 1.2% for White patients, 2.3% for Black patients, and 1.2% for Hispanic patients (P<.0001). Black patients had the highest rates of readmission for hypertensive disorders (37%, P<.0001). In adjusted models, Black patients were more likely to be readmitted than White patients (odds ratio 1.64, CI 1.52–1.77). The majority of readmissions occurred in the first week after delivery; however, Black patients had higher rates of readmission in the second week relative to all other groups (P<.0001). CONCLUSION: Hypertension is a leading factor for postpartum readmission in Maryland. Black patients were more likely to be readmitted for hypertensive disorders of pregnancy and to have delayed readmission relative to other race/ethnic groups. Maryland public health officials should address disparities with interventions targeting racial and ethnic minorities, patients at risk for hypertensive disorders, and barriers to timely care.
{"title":"Postpartum Readmission in Maryland by Race and Ethnicity [ID: 1358223]","authors":"S. Hamilton, Shari Lawson, Sarah Olson, K. Voegtline","doi":"10.1097/01.AOG.0000930392.60389.a5","DOIUrl":"https://doi.org/10.1097/01.AOG.0000930392.60389.a5","url":null,"abstract":"INTRODUCTION: In Maryland, 81% of pregnancy-related deaths occurred in the postpartum period. We sought to compare postpartum readmission by race and ethnicity to better understand disparities in maternal mortality. METHODS: In this retrospective study (2016–2019), childbirth hospitalizations from the Maryland State Inpatient Database for childbearing age patients were analyzed. Indication for readmission was described. Multivariable logistic regression models were employed to determine race and ethnicity differences in postpartum readmissions, adjusting for maternal and obstetric characteristics (Johns Hopkins IRB00320807). RESULTS: Among total deliveries (n=260,778), 3,914 patients (1.5%) were readmitted within 60 days of delivery. The most common primary diagnoses at readmission were hypertension and infection. The prevalence of readmission was 1.2% for White patients, 2.3% for Black patients, and 1.2% for Hispanic patients (P<.0001). Black patients had the highest rates of readmission for hypertensive disorders (37%, P<.0001). In adjusted models, Black patients were more likely to be readmitted than White patients (odds ratio 1.64, CI 1.52–1.77). The majority of readmissions occurred in the first week after delivery; however, Black patients had higher rates of readmission in the second week relative to all other groups (P<.0001). CONCLUSION: Hypertension is a leading factor for postpartum readmission in Maryland. Black patients were more likely to be readmitted for hypertensive disorders of pregnancy and to have delayed readmission relative to other race/ethnic groups. Maryland public health officials should address disparities with interventions targeting racial and ethnic minorities, patients at risk for hypertensive disorders, and barriers to timely care.","PeriodicalId":19405,"journal":{"name":"Obstetrics & Gynecology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79402256","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-05-01DOI: 10.1097/01.AOG.0000929972.61251.d7
Brittney M Wells, E. Doe, R. Farias-Eisner, Mitchell Taylor
INTRODUCTION: Epithelial adenocarcinoma of the ovary (EOC) is the second most common cancer affecting the female reproductive system and is associated with the fifth highest rate of cancer-related deaths in women. With many women presenting in late stages, the estimated chance of survival for 2, 5, and 10 years were 65%, 44%, and 36%, respectively. In recent literature, the role of HDL-associated apolipoproteins has been shown to be effective in the treatment of proinflammatory diseases, including cancer. Previously we developed a novel 20-amino acid mimetic peptide, HM-10/10, which was able to inhibit tumor development and growth in EOC models in vitro and in vivo. These findings prompted our decision to further our research by performing characterization to advance HM-10/10 as our apolipoprotein mimetic peptide candidate of choice for use as a novel therapeutic agent against EOC. The aim of this study was to report the pharmacokinetic (PK) and pharmacodynamic (PD) properties of HM-10/10 relative to its stability in vitro. METHODS: To evaluate PK/PD, multiple procedures were performed in vitro. RESULTS: The results demonstrated PK/PD good stability in plasma and the gastric environment. However, under conditions modeling the small intestine, HM-10/10 demonstrated significant degradation, likely because of the diverse array of peptidases encountered therein. CONCLUSION: These data highlight the PK/PD of HM-10/10 and demonstrate its potential as an effective therapeutic for treating EOC. The preferred route of delivery of HM-10/10 is oral, and toward that end, HM-10/10 demonstrated remarkable stability over a broad physiologic pH range; however, its stability was significantly degraded by conditions simulating the small intestine.
{"title":"Novel Anti-Ovarian Epithelial Adenocarcinoma Agent: HM-10/10 HDL-Mimetic Peptide—Pharmacokinetic and Pharmacodynamic Characterization [ID: 1377510]","authors":"Brittney M Wells, E. Doe, R. Farias-Eisner, Mitchell Taylor","doi":"10.1097/01.AOG.0000929972.61251.d7","DOIUrl":"https://doi.org/10.1097/01.AOG.0000929972.61251.d7","url":null,"abstract":"INTRODUCTION: Epithelial adenocarcinoma of the ovary (EOC) is the second most common cancer affecting the female reproductive system and is associated with the fifth highest rate of cancer-related deaths in women. With many women presenting in late stages, the estimated chance of survival for 2, 5, and 10 years were 65%, 44%, and 36%, respectively. In recent literature, the role of HDL-associated apolipoproteins has been shown to be effective in the treatment of proinflammatory diseases, including cancer. Previously we developed a novel 20-amino acid mimetic peptide, HM-10/10, which was able to inhibit tumor development and growth in EOC models in vitro and in vivo. These findings prompted our decision to further our research by performing characterization to advance HM-10/10 as our apolipoprotein mimetic peptide candidate of choice for use as a novel therapeutic agent against EOC. The aim of this study was to report the pharmacokinetic (PK) and pharmacodynamic (PD) properties of HM-10/10 relative to its stability in vitro. METHODS: To evaluate PK/PD, multiple procedures were performed in vitro. RESULTS: The results demonstrated PK/PD good stability in plasma and the gastric environment. However, under conditions modeling the small intestine, HM-10/10 demonstrated significant degradation, likely because of the diverse array of peptidases encountered therein. CONCLUSION: These data highlight the PK/PD of HM-10/10 and demonstrate its potential as an effective therapeutic for treating EOC. The preferred route of delivery of HM-10/10 is oral, and toward that end, HM-10/10 demonstrated remarkable stability over a broad physiologic pH range; however, its stability was significantly degraded by conditions simulating the small intestine.","PeriodicalId":19405,"journal":{"name":"Obstetrics & Gynecology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79446735","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-05-01DOI: 10.1097/01.aog.0000930248.05306.cd
Malena Wheeler, H. Hong, G. Swamy, Tracy Truong, Shakthi Unnithan
INTRODUCTION: Black birthing people are at increased risk for cesarean delivery (CD) and gestational hypertension (gHTN), compared to their White counterparts. In the ARRIVE trial, labor induction at 39 weeks decreased CD and gHTN in low-risk nulliparous patients. Our aim was to determine whether racial differences in labor induction, CD or gHTN changed after ARRIVE and the COVID-19 pandemic. METHODS: We conducted an IRB-approved, retrospective cohort study using publicly available birth certificate data from three time periods: pre-ARRIVE (January 1, 2015 to August 31, 2018), post-ARRIVE (September 1, 2018 to February 29, 2020), and post-COVID (March 1, 2020 to December 31, 2020). All non-Hispanic Black (NHB) or White (NHW) nulliparous patients with a singleton gestation who delivered at more than 39 weeks of gestation with no documented high-risk conditions were included. Odds of labor induction, gHTN, and CD were compared by time period and race and ethnicity using an interrupted time series analysis adjusted for seasonality and covariates. RESULTS: There were 471,351 NHB and 2,265,018 NHW birth records included in the analysis. Post ARRIVE, the rate of labor induction increased among NHB and NHW birthing people. Non-Hispanic Black patients were less likely to be induced than their White counterparts before and after the publication of ARRIVE and COVID-19. In the adjusted ITS analysis, the odds of induction of labor (IOL) were lower while the odds of gestational hypertension and cesarean birth were higher for NHB compared to NHW in all three time periods. CONCLUSION: It is plausible that the racial difference in 39-week IOL may contribute to racial disparities in gestational hypertension and cesarean delivery. The results of the ARRIVE trial suggest that ensuring equitable access to IOL in the 39th week may be one strategy to reduce obstetric racial disparities.
{"title":"The Effect of the ARRIVE Trial and the COVID-19 Pandemic on Obstetric Practice and Racial Disparities [ID: 1380285]","authors":"Malena Wheeler, H. Hong, G. Swamy, Tracy Truong, Shakthi Unnithan","doi":"10.1097/01.aog.0000930248.05306.cd","DOIUrl":"https://doi.org/10.1097/01.aog.0000930248.05306.cd","url":null,"abstract":"INTRODUCTION: Black birthing people are at increased risk for cesarean delivery (CD) and gestational hypertension (gHTN), compared to their White counterparts. In the ARRIVE trial, labor induction at 39 weeks decreased CD and gHTN in low-risk nulliparous patients. Our aim was to determine whether racial differences in labor induction, CD or gHTN changed after ARRIVE and the COVID-19 pandemic. METHODS: We conducted an IRB-approved, retrospective cohort study using publicly available birth certificate data from three time periods: pre-ARRIVE (January 1, 2015 to August 31, 2018), post-ARRIVE (September 1, 2018 to February 29, 2020), and post-COVID (March 1, 2020 to December 31, 2020). All non-Hispanic Black (NHB) or White (NHW) nulliparous patients with a singleton gestation who delivered at more than 39 weeks of gestation with no documented high-risk conditions were included. Odds of labor induction, gHTN, and CD were compared by time period and race and ethnicity using an interrupted time series analysis adjusted for seasonality and covariates. RESULTS: There were 471,351 NHB and 2,265,018 NHW birth records included in the analysis. Post ARRIVE, the rate of labor induction increased among NHB and NHW birthing people. Non-Hispanic Black patients were less likely to be induced than their White counterparts before and after the publication of ARRIVE and COVID-19. In the adjusted ITS analysis, the odds of induction of labor (IOL) were lower while the odds of gestational hypertension and cesarean birth were higher for NHB compared to NHW in all three time periods. CONCLUSION: It is plausible that the racial difference in 39-week IOL may contribute to racial disparities in gestational hypertension and cesarean delivery. The results of the ARRIVE trial suggest that ensuring equitable access to IOL in the 39th week may be one strategy to reduce obstetric racial disparities.","PeriodicalId":19405,"journal":{"name":"Obstetrics & Gynecology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80204524","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-05-01DOI: 10.1097/01.aog.0000929712.81628.b2
T. Ibrahim, L. Clore, Tara Mathias-Prabhu, Lewis Rubin, Rachel Scott, Rebecca Yamamoto
INTRODUCTION: The COVID-19 pandemic has affected several maternal and perinatal outcomes. However, the effect of maternal SARS-CoV-2 infection on newborn birth weight has not been comprehensively evaluated. We performed a systematic review to determine the scope of literature considering the effect of maternal SARS-CoV-2 infection on birth weight normalized for gestational age. METHODS: We searched OVID Medline, EMBASE, Cochrane CENTRAL, Web of Science, and Google Scholar databases from January 1, 2019, to June 17, 2022, using keywords “gestational age,” “birthweight,” “newborn,” and “COVID-19.” Studies that were nonhuman, unspecified date/location, published in non-English language, systematic reviews, meta-analyses, case reports, case series, narrative reviews, and editorials were excluded. We extracted data from included publications on perinatal and maternal outcomes, demographics, and study type. RESULTS: Of 899 studies identified, 204 met criteria and 24 included birth weight and gestational age data on COVID-19-positive (n=10,193) and -negative (n=611,018) maternal/newborn dyads. 11 retrospective cohort, 10 prospective cohort, and 3 case–control studies from Europe (33%), North America (25%), Asia (21%), and the Middle East (13%) were evaluated. In those comparing COVID-19-positive versus -negative mothers, most studies did not find significant differences in gestational age and birth weight. Among those studies comparing mild versus severe disease, the majority found significant differences in gestational age and birth weight. CONCLUSION: This internationally aggregated systematic review reveals potential differences in birth weight by disease severity that prompt an ongoing investigation of the effects of maternal SARS-CoV-2 infection on gestational age-dependent birth weight.
导言:COVID-19大流行影响了几种孕产妇和围产期结局。然而，母体感染SARS-CoV-2对新生儿出生体重的影响尚未得到全面评价。我们进行了一项系统综述，以确定考虑母体SARS-CoV-2感染对胎龄标准化出生体重影响的文献范围。方法:我们从2019年1月1日至2022年6月17日检索OVID Medline、EMBASE、Cochrane CENTRAL、Web of Science和Google Scholar数据库，使用关键词“胎龄”、“出生体重”、“新生儿”和“COVID-19”。排除非人类、未确定日期/地点、以非英语语言发表的研究、系统综述、荟萃分析、病例报告、病例系列、叙述性综述和社论。我们从包括围产期和产妇结局、人口统计学和研究类型的出版物中提取数据。结果:在确定的899项研究中，204项符合标准，24项包括covid -19阳性(n=10,193)和阴性(n= 611018)孕产妇/新生儿双体的出生体重和胎龄数据。11项回顾性队列研究、10项前瞻性队列研究和3项病例对照研究分别来自欧洲(33%)、北美(25%)、亚洲(21%)和中东(13%)。在比较covid -19阳性母亲和阴性母亲的研究中，大多数研究没有发现胎龄和出生体重的显着差异。在那些比较轻微和严重疾病的研究中，大多数发现胎龄和出生体重有显著差异。结论:这项国际汇总的系统综述揭示了疾病严重程度对出生体重的潜在差异，促使人们继续研究母体SARS-CoV-2感染对胎龄依赖性出生体重的影响。
{"title":"SARS-CoV-2 Maternal Infection and Newborn Outcomes: A Comprehensive Systematic Review [ID: 1377802]","authors":"T. Ibrahim, L. Clore, Tara Mathias-Prabhu, Lewis Rubin, Rachel Scott, Rebecca Yamamoto","doi":"10.1097/01.aog.0000929712.81628.b2","DOIUrl":"https://doi.org/10.1097/01.aog.0000929712.81628.b2","url":null,"abstract":"INTRODUCTION: The COVID-19 pandemic has affected several maternal and perinatal outcomes. However, the effect of maternal SARS-CoV-2 infection on newborn birth weight has not been comprehensively evaluated. We performed a systematic review to determine the scope of literature considering the effect of maternal SARS-CoV-2 infection on birth weight normalized for gestational age. METHODS: We searched OVID Medline, EMBASE, Cochrane CENTRAL, Web of Science, and Google Scholar databases from January 1, 2019, to June 17, 2022, using keywords “gestational age,” “birthweight,” “newborn,” and “COVID-19.” Studies that were nonhuman, unspecified date/location, published in non-English language, systematic reviews, meta-analyses, case reports, case series, narrative reviews, and editorials were excluded. We extracted data from included publications on perinatal and maternal outcomes, demographics, and study type. RESULTS: Of 899 studies identified, 204 met criteria and 24 included birth weight and gestational age data on COVID-19-positive (n=10,193) and -negative (n=611,018) maternal/newborn dyads. 11 retrospective cohort, 10 prospective cohort, and 3 case–control studies from Europe (33%), North America (25%), Asia (21%), and the Middle East (13%) were evaluated. In those comparing COVID-19-positive versus -negative mothers, most studies did not find significant differences in gestational age and birth weight. Among those studies comparing mild versus severe disease, the majority found significant differences in gestational age and birth weight. CONCLUSION: This internationally aggregated systematic review reveals potential differences in birth weight by disease severity that prompt an ongoing investigation of the effects of maternal SARS-CoV-2 infection on gestational age-dependent birth weight.","PeriodicalId":19405,"journal":{"name":"Obstetrics & Gynecology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80799546","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-05-01DOI: 10.1097/01.AOG.0000931004.25129.8a
A. Kraus, L. Kucirka, Nozomi Sakai, Elizabeth Weddendorf, O. Young
INTRODUCTION: The purpose of this study is to describe the effect of remdesivir on liver function test (LFT) trends when used in the treatment of COVID-19 in pregnant people. METHODS: This was a retrospective cohort study examining pregnant people with COVID-19 admitted to an academic medical center between October 1, 2020 and December 31, 2021. Patient data were obtained by querying the Data Warehouse for Health, a data repository sourced from the Epic EHR. Patient charts were reviewed to abstract missing data and to ensure accuracy of key variables. Demographics, clinical characteristics, and pregnancy outcomes were compared between those who received remdesivir and those who did not. RESULTS: The study cohort comprised 102 pregnant individuals, of whom 21 received remdesivir. Mean length of stay for patients who received remdesivir was 11.4 versus 4.2 days, and they were more likely to require intensive care unit admission (57.1% versus 2.5%) and intubation (9.5% versus 0%). Those who received remdesivir were more likely to deliver by cesarean section (62.5% versus 38.2%) and had a lower mean gestational age at delivery (35.5 weeks versus 37.8 weeks). Ten patients had a LFT doubling after treatment, and two were diagnosed with preterm preeclampsia. Patients with LFT doubling were more likely to be delivered by cesarean section (87.5% versus 16.8%) and had a lower mean gestational age at delivery (33.2 weeks versus 38.2 weeks). CONCLUSION: Thirty-three percent of patients treated with remdesivir had a doubling in LFTs. Two had increases attributed to preterm preeclampsia. Further research is essential to elucidate the autonomous effects of remdesivir, COVID-19, and preeclampsia, on liver function.
{"title":"The Effect of Remdesivir on Liver Function Test Trends in Pregnant People With COVID-19 [ID: 1356660]","authors":"A. Kraus, L. Kucirka, Nozomi Sakai, Elizabeth Weddendorf, O. Young","doi":"10.1097/01.AOG.0000931004.25129.8a","DOIUrl":"https://doi.org/10.1097/01.AOG.0000931004.25129.8a","url":null,"abstract":"INTRODUCTION: The purpose of this study is to describe the effect of remdesivir on liver function test (LFT) trends when used in the treatment of COVID-19 in pregnant people. METHODS: This was a retrospective cohort study examining pregnant people with COVID-19 admitted to an academic medical center between October 1, 2020 and December 31, 2021. Patient data were obtained by querying the Data Warehouse for Health, a data repository sourced from the Epic EHR. Patient charts were reviewed to abstract missing data and to ensure accuracy of key variables. Demographics, clinical characteristics, and pregnancy outcomes were compared between those who received remdesivir and those who did not. RESULTS: The study cohort comprised 102 pregnant individuals, of whom 21 received remdesivir. Mean length of stay for patients who received remdesivir was 11.4 versus 4.2 days, and they were more likely to require intensive care unit admission (57.1% versus 2.5%) and intubation (9.5% versus 0%). Those who received remdesivir were more likely to deliver by cesarean section (62.5% versus 38.2%) and had a lower mean gestational age at delivery (35.5 weeks versus 37.8 weeks). Ten patients had a LFT doubling after treatment, and two were diagnosed with preterm preeclampsia. Patients with LFT doubling were more likely to be delivered by cesarean section (87.5% versus 16.8%) and had a lower mean gestational age at delivery (33.2 weeks versus 38.2 weeks). CONCLUSION: Thirty-three percent of patients treated with remdesivir had a doubling in LFTs. Two had increases attributed to preterm preeclampsia. Further research is essential to elucidate the autonomous effects of remdesivir, COVID-19, and preeclampsia, on liver function.","PeriodicalId":19405,"journal":{"name":"Obstetrics & Gynecology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81556989","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-05-01DOI: 10.1097/01.aog.0000929784.36864.2d
Sanjana Satish, Alejandro M A Mantero, S. Sonalkar
INTRODUCTION: Cisgender women account for almost 20% of new human immunodeficiency virus (HIV) infections in the United States. This study aims to assess contraception use at last intercourse in cisgender women at high risk for HIV acquisition. METHODS: We abstracted demographics, socioeconomic status, HIV risk, and reproductive health information from the 2017 iteration of the Centers for Disease Control and Prevention Behavioral Risk Factor Surveillance System. We used survey-weighted logistic regression adjusted for several demographic factors to compare trends of contraception use between those at low and high risk for HIV acquisition, which was defined as those who have engaged in transactional sex practices, used injection drugs, or been treated for a sexually transmitted infection in the past year. RESULTS: Women at high risk for HIV acquisition had no significant difference in contraception use at last intercourse compared to those at low risk (P=.262, odds ratio [OR] 1.11 [0.93–1.32]). Among those who did not use contraception at last intercourse, women at risk for HIV acquisition were more likely to state indifference toward getting pregnant (P=.029, OR 1.79 [1.06–3.01]) and lapse in method use (P=.001, OR 4.55 [1.80–11.5]) as reasons for not using contraception. Additionally, those at high risk for HIV were more likely to have had an intrauterine device (IUD) (unknown type) at last intercourse (P<.001, OR 1.70 [1.28–2.24]) and less likely to have used hormonal shots (P=.015, OR 0.47 [0.26–0.86]). CONCLUSION: Women at risk for HIV are more likely to have had an IUD at last intercourse, which could indicate a role for the integration of HIV preexposure prophylaxis and family planning. Contraception method preference in this population and attitudes toward pregnancy should be further investigated.
简介:在美国，顺性别妇女几乎占新发人类免疫缺陷病毒(HIV)感染的20%。本研究旨在评估易感染艾滋病毒的顺性女性在最后性交时使用避孕措施的情况。方法:我们从美国疾病控制与预防中心行为风险因素监测系统的2017年迭代中提取人口统计学、社会经济状况、艾滋病毒风险和生殖健康信息。我们使用调查加权逻辑回归，调整了几个人口统计学因素，比较低风险和高风险HIV感染人群的避孕使用趋势，HIV感染的定义是那些从事交易性行为、使用注射药物或在过去一年中接受过性传播感染治疗的人。结果:HIV感染高危妇女与低危妇女在最后性交时使用避孕药具的差异无统计学意义(P=。262，优势比[OR] 1.11[0.93-1.32])。在那些在最后一次性交中没有采取避孕措施的妇女中，有感染艾滋病毒风险的妇女更有可能对怀孕漠不关心(P=。029, OR 1.79[1.06-3.01])和方法使用失误(P=。0.001, OR 4.55[1.80-11.5])作为不采取避孕措施的原因。此外，艾滋病毒高危人群在最后性交时更有可能使用宫内节育器(类型未知)(P< 0.05)。0.001, OR 1.70[1.28-2.24])，使用激素注射的可能性更低(P=。0.15，或0.47[0.26-0.86])。结论:HIV感染高危妇女在最后性交时使用宫内节育器的可能性较大，提示HIV暴露前预防与计划生育相结合具有重要意义。该人群的避孕方法偏好及对妊娠的态度有待进一步调查。
{"title":"Trends in Contraception Use and Contraception Method Preference at Last Intercourse in Cisgender Women at High Risk for HIV Acquisition [ID: 1373337]","authors":"Sanjana Satish, Alejandro M A Mantero, S. Sonalkar","doi":"10.1097/01.aog.0000929784.36864.2d","DOIUrl":"https://doi.org/10.1097/01.aog.0000929784.36864.2d","url":null,"abstract":"INTRODUCTION: Cisgender women account for almost 20% of new human immunodeficiency virus (HIV) infections in the United States. This study aims to assess contraception use at last intercourse in cisgender women at high risk for HIV acquisition. METHODS: We abstracted demographics, socioeconomic status, HIV risk, and reproductive health information from the 2017 iteration of the Centers for Disease Control and Prevention Behavioral Risk Factor Surveillance System. We used survey-weighted logistic regression adjusted for several demographic factors to compare trends of contraception use between those at low and high risk for HIV acquisition, which was defined as those who have engaged in transactional sex practices, used injection drugs, or been treated for a sexually transmitted infection in the past year. RESULTS: Women at high risk for HIV acquisition had no significant difference in contraception use at last intercourse compared to those at low risk (P=.262, odds ratio [OR] 1.11 [0.93–1.32]). Among those who did not use contraception at last intercourse, women at risk for HIV acquisition were more likely to state indifference toward getting pregnant (P=.029, OR 1.79 [1.06–3.01]) and lapse in method use (P=.001, OR 4.55 [1.80–11.5]) as reasons for not using contraception. Additionally, those at high risk for HIV were more likely to have had an intrauterine device (IUD) (unknown type) at last intercourse (P<.001, OR 1.70 [1.28–2.24]) and less likely to have used hormonal shots (P=.015, OR 0.47 [0.26–0.86]). CONCLUSION: Women at risk for HIV are more likely to have had an IUD at last intercourse, which could indicate a role for the integration of HIV preexposure prophylaxis and family planning. Contraception method preference in this population and attitudes toward pregnancy should be further investigated.","PeriodicalId":19405,"journal":{"name":"Obstetrics & Gynecology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82965399","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-05-01DOI: 10.1097/01.aog.0000930500.55836.e6
J. Greenberg, J. Apuzzio, Zainab Chaudhary, Lisa Gittens‐Williams, Christine Martino, Shauna F. Williams
INTRODUCTION: The Centers for Disease Control and Prevention 2020 Hear Her Campaign educates pregnant women, their support networks, and providers about urgent maternal warning signs, and empowers women to speak up; however, the effectiveness of this campaign is unknown. In 2021, our institution displayed and distributed campaign materials and formally coached patients. We performed a retrospective cohort study to assess the effects of this initiative on prenatal visits and postpartum office and emergency room visits and patient–provider communications in an urban, academic medical center. METHODS: A 3-month period before and after promotion of the Hear Her campaign was studied. Patients who delivered July 1, 2021, to September 30, 2021, were the study group, and patients who delivered July 1, 2019, to September 30, 2019, were the control group. Demographic data, number of prenatal visits, postpartum office and emergency room visits, and patient–provider communications were compared. Mann-Whitney, χ2, and Fisher's exact tests were used for analysis. This study was IRB approved. RESULTS: The study group had 346 patients, and the control, 369. Maternal demographics were similar. Median number of prenatal visits, postpartum follow-up rates, and median number of patients presenting to the emergency department postpartum were similar between the study and control groups, 7 versus 8, 68.2% versus 69.6%, and 57 (16.5%) versus 50 (13.6%), respectively. Patient–provider communications significantly increased, with 11.6% of patients communicating from 1.6% (P<.0001). CONCLUSION: Promotion of the Hear Her Campaign in this inner-city cohort correlated with an increase in maternal interaction with the health care system via patient–provider communication without increasing the use of emergency department services. More studies are needed to evaluate the effect on maternal health outcomes.
{"title":"Implementation of the Hear Her Campaign [ID: 1339546]","authors":"J. Greenberg, J. Apuzzio, Zainab Chaudhary, Lisa Gittens‐Williams, Christine Martino, Shauna F. Williams","doi":"10.1097/01.aog.0000930500.55836.e6","DOIUrl":"https://doi.org/10.1097/01.aog.0000930500.55836.e6","url":null,"abstract":"INTRODUCTION: The Centers for Disease Control and Prevention 2020 Hear Her Campaign educates pregnant women, their support networks, and providers about urgent maternal warning signs, and empowers women to speak up; however, the effectiveness of this campaign is unknown. In 2021, our institution displayed and distributed campaign materials and formally coached patients. We performed a retrospective cohort study to assess the effects of this initiative on prenatal visits and postpartum office and emergency room visits and patient–provider communications in an urban, academic medical center. METHODS: A 3-month period before and after promotion of the Hear Her campaign was studied. Patients who delivered July 1, 2021, to September 30, 2021, were the study group, and patients who delivered July 1, 2019, to September 30, 2019, were the control group. Demographic data, number of prenatal visits, postpartum office and emergency room visits, and patient–provider communications were compared. Mann-Whitney, χ2, and Fisher's exact tests were used for analysis. This study was IRB approved. RESULTS: The study group had 346 patients, and the control, 369. Maternal demographics were similar. Median number of prenatal visits, postpartum follow-up rates, and median number of patients presenting to the emergency department postpartum were similar between the study and control groups, 7 versus 8, 68.2% versus 69.6%, and 57 (16.5%) versus 50 (13.6%), respectively. Patient–provider communications significantly increased, with 11.6% of patients communicating from 1.6% (P<.0001). CONCLUSION: Promotion of the Hear Her Campaign in this inner-city cohort correlated with an increase in maternal interaction with the health care system via patient–provider communication without increasing the use of emergency department services. More studies are needed to evaluate the effect on maternal health outcomes.","PeriodicalId":19405,"journal":{"name":"Obstetrics & Gynecology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90112167","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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