Pub Date : 2025-02-22DOI: 10.1016/j.ajogmf.2025.101656
Afshan B Hameed, Maryam Tarsa, Ashten Waks, Anna Grodzinsky, Karen L Florio, Jenny Chang, Marni B Jacobs, Omotayo I Balogun, Heike Thiel de Bocanegra
Background: Cardiovascular disease (CVD) is the leading cause of maternal mortality in the United States, accounting for one in three pregnancy-related deaths. A standardized CVD Risk Assessment can guide clinicians in identifying patients at risk for CVD.
Objective: The objective of this study was to evaluate whether a standardized CVD risk assessment yields more abnormal findings on follow-up CVD testing among pregnant and postpartum patients compared to assessments based on clinician judgment alone.
Study design: A retrospective chart review was performed across three geographically and ethnically diverse hospital networks that had implemented the CVD Risk Assessment algorithm. The analysis included a total of 31,232 pregnant and postpartum patients who had presented for obstetric care visit from September 2020 to August 2024. We calculated the proportion of patients with abnormal composite brain natriuretic peptide (BNP), electrocardiogram (EKG), and/or echocardiogram test results by risk assessment group, and a two Proportion Z-Test was conducted to compare proportions. We then calculated the odds of having abnormal tests for each risk assessment group.
Results: Standardized CVD risk assessment yielded more abnormal composite test results than clinician judgment alone (6.9% vs. 4.2%; p<.0001). There was a greater proportion of abnormal test results among the risk-positive than the risk-negative group (23.4% vs. 6.6%; P<.0001). Patients assessed for CVD had 1.69 times the odds of having an abnormal test than those tested based on clinician judgment alone (P<.0001). Risk-positive patients had 4.31 times the odds of having an abnormal test than risk-negative patients (P<.0001).
Conclusion: Implementing a standardized CVD Risk Assessment algorithm may enhance the detection of cardiovascular disease in pregnant and postpartum patients with previously unknown CVD or at risk of developing CVD, providing a valuable tool that complements clinician judgment for improved perinatal outcomes.
{"title":"Results of cardiovascular testing among pregnant and postpartum persons undergoing standardized cardiovascular risk assessment.","authors":"Afshan B Hameed, Maryam Tarsa, Ashten Waks, Anna Grodzinsky, Karen L Florio, Jenny Chang, Marni B Jacobs, Omotayo I Balogun, Heike Thiel de Bocanegra","doi":"10.1016/j.ajogmf.2025.101656","DOIUrl":"10.1016/j.ajogmf.2025.101656","url":null,"abstract":"<p><strong>Background: </strong>Cardiovascular disease (CVD) is the leading cause of maternal mortality in the United States, accounting for one in three pregnancy-related deaths. A standardized CVD Risk Assessment can guide clinicians in identifying patients at risk for CVD.</p><p><strong>Objective: </strong>The objective of this study was to evaluate whether a standardized CVD risk assessment yields more abnormal findings on follow-up CVD testing among pregnant and postpartum patients compared to assessments based on clinician judgment alone.</p><p><strong>Study design: </strong>A retrospective chart review was performed across three geographically and ethnically diverse hospital networks that had implemented the CVD Risk Assessment algorithm. The analysis included a total of 31,232 pregnant and postpartum patients who had presented for obstetric care visit from September 2020 to August 2024. We calculated the proportion of patients with abnormal composite brain natriuretic peptide (BNP), electrocardiogram (EKG), and/or echocardiogram test results by risk assessment group, and a two Proportion Z-Test was conducted to compare proportions. We then calculated the odds of having abnormal tests for each risk assessment group.</p><p><strong>Results: </strong>Standardized CVD risk assessment yielded more abnormal composite test results than clinician judgment alone (6.9% vs. 4.2%; p<.0001). There was a greater proportion of abnormal test results among the risk-positive than the risk-negative group (23.4% vs. 6.6%; P<.0001). Patients assessed for CVD had 1.69 times the odds of having an abnormal test than those tested based on clinician judgment alone (P<.0001). Risk-positive patients had 4.31 times the odds of having an abnormal test than risk-negative patients (P<.0001).</p><p><strong>Conclusion: </strong>Implementing a standardized CVD Risk Assessment algorithm may enhance the detection of cardiovascular disease in pregnant and postpartum patients with previously unknown CVD or at risk of developing CVD, providing a valuable tool that complements clinician judgment for improved perinatal outcomes.</p>","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":" ","pages":"101656"},"PeriodicalIF":3.8,"publicationDate":"2025-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143484519","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-21DOI: 10.1016/j.ajogmf.2025.101618
Emily S Miller, Suneet P Chauhan, Karin A Fox, Adam K Lewkowitz, Tracy A Manuck, Molly J Stout, Terri-Ann Bennett, Vincenzo Berghella
{"title":"Delivering insights through new perspectives, mentorship, and academic debate.","authors":"Emily S Miller, Suneet P Chauhan, Karin A Fox, Adam K Lewkowitz, Tracy A Manuck, Molly J Stout, Terri-Ann Bennett, Vincenzo Berghella","doi":"10.1016/j.ajogmf.2025.101618","DOIUrl":"https://doi.org/10.1016/j.ajogmf.2025.101618","url":null,"abstract":"","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":" ","pages":"101618"},"PeriodicalIF":3.8,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143477103","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-20DOI: 10.1016/j.ajogmf.2025.101654
Sally Yang, Wei Zhou, Evdokia Dimitriadis, Ellen Menkhorst
<p><strong>Objective: </strong>Wide-spread endothelial dysfunction is thought to underlie the maternal symptoms of preeclampsia. Endothelial dysfunction is strongly associated with abnormal circulating lipoprotein cholesterol levels. This systematic review aimed to assess whether maternal circulating high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, and very-low-density lipoprotein cholesterol levels were altered before or at the time of preeclampsia diagnosis. This may provide an understanding of the pathogenesis of preeclampsia and the predictive and diagnostic utility of lipoprotein cholesterol levels in distinguishing pregnancies complicated by preeclampsia from normal pregnancies.</p><p><strong>Data sources: </strong>Literature searches were conducted in Ovid MEDLINE, Embase, Cumulative Index of Nursing and Allied Health Literature, and Google Scholar from inception to April 2024 for studies reporting high-density lipoprotein, low-density lipoprotein, and very-low-density lipoprotein levels in normal pregnancies and pregnancies complicated by preeclampsia.</p><p><strong>Study eligibility criteria: </strong>The selected studies included the following: population of pregnant women, exposure to preeclampsia, blood samples collected during a specific trimester of pregnancy, and at least 1 primary outcome (high-density lipoprotein, low-density lipoprotein, or very-low-density lipoprotein). Of note, 2 reviewers were involved in the study selection. The excluded studies included pregnancies complicated by other risk factors for preeclampsia (eg, preexisting hypertension, diabetes mellitus, and obesity) and other pregnancy-related hypertensive disorders (pregnancy-induced hypertension, eclampsia, and hemolysis, elevated liver enzymes, and low platelet count).</p><p><strong>Methods: </strong>The quality of the included studies was evaluated using the Newcastle-Ottawa Scale for case-control, cohort, and cross-sectional studies.</p><p><strong>Results: </strong>A total of 41 studies were included. The quality of the studies was generally good. However, 59% of the studies did not control for the gestational age at which the blood samples were collected. No consistent change in high-density lipoprotein or low-density lipoprotein levels was found before preeclampsia diagnosis in the first, second, or third trimesters of pregnancy. Very-low-density lipoprotein was significantly elevated in 2 of 2 studies that reported levels before preeclampsia diagnosis in the late second (>23 weeks of gestation) or third trimester of pregnancy. After preeclampsia diagnosis in the third trimester of pregnancy, very-low-density lipoprotein levels were significantly elevated in 9 of 11 studies, and high-density lipoprotein levels were significantly decreased in 15 of 19 studies.</p><p><strong>Conclusion: </strong>Very-low-density lipoprotein is highly atherogenic, and its elevation before and at the time of preeclampsia diagnosis suggests a role in t
{"title":"Maternal blood lipoprotein cholesterol prior to and at the time of diagnosis of preeclampsia: a systematic review.","authors":"Sally Yang, Wei Zhou, Evdokia Dimitriadis, Ellen Menkhorst","doi":"10.1016/j.ajogmf.2025.101654","DOIUrl":"10.1016/j.ajogmf.2025.101654","url":null,"abstract":"<p><strong>Objective: </strong>Wide-spread endothelial dysfunction is thought to underlie the maternal symptoms of preeclampsia. Endothelial dysfunction is strongly associated with abnormal circulating lipoprotein cholesterol levels. This systematic review aimed to assess whether maternal circulating high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, and very-low-density lipoprotein cholesterol levels were altered before or at the time of preeclampsia diagnosis. This may provide an understanding of the pathogenesis of preeclampsia and the predictive and diagnostic utility of lipoprotein cholesterol levels in distinguishing pregnancies complicated by preeclampsia from normal pregnancies.</p><p><strong>Data sources: </strong>Literature searches were conducted in Ovid MEDLINE, Embase, Cumulative Index of Nursing and Allied Health Literature, and Google Scholar from inception to April 2024 for studies reporting high-density lipoprotein, low-density lipoprotein, and very-low-density lipoprotein levels in normal pregnancies and pregnancies complicated by preeclampsia.</p><p><strong>Study eligibility criteria: </strong>The selected studies included the following: population of pregnant women, exposure to preeclampsia, blood samples collected during a specific trimester of pregnancy, and at least 1 primary outcome (high-density lipoprotein, low-density lipoprotein, or very-low-density lipoprotein). Of note, 2 reviewers were involved in the study selection. The excluded studies included pregnancies complicated by other risk factors for preeclampsia (eg, preexisting hypertension, diabetes mellitus, and obesity) and other pregnancy-related hypertensive disorders (pregnancy-induced hypertension, eclampsia, and hemolysis, elevated liver enzymes, and low platelet count).</p><p><strong>Methods: </strong>The quality of the included studies was evaluated using the Newcastle-Ottawa Scale for case-control, cohort, and cross-sectional studies.</p><p><strong>Results: </strong>A total of 41 studies were included. The quality of the studies was generally good. However, 59% of the studies did not control for the gestational age at which the blood samples were collected. No consistent change in high-density lipoprotein or low-density lipoprotein levels was found before preeclampsia diagnosis in the first, second, or third trimesters of pregnancy. Very-low-density lipoprotein was significantly elevated in 2 of 2 studies that reported levels before preeclampsia diagnosis in the late second (>23 weeks of gestation) or third trimester of pregnancy. After preeclampsia diagnosis in the third trimester of pregnancy, very-low-density lipoprotein levels were significantly elevated in 9 of 11 studies, and high-density lipoprotein levels were significantly decreased in 15 of 19 studies.</p><p><strong>Conclusion: </strong>Very-low-density lipoprotein is highly atherogenic, and its elevation before and at the time of preeclampsia diagnosis suggests a role in t","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":" ","pages":"101654"},"PeriodicalIF":3.8,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143477104","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-19DOI: 10.1016/j.ajogmf.2025.101642
Emily S Miller, Lisa Mele, Maged M Costantine
{"title":"The association between perinatal depressive symptoms and child neurodevelopment: a response.","authors":"Emily S Miller, Lisa Mele, Maged M Costantine","doi":"10.1016/j.ajogmf.2025.101642","DOIUrl":"10.1016/j.ajogmf.2025.101642","url":null,"abstract":"","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":" ","pages":"101642"},"PeriodicalIF":3.8,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143473068","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-18DOI: 10.1016/j.ajogmf.2025.101650
Nathanael N. Hoskins DO, Elisabeth L. Stark MD, Fabrizio Zullo MD, Moeun Son MD, MSCI, Vincenzo Berghella MD
{"title":"The impact of inpatient nipple stimulation on labor duration: a systematic review and meta-analysis","authors":"Nathanael N. Hoskins DO, Elisabeth L. Stark MD, Fabrizio Zullo MD, Moeun Son MD, MSCI, Vincenzo Berghella MD","doi":"10.1016/j.ajogmf.2025.101650","DOIUrl":"10.1016/j.ajogmf.2025.101650","url":null,"abstract":"","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":"7 4","pages":"Article 101650"},"PeriodicalIF":3.8,"publicationDate":"2025-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143469267","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-18DOI: 10.1016/j.ajogmf.2025.101651
Sara Sereno
{"title":"Obstetrics and gynecology: a beautiful paradox.","authors":"Sara Sereno","doi":"10.1016/j.ajogmf.2025.101651","DOIUrl":"10.1016/j.ajogmf.2025.101651","url":null,"abstract":"","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":" ","pages":"101651"},"PeriodicalIF":3.8,"publicationDate":"2025-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143469335","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-17DOI: 10.1016/j.ajogmf.2025.101633
Ben W Mol
{"title":"Letter to the editor regarding \"Propranolol to decrease time to delivery: a meta-analysis of randomized controlled trials\".","authors":"Ben W Mol","doi":"10.1016/j.ajogmf.2025.101633","DOIUrl":"10.1016/j.ajogmf.2025.101633","url":null,"abstract":"","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":" ","pages":"101633"},"PeriodicalIF":3.8,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143459936","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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