Pub Date : 2024-10-05DOI: 10.1016/j.ajogmf.2024.101516
Sarah B. Bergbower DCLS , Antonio F. Saad MD , Natalie M. Williams-Bouyer PhD , Rajkumar Rajendran DCLS
<div><h3>BACKGROUND</h3><div>Asymptomatic bacteriuria affects 2% to 15% of pregnant women, with 20% to 40% developing symptoms later. Symptomatic urinary tract infections are more common in pregnancy, with a prevalence of 33%, posing risks, such as preterm delivery, low birthweight, and maternal pyelonephritis. The gold standard for urinary tract infection detection is a urine culture, but point-of-care urinalysis dipsticks are frequently performed as screens during regular obstetrical visits. Leukocyte esterase has been used to justify the treatment of asymptomatic bacteriuria, even with low sensitivity and specificity. Confirmatory tests are crucial for avoiding false positives and ensuring optimal outcomes. Current guidelines for urinalysis dipstick interpretation and the decision to treat asymptomatic bacteriuria in pregnancy are limited. It remains unclear whether an evidence-based algorithm can improve test utilization, diagnosis, and treatment decisions for asymptomatic bacteriuria in pregnancy.</div></div><div><h3>OBJECTIVE</h3><div>The primary objective of our study was to develop, implement, and evaluate an evidence-based algorithm to guide urinalysis interpretation, culture, diagnosis, and antibiotic stewardship of asymptomatic bacteriuria in pregnant patients during routine obstetric visits.</div></div><div><h3>STUDY DESIGN</h3><div>The project involves both retrospective and quasi-experimental prospective medical record reviews of pregnant patients aged ≥18 years, beyond 20 weeks of gestation, from routine obstetrical visits with urinalysis dipstick tests. A doctorate in clinical laboratory sciences student developed an educational algorithm to guide urinalysis dipstick interpretation, culturing necessity, and treatment decisions based on evidence-based practice. Our study considered patient records from February 1, 2022, to February 28, 2022, as retrospective (prealgorithm implementation) data and January 24, 2023, to February 22, 2023, as prospective (postalgorithm implementation) data. Data collected from the electronic medical record included deidentified patient information, urinalysis results, culture dates and outcomes, antibiotic prescriptions, urinary tract infection or asymptomatic bacteriuria diagnoses, provider details, adverse pregnancy outcomes, and demographics. Data analysis using SPSS (version 29; SPSS IBM, Armonk, NY) involved chi-square tests, likelihood ratios, and effect size calculations, with <em>P</em> values of <.05 considered statistically significant.</div></div><div><h3>RESULTS</h3><div>This study examined a total of 1176 patient records. Preimplementation data included 440 records, of which 224 were abnormal urinalyses and 216 were normal urinalyses. Postimplementation data included 736 records, of which 255 were abnormal urinalyses and 481 were normal urinalysis. The patient demographics predominantly featured White individuals (87%), with a median maternal age of 27 years and a gestational age of 32
{"title":"Implementation of an algorithm for testing, diagnosis, and antibiotic stewardship of asymptomatic bacteriuria in pregnancy","authors":"Sarah B. Bergbower DCLS , Antonio F. Saad MD , Natalie M. Williams-Bouyer PhD , Rajkumar Rajendran DCLS","doi":"10.1016/j.ajogmf.2024.101516","DOIUrl":"10.1016/j.ajogmf.2024.101516","url":null,"abstract":"<div><h3>BACKGROUND</h3><div>Asymptomatic bacteriuria affects 2% to 15% of pregnant women, with 20% to 40% developing symptoms later. Symptomatic urinary tract infections are more common in pregnancy, with a prevalence of 33%, posing risks, such as preterm delivery, low birthweight, and maternal pyelonephritis. The gold standard for urinary tract infection detection is a urine culture, but point-of-care urinalysis dipsticks are frequently performed as screens during regular obstetrical visits. Leukocyte esterase has been used to justify the treatment of asymptomatic bacteriuria, even with low sensitivity and specificity. Confirmatory tests are crucial for avoiding false positives and ensuring optimal outcomes. Current guidelines for urinalysis dipstick interpretation and the decision to treat asymptomatic bacteriuria in pregnancy are limited. It remains unclear whether an evidence-based algorithm can improve test utilization, diagnosis, and treatment decisions for asymptomatic bacteriuria in pregnancy.</div></div><div><h3>OBJECTIVE</h3><div>The primary objective of our study was to develop, implement, and evaluate an evidence-based algorithm to guide urinalysis interpretation, culture, diagnosis, and antibiotic stewardship of asymptomatic bacteriuria in pregnant patients during routine obstetric visits.</div></div><div><h3>STUDY DESIGN</h3><div>The project involves both retrospective and quasi-experimental prospective medical record reviews of pregnant patients aged ≥18 years, beyond 20 weeks of gestation, from routine obstetrical visits with urinalysis dipstick tests. A doctorate in clinical laboratory sciences student developed an educational algorithm to guide urinalysis dipstick interpretation, culturing necessity, and treatment decisions based on evidence-based practice. Our study considered patient records from February 1, 2022, to February 28, 2022, as retrospective (prealgorithm implementation) data and January 24, 2023, to February 22, 2023, as prospective (postalgorithm implementation) data. Data collected from the electronic medical record included deidentified patient information, urinalysis results, culture dates and outcomes, antibiotic prescriptions, urinary tract infection or asymptomatic bacteriuria diagnoses, provider details, adverse pregnancy outcomes, and demographics. Data analysis using SPSS (version 29; SPSS IBM, Armonk, NY) involved chi-square tests, likelihood ratios, and effect size calculations, with <em>P</em> values of <.05 considered statistically significant.</div></div><div><h3>RESULTS</h3><div>This study examined a total of 1176 patient records. Preimplementation data included 440 records, of which 224 were abnormal urinalyses and 216 were normal urinalyses. Postimplementation data included 736 records, of which 255 were abnormal urinalyses and 481 were normal urinalysis. The patient demographics predominantly featured White individuals (87%), with a median maternal age of 27 years and a gestational age of 32 ","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":"6 11","pages":"Article 101516"},"PeriodicalIF":3.8,"publicationDate":"2024-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142393963","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 : 2024-10-05DOI: 10.1016/j.ajogmf.2024.101503
Francesco D'Antonio, Delia Marinceu, Nashwa Eltaweel, Smriti Prasad, Asma Khalil
<p><strong>Objectives: </strong>Twin-to-twin transfusion syndrome (TTTS) is associated with excess perinatal mortality and morbidity. Even though Quintero staging is commonly used to assess its severity, the limitations of its prognostic value have been highlighted by researchers over the years. Recent literature indicates that fetal survival, whether for both twins or at least one, following fetoscopic laser photocoagulation of the placental anastomoses is similar in TTTS Quintero stages I and II (combined) and III and IV (combined). In this context we perform a systematic review and meta-analysis of the published literature to elucidate the survival rate of twins according to the stage of TTTS and to compare the survival rates in pregnancies complicated by stage I and II (combined) vs those with stages III and IV (combined).</p><p><strong>Data sources: </strong>Medline, Embase and Cochrane databases were searched.</p><p><strong>Study eligibility criteria: </strong>The inclusion criteria were studies reporting the outcome of MCDA twin pregnancies with TTTS undergoing laser therapy according to the Quintero stage of the disease. The primary outcome was double survival at birth. The secondary outcomes were no survival, and survival of at least one twin. All the explored outcomes were reported according to the Quintero staging system. Furthermore, we aimed to compare all the observed outcomes in pregnancies complicated by TTTS affected by stage I and II vs those with stages III and IV.</p><p><strong>Study appraisal and synthesis methods: </strong>Random-effect meta-analyses were used to combine data, and the results reported as pooled proportions or odd ratios (OR) with their 95% confidence intervals (CI).</p><p><strong>Results: </strong>26 studies were included. Survival of both fetuses was observed in 72.9% (95% CI 68.2-77.3) of pregnancies complicated by stage I, 67.9% (95% CI 62.3-73.3) with stage II, 48.1% (95% CI 42.5-53.8) with stage III, and 53.4% (95% CI 42.5-64.3) with stage IV TTTS (Table 3). At least one survivor was reported in 89.4% (95% CI 86.9-91.9) of cases with stage I, 87.1% (95% CI 82.9-90.7) with stage II, 77.3% (95% CI 71.7-82.5) with stage III, and 80.1% (95% CI 69.4-89.0) with stage 4. The corresponding figures for no survivors were 10.7% (95% CI 7.7-14.0), 11.4% (95% CI 7.8-15.6), 20.4% (95% CI 15.6-25.8), and 16.7% (95% CI 8.3-27.2), respectively. When comparing the different outcomes according to the different TTTS stages, there was no significant difference in the incidence of double survival (p=0.933), at least one survivor (p=0.688), and no survivors (p=0.866) between stages I and II TTTS. There was also no significant difference in the incidence of double survival (p=0.201), at least one survivor (p=0.380), and no survivors (p=0.947) between stages III and IV. Conversely, when comparing the outcome of pregnancies with stage I/II (combined) vs stages III/IV (combined), the incidence of double survival was significantly
目的：双胎输血综合征（TTTS）与围产期死亡率和发病率过高有关。尽管昆特罗分期常用于评估其严重程度，但多年来研究人员一直在强调其预后价值的局限性。最近的文献表明，胎儿镜激光光凝胎盘吻合口后，无论是双胎还是至少一胎，TTTS 昆特罗分期 I、II（合并）和 III、IV（合并）的胎儿存活率相似。在此背景下，我们对已发表的文献进行了系统回顾和荟萃分析，以根据 TTTS 的分期阐明双胞胎的存活率，并比较 I 期和 II 期（合并）与 III 期和 IV 期（合并）并发症妊娠的存活率：研究资格标准：纳入标准为根据昆特罗疾病分期对接受激光治疗的 MCDA 双胎 TTTS 结果进行报告的研究。主要结果是出生时双胎存活。次要结果是无存活和至少有一个双胞胎存活。所有探讨的结果均根据昆特罗分期系统进行报告。此外，我们还旨在比较I期和II期TTTS并发妊娠与III期和IV期TTTS并发妊娠的所有观察结果：结果：共纳入 26 项研究。在 I 期并发 TTTS 的孕妇中，72.9%（95% CI 68.2-77.3）、II 期 67.9%（95% CI 62.3-73.3）、III 期 48.1%（95% CI 42.5-53.8）、IV 期 53.4%（95% CI 42.5-64.3）的胎儿存活（表 3）。89.4% (95% CI 86.9-91.9)的 I 期病例、87.1% (95% CI 82.9-90.7)的 II 期病例、77.3% (95% CI 71.7-82.5)的 III 期病例和 80.1% (95% CI 69.4-89.0)的 4 期病例至少有一名幸存者。无幸存者的相应数字分别为10.7%（95% CI 7.7-14.0）、11.4%（95% CI 7.8-15.6）、20.4%（95% CI 15.6-25.8）和16.7%（95% CI 8.3-27.2）。在比较不同 TTTS 分期的不同结果时，I 期和 II 期 TTTS 的双胎存活率（P=0.933）、至少一胎存活率（P=0.688）和无一胎存活率（P=0.866）均无显著差异。在 III 期和 IV 期之间，双胎存活率（p=0.201）、至少一名存活者（p=0.380）和无存活者（p=0.947）的发生率也无明显差异。相反，在比较Ⅰ/Ⅱ期（合并）与Ⅲ/Ⅳ期（合并）妊娠的结局时，Ⅰ/Ⅱ期妊娠的双胎存活率明显更高（OR 2.19；95% CI 1.9-2.6，p）：并发 TTTS 并接受胎儿镜激光凝固胎盘吻合术治疗的 MCDA 双胎妊娠的围产期存活率在 I 期和 II 期、III 期和 IV 期之间没有明显差异，只是 III 期比 IV 期有更高的单胎存活率。本系统综述的研究结果将有助于对并发 TTTS 的双胎妊娠进行个体化风险评估，并为父母提供量身定制的咨询服务。该研究还强调，有必要开展研究，以更好地确定TTTS并发症孕妇的产前死亡风险因素：TTTS并发的MCDA双胎妊娠在接受胎儿镜激光凝固胎盘吻合术治疗后，其围产期存活率在I期和II期、III期和IV期之间没有显著差异。
{"title":"Survival rates in pregnancies complicated by twin-to-twin transfusion syndrome undergoing laser therapy: a systematic review and meta-analysis: Survival rates in twin-to-twin transfusion syndrome.","authors":"Francesco D'Antonio, Delia Marinceu, Nashwa Eltaweel, Smriti Prasad, Asma Khalil","doi":"10.1016/j.ajogmf.2024.101503","DOIUrl":"https://doi.org/10.1016/j.ajogmf.2024.101503","url":null,"abstract":"<p><strong>Objectives: </strong>Twin-to-twin transfusion syndrome (TTTS) is associated with excess perinatal mortality and morbidity. Even though Quintero staging is commonly used to assess its severity, the limitations of its prognostic value have been highlighted by researchers over the years. Recent literature indicates that fetal survival, whether for both twins or at least one, following fetoscopic laser photocoagulation of the placental anastomoses is similar in TTTS Quintero stages I and II (combined) and III and IV (combined). In this context we perform a systematic review and meta-analysis of the published literature to elucidate the survival rate of twins according to the stage of TTTS and to compare the survival rates in pregnancies complicated by stage I and II (combined) vs those with stages III and IV (combined).</p><p><strong>Data sources: </strong>Medline, Embase and Cochrane databases were searched.</p><p><strong>Study eligibility criteria: </strong>The inclusion criteria were studies reporting the outcome of MCDA twin pregnancies with TTTS undergoing laser therapy according to the Quintero stage of the disease. The primary outcome was double survival at birth. The secondary outcomes were no survival, and survival of at least one twin. All the explored outcomes were reported according to the Quintero staging system. Furthermore, we aimed to compare all the observed outcomes in pregnancies complicated by TTTS affected by stage I and II vs those with stages III and IV.</p><p><strong>Study appraisal and synthesis methods: </strong>Random-effect meta-analyses were used to combine data, and the results reported as pooled proportions or odd ratios (OR) with their 95% confidence intervals (CI).</p><p><strong>Results: </strong>26 studies were included. Survival of both fetuses was observed in 72.9% (95% CI 68.2-77.3) of pregnancies complicated by stage I, 67.9% (95% CI 62.3-73.3) with stage II, 48.1% (95% CI 42.5-53.8) with stage III, and 53.4% (95% CI 42.5-64.3) with stage IV TTTS (Table 3). At least one survivor was reported in 89.4% (95% CI 86.9-91.9) of cases with stage I, 87.1% (95% CI 82.9-90.7) with stage II, 77.3% (95% CI 71.7-82.5) with stage III, and 80.1% (95% CI 69.4-89.0) with stage 4. The corresponding figures for no survivors were 10.7% (95% CI 7.7-14.0), 11.4% (95% CI 7.8-15.6), 20.4% (95% CI 15.6-25.8), and 16.7% (95% CI 8.3-27.2), respectively. When comparing the different outcomes according to the different TTTS stages, there was no significant difference in the incidence of double survival (p=0.933), at least one survivor (p=0.688), and no survivors (p=0.866) between stages I and II TTTS. There was also no significant difference in the incidence of double survival (p=0.201), at least one survivor (p=0.380), and no survivors (p=0.947) between stages III and IV. Conversely, when comparing the outcome of pregnancies with stage I/II (combined) vs stages III/IV (combined), the incidence of double survival was significantly","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":" ","pages":"101503"},"PeriodicalIF":3.8,"publicationDate":"2024-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142393965","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 : 2024-10-05DOI: 10.1016/j.ajogmf.2024.101523
Kavita Vani MD, Cien Huang BA, Jessica Hecht BA, Matthew R. Lootens PhD, Chavi Eve Karkowksy MD, Kevin Fiori MD, MPH, MS, Edith Gurewitsch Allen MD, MBA, MEd, David W. Lounsbury PhD
{"title":"Implementing a specialized fourth trimester clinic pilot for high-risk individuals","authors":"Kavita Vani MD, Cien Huang BA, Jessica Hecht BA, Matthew R. Lootens PhD, Chavi Eve Karkowksy MD, Kevin Fiori MD, MPH, MS, Edith Gurewitsch Allen MD, MBA, MEd, David W. Lounsbury PhD","doi":"10.1016/j.ajogmf.2024.101523","DOIUrl":"10.1016/j.ajogmf.2024.101523","url":null,"abstract":"","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":"6 12","pages":"Article 101523"},"PeriodicalIF":3.8,"publicationDate":"2024-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142393964","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 : 2024-10-05DOI: 10.1016/j.ajogmf.2024.101519
Densearn Seo , Rashvinder Kaur , Meghna Prasannan Ponganam , Kah Wai Sam , Maclean Hill , Miranda Davies-Tuck , Ritesh Rikain Warty , Vinayak Smith , Thiam Chye Tan , Deborah Fox , Kirsten R Palmer
Objectives
Induction of labor is commonly undertaken when ongoing pregnancy poses a risk to either the mother or fetus. Often cervical preparation is required with mechanical methods increasingly popular due to their improved safety. This study evaluates the efficacy, safety, and acceptability of digital versus speculum-based balloon insertion for cervical preparation, aiming to identify gaps and inform future research.
Data source
PubMed, Ovid MEDLINE, EMBASE, and Scopus were searched from database inception until 30 June 2023.
Study eligibility criteria
Included studies were randomized controlled trials comparing digital versus speculum-based insertion of catheter-related balloons for labor induction in individuals with viable singleton pregnancies, in both inpatient and outpatient settings, written in English. Exclusions included studies not using cervical balloons, comparisons to nonballoon methods, nonhuman studies, and nonprimary literature like guidelines, reviews, commentaries, and opinion pieces.
Methods
Title and abstract screening were performed by 4 authors. Full-text articles were assessed against inclusion criteria. Selection was agreed upon by consensus among 3 authors, with a fourth consulted for disputes. The risk of bias was assessed using the Cochrane Risk of Bias Tool 2.0 for randomized trials. A meta-analysis was also performed.
Results
Out of 3397 studies, 4 met the inclusion criteria, all being randomized controlled trials with some concerns in at least one domain but no high risk of bias. Two studies found digital insertion significantly less painful than speculum-based insertion (P<.001), while one reported no difference (P=.72). Maternal satisfaction was comparable, with one study favoring digital insertion (P=.011). Meta-analysis findings for other outcome measures suggest no difference between speculum or digital insertion. However, due to substantial heterogeneity, findings for procedural time, time from induction to delivery, and epidural rate should be cautiously interpreted.
Conclusions
Digital insertion for cervical preparation appears associated with reduced pain and higher patient acceptability compared to speculum-based insertion. Additionally, efficacy and safety were comparable, indicating it is a preferable option for clinical use. There was no difference in other procedural, obstetric, or neonatal outcomes, however, more rigorous research employing standardized outcome measures is needed to facilitate a clinically meaningful interpretation.
目的：当持续妊娠对母亲或胎儿造成风险时，通常会进行引产。通常需要进行宫颈准备，机械方法因其更高的安全性而越来越受欢迎。本研究评估了数字式宫颈准备与窥器式宫颈球囊插入的有效性、安全性和可接受性，旨在找出差距并为未来研究提供参考：研究资格标准：纳入的研究均为在住院和门诊环境中，用英语撰写的随机对照试验，比较了数字导管相关球囊与窥器插入导管相关球囊引产术在单胎存活妊娠患者中的应用。排除范围包括未使用宫颈球囊的研究、与非球囊方法的比较、非人类研究以及非主要文献，如指南、综述、评论和观点文章：由四位作者对标题和摘要进行筛选。根据纳入标准对全文进行评估。三位作者一致同意入选，如有争议可咨询第四位作者。采用 Cochrane Risk of Bias Tool 2.0 评估随机试验的偏倚风险。此外还进行了一项荟萃分析：在 3397 项研究中，有四项符合纳入标准，它们都是随机对照试验，至少在一个领域存在一些问题，但没有高偏倚风险。两项研究发现，数字插入法的疼痛明显低于窥阴器插入法（pConclusions：与使用窥阴器插入宫颈相比，数字化插入宫颈准备术可减少疼痛，患者的接受度也更高。此外，其疗效和安全性也相当，这表明它是临床使用的一种可取选择。在其他程序、产科或新生儿结果方面没有差异，但需要采用标准化的结果测量方法进行更严格的研究，以便做出有临床意义的解释。
{"title":"Digital versus speculum-based balloon catheter insertion for labor induction: a systematic review and meta-analysis","authors":"Densearn Seo , Rashvinder Kaur , Meghna Prasannan Ponganam , Kah Wai Sam , Maclean Hill , Miranda Davies-Tuck , Ritesh Rikain Warty , Vinayak Smith , Thiam Chye Tan , Deborah Fox , Kirsten R Palmer","doi":"10.1016/j.ajogmf.2024.101519","DOIUrl":"10.1016/j.ajogmf.2024.101519","url":null,"abstract":"<div><h3>Objectives</h3><div>Induction of labor is commonly undertaken when ongoing pregnancy poses a risk to either the mother or fetus. Often cervical preparation is required with mechanical methods increasingly popular due to their improved safety. This study evaluates the efficacy, safety, and acceptability of digital versus speculum-based balloon insertion for cervical preparation, aiming to identify gaps and inform future research.</div></div><div><h3>Data source</h3><div>PubMed, Ovid MEDLINE, EMBASE, and Scopus were searched from database inception until 30 June 2023.</div></div><div><h3>Study eligibility criteria</h3><div>Included studies were randomized controlled trials comparing digital versus speculum-based insertion of catheter-related balloons for labor induction in individuals with viable singleton pregnancies, in both inpatient and outpatient settings, written in English. Exclusions included studies not using cervical balloons, comparisons to nonballoon methods, nonhuman studies, and nonprimary literature like guidelines, reviews, commentaries, and opinion pieces.</div></div><div><h3>Methods</h3><div>Title and abstract screening were performed by 4 authors. Full-text articles were assessed against inclusion criteria. Selection was agreed upon by consensus among 3 authors, with a fourth consulted for disputes. The risk of bias was assessed using the Cochrane Risk of Bias Tool 2.0 for randomized trials. A meta-analysis was also performed.</div></div><div><h3>Results</h3><div>Out of 3397 studies, 4 met the inclusion criteria, all being randomized controlled trials with some concerns in at least one domain but no high risk of bias. Two studies found digital insertion significantly less painful than speculum-based insertion (<em>P</em><.001), while one reported no difference (<em>P</em>=.72). Maternal satisfaction was comparable, with one study favoring digital insertion (<em>P</em>=.011). Meta-analysis findings for other outcome measures suggest no difference between speculum or digital insertion. However, due to substantial heterogeneity, findings for procedural time, time from induction to delivery, and epidural rate should be cautiously interpreted.</div></div><div><h3>Conclusions</h3><div>Digital insertion for cervical preparation appears associated with reduced pain and higher patient acceptability compared to speculum-based insertion. Additionally, efficacy and safety were comparable, indicating it is a preferable option for clinical use. There was no difference in other procedural, obstetric, or neonatal outcomes, however, more rigorous research employing standardized outcome measures is needed to facilitate a clinically meaningful interpretation.</div></div>","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":"6 12","pages":"Article 101519"},"PeriodicalIF":3.8,"publicationDate":"2024-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142393959","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-05DOI: 10.1016/j.ajogmf.2024.101509
Frank I. Jackson DO, Nathan A. Keller MD, Insaf Kouba MD, Alexis Palmer BA, Sarika Arora BA, Jolene Muscat MD, Luis A. Bracero MD, Matthew J. Blitz MD, MBA
{"title":"Complications associated with oral glucose testing in pregnant patients with prior bariatric surgery","authors":"Frank I. Jackson DO, Nathan A. Keller MD, Insaf Kouba MD, Alexis Palmer BA, Sarika Arora BA, Jolene Muscat MD, Luis A. Bracero MD, Matthew J. Blitz MD, MBA","doi":"10.1016/j.ajogmf.2024.101509","DOIUrl":"10.1016/j.ajogmf.2024.101509","url":null,"abstract":"","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":"6 12","pages":"Article 101509"},"PeriodicalIF":3.8,"publicationDate":"2024-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142393958","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 : 2024-10-01DOI: 10.1016/j.ajogmf.2024.101478
Kate Mills MPH , Annie R.A. McDougall PhD , Annie Tan MPH , Maureen Makama PhD , Phi-Yen Nguyen MPH , Elizabeth Armari MBBS, DRANZCOG , Zoe Bradfield PhD , Roxanne Hastie PhD , Anne Ammerdorffer PhD , A. Metin Gülmezoglu PhD , Joshua P. Vogel PhD
OBJECTIVE
This systematic review evaluated the available evidence on the effects of proton pump inhibitors during pregnancy on preeclampsia and related maternal, fetal, and neonatal outcomes.
DATA SOURCES
Five electronic databases (MEDLINE, Embase, CINAHL, Cochrane Central Register of Controlled Trials, and Global Medicus Index) were searched on November 17, 2023.
STUDY ELIGIBILITY CRITERIA
Randomized controlled trials of pregnant women who used any class or dose of proton pump inhibitor were eligible.
METHODS
A meta-analysis was conducted for all outcomes of interest using random-effects models. Results were presented as risk ratios or mean difference. Quality assessment was performed using the Risk of Bias 2 tool, and Grading of Recommendations, Assessment, Development, and Evaluations assessment was completed to evaluate the certainty of the evidence. The study was registered in the International Prospective Register of Systematic Reviews under identifier CRD42023423673.
RESULTS
Our search identified 3879 records that were screened independently by 2 authors. Nine reports (describing 8 trials) met our eligibility criteria, however, 6 trials were ultimately excluded from our analysis because women were only given proton pump inhibitors immediately before cesarean delivery for acid aspiration prevention. The 2 trials that were included in the meta-analysis evaluated the treatment of 177 women with diagnosed preeclampsia. For the primary outcomes, moderate-certainty evidence showed that the use of proton pump inhibitors likely has no effect on the risk for hemolysis, elevated liver enzymes, and low platelet count syndrome (risk ratio, 1.21; 95% confidence interval, 0.37–3.99; I²=0%) or perinatal mortality (risk ratio, 0.81; 95% confidence interval, 0.36–1.79; I²=0%), and there were insufficient data to conduct a meta-analysis on all other primary outcomes, including eclampsia and neonatal mortality. No trials investigated the use of proton pump inhibitors for the prevention of preeclampsia.
CONCLUSION
Given the limited outcome data, we are uncertain about the effect of proton pump inhibitors on women with preeclampsia. Further trials are required to determine what (if any) effects proton pump inhibitors might have for preeclampsia prevention or treatment.
目的：这是一篇系统性综述：本系统综述评估了孕期服用 PPIs 对子痫前期及相关孕产妇、胎儿和新生儿结局影响的现有证据：数据来源：2023 年 11 月 17 日检索了五个电子数据库（MEDLINE、Embase、CINAHL、Cochrane CENTRAL 和 Global Medicus Index）：研究评估和综合方法：采用随机效应模型对所有相关结果进行 Meta 分析。结果以风险比或平均差表示。使用 "偏倚风险2 "工具进行了质量评估，并完成了 "建议、评估、发展和评价分级"（GRADE）评估，以评价证据的确定性。该研究已在 PROSPERO（CRD42023423673）上注册：结果：我们的检索发现了 3,879 条记录，这些记录由两位作者独立筛选。有九份报告（描述了八项试验）符合我们的资格标准，但最终有六项试验被排除在我们的分析之外，因为妇女仅在剖腹产前立即服用 PPIs 以预防酸吸入。纳入荟萃分析的两项试验评估了 177 名确诊子痫前期妇女的治疗情况。在主要结果方面，中度确定性证据显示，使用 PPIs 对 HELLP 综合征（RR 1.21，95% CI 0.37 - 3.99，I² = 0%）或围产期死亡率（RR 0.81，95% CI 0.36 - 1.79，I² = 0%）的风险可能没有影响，而对所有其他主要结果（包括子痫和新生儿死亡率）进行荟萃分析的数据不足。没有试验研究了预防子痫前期的PPIs：鉴于结果数据有限，我们无法确定PPIs对子痫前期妇女的影响。需要进行更多试验，以确定 PPIs 对子痫前期的预防或治疗有哪些影响（如果有的话）。
{"title":"The effects of proton pump inhibitors during pregnancy on treatment of preeclampsia and related outcomes: a systematic review and meta-analysis","authors":"Kate Mills MPH , Annie R.A. McDougall PhD , Annie Tan MPH , Maureen Makama PhD , Phi-Yen Nguyen MPH , Elizabeth Armari MBBS, DRANZCOG , Zoe Bradfield PhD , Roxanne Hastie PhD , Anne Ammerdorffer PhD , A. Metin Gülmezoglu PhD , Joshua P. Vogel PhD","doi":"10.1016/j.ajogmf.2024.101478","DOIUrl":"10.1016/j.ajogmf.2024.101478","url":null,"abstract":"<div><h3>OBJECTIVE</h3><div>This systematic review evaluated the available evidence on the effects of proton pump inhibitors during pregnancy on preeclampsia and related maternal, fetal, and neonatal outcomes.</div></div><div><h3>DATA SOURCES</h3><div>Five electronic databases (MEDLINE, Embase, CINAHL, Cochrane Central Register of Controlled Trials, and Global Medicus Index) were searched on November 17, 2023.</div></div><div><h3>STUDY ELIGIBILITY CRITERIA</h3><div>Randomized controlled trials of pregnant women who used any class or dose of proton pump inhibitor were eligible.</div></div><div><h3>METHODS</h3><div>A meta-analysis was conducted for all outcomes of interest using random-effects models. Results were presented as risk ratios or mean difference. Quality assessment was performed using the Risk of Bias 2 tool, and Grading of Recommendations, Assessment, Development, and Evaluations assessment was completed to evaluate the certainty of the evidence. The study was registered in the International Prospective Register of Systematic Reviews under identifier CRD42023423673.</div></div><div><h3>RESULTS</h3><div>Our search identified 3879 records that were screened independently by 2 authors. Nine reports (describing 8 trials) met our eligibility criteria, however, 6 trials were ultimately excluded from our analysis because women were only given proton pump inhibitors immediately before cesarean delivery for acid aspiration prevention. The 2 trials that were included in the meta-analysis evaluated the treatment of 177 women with diagnosed preeclampsia. For the primary outcomes, moderate-certainty evidence showed that the use of proton pump inhibitors likely has no effect on the risk for hemolysis, elevated liver enzymes, and low platelet count syndrome (risk ratio, 1.21; 95% confidence interval, 0.37–3.99; I²=0%) or perinatal mortality (risk ratio, 0.81; 95% confidence interval, 0.36–1.79; I²=0%), and there were insufficient data to conduct a meta-analysis on all other primary outcomes, including eclampsia and neonatal mortality. No trials investigated the use of proton pump inhibitors for the prevention of preeclampsia.</div></div><div><h3>CONCLUSION</h3><div>Given the limited outcome data, we are uncertain about the effect of proton pump inhibitors on women with preeclampsia. Further trials are required to determine what (if any) effects proton pump inhibitors might have for preeclampsia prevention or treatment.</div></div>","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":"6 10","pages":"Article 101478"},"PeriodicalIF":3.8,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142120787","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
<div><h3>OBJECTIVE</h3><div>The aim of this systematic review and meta-analysis was to assess the rate of genomic abnormalities detected in pregnancies with apparently isolated hydramnios and to explore the role of confirmed fetal phenotype.</div></div><div><h3>DATA SOURCES</h3><div>The PubMed, Cochrane Library, Google Scholar, and Scopus databases were searched up to May 4, 2024.</div></div><div><h3>STUDY ELIGIBILITY CRITERIA</h3><div>Observational studies that were published after the year 2000, written in a European language, and that reported the genomic outcomes of pregnancies complicated by prenatally diagnosed isolated polyhydramnios were included in this meta-analysis.</div></div><div><h3>METHODS</h3><div>The main outcome was the incidence of genomic abnormalities, defined as chromosomal numerical or structural anomalies or monogenic syndromes, that were diagnosed prenatally or postnatally in neonates from pregnancies complicated by isolated polyhydramnios. Additional outcomes included the incidence of chromosomal abnormalities, including both numerical and structural aberrations of the chromosomes (detected by karyotype or chromosomal microarray), monogenic abnormalities (detected by next-generation sequencing or clinical genetic examination after the result of a normal karyotype or chromosomal microarray), genetic syndromes in general (diagnosed clinically with or without genetic confirmation), and structural abnormalities detected postnatally. Pooled proportions were calculated for each outcome.</div></div><div><h3>RESULTS</h3><div>A total of 12 studies (2561 pregnancies complicated by isolated hydramnios) were included in the meta-analysis. The pooled prevalence of genomic anomalies in fetuses with apparently isolated polyhydramnios (12 studies, 2634 fetuses) was 4.5% (95% confidence interval, 2.6–7.6). The pooled prevalence of chromosomal abnormalities (11 studies, 2427 fetuses) was 2.1% (95% confidence interval, 1.1–3.7). The proportion of major structural defects detected postnatally (9 studies, 1731 fetuses) was 2.9% (95% confidence interval, 1.5–5.4); in this particular subgroup (4 studies, 14 fetuses), the pooled prevalence of genomic anomalies was 29.8% (95% confidence interval, 11.3–58.6). A meta-regression analysis indicated that the rate of genomic anomalies was positively associated with the severity of hydramnios. In addition, the pooled rate of monogenic anomalies was 5.6% (95% confidence interval, 2–5; I<sup>2</sup>=58%) in the 2 studies that used next-generation sequencing for genomic diagnosis.</div></div><div><h3>CONCLUSION</h3><div>This meta-analysis showed that the rate of genomic anomalies in apparently isolated polyhydramnios is 4.5%; approximately half of them are chromosomal abnormalities and the other half are nonchromosomal genomic anomalies. From a clinical standpoint, chromosomal microarray analysis and possibly next-generation sequencing could be considered even in cases of apparently isolated polyhydramnio
{"title":"Genomic abnormalities in apparently isolated polyhydramnios and the role of confirmed fetal phenotype: a systematic review and meta-analysis","authors":"Evangelia Tsakmaki MD, MSc , Athina Ververi MD, PhD , Christos Chatzakis MD, PhD , Paolo Cavoretto MD, PhD , Alexandros Sotiriadis MD, PhD","doi":"10.1016/j.ajogmf.2024.101469","DOIUrl":"10.1016/j.ajogmf.2024.101469","url":null,"abstract":"<div><h3>OBJECTIVE</h3><div>The aim of this systematic review and meta-analysis was to assess the rate of genomic abnormalities detected in pregnancies with apparently isolated hydramnios and to explore the role of confirmed fetal phenotype.</div></div><div><h3>DATA SOURCES</h3><div>The PubMed, Cochrane Library, Google Scholar, and Scopus databases were searched up to May 4, 2024.</div></div><div><h3>STUDY ELIGIBILITY CRITERIA</h3><div>Observational studies that were published after the year 2000, written in a European language, and that reported the genomic outcomes of pregnancies complicated by prenatally diagnosed isolated polyhydramnios were included in this meta-analysis.</div></div><div><h3>METHODS</h3><div>The main outcome was the incidence of genomic abnormalities, defined as chromosomal numerical or structural anomalies or monogenic syndromes, that were diagnosed prenatally or postnatally in neonates from pregnancies complicated by isolated polyhydramnios. Additional outcomes included the incidence of chromosomal abnormalities, including both numerical and structural aberrations of the chromosomes (detected by karyotype or chromosomal microarray), monogenic abnormalities (detected by next-generation sequencing or clinical genetic examination after the result of a normal karyotype or chromosomal microarray), genetic syndromes in general (diagnosed clinically with or without genetic confirmation), and structural abnormalities detected postnatally. Pooled proportions were calculated for each outcome.</div></div><div><h3>RESULTS</h3><div>A total of 12 studies (2561 pregnancies complicated by isolated hydramnios) were included in the meta-analysis. The pooled prevalence of genomic anomalies in fetuses with apparently isolated polyhydramnios (12 studies, 2634 fetuses) was 4.5% (95% confidence interval, 2.6–7.6). The pooled prevalence of chromosomal abnormalities (11 studies, 2427 fetuses) was 2.1% (95% confidence interval, 1.1–3.7). The proportion of major structural defects detected postnatally (9 studies, 1731 fetuses) was 2.9% (95% confidence interval, 1.5–5.4); in this particular subgroup (4 studies, 14 fetuses), the pooled prevalence of genomic anomalies was 29.8% (95% confidence interval, 11.3–58.6). A meta-regression analysis indicated that the rate of genomic anomalies was positively associated with the severity of hydramnios. In addition, the pooled rate of monogenic anomalies was 5.6% (95% confidence interval, 2–5; I<sup>2</sup>=58%) in the 2 studies that used next-generation sequencing for genomic diagnosis.</div></div><div><h3>CONCLUSION</h3><div>This meta-analysis showed that the rate of genomic anomalies in apparently isolated polyhydramnios is 4.5%; approximately half of them are chromosomal abnormalities and the other half are nonchromosomal genomic anomalies. From a clinical standpoint, chromosomal microarray analysis and possibly next-generation sequencing could be considered even in cases of apparently isolated polyhydramnio","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":"6 10","pages":"Article 101469"},"PeriodicalIF":3.8,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142047297","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 : 2024-10-01DOI: 10.1016/j.ajogmf.2024.101475
Alina Tvina MD , Anna Palatnik MD
Background
Hospital stay after an uncomplicated delivery is typically 2 days for vaginal birth and 3 days for cesarean birth. Health maintenance organizations and third-party payers have encouraged shorter maternity stays. The safety of earlier discharge is unclear particularly when it comes to patients diagnosed with hypertensive disorders of pregnancy (HDP).
Objective
To examine whether expedited discharge amongst patients with HDP will have a negative effect on postpartum readmission rate and blood pressure related complications.
Study design
This was a single academic center retrospective cohort study of patients with HDP (gestational hypertension, preeclampsia, or chronic hypertension) for 2 epochs: 2015–2018, prior to implementation of an expedited discharge policy, and 2019–2020 after hospital wide implementation of expedited postpartum discharge. The expedited discharge policy entailed patients being discharged home as soon as day 1 after a vaginal delivery and day 2 after a cesarean delivery. The primary outcome was unplanned health care utilization postpartum, defined as emergency department (ED) visits, unscheduled clinic visits, and hospital readmission. Secondary outcomes were planned postpartum visits attendance, antihypertensive medication initiation after discharge, and blood pressure control throughout the first year. Bivariable and multivariable logistic regression analyses were run to evaluate the association between expedited discharge and primary and secondary outcomes.
Results
A total of 1,441 patients were included in the analysis. There were no statistically significant differences in the rate of unplanned health care utilization (11.3% in the standard postpartum discharge group vs. 13.8% in the expedited discharge group, P=.17). Systolic and diastolic blood pressures did not differ between the groups at 1–2 weeks, six weeks, and one year postpartum. Patients in the expedited discharge group were more likely to attend the 1–2-week postpartum blood pressure check (58.7% vs. 51.7%, P=.02, adjusted OR 1.33, 95% CI 1.08–1.77). Other secondary outcomes did not differ between the two cohort groups.
Conclusion
In this single academic center study, expedited discharge after delivery in patients with HDP was not associated with a higher rate of unplanned healthcare utilization postpartum.
{"title":"Expedited versus standard postpartum discharge in patients with hypertensive disorders of pregnancy and its effect on the postpartum course","authors":"Alina Tvina MD , Anna Palatnik MD","doi":"10.1016/j.ajogmf.2024.101475","DOIUrl":"10.1016/j.ajogmf.2024.101475","url":null,"abstract":"<div><h3>Background</h3><div>Hospital stay after an uncomplicated delivery is typically 2 days for vaginal birth and 3 days for cesarean birth. Health maintenance organizations and third-party payers have encouraged shorter maternity stays. The safety of earlier discharge is unclear particularly when it comes to patients diagnosed with hypertensive disorders of pregnancy (HDP).</div></div><div><h3>Objective</h3><div>To examine whether expedited discharge amongst patients with HDP will have a negative effect on postpartum readmission rate and blood pressure related complications.</div></div><div><h3>Study design</h3><div>This was a single academic center retrospective cohort study of patients with HDP (gestational hypertension, preeclampsia, or chronic hypertension) for 2 epochs: 2015–2018, prior to implementation of an expedited discharge policy, and 2019–2020 after hospital wide implementation of expedited postpartum discharge. The expedited discharge policy entailed patients being discharged home as soon as day 1 after a vaginal delivery and day 2 after a cesarean delivery. The primary outcome was unplanned health care utilization postpartum, defined as emergency department (ED) visits, unscheduled clinic visits, and hospital readmission. Secondary outcomes were planned postpartum visits attendance, antihypertensive medication initiation after discharge, and blood pressure control throughout the first year. Bivariable and multivariable logistic regression analyses were run to evaluate the association between expedited discharge and primary and secondary outcomes.</div></div><div><h3>Results</h3><div>A total of 1,441 patients were included in the analysis. There were no statistically significant differences in the rate of unplanned health care utilization (11.3% in the standard postpartum discharge group vs. 13.8% in the expedited discharge group, <em>P</em>=.17). Systolic and diastolic blood pressures did not differ between the groups at 1–2 weeks, six weeks, and one year postpartum. Patients in the expedited discharge group were more likely to attend the 1–2-week postpartum blood pressure check (58.7% vs. 51.7%, <em>P</em>=.02, adjusted OR 1.33, 95% CI 1.08–1.77). Other secondary outcomes did not differ between the two cohort groups.</div></div><div><h3>Conclusion</h3><div>In this single academic center study, expedited discharge after delivery in patients with HDP was not associated with a higher rate of unplanned healthcare utilization postpartum.</div></div>","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":"6 10","pages":"Article 101475"},"PeriodicalIF":3.8,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142112973","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 : 2024-10-01DOI: 10.1016/j.ajogmf.2024.101470
Laura C. Ha MD , Mariam Naqvi MD , Patrick Conley MS , C. Noel Bairey Merz MD , Bethany Barone Gibbs PhD , Lisa D. Levine MD, MSCE , George A. Saade MD , Sarah Kilpatrick MD, PhD , Natalie A. Bello MD, MPH
Background
Activity restriction is a common recommendation given to patients during pregnancy for various indications, despite lack of definitive data showing improvements in pregnancy outcomes.
Objective
To determine if activity restriction (AR) in pregnancy is associated with decreased odds of adverse pregnancy outcomes (APOs).
Study design
Secondary analysis of the Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-Be (nuMoM2b) prospective cohort. Nulliparous singletons were followed at 8 sites from October 2010–September 2013. Demographic and clinical data were collected at 4 timepoints, and participants were surveyed about AR recommendations at 22w0d-29w6d and delivery. We excluded participants missing data on AR and age. Participants were grouped according to history of AR, and APOs included: gestational hypertension (gHTN), preeclampsia/eclampsia, preterm birth (PTB), and small for gestational age (SGA) neonate. Associations between AR and APOs were examined using uni- and multivariable logistic regression models adjusting for a priori identified APO risk factors.
Results
Of 10,038 nuMoM2b participants, 9,312 met inclusion criteria and 1,386 (14.9%) were recommended AR; participants identifying as Black (aOR 0.81 [95% CI 0.68–0.98]) or Hispanic (aOR 0.73 [95% CI 0.61–0.87]) were less likely to be placed on AR when compared to those identifying as White. Overall, 3,197 (34.3%) experienced at least one APO (717 [51.7%] of participants with AR compared to 2,480 [31.3%] participants without AR). After adjustment for baseline differences, the AR group had increased odds of gHTN (aOR 1.61 [95% CI 1.35–1.92]), preeclampsia/eclampsia (aOR 2.52 [95% CI 2.06–3.09]) and iatrogenic and spontaneous PTB (aOR 2.98 [95% CI 2.41–3.69]), but not delivery of an SGA neonate.
Conclusion
AR in pregnancy was independently associated with increased odds of hypertensive disorders of pregnancy and PTB, but future prospective work is needed to determine potential causality. Further, participants identifying as Black or Hispanic were significantly less likely to be recommended AR compared to those identifying as White. While AR is not an evidence-based practice, these findings suggest bias may impact which patients receive advice to limit activity in pregnancy.
背景：尽管缺乏明确的数据显示妊娠结局有所改善，但限制活动是妊娠期因各种适应症而向患者提出的常见建议：研究设计：研究设计：对无胎儿妊娠结局研究进行二次分析：研究设计：对无子宫妊娠结局研究：待产母亲监测（nuMoM2b）前瞻性队列进行二次分析。从 2010 年 10 月至 2013 年 9 月，在 8 个地点对无妊娠期的单胎进行了随访。我们在 4 个时间点收集了人口统计学和临床数据，并就 22w0d-29w6d 和分娩时的 AR 建议对参与者进行了调查。我们排除了缺失 AR 和年龄数据的参与者。根据AR病史对参与者进行分组，APO包括：妊娠高血压（gHTN）、子痫前期/子痫、早产（PTB）和胎龄小（SGA）新生儿。使用单变量和多变量逻辑回归模型研究了AR与APO之间的关系，并对事先确定的APO风险因素进行了调整：在 10,038 名 nuMoM2b 参与者中，9,312 人符合纳入标准，1,386 人（14.9%）被建议使用 AR；与白人相比，黑人 [aOR 0.81 (95% CI 0.68-0.98)] 或西班牙裔 [aOR 0.73 (95% CI 0.61-0.87)] 参与者使用 AR 的可能性较低。总体而言，有 3197 人（34.3%）至少经历过一次 APO [有 AR 的参与者为 717 人（51.7%），无 AR 的参与者为 2480 人（31.3%）]。在对基线差异进行调整后，AR 组发生 gHTN [aOR 1.61 (95% CI 1.35-1.92)]、子痫前期/子痫 [aOR 2.52 (95% CI 2.06-3.09)]、先天性和自发性 PTB [aOR 2.98 (95% CI 2.41-3.69)]的几率增加，但不包括分娩 SGA 新生儿：结论：妊娠期AR与妊娠期高血压疾病和先天性脑瘫发生几率的增加有独立关联，但需要未来的前瞻性工作来确定潜在的因果关系。此外，与白人相比，黑人或西班牙裔受试者被建议进行 AR 的可能性要低得多。虽然AR并不是一种循证实践，但这些研究结果表明，偏见可能会影响哪些患者接受限制孕期活动的建议。
{"title":"Activity restriction and risk of adverse pregnancy outcomes","authors":"Laura C. Ha MD , Mariam Naqvi MD , Patrick Conley MS , C. Noel Bairey Merz MD , Bethany Barone Gibbs PhD , Lisa D. Levine MD, MSCE , George A. Saade MD , Sarah Kilpatrick MD, PhD , Natalie A. Bello MD, MPH","doi":"10.1016/j.ajogmf.2024.101470","DOIUrl":"10.1016/j.ajogmf.2024.101470","url":null,"abstract":"<div><h3>Background</h3><div>Activity restriction is a common recommendation given to patients during pregnancy for various indications, despite lack of definitive data showing improvements in pregnancy outcomes.</div></div><div><h3>Objective</h3><div>To determine if activity restriction (AR) in pregnancy is associated with decreased odds of adverse pregnancy outcomes (APOs).</div></div><div><h3>Study design</h3><div>Secondary analysis of the Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-Be (nuMoM2b) prospective cohort. Nulliparous singletons were followed at 8 sites from October 2010–September 2013. Demographic and clinical data were collected at 4 timepoints, and participants were surveyed about AR recommendations at 22w0d-29w6d and delivery. We excluded participants missing data on AR and age. Participants were grouped according to history of AR, and APOs included: gestational hypertension (gHTN), preeclampsia/eclampsia, preterm birth (PTB), and small for gestational age (SGA) neonate. Associations between AR and APOs were examined using uni- and multivariable logistic regression models adjusting for <em>a priori</em> identified APO risk factors.</div></div><div><h3>Results</h3><div>Of 10,038 nuMoM2b participants, 9,312 met inclusion criteria and 1,386 (14.9%) were recommended AR; participants identifying as Black (aOR 0.81 [95% CI 0.68–0.98]) or Hispanic (aOR 0.73 [95% CI 0.61–0.87]) were less likely to be placed on AR when compared to those identifying as White. Overall, 3,197 (34.3%) experienced at least one APO (717 [51.7%] of participants with AR compared to 2,480 [31.3%] participants without AR). After adjustment for baseline differences, the AR group had increased odds of gHTN (aOR 1.61 [95% CI 1.35–1.92]), preeclampsia/eclampsia (aOR 2.52 [95% CI 2.06–3.09]) and iatrogenic and spontaneous PTB (aOR 2.98 [95% CI 2.41–3.69]), but not delivery of an SGA neonate.</div></div><div><h3>Conclusion</h3><div>AR in pregnancy was independently associated with increased odds of hypertensive disorders of pregnancy and PTB, but future prospective work is needed to determine potential causality. Further, participants identifying as Black or Hispanic were significantly less likely to be recommended AR compared to those identifying as White. While AR is not an evidence-based practice, these findings suggest bias may impact which patients receive advice to limit activity in pregnancy.</div></div>","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":"6 10","pages":"Article 101470"},"PeriodicalIF":3.8,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142047293","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 : 2024-10-01DOI: 10.1016/j.ajogmf.2024.101473
Chris E. Philip MD , Ethan Litman MD , Barbara O'Brien MD , Jeanne-Marie Guise MD, MPH, MBA , David M. Haas MD, MS
{"title":"Cochrane Update: news and reviews from the Cochrane US Network","authors":"Chris E. Philip MD , Ethan Litman MD , Barbara O'Brien MD , Jeanne-Marie Guise MD, MPH, MBA , David M. Haas MD, MS","doi":"10.1016/j.ajogmf.2024.101473","DOIUrl":"10.1016/j.ajogmf.2024.101473","url":null,"abstract":"","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":"6 10","pages":"Article 101473"},"PeriodicalIF":3.8,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142074126","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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