American journal of perinatology最新文献

This study aimed to determine the temporal trends and racial differences in the infant mortality rate (IMR) in preterm infants with birth weight <500 g in the United States from 2005 through 2022.This was a retrospective cross-sectional study of data from the CDC's Wide-ranging Online Data for Epidemiologic Research. Infants with gestational age (GA) 22 to 28 weeks, with birth weight of <500 g, and deaths up to 1 year of age were included. IMR was calculated as deaths per 1,000 live births for each GA and year, and further stratified by maternal race. We evaluated trends with Joinpoint regression and IMR trends were reported using average annual percentage change (AAPC) with 95% confidence intervals (CI). The fetuses-at-risk approach was used to examine racial/ethnic differences in IMR.During the study period, 39,511 out of 50,855 infants born at 22 to 28 weeks GA with birth weight <500 g died within the first year (overall IMR 776.93 per 1,000). The IMR was inversely related to gestational age. The overall IMR decreased significantly from 817.48 to 714.51 (AAPC of -0.8%; CI, -1.0, -0.6) and in all the three racial/ethnic groups. As per the fetuses-at-risk approach, non-Hispanic Black (NHB) infants had the highest IMR of 1.33 per 1,000 fetuses-at-risk compared with 0.39 for non-Hispanic White (NHW) and 0.46 for Hispanic infants (p < 0.01).The IMR in extremely preterm infants weighing <500 g at birth decreased significantly, overall, and in all racial/ethnic groups. However, significant racial/ethnic differences persist. · Infant mortality rate decreased significantly in preterm infants with birth weight <500 g.. · The IMR decreased significantly in the three racial/ethnic groups studied.. · The IMR was significantly higher in non-Hispanic Black infants..

We aimed to determine if the implementation of teleconsults in the community hospital would decrease the time to initiation of therapeutic hypothermia (TH).We compared neonates treated with TH prior to implementation of the teleconsult program (pretele) to those treated after (posttele) for the outcomes of time to initiation of TH, seizures, and death/severe injury on brain MRI. We controlled for confounders using multivariable linear and logistic regression models.There were 52 pretele neonates and 49 posttele who were all born in community hospitals and treated with TH. Mothers in the posttele group were older and had higher rates of gestational diabetes. Fewer neonates with mild encephalopathy were cooled in the posttele period (13 [25.0%] pretele vs. 2 [4.1%] posttele). After controlling for gestational diabetes, maternal age, and severity of encephalopathy, there was no difference in time to TH initiation (p = 0.445), brain injury or death (p = 0.136), or seizure (p = 0.433) between the pre-and posttele groups. In the sub-analysis of the posttele group, the time to initiation was 4.50 hours (3.75, 5.00) for those with teleconsults versus 3.25 (2.12, 4.00) hours (p = 0.007) for those without.When comparing pre- to posttele groups, teleconsults in the community hospital did not significantly change the time to initiate TH or result in more adverse short-term outcomes of seizures or death/brain injury. In the sub-analysis of the posttele group, teleconsults did result in delayed initiation of TH but also possibly improved patient selection with fewer mildly encephalopathic neonates treated. · Telemedicine did not reduce the time to initiate TH.. · Fewer mild NE neonates received TH posttele.. · Multiple NE exams increased for the posttele group.. · No short-term adverse outcome differences were found..

This study aimed to examine whether newborns with orofacial clefts are at increased prevalence of poor birth health outcomes.This is a population-based cross-sectional study, conducted with information from 25,879,282 live births registered in the U.S. Vital Statistics Natality Birth Data from 2017 to 2023. The prevalence ratios and logistic regression models between orofacial cleft status (all, isolated, or nonisolated) and each child's birth health variables (delivery method, maternal morbidity, 5-minute Apgar score, gestational age, birth weight, abnormal conditions, infant breastfed at discharge) were calculated, assuming a p ≤ 0.05 as statistically significant.The prevalence ratios showed that newborns with orofacial clefts were more susceptible to being born by cesarean section (prevalence ratio [PR] = 1.18, p = 0.000, 95% confidence interval [CI] = 1.16-1.21), having lower birth weight (PR = 2.18, p = 0.000, 95% CI = 2.11-2.25), lower Apgar 5 score (PR = 4.08, p = 0.000, 95% CI = 4.08-4.50), prematurity (PR = 1.55, p = 0.000, 95% CI = 1.50-1.60), experiencing more abnormal conditions at birth (PR = 3.72, p = 0.000, 95% CI = 3.64-3.80), and having more difficulty to be breastfed (PR = 2.16, p = 0.000, 95% CI = 2.11-2.22) than newborns without clefts. These ratios were even higher among those with nonisolated orofacial clefts. Associations were statistic significant even after adjustments.This study provides evidence that newborns with orofacial clefts are at increased prevalence of poor birth health outcomes. · Orofacial clefts are associated to higher prevalence of birth outcomes.. · Newborns with orofacial clefts were more susceptible to have low birth weight.. · Newborns with orofacial clefts were more susceptible to preterm birth..

Social determinants of health (SDOH) may impact the incidence of respiratory syncytial virus (RSV) infection and the uptake of vaccinations in pregnancy. The objective of this study is to identify contributors to disparities in RSV vaccination in pregnancy.This is a retrospective cohort study of patients delivering at term within three hospitals during February and March 2024, comparing pregnant patients identified as receiving versus not receiving RSV vaccinations. This period and gestational age were chosen to include patients who would have qualified for RSV vaccination administration. Vaccination status was extracted from standardized admission templates where these variables were recorded as discrete fields. Patients without RSV vaccination information were excluded. Sociodemographic factors, COVID-19 vaccination status, and delivery campus were evaluated. Outcomes were analyzed using chi-squared, t-test, and McNemar test.A total of 2,181 patients met inclusion criteria and RSV vaccination information was available for 1,548 patients (71%) with a 14% vaccination rate. Compared with those not vaccinated (n = 1,332), RSV-vaccinated patients (n = 216) were more likely to be older (30.7 vs. 34.8, p < 0.001), have private insurance (42 vs. 85%, p < 0.001), speak English (82 vs. 95%, p < 0.001), and deliver at our regional perinatal center (26 vs. 77%, p < 0.001). Fifty percent of RSV-vaccinated patients had a history of COVID-19 vaccination compared with 33% of those not vaccinated against RSV (p < 0.001).SDOH was associated with differences in RSV vaccination status. In addition, patients without RSV vaccination were less likely to have had COVID-19 vaccination. These findings highlight the need to address SDOH to increase vaccination rates for vulnerable populations. · The rate of RSV vaccination in pregnant patients is low.. · Patients vaccinated against RSV tended to be older, privately insured, and English-speaking.. · SDOH and COVID-19 vaccination status are associated with RSV vaccination rates..

Postpartum pain management practices have significant variation and are known to be influenced by nonclinical factors. We aimed to examine factors that contribute to clinicians' assessment and management of postpartum pain, including the role of opioids.We conducted a qualitative study of obstetric clinicians providing postpartum care at a single, large, tertiary care center (November 2021-June 2022). Attending and trainee OB/GYN physicians and advanced practice providers (APPs) completed in-depth interviews using a semistructured interview guide. Purposive sampling was employed to ensure a representative sample of each clinician type was included. Participants were asked about factors that influence postpartum pain management. Data were analyzed using the constant comparative method.Of 46 participants, 48% were attending physicians, 32% trainee physicians, and 20% APPs. The analysis demonstrated three key themes related to postpartum assessment and management: influencing factors (knowledge or experiences that influence practice), objective findings, and the role of counseling. While clinicians reported guidelines and patient satisfaction as major influencing factors, several also shared the inherent conflict that may arise between them. Objective findings, specifically the impact of pain on patients achieving functional goals, also influenced clinician decision-making. Conversely, many participants reported the limited utility of the numeric pain scale as an objective metric. Additionally, the role of counseling in shared decision-making and providing anticipatory guidance was emphasized. Finally, clinicians had a range of opinions on the role of opioids in pain management, but many spoke to the value of opioids as second-line treatment and the impact of the opioid epidemic on prescribing practices.The factors that influence clinicians' assessment and management of postpartum pain are occasionally in conflict. Furthermore, objective measures, such as the numeric pain scale, have significant limitations. · Guidelines and patient satisfaction influence care.. · Guidelines and patient satisfaction can conflict.. · The numeric pain scale has significant limitations.. · Opioids are valuable as second-line pain treatment..

Increasing the vaginal birth after cesarean (VBAC) rate to 18% was a Healthy People 2020 goal. Detailed data on racial/ethnic differences in VBAC rates is lacking and can inform efforts to equitably increase VBAC rates. This study aimed to assess racial/ethnic variation in VBAC rates and to describe group trends in VBAC rates in California between 2011 and 2021.This retrospective cohort study used a database of birth certificates linked to hospital discharge records. We analyzed singleton, term live births among people who had a history of at least one prior cesarean birth, no identified contraindications to a vaginal birth, and self-identified their racial/ethnic group as Hispanic or non-Hispanic (American Indian-Alaskan Native (AIAN), Asian, Black, Hawaiian/Pacific Islander, or white). VBAC births were identified from birth certificate records. Differences between VBAC rates were assessed using univariable and multivariable Poisson log-linear regression while adjusting for potential confounders.A total of 607,808 birthing people were included (2,234 AIAN, 84,899 Asian, 34,217 Black, 2,559 Hawaiian/Pacific Islander, 334,116 Hispanic, 149,783 white). Over the study period, Hawaiian/Pacific Islander birthing people had the highest average VBAC rate at 11.5% (AIAN, 6.5%; Asian, 8.8%; Black, 8.0%; Hispanic, 7.4%; white, 9.5%). In adjusted models, Black (aRR = 1.06, 95% CI: 1.01-1.11) and Hawaiian/Pacific Islander (aRR = 1.43, 95% CI: 1.27-1.61) birthing people were more likely to have a VBAC compared with white birthing people, while Hispanic birthing people were less likely (aRR = 0.96, 95% CI: 0.93-0.98). VBAC rates increased significantly (p < 0.001) over time for all groups except AIAN birthing people.VBAC rates increased for most racial/ethnic groups in California. With the exception of the Hawaiian/Pacific Islander group, there were small and likely not clinically significant differences in the chances for a VBAC across groups. No group in California met the Healthy People 2020 goal VBAC rate of 18%. · VBAC rates increased for most racial/ethnic groups.. · The VBAC rate for AIAN birthing people did not increase.. · No group met the Healthy People 2020 goal VBAC rate of 18%..

The long-term effects of the novel coronavirus disease 2019 (COVID-19) infection during pregnancy are poorly characterized in mothers and their infants. The aim of this study was to assess the physical, mental, and emotional well-being of mothers and infants in the first year postpartum who were exposed to and/or diagnosed with COVID-19 infection.This direct-to-participant cohort study recruited 96 mother-infant pairs delivering at Pediatrix Medical Group sites, where mothers tested positive for COVID-19 during their pregnancy or birth hospitalization and/or infants tested positive for COVID-19 prior to hospital discharge. Main outcome measures included scored responses to surveys administered at 6 and 12 months postpartum and infant health status from newborn admission through the first year after birth.Mothers with COVID-19 infection during pregnancy often reported persistent physical, mental, and emotional stress affecting both themselves and their infants. Scores assessing infant temperament were higher than reported in prior literature. Infants were relatively healthy throughout their first year after birth.The experience of COVID-19 infection during pregnancy may create a unique set of circumstances that affects the well-being of infants and their mothers separately as well as the child-caregiver relationship. Early life events have the potential to generate lasting consequences; therefore, it is important to identify these issues to maximize support and intervene if indicated. · Experiencing COVID-19 in pregnancy is unique.. · Possible effects on temperament, and relationships.. · This impact may persist for at least 1 year postpartum..

Prior studies have yielded mixed results regarding ambulation with neuraxial analgesia and labor outcomes, and studies did not include a significant obese population. We sought to evaluate the feasibility of ambulation with optimized neuraxial analgesia in laboring nulliparous obese patients.This was a pilot study at the University of Chicago (approval no.: IRB 19-1600, CT NCT04504682). Inclusion criteria were delivery BMI of ≥35 kg/m², nulliparity, and term gestation. Contraindications to ambulation or vaginal delivery conferred ineligibility. Combined spinal-epidural analgesia was initiated per our institution's policy. Following epidural catheter placement, serial blood pressure measurements and motor assessments including a straight leg test and a step stool test were completed per safety protocol. Patients who passed these assessments were enrolled. Patients were encouraged to ambulate for 20 minutes every hour while on fetal and uterine telemetry. Ambulation was discouraged after complete dilation. Demographics and delivery outcomes were collected. Our primary objective was to evaluate feasibility through acceptability, and safety via the number of falls, and percentage of patients with any ambulation. The study was closed early due to enrollment difficulties and in the setting of the COVID-19 pandemic.A total of 105 patients were identified for the trial: 20 were ineligible for the study, 20 could not be approached, and 40 declined study participation, leaving 25 patients who consented. Of those 25, 14 completed the study. Out of 14 participants, 11 were ambulated. The average BMI of these participants was 43 kg/m². No patients fell during the trial.A pilot trial of ambulation during neuraxial analgesia among an obese nulliparous population demonstrated no safety concerns, but with concern regarding feasibility as there was low acceptance. · Pilot trial of ambulation with neuraxial analgesia among obese patients had limited enrollment.. · Trial of ambulation with epidural among obese nulliparous patients demonstrated no safety concerns.. · Further studies are needed for efficacy..

Monoamniotic twins is rare and associated with a high rate of perinatal morbidity and mortality. In addition to the common risks, more specific complications, cord entanglement in particular, worsen their prognosis. The literature about the optimal gestational age for birth and mode of delivery is still conflicting. To evaluate strategy used in France for the prenatal and intrapartum management monoamniotic twin pregnancies in France.This retrospective multicenter study retrieved the strategies and outcomes for 149 monoamniotic twin pregnancies from 10 university hospitals in France over an 18-year period. Two methods of managing the follow-up methods of these pregnancies with a propensity score were distinguished: follow-up in a participating maternity unit as an inpatient or outpatient. Two populations were analyzed: inpatients and outpatients were compared among all pregnancies and fetuses from 26^0/7 to 34^6/7 weeks of gestation (n = 92). All pregnancies and fetuses not born after 35^0/7 weeks of gestation (n = 57) were analyzed separately. The primary endpoints were intrauterine and perinatal mortality rates.Perinatal mortality didn't differ between the 38 inpatient and 54 outpatient pregnancies (15.8 vs. 14.8%). The same was true for all fetuses and newborns with 7 deaths out of 76 (9.2% for inpatients) and 10 deaths out of 108 (9.2% for outpatients, p = 0.99). Finally, 57 pregnancies (33%) continued past 35 weeks. One death in utero was observed at 20 weeks and only one other at 35 weeks (1.5%).This study shows no differences between inpatient and outpatient management and suggests that some perinatal centers envision continuing these pregnancies past 35 weeks. Vaginal delivery is not strictly contraindicated, although cesarean delivery is safe and most often recommended. · Monoamniotic twin pregnancies are rare with an elevated risk of fetal and neonatal mortality.. · To monitor the risk factors closely, they can be managed either as inpatients or outpatients.. · Delivery, most often by cesarean, around 32 to 34 weeks, is recommended because of the rare but avoidable and thus especially distressing in utero deaths.. · Controversy persists, nonetheless, about management (inpatient or outpatient), optimal gestation age for delivery, and mode of delivery.

Pregnant people with disabilities face higher complication rates, yet few guidelines exist on caring for this population. This study evaluates obstetrics and gynecology (OBGYN) residents' comfort in caring for pregnant people with physical disabilities.A 19-question e-survey was developed and piloted for content and face validation. Likert scale was used to assess comfort in caring for pregnant patients with physical disabilities. The e-survey was sent to U.S. OBGYN residents via CREOG-coordinator listserv, a listserv to all U.S. OBGYN residency coordinators, in February 2024, with three reminder emails. Descriptive statistics were used to analyze the data, and variables with clinical and statistical significance were considered for adjustment in regression models.Eighty-eight residents completed the survey. The mean age was 29 years; 88% identified as female. All ACOG regions were represented. Eight and 44% reported formal education on disability care in residency and medical school, respectively. Seventy-three percent felt uncomfortable positioning disabled patients for a pelvic examination, 59% felt uncomfortable discussing sexual health practices, and 89% felt uncomfortable making recommendations regarding the mode of delivery. Those without education in residency were 91% less likely to be comfortable making recommendations regarding the mode of delivery (absolute risk reduction [aRR]: 0.09; 95% confidence interval [CI]: 0.01 and 0.59). Only 30% were comfortable discussing lactation/breastfeeding with patients with physical disabilities; residents without personal experience including caring for family members or friends or other caretaking experiences were 66% less likely to be comfortable (aRR: 0.34; 95% CI: 0.12 and 0.99). A total of 92.5% of residents wanted more education in this space. Of those 83, 71, and 82% desired didactics, patient panels, and simulations, respectively.Among responding residents, comfort in caring for pregnant people with physical disabilities is low. Additional training is necessary to adequately care for this population. · OBGYN resident comfort with disability care is low.. · Few residents receive formal disability training.. · Formal education improves disability care comfort..