Fetal Diagnosis and Therapy最新文献

{"title":"A Clinical Outcomes Data Archive for a Comprehensive Fetal Diagnosis and Treatment Center.","authors":"Thomas A Reynolds, Matthew A Goldshore, Sabrina Flohr, Sierra Land, Leny Mathew, Juliana S Gebb, Edward R Oliver, Natalie E Rintoul, Anne M Ades, Elizabeth E Foglia, Catherine M Avitabile, Howard B Panitch, Gregory G Heuer, Lori J Howell, N Scott Adzick, Holly L Hedrick","doi":"10.1159/000541877","DOIUrl":"10.1159/000541877","url":null,"abstract":"<p><strong>Introduction: </strong>Data on near- and long-term clinical outcomes are critical for the care of all maternal-fetal patients presenting to a fetal center. This is especially important since physiologic and neurodevelopmental attributes do not manifest until later childhood when multilevel (e.g., individual, family, policy) factors have a direct influence on health outcomes. Electronic health records (EHRs) create opportunity for efficient data collection. However, documentation structures are not designed for acquisition of key attributes, and changes over time and between-clinician differences can affect resultant output. Therefore, EHR derived datasets have limited ability to accurately characterize the clinical presentation and care trajectory of patients with congenital anomalies. In addition, in most systems, the fetus lacks a digital identity and requires relinking fetal attributes documented in the maternal chart to those from the pediatric EHR. This conundrum amplifies in the setting of multiple gestation, returning maternal patients, and pregnancies with fetal demise. Moreover, current data capture systems result in incomplete abstraction of variables that may confound, mediate, or moderate critical associations. Our objective was to develop and implement a prospective data capture platform to transform EHR data into an analytic-grade database for multipurpose use.</p><p><strong>Methods: </strong>A unified platform for longitudinal follow-up of maternal-child dyads cared for at our fetal center, named the Clinical Outcomes Data Archive (CODA), was constructed. CODA was designed using a data dictionary based on multidisciplinary and interprofessional expert input, a relational identity for each patient, fetus, and pregnancy, and a process by which EHR-sourced and chart-abstracted data are validated by a well-trained team. Descriptive analyses were performed for data acquired between July 2022 and July 2023, and a comparison of studies before and after implementation of CODA is presented.</p><p><strong>Conclusion: </strong>5,394,106 data points were validated for 7,662 patients across 12 conditions. 2% of data points were found to be unreliable or undocumented. 91% of data points were sourced from the EHR. Eighty-five percent of condition-specific variables required manual chart abstraction. The study conducted with CODA was able to contribute to 18 other studies. CODA successfully merges EHR-sourced and manually abstracted documentation for longitudinal study of the maternal-child dyad.</p>","PeriodicalId":12189,"journal":{"name":"Fetal Diagnosis and Therapy","volume":" ","pages":"139-147"},"PeriodicalIF":1.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142389216","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Added Value in Low-Risk Pregnancies of Longitudinal Changes in Uterine Doppler and Circulating Angiogenic Factors during the Third Trimester in Predicting Term Preeclampsia.","authors":"Lucie Roubalova, Vladimira Kroutilova, Maria Fernanda Lopez-G Tinajero, Judit Martinez-Egea, Claudia Pumarola, Francesc Figueras, Marek Lubusky","doi":"10.1159/000541731","DOIUrl":"10.1159/000541731","url":null,"abstract":"<p><strong>Introduction: </strong>The objective of this study was to assess the relationship between longitudinal changes in the uterine Doppler velocimetry and the maternal profile of angiogenic factors in the third trimester and to assess their ability to predict term preeclampsia (PE).</p><p><strong>Methods: </strong>A cohort of low-risk pregnant women was scheduled for a uterine Doppler evaluation and measurement of the circulating levels of angiogenic factors at ∼30 and ∼36 weeks. The performance of both parameters and their change over time in predicting term PE was evaluated.</p><p><strong>Results: </strong>A total of 1,191 women were analyzed, of which 28 (2.4%) women developed term PE. At ∼30 weeks, a model including the sFlt-1/PlGF (fms-like tyrosine kinase-1/placental growth factor) ratio and the uterine Doppler explained 16.2% of the uncertainty of developing term PE, while at ∼36 weeks, the same variables explained 25.2% [p < 0.001]. The longitudinal changes of both predictors had an R2 of 26.8%, which was not different from that of the ∼36 weeks evaluation [p = 0.45]. The area under the curve (AUC) of the ∼36 weeks ratio was significantly higher than at ∼30 weeks (0.86 [0.77-0.94] vs. 0.81 [0.73-0.9]; p = 0.043). The AUC of the longitudinal change of the ratio (0.85 [0.77-0.94]) did not differ from that of at ∼36 weeks (p = 0.82). At ∼36 weeks, for a 10% of false positives, the ratio had a detection rate of 71.4%.</p><p><strong>Conclusion: </strong>A cross-sectional measurement of the sFlt-1/PlGF ratio outperforms uterine Doppler in predicting term PE. The combination of both markers does not improve such prediction, nor the evaluation of the longitudinal changes between weeks.</p>","PeriodicalId":12189,"journal":{"name":"Fetal Diagnosis and Therapy","volume":" ","pages":"233-242"},"PeriodicalIF":1.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142575593","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Systematic Ultrasound Evaluation of Olfactory Sulci in Fetuses with Congenital Heart Defects: A Clue for CHARGE Syndrome Diagnosis.","authors":"Ron Charach, Míriam Pérez-Cruz, Narcis Masoller, Míriam Illa, Elena Monterde, Josep Maria Martínez-Crespo, Antoni Borrell, Marta Gómez-Chiari, Mónica Rebollo-Polo, Mar Borregan, Olga Gómez, Elisenda Eixarch","doi":"10.1159/000543190","DOIUrl":"10.1159/000543190","url":null,"abstract":"<p><strong>Introduction: </strong>Arhinencephaly have been identified as a significant feature in CHARGE syndrome. This study aimed to evaluate the diagnostic role of olfactory sulci (OS) in identifying CHARGE syndrome among fetuses with major congenital heart defects (CHDs).</p><p><strong>Methods: </strong>We prospectively evaluated OS development in fetuses diagnosed with CHDs from 2017 to 2021. Neurosonography was performed using transabdominal and transvaginal approaches after 30 weeks of gestation. OS assessment was conducted in the trans-frontal coronal plane, classifying their appearance as fully developed, hypoplastic, or absent. Abnormal OS cases underwent MRI and trio-based clinical exome sequencing (CES).</p><p><strong>Results: </strong>The study included 147 fetuses with CHD. Abnormal OS were found in 4 fetuses (2.7%) which also exhibited other additional anomalies. OS were absent in cases 1-3 and hypoplastic in case 4. MRI confirmed OS abnormalities in all cases, and trio-based CES identified a CHD7 gene mutation in cases 1, 2, and 4, supporting the diagnosis of CHARGE syndrome. Case 3 had normal trio-based CES results. No other CHARGE syndrome cases were diagnosed postnatally among the cases with normal OS.</p><p><strong>Conclusions: </strong>Systematic evaluation of OS in fetuses with major CHD might contribute to the diagnosis of CHARGE syndrome. Our findings support the inclusion of OS assessment in the prenatal evaluation of fetuses with major CHDs.</p>","PeriodicalId":12189,"journal":{"name":"Fetal Diagnosis and Therapy","volume":" ","pages":"280-290"},"PeriodicalIF":1.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12129418/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142983227","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Safety and Effectiveness of Fetal Myelomeningocele Repair: Case Series Analysis Using an Exteriorized Uterus and a Fetoscopic Approach.","authors":"Márcio Lopes Miranda, Renato Ximenes, Kleber Cursino Andrade, Carlos Baldo, Mauro Villarreal, Marcos Roberto Caetano, Giuliane Lajos, Mateus Dal Fabbro, Joaquim Murray Bustorff-Silva, Emrah Aydin, Jose L Peiro","doi":"10.1159/000546549","DOIUrl":"10.1159/000546549","url":null,"abstract":"<p><strong>Introduction: </strong>This study evaluated the surgical details and outcomes of fetal myelomeningocele (MMC) repair using a minimally invasive fetoscopic approach with uterine exposure.</p><p><strong>Methods: </strong>This retrospective case series study examines consecutive fetuses who underwent fetoscopic spina bifida repair performed by a single team. The pregnant women's demographic data, surgical technical aspects, complications, and neonatal surgical outcomes were analyzed.</p><p><strong>Results: </strong>From 2019 to 2022, 32 fetuses underwent the fetoscopic repair of MMC at an average gestational age of 25.2 ± 0.9 weeks (range 23.2-26.6). Dura mater collagen substitutes were used for duraplasty in all cases, and in three, an additional myofascial flap was used. There were no significant maternal complications. Overall perinatal complication rate was 18% (6/32), including a perinatal mortality rate of 12.5% (4/32) and two cases of skin suture dehiscence. No cases of cerebrospinal fluid (CSF) leakage were observed. The mean gestational age at birth was 34.6 ± 3.6 weeks, and 31% of deliveries were vaginal. Among the 28 neonates followed for at least 12 months, and only 14% required CSF diversion.</p><p><strong>Conclusion: </strong>Exteriorized uterus fetoscopic repair of MMC proved safe for the mother and effective in closing the neural tube defect. It also reduced the necessity for CSF diversion and preserved uterine function for future pregnancies. These findings endorse the potential of minimally invasive techniques in fetal MMC repair.</p>","PeriodicalId":12189,"journal":{"name":"Fetal Diagnosis and Therapy","volume":" ","pages":"521-531"},"PeriodicalIF":1.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144173115","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Delivery Room Resuscitation of Infants with Congenital Diaphragmatic Hernia: Lessons Learned through Video Review.","authors":"K Taylor Wild, Natalie Rintoul, Holly L Hedrick, Lauren Heimall, Leane Soorikian, Elizabeth E Foglia, Anne M Ades, Heidi M Herrick","doi":"10.1159/000538536","DOIUrl":"10.1159/000538536","url":null,"abstract":"<p><strong>Introduction: </strong>Delivery room (DR) interventions for infants with congenital diaphragmatic hernia (CDH) are not well described. This study sought to describe timing and order of DR interventions and identify system factors impacting CDH DR resuscitations using a human factors framework.</p><p><strong>Methods: </strong>This was a single-center observational study of video-recorded CDH DR resuscitations documenting timing and order of interventions. The team used the Systems Engineering Initiative for Patient Safety (SEIPS) model to identify system factors impacting DR resuscitations and time to invasive ventilation.</p><p><strong>Results: </strong>We analyzed 31 video-recorded CDH resuscitations. We observed variability in timing and order of resuscitation tasks. The \"Internal Environment\" and \"Tasks\" components of the SEIPS model were prominent factors affecting resuscitation efficiency; significant room and bed spatial constraints exist, and nurses have a significant task burden. Additionally, endotracheal tube preparation was a prominent barrier to timely invasive ventilation.</p><p><strong>Conclusion: </strong>Video review revealed variation in event timing and order during CDH resuscitations. Standardization of the room setup, equipment, and event order and reallocation of tasks facilitate more efficient intubation and ventilation, representing targets for CDH DR improvement initiatives. This work emphasizes the utility of rigorous human factors review to identify areas for improvement during DR resuscitation.</p>","PeriodicalId":12189,"journal":{"name":"Fetal Diagnosis and Therapy","volume":" ","pages":"124-132"},"PeriodicalIF":1.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140293193","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bleeding Complications between Bivalirudin and Heparin for Extracorporeal Membrane Oxygenation in Neonates with Congenital Diaphragmatic Hernia.","authors":"Caroline Credille, Caitlin R Eason, Lauren L Evans, Samantha Bothwell, Jason Gien, Alyssa E Vaughn, John P Kinsella, Pavika Varma, Kenneth W Liechty, S Christopher Derderian","doi":"10.1159/000542760","DOIUrl":"10.1159/000542760","url":null,"abstract":"<p><strong>Introduction: </strong>Neonates with congenital diaphragmatic hernia (CDH) who undergo repair while on extracorporeal membrane oxygenation (ECMO) are at risk of developing post-operative bleeding complications. Balanced anticoagulation is critical to maintain ECMO flow and avoid bleeding. Heparin has historically been our first-line anticoagulant; however, recently, we transitioned to bivalirudin, a direct thrombin inhibitor. The objective of this pilot study was to compare post-operative surgical bleeding complications between the two groups.</p><p><strong>Methods: </strong>We performed a single center retrospective cohort study of patients who underwent CDH repair while on ECMO between 2008 and 2023. Neonates were stratified based on the type of anticoagulant initiated after CDH repair. Outcomes included bleeding requiring surgical re-operation, intracranial hemorrhage, volume of blood products transfused, number of circuit changes, days on ECMO, and overall survival.</p><p><strong>Results: </strong>Among 62 neonates with CDH who underwent repair on ECMO, 44 (71%) were managed post-CDH repair with heparin and 18 (29%) with bivalirudin. One (5.6%) neonate managed with bivalirudin underwent re-operation following CDH repair for a bleeding complication compared to 17 (38.6%) managed with heparin (p = 0.022). In addition, the bivalirudin cohort utilized half of the total blood product volume compared to the heparin cohort (p = 0.020). Despite these benefits, there were no significant differences between groups for incidence of intracranial hemorrhage, number of circuit changes, days on ECMO, and overall survival.</p><p><strong>Conclusion: </strong>Anticoagulation with bivalirudin in neonates who underwent CDH repair while on ECMO was associated with decreased surgical bleeding complications and less total blood product transfused. This pilot analysis is the first to compare heparin to bivalirudin and stresses the importance of a multicenter study.</p>","PeriodicalId":12189,"journal":{"name":"Fetal Diagnosis and Therapy","volume":" ","pages":"133-138"},"PeriodicalIF":1.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142727419","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Psychological Impact in Early Pregnancy Loss: The Effects of Disclosing the Causative Chromosomal Anomaly.","authors":"Maria Borrell, Montse Pauta, Aida Mallorquí, Victoria Ardiles-Ruesjas, Virginia Borobio, Carmen Illanes, Isabel Matas, Antoni Borrell","doi":"10.1159/000543684","DOIUrl":"10.1159/000543684","url":null,"abstract":"<p><strong>Introduction: </strong>The study investigated whether the disclosure of the chromosomal anomaly causing early pregnancy loss (EPL) favors the grief process and reduces psychological distress.</p><p><strong>Methods: </strong>Women experiencing EPL were invited to participate in the study at the time they were offered chorionic villi sampling (CVS) and karyotyping before uterine evacuation. They completed two online surveys: one a week after EPL and another a month later, after receiving cytogenetic results. The surveys measured anxiety (Hospital Anxiety and Depression Scale [HADS]), Beck Depression Inventory (BDI-II) cognitive depression factor items, post-traumatic stress disorder (Impact of the Event Scale-Revised [IES-R]), and rumination (Ruminative Responses Scale [RRS-10]). Participants were divided into groups based on the chromosomal anomaly found at CVS: A1 (autosomal trisomy), A2 (other anomalies), and B (no anomalies).</p><p><strong>Results: </strong>A significant score decline was observed in the four studied psychological scales assessing anxiety, depression, post-traumatic stress, and rumination, between the first and second survey. The proportion of women with a clinical score also demonstrated a significant decline, except for anxiety. When these changes were assessed after karyotypic group stratification, the group with other chromosomal anomalies (A2) showed the highest drop. This group also demonstrated a significantly higher depression score decline at multivariate regression analysis of the median.</p><p><strong>Conclusion: </strong>EPL significantly impacts women's mental health, with 19%-51% experiencing manifestations. Disclosing chromosomal anomalies may aid in psychological recovery, particularly in reducing clinical scores for depression.</p>","PeriodicalId":12189,"journal":{"name":"Fetal Diagnosis and Therapy","volume":" ","pages":"377-387"},"PeriodicalIF":1.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12324762/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143188758","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Role of Intrauterine Infectious and Inflammatory Complications in the Development of Necrotizing Enterocolitis in a Newborn from Preterm Prelabor Rupture of Membranes' Gestation: A Retrospective Cohort Study.","authors":"Ivana Musilova, Jana Leskova, Marian Kacerovsky, Julie Ledvinova, Anna Parmar, Helena Hornychova, Radek Stichhauer, Jan Maly, Ivana Musilova","doi":"10.1159/000546257","DOIUrl":"10.1159/000546257","url":null,"abstract":"<p><strong>Introduction: </strong>This study aimed to evaluate whether the presence of microbial invasion of the amniotic cavity (MIAC) and/or acute histological chorioamnionitis (HCA), as well as their subtypes, in pregnancies complicated by preterm prelabor rupture of membranes (PPROM) is related to the subsequent development of necrotizing enterocolitis (NEC) in newborns from these pregnancies.</p><p><strong>Methods: </strong>This retrospective study included 295 women with singleton pregnancies complicated by PPROM between gestational ages 24+0 and 31+6 weeks who underwent transabdominal amniocentesis. MIAC was detected using a combination of cultivated and noncultivated methods. HCA was revealed by histopathological examination of the placenta. Only neonates with stage IIa of the modified Bell's criteria were considered to have NEC.</p><p><strong>Results: </strong>NEC developed in 3% (10/295) of newborns. There were no differences in the rates of MIAC (p = 0.33), HCA with the absence (p = 1.00) or presence of fetal inflammatory response (p = 0.52), and HCA with acute inflammation of the amnion (p = 0.20) between those who developed and did not develop NEC.</p><p><strong>Conclusion: </strong>Neither MIAC nor HCA was associated with the development of NEC in newborns from singleton pregnancies complicated by PPROM between 24+0 and 31+6 weeks of gestation.</p>","PeriodicalId":12189,"journal":{"name":"Fetal Diagnosis and Therapy","volume":" ","pages":"468-482"},"PeriodicalIF":1.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143985349","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Utility of 3-Dimensional Modeling in Prenatally Diagnosed Large Fetal Neck Mass.","authors":"Devashish S Joshi, Michael A Stellon, Michael D Puricelli, Michael J Beninati, Sylvana Garcia-Rodriguez, Casey Winchester, Teresa Chapman, Inna N Lobeck","doi":"10.1159/000541950","DOIUrl":"10.1159/000541950","url":null,"abstract":"<p><strong>Introduction: </strong>Prenatally diagnosed large fetal neck mass requires multidisciplinary consultation and evaluation of perinatal treatment options. The decision to perform ex utero intrapartum treatment (EXIT) is based on risk-benefit assessment for both the infant and mother. Though fetal ultrasound and MRI assist with operative planning, a three-dimensional anatomic model offers improved anatomic visualization and prenatal patient counseling.</p><p><strong>Case presentation: </strong>Multiple surveillance ultrasound exams between gestational weeks 16 and 32 plus fetal MRI at 29/3 weeks were performed for fetal evaluation. A 3-dimensional model was printed (Form 3 and 3L, clear resin, Formlabs) incorporating fetal MRI (Ax SSFSE TE 100 DL and Cor SSFSE Brain DL) and using Mimics Medical and 3-matic Medical software (Materialise). A left fetal multicystic neck mass measuring 2.1 × 1.8 × 1.5 cm was diagnosed at 16/6 weeks gestation in a G8P2416. Fetal MRI performed at 29/3 weeks showed a large exophytic mixed solid-cystic cervicofacial mass, 10.3 × 9.4 × 10.6 cm arising from the left mandible, concerning for a teratoma. Prior to delivery, the model was used to educate and counsel the family regarding the complex clinical situation and the reasoning for delivery via EXIT followed by mass resection. Additionally, the model demonstrated tracheal narrowing and oropharyngeal compression, supporting airway intervention planning. The fetus was delivered at 32/3 weeks via EXIT to intubation using rigid bronchoscopy. Duration of time on placental support was 12 min. On day of life 5, the patient underwent resection of the cervical mass. Pathology revealed an immature teratoma, histologic grade 3 without yolk sac elements, and negative regional lymph nodes.</p><p><strong>Conclusion: </strong>Three-dimensional fetal modeling facilitates perinatal airway needs assessment, patient counseling, delivery, and postnatal management.</p>","PeriodicalId":12189,"journal":{"name":"Fetal Diagnosis and Therapy","volume":" ","pages":"172-177"},"PeriodicalIF":1.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142399860","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Mortality of Politics: An American Paradox.","authors":"Mark I Evans, Gregory F Ryan, David W Britt, Christian R Macedonia","doi":"10.1159/000541912","DOIUrl":"10.1159/000541912","url":null,"abstract":"<p><strong>Introduction: </strong>The USA has the poorest health statistics of any high-income country. Political polarization has risen dramatically; newer safety net programs (the Affordable Care Act [ACA]) are unevenly provided because many Republican-leaning states refused expanded Federal coverage. Democratic programs have reduced physician leadership of medicine. Both have been deleterious. Here, we investigated associations among four key health measures two of which directly impact pregnancy outcomes and two that affect all patients by percentage of each state that voted for the Republican versus Democratic candidate in the 2020 presidential election.</p><p><strong>Methods: </strong>For each state, we used public, non-partisan databases to assess the incidence of COVID, maternal, and infant mortality per 100,000 population and average life expectancy. Correlations among these four outcome variables and percentage Republican vote were calculated (r), contextualized by measuring associations with related variables including COVID vaccination rates, access to medical care, and incidences of heart disease, obesity, diabetes, gunshot deaths, and automotive fatalities.</p><p><strong>Results: </strong>COVID mortality, maternal and infant mortality, and life expectancy were highly correlated with percentage Republican (\"red\") vote per state. If \"red\" states had vaccination rates equivalent to Democratic-leaning (\"blue\") states, 72,000 deaths could have been avoided. Overall, \"red\" states have lower health metrics, reduced access to care, and higher comorbidities.</p><p><strong>Conclusion: </strong>The percent Republican vote was strongly associated, but not the whole answer, with worse health outcomes for multiple key measures of public health including mortality, access to care, and various comorbidities. Overall, the ACA has improved patient access to care but has also led to \"maternity care deserts\" disproportionately in rural areas in \"red\" states. Translating insurance coverage into improved care and outcomes requires further analysis and will require multi-pronged approaches including expanding coverage and incentivizing quality care.</p>","PeriodicalId":12189,"journal":{"name":"Fetal Diagnosis and Therapy","volume":" ","pages":"65-80"},"PeriodicalIF":1.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142389217","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}