American Journal of Obstetrics & Gynecology Mfm最新文献

{"title":"Risk factor stratification for urgent and nonurgent transfusion in patients giving birth","authors":"Douglas S. Richards MD , Sarah J. Ilstrup MD , M. Sean Esplin MD , Donna Dizon-Townson MD , Allison M. Butler MStat , Brett D. Einerson MD","doi":"10.1016/j.ajogmf.2024.101506","DOIUrl":"10.1016/j.ajogmf.2024.101506","url":null,"abstract":"<div><h3>Background</h3><div>A common approach to attempt to reduce maternal morbidity from hemorrhage is to recognize patients at increased risk, and to make advance preparations for possible blood transfusion in these patients. Preparation may consist of a hold clot, type, and screen, or crossmatch. Most hospitals, including ours, have pathways or guidelines that lay out which of these preparations should be made at the time a patient is admitted to labor and delivery. These are often based on risk factors for hemorrhage but do not take into account the probability that transfusion will be needed. The cost-effectiveness of performing a type and screen or routine crossmatch on patients admitted for delivery has been questioned. Several studies have shown that the chance of transfusions in individuals giving birth is very low. In terms of the need for routine blood preparation, the need for urgent transfusion is most relevant. This has not been included in studies of transfusion rates.</div></div><div><h3>Objective</h3><div>The purpose of this study was to quantify the relative importance of risk factors present on admission for needing a blood transfusion and to develop a formula to define each individual's risk. This could then be used to decide an appropriate level of initial blood preparation for patients at different risk levels.</div></div><div><h3>Study Design</h3><div>Risk factors for hemorrhage and the level of transfusion preparation were extracted from the medical records of a cohort of 89,881 patients delivering in an 18-hospital healthcare system over 40 months. We tabulated the number who required at least one RBC transfusion and the number needing an urgent transfusion-defined as receiving blood during labor or within 4 hours after delivery. Odds ratios for requiring a transfusion were calculated for each risk factor. We then calculated the probability of needing a transfusion for each patient based on their risk factor profile.</div></div><div><h3>Results</h3><div>A total of 643 patients had any transfusion during their hospitalization (0.72% of deliveries), and 311 had an urgent transfusion (0.35% of deliveries). The calculated probability of needing a transfusion was less than 1% in 87.8% of patients and was greater than 5% in 1.2% of patients. The chance of needing a transfusion was highest for placenta accreta spectrum, admission Hgb <8.0, and placenta previa. A second tier of risk factors included abruption, bleeding with no specific diagnosis, and Hgb between 8.0 and 10.0.</div></div><div><h3>Conclusion</h3><div>In our cohort, very few patients received a transfusion. Applying a formula derived from patient-specific risk factors, we found that almost all patients have a very low probability of needing a transfusion, especially an urgent transfusion. Based on these results, we suggest that a hold clot be used except for the highest-risk patients or in settings with barriers to procuring blood in the rare case of urgent tra","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":"6 11","pages":"Article 101506"},"PeriodicalIF":3.8,"publicationDate":"2024-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142297367","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}

{"title":"What is the best mode of delivery in nulliparous, singleton, term, vertex pregnancies","authors":"Vincenzo Berghella MD ,&nbsp;Victoria Adewale MD ,&nbsp;Tanvi Rana MD ,&nbsp;Giulia Bonanni MD ,&nbsp;Suneet P. Chauhan MD, Hon DSc ,&nbsp;Federica Bellussi MD, PhD ,&nbsp;Dwight Rouse MD, MPH ,&nbsp;Jon Barrett MD","doi":"10.1016/j.ajogmf.2024.101501","DOIUrl":"10.1016/j.ajogmf.2024.101501","url":null,"abstract":"<div><div>With approximately 145 million births occurring worldwide each year—over 30 million by cesarean delivery (CD), the need for evaluation of maternal and perinatal outcomes in different delivery scenarios is more pressing than ever. Recently, in a meta-analysis of the available randomized controlled trials, planned CD was associated with significantly decreased rates of low umbilical artery pH, and neonatal complications such as birth trauma, tube feeding, and hypotonia when compared to planned vaginal delivery (VD). Among singleton pregnancies, planned CD was associated with a significantly lower rate of perinatal death. For mothers, planned CD was associated with significantly less chorioamnionitis, more wound infection, and less urinary incontinence at 1 to 2 years. Conversely, planned VD has been associated with benefits such as a lower incidence of wound infection and quicker postpartum recovery compared to planned CD. Nonetheless, several risk factors for CD are increasing—such as older maternal age, obesity, diabetes, excessive gestational weight gain, and birth weight—while maternal pelvises are getting smaller. Concerns about the potential long-term risks of multiple cesarean deliveries, such as placenta accreta spectrum disorders, highlight the need for a balanced evaluation of both delivery modes. However, the total fertility rate is decreasing in the US and around the world, with many people wanting two or fewer babies, which decreases future risk of placenta accreta incurred by multiple cesarean deliveries in these individuals. Furthermore, one in four obstetricians-gynecologists has undergone a CD on maternal request for their nulliparous, singleton, term, vertex (NSTV) pregnancy, and CD rates less than about 19% have been associated with higher perinatal and maternal mortality. Thus, we propose that it is imperative that we prioritize conducting randomized trials to compare planned cesarean to planned VD for NSTV pregnancies. Such trials would need to include 8000 or more individuals; they would ideally follow each participant to the end of their reproductive life and study perinatal and maternal outcomes, including nonbiologic outcomes such as patient satisfaction, postpartum depression, breastfeeding rates, mother-infant bonding, post-traumatic stress, and cost-effectiveness. The time for such a trial is now, as it holds the potential to inform and improve obstetrical care practices globally.</div></div>","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":"6 11","pages":"Article 101501"},"PeriodicalIF":3.8,"publicationDate":"2024-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142297380","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}

{"title":"Oxytocin with calcium vs oxytocin for induction of labor in women with term premature rupture of membranes: a randomized controlled trial","authors":"Ruixiang Cai MD,&nbsp;Lingyan Chen MD,&nbsp;Yunguang Xing BD,&nbsp;Yuguo Deng MD,&nbsp;Juan Li MD,&nbsp;Fangfang Guo BD,&nbsp;Li Liu BD,&nbsp;Cuihua Xie BD,&nbsp;Jinying Yang PhD","doi":"10.1016/j.ajogmf.2024.101502","DOIUrl":"10.1016/j.ajogmf.2024.101502","url":null,"abstract":"<div><h3>BACKGROUND</h3><div>Intravenous calcium administration has shown promise in enhancing uterine contractions and reducing blood loss during cesarean delivery, but this regimen has not been compared in vaginal labor induction.</div></div><div><h3>OBJECTIVE</h3><div>This study aimed to determine the efficacy of oxytocin combined with calcium vs oxytocin alone for inducing labor in women with term premature rupture of membranes.</div></div><div><h3>STUDY DESIGN</h3><div>This single-blind, randomized controlled trial was conducted between October 2022 and May 2023 at a tertiary university hospital. Patients diagnosed with premature rupture of membranes were randomly allocated into 2 groups. The intervention group received a bolus of 10 mL of calcium gluconate followed by a continuous infusion of oxytocin via a pump (n=210), whereas the control group received only oxytocin infusion (n=218). The primary outcome was successful vaginal deliveries within 24 hours after labor induction. The secondary outcomes included the interval from labor induction to delivery, vaginal delivery blood loss, and maternal and neonatal complications.</div></div><div><h3>RESULTS</h3><div>Baseline characteristics, including maternal age, body mass index, and Bishop score before labor induction, were comparable between the groups. The rate of vaginal delivery within 24 hours after labor induction was statistically higher in the intervention group (79.52% vs 70.64%; <em>P</em>=.04). The participants in the intervention group experienced a shortened interval between labor induction and delivery (10.48 vs 11.25 hours; <em>P</em>=.037) and demonstrated a higher success rate in labor induction assessed by the onset of the active phase (93.80% vs 87.61%; <em>P</em>=.04) without increasing the cesarean delivery rate. Reduced hemorrhage was observed in the intervention group (242.5 vs 255.0 mL; <em>P</em>=.0015), and the maternal and neonatal outcomes were comparable between the groups.</div></div><div><h3>CONCLUSION</h3><div>The coadministration of calcium and oxytocin in labor induction among pregnancies with premature rupture of membranes was more efficient and safer than the administration of oxytocin alone. Our research suggests that the combination therapy of calcium and oxytocin may offer significant advantages during the process of labor induction and result in better outcomes.</div></div><div><h3>Video Abstract</h3><div><span><span><span><span><video><source></source></video></span><span><span>Download: <span>Download video (8MB)</span></span></span></span><span><span><p><span>Video</span>. </p></span></span></span></span></div></div>","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":"6 11","pages":"Article 101502"},"PeriodicalIF":3.8,"publicationDate":"2024-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142297362","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}

{"title":"Optimizing induction of labor: the Birth Efficiency and Satisfaction Induction of Labor (BEST induction of labor) study","authors":"Sydney M. Thayer MD,&nbsp;Sarah Y. Cohen MD, MPH,&nbsp;Samantha A.S. Williams BS,&nbsp;Lori Stevenson MSN, RNC-OB,&nbsp;Kali Stewart MD,&nbsp;Bree Goodman MD,&nbsp;Nandini Raghuraman MD, MSCI,&nbsp;Ebony B. Carter MD, MPH,&nbsp;Anthony O. Odibo MD, MSCE,&nbsp;Jeannie C. Kelly MD, MS","doi":"10.1016/j.ajogmf.2024.101507","DOIUrl":"10.1016/j.ajogmf.2024.101507","url":null,"abstract":"","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":"6 11","pages":"Article 101507"},"PeriodicalIF":3.8,"publicationDate":"2024-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142297361","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}

{"title":"Placental mosaicism for autosomal trisomies: comprehensive follow-up of 528 Danish cases (1983–2021)","authors":"Simon H. Thomsen MD ,&nbsp;Ida C.B. Lund MD, PhD ,&nbsp;Iben Bache MD, PhD ,&nbsp;Naja Becher MD, PhD ,&nbsp;Ida Vogel MD, PhD, DMSc","doi":"10.1016/j.ajogmf.2024.101497","DOIUrl":"10.1016/j.ajogmf.2024.101497","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;Mosaicism, characterized by the presence of two or more chromosomally distinct cell lines, is detected in 2% to 4% of chorionic villus samples (CVSs). In these cases, the aberration may be confined to the placenta or additionally present in the fetus. Fetal involvement may manifest as fetal malformations, while confined placental mosaicism (CPM) poses risks such as preterm birth and low birth weight. Differentiating between true fetal mosaicism and CPM at the time of the chorionic villus sampling is challenging and requires follow-up by an amniocentesis and ultrasonography.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Objective&lt;/h3&gt;&lt;div&gt;To estimate the risk of fetal involvement or adverse pregnancy outcomes for specific chromosomes after detecting mosaicism for an autosomal trisomy in a CVS and identify high (red), intermediate (yellow), and low (green) risk chromosomes. Further, to explore possible associations with level of mosaicism and screening parameters.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Study Design&lt;/h3&gt;&lt;div&gt;A retrospective descriptive study of all singleton pregnancies with mosaicism detected in CVSs from 1983 to 2021 identified in the Danish Cytogenetic Central Registry and the Danish Fetal Medicine Database.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Of 90,973 CVSs, 528 cases had mosaicism involving an autosomal trisomy and where genetic follow-up had been performed. The overall risk of fetal involvement was 13% (69/528) with extensive variations depending on which chromosome was involved (eg, trisomy 7: 0% [0/55] or trisomy 21: 46% [19/41]). Higher levels of mosaicism in the CVS suggested fetal involvement as mean mosaic level was 55% in true fetal mosaics vs 28% in cases confined to the placenta (&lt;em&gt;P&lt;/em&gt;=.0002). In cases with CPM (459/528), the risk of delivering small-for-gestational-age neonates was 14% (48/341). The risk of preterm birth (before 37 weeks) was 15% (51/343). The collective risk of adverse outcome was 22% (76/343) in pregnancies that continued and where information on birth weight and gestational age at birth was available. Adverse outcomes varied substantially between chromosomes. Also, multiple-of-the-median (MoM) values of pregnancy-associated plasma protein A was predictive of these issues as it was significantly lower in cases with adverse outcome compared to cases with a normal outcome (small for gestational age: 0.23 MoM vs 0.47 MoM, &lt;em&gt;P&lt;/em&gt;&lt;.0001) or preterm birth: 0.25 MoM vs 0.47 MoM, &lt;em&gt;P&lt;/em&gt;&lt;.0001). After the introduction of combined first-trimester screening (cFTS) in 2004, the detection of cases with fetal involvement seemed to increase as the risk before 2004 was 9% (16/174) compared to 15% (53/354) after 2004 (risk ratio: 1.7 [95% CI: 1.0; 2.8]). The risk of adverse outcome in CPM pregnancies increased from 16% (22/139) before 2004 to 27% (55/204) after 2004 (risk ratio 1.7 [95% CI: 1.1; 2.7]).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusion&lt;/h3&gt;&lt;div&gt;Introducing cFTS increased the detection of placental mosaicism with f","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":"6 11","pages":"Article 101497"},"PeriodicalIF":3.8,"publicationDate":"2024-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142297364","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}

{"title":"Postpartum post-traumatic stress symptoms and their association with mood and parenting stress","authors":"Sarah Heerboth MD ,&nbsp;Katharine E. Bruce MPH,&nbsp;Terri L. Fletcher PhD,&nbsp;Alison M. Stuebe MD, MSc,&nbsp;Alison N. Goulding MD, MSCR","doi":"10.1016/j.ajogmf.2024.101505","DOIUrl":"10.1016/j.ajogmf.2024.101505","url":null,"abstract":"","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":"6 11","pages":"Article 101505"},"PeriodicalIF":3.8,"publicationDate":"2024-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142297365","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}

{"title":"Trends in nuchal translucency measurement at late first trimester ultrasound, and prenatal diagnostic testing after the introduction of cell-free fetal DNA screening: data from a large health system in New York from 2010–2023","authors":"Frank I. Jackson DO,&nbsp;Insaf Kouba MD,&nbsp;Nathan A. Keller MD,&nbsp;Luis A. Bracero MD,&nbsp;Nidhi Vohra MD,&nbsp;Matthew J. Blitz MD, MBA","doi":"10.1016/j.ajogmf.2024.101499","DOIUrl":"10.1016/j.ajogmf.2024.101499","url":null,"abstract":"","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":"6 11","pages":"Article 101499"},"PeriodicalIF":3.8,"publicationDate":"2024-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142297371","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}

{"title":"Cesarean delivery, labor duration, and mothers’ mortality risk over 50 years of follow-up","authors":"Susanna D. Mitro PhD ,&nbsp;Rajeshwari Sundaram PhD ,&nbsp;Sonia M. Grandi PhD ,&nbsp;Stefanie N. Hinkle PhD ,&nbsp;James L. Mills MD ,&nbsp;Pauline Mendola PhD ,&nbsp;Sunni L. Mumford PhD ,&nbsp;Yan Qiao MPH ,&nbsp;Anokhi Cifuentes MPH ,&nbsp;Cuilin Zhang MD, PhD ,&nbsp;Enrique F. Schisterman PhD ,&nbsp;Katherine L. Grantz MD, MS","doi":"10.1016/j.ajogmf.2024.101498","DOIUrl":"10.1016/j.ajogmf.2024.101498","url":null,"abstract":"<div><h3>Background</h3><div>Pregnancy complications have been recognized as a window to future health. Though cesarean delivery is common, it is unknown whether labor duration and mode of delivery are associated with maternal long-term mortality.</div></div><div><h3>Objective</h3><div>To examine whether labor duration and mode of delivery were associated with all-cause and cause-specific mortality.</div></div><div><h3>Study Design</h3><div>Participants were mothers from the multisite Collaborative Perinatal Project (CPP) cohort (1959–1966; <em>n</em>=43,646, limited to last CPP delivery). We ascertained all-cause and specific causes of death as of 2016 via linkage to the National Death Index and Social Security Death Master File. Hazard ratios (HR) testing mode of delivery and labor duration were estimated using Cox proportional hazards models adjusted for demographic and clinical characteristics. We further stratified analyses by parity.</div></div><div><h3>Results</h3><div>Among participants with a recorded delivery mode, 5.9% (2486/42,335) had a cesarean delivery. Participants who had a cesarean were older (26.9 vs 24.3 years), with higher body mass index (24.0 vs 22.7 kg/m²), were less likely to be nulliparous (21% vs 30%), and more likely to have a household income of at least $6000 (22% vs 17%), to smoke ≥1 pack/d (18% vs 15%), to have diabetes mellitus (12% vs 1%) and to have a prior medical condition (47% vs 34%), compared to participants with a vaginal delivery. Delivery mode was similar by race/ethnicity, marital status, and education. Median labor duration was 395 minutes among participants who had an intrapartum cesarean delivery and 350 minutes among participants delivered vaginally. By 2016, 52.2% of participants with a cesarean delivery and 38.5% of participants with a vaginal delivery had died. Cesarean vs vaginal delivery was significantly associated with increased risk for all-cause mortality (HR=1.16 (95% confidence interval [CI]: 1.09, 1.23); in nulliparas, HR=1.27 (95% CI: 1.09, 1.47); in multiparas, HR=1.13 (95% CI: 1.06, 1.21) as well as increased risk of death from cardiovascular disease, diabetes, respiratory disease, infection, and kidney disease. Associations with death from cardiovascular disease, infection, and kidney disease were stronger for multiparas than nulliparas, though the association with death from diabetes was stronger among nulliparas. Labor duration was not significantly related to overall mortality.</div></div><div><h3>Conclusion</h3><div>In a historic United States cohort with a low cesarean delivery rate, cesarean delivery was an indicator for subsequent increased mortality risk, particularly related to cardiovascular disease and diabetes. Future studies with long-term follow-up are warranted given the current high prevalence of cesarean delivery.</div></div>","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":"6 11","pages":"Article 101498"},"PeriodicalIF":3.8,"publicationDate":"2024-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142297345","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}

{"title":"Lived experience of hypertensive disorders of pregnancy: a systematic review and meta-synthesis","authors":"Sara R. Wetzler MPhil ,&nbsp;Tabitha Wishlade MSc ,&nbsp;Frances Cates ,&nbsp;Isla Kuhn MSc ,&nbsp;Catherine E. Aiken PhD","doi":"10.1016/j.ajogmf.2024.101494","DOIUrl":"10.1016/j.ajogmf.2024.101494","url":null,"abstract":"<div><h3>Background</h3><div>Hypertensive disorders are major causes of maternal and neonatal morbidity and mortality, affecting ∼10% pregnancies worldwide.</div></div><div><h3>Objective</h3><div>Understanding the lived experience of women with hypertensive disorders during pregnancy is important to inform best practice and provide holistic care.</div></div><div><h3>Study Design</h3><div>This is a systematic review and meta-synthesis of studies containing qualitative components relating to direct lived experience of hypertensive disorders of pregnancy. Medline via Ovid, Embase via Ovid, CINAHL via Ebsco, PsycINFO via Ebsco, Scopus, Web of Science Core Collection, and ASSIA via ProQuest were searched between database inception and June 2024. Quality assessment was performed using the Critical Appraisal Skills Programme checklist for qualitative research. Themes were labeled and organized into a framework using NVivo software.</div></div><div><h3>Results</h3><div>Eighteen studies were included in the meta-synthesis. Anxiety, stress, fear and panic emerged as the most common emotional experiences during hypertensive disorders of pregnancy. Loss of control was also mentioned frequently and consistently across studies (frequency effect size 38.9% and intensity effect size 15.3%). Emotional responses to physical symptoms or lack thereof, and feelings about the impact of the complicated pregnancy on family and community also emerged as central themes associated with hypertensive disorders of pregnancy.</div></div><div><h3>Conclusion</h3><div>A range of emotional experiences was captured across the studies included in our meta-synthesis, some of which were observed across global settings whereas others were context-dependent. Interventions and care pathways for pregnancies affected by hypertensive disorders should aim to support women through complex emotional experiences as well as reducing morbidity and mortality.</div></div>","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":"6 11","pages":"Article 101494"},"PeriodicalIF":3.8,"publicationDate":"2024-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142297350","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}

{"title":"The association between perinatal depressive symptoms and child neurodevelopment","authors":"Emily S. Miller MD, MPH ,&nbsp;Maged M. Costantine MD, MBA ,&nbsp;Lisa Mele ScM ,&nbsp;Michael W. Varner MD ,&nbsp;Uma M. Reddy MD, MPH ,&nbsp;Ronald J. Wapner MD ,&nbsp;John M. Thorp Jr MD ,&nbsp;George R. Saade MD ,&nbsp;Alan T.N. Tita MD, PhD ,&nbsp;Dwight J. Rouse MD ,&nbsp;Baha Sibai MD ,&nbsp;Brian M. Mercer MD ,&nbsp;Steve N. Caritis MD ,&nbsp;Brian M. Casey MD ,&nbsp;Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network, Bethesda, MD, United States","doi":"10.1016/j.ajogmf.2024.101488","DOIUrl":"10.1016/j.ajogmf.2024.101488","url":null,"abstract":"<div><h3>Background</h3><div>Perinatal depression has been suggested to adversely impact child neurodevelopment. However, the complexity of the early childhood environment challenges conclusive findings.</div></div><div><h3>Objective</h3><div>To evaluate whether there is an association between perinatal depressive symptoms and child intelligence quotient (IQ) at 5 years of age.</div></div><div><h3>Study Design</h3><div>Secondary analysis of an ancillary study to a multicenter randomized trial of thyroxine therapy for pregnant individuals with subclinical hypothyroidism. Dyads of infants and birthing parent, with completed Center for Epidemiological Studies-Depression (CES-D) screens during pregnancy and postpartum and child neurodevelopment testing completed at five years of age (<em>n</em>=209) were included. CES-D screening was performed at 11–20 weeks, 34–38 weeks, and one-year postpartum. Depressive symptoms were categorized as antenatal (i.e., a positive screen at any point during pregnancy) or postpartum. The primary outcome was child IQ score &lt; 85 at 5 years of age using the Wechsler Preschool and Primary Scale of Intelligence III (WPPSI-III) Full Scale test. Secondary outcomes included other assessments of childhood neurodevelopment. Bivariable analyses and multivariable logistic regressions were utilized.</div></div><div><h3>Results</h3><div>Of the 209 birthing people included, 72 (34%) screened positive for depression during pregnancy and 32 (15%) screened positive one year postpartum. Children born to individuals with a positive antenatal depression screen had a higher odds of IQ &lt; 85 at 5 years of age compared with children born to individuals with a CES-D &lt; 16 (35% vs. 18%, OR 2.4, 95% CI 1.2–4.7). Similar findings were seen for children born to individuals with a positive postpartum depression screen (47% vs. 21%, OR 3.3, 95% CI 1.5–7.3). These associations did not persist in multivariable analyses that controlled for social determinants of health and clinical characteristics (adjusted odd ratio [aOR] 1.4, 95% CI 0.7–3.1; aOR 2.1, 95% CI 0.9–5.1, for antenatal and postpartum depressive symptoms, respectively). Similar findings were observed for other adverse neurodevelopmental outcomes.</div></div><div><h3>Conclusions</h3><div>Having a positive perinatal depression screen was not associated with child cognitive outcomes after controlling for covariates including social determinants of health.</div></div>","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":"6 11","pages":"Article 101488"},"PeriodicalIF":3.8,"publicationDate":"2024-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142297370","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}