Pregnancy (Hoboken, N.J.)最新文献

{"title":"Implementation of a statewide bundle on obstetric hemorrhage in New York.","authors":"J Christopher Glantz, Amanda L Roy, Peter S Bernstein, Dena Goffman, Mary E D'Alton, Kristen Lawless, Marilyn A Kacica","doi":"10.1002/pmf2.70046","DOIUrl":"10.1002/pmf2.70046","url":null,"abstract":"<p><strong>Introduction: </strong>Obstetric hemorrhage is one of the leading causes of maternal death and also one of the most preventable. In 2017, a New York statewide initiative led by the New York State Perinatal Quality Collaborative asked birthing hospitals to implement an ACOG District II Safe Motherhood Initiative evidence-based bundle on recognition and management of hemorrhage, and to assist and offer extensive education, assistance, and feedback. This report describes the process and results.</p><p><strong>Methods: </strong>The bundle was available to all birthing hospitals. Hospitals were asked to implement 21 measures, with a goal of each measure being implemented by at least 85% of hospitals. Webinars and teaching sessions were attended by participating hospital teams to foster collaborative learning, share best practices, provide technical assistance and education, and serve as a forum for discussion of successes and barriers. Hospitals used standardized data collection forms to report measure implementation, aggregate patient data, and for major hemorrhages (requiring massive transfusion, hysterectomy, transfer to a higher level of care, or death), deidentified patient-level data. Data were analyzed using chi-square, repeated measures ANOVA, linear regression, and Cochrane's Q tests.</p><p><strong>Results: </strong>Eighty-six hospitals initially engaged (78 ultimately completed), with teams attending 35 webinars and 3 learning sessions. At the initiative's start, 6 of the 21 measures already were in place at 85% of hospitals; by the initiative's end, this increased to 19 of 21 with significant increases (<i>p</i> < 0.05) for all but two. The percent of patients defined as having obstetric hemorrhages increased during the initiative as use of quantitative blood loss (QBL) increased from 9.8% to 14.5% (<i>p</i> < 0.001); among patients with major hemorrhages, exclusive QBL use increased blood loss volume by 287 mL (<i>p</i> = 0.004). Among patients with major hemorrhages, the need for transfer to higher levels of care decreased during the initiative (<i>p</i> = 0.02), although rates of hysterectomy or use of massive transfusion were unchanged.</p><p><strong>Conclusion: </strong>A comprehensive statewide initiative encouraging hospitals to adopt an evidence-based bundle on obstetric hemorrhage was successful in that 19 of 21 measures were implemented by ≥85% of hospitals. Focused statewide initiatives can improve hospitals' ability to provide evidence-based obstetrical care.</p>","PeriodicalId":520540,"journal":{"name":"Pregnancy (Hoboken, N.J.)","volume":"1 4","pages":"e70046"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12217413/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144562592","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Breastfeeding patterns among parturients with diabetes: a secondary analysis of the MOMPOD randomized clinical trial.","authors":"Minhazur Sarker, Marni B Jacobs, Kim Boggess, Ashley N Battarbee, Jerrie Refuerzo, Noelia Zork, Kacey Eichelberger, Celeste Durnwald, Mark Landon, Kjersti Aagaard, Kedra Wallace, Christina Scifres, Sherri Longo, Alison Stuebe, Gladys A Ramos","doi":"10.1002/pmf2.12040","DOIUrl":"10.1002/pmf2.12040","url":null,"abstract":"<p><strong>Introduction: </strong>Insulin resistance is associated with decreased milk supply in lactating people. Metformin is hypothesized to increase breast milk production by decreasing insulin resistance, suggesting use may increase breastfeeding success. We aimed to determine the association between metformin use during pregnancy and breastfeeding initiation and continuation.</p><p><strong>Methods: </strong>This was a secondary analysis of the MOMPOD randomized controlled trial of metformin versus placebo in addition to insulin therapy among pregnant people with type 2 diabetes and early diabetes. We included parturients who delivered a living neonate, received at least one dose of study drug or placebo, endorsed an intention to breastfeed, and completed a breastfeeding survey. Breastfeeding intentions and breastfeeding outcomes were collected utilizing a breastfeeding questionnaire at 24-30 weeks and 30-days postpartum respectively. The primary outcome was breastfeeding at 30-days postpartum defined by exclusive or partial breastfeeding. Secondary outcomes included immediate breastfeeding defined as any breastfeeding during the postpartum hospital admission until at least postpartum day 3, onset of lactogenesis (days), breast and bra size, and breastfeeding challenges. Baseline characteristics and outcomes were compared using chi-square, t-test, or Wilcoxon tests, as appropriate.</p><p><strong>Results: </strong>Among the 794 women randomized and receiving either placebo or metformin in the primary trial, 378 (47.6%) met inclusion criteria with 194 (51.3%) in metformin and 184 (48.7%) in placebo groups. There were no significant differences in baseline characteristics. Immediate breastfeeding was comparable between groups (91.1% vs 88.9%, p=0.53) and there was no difference in onset of lactogenesis. Thirty days postpartum, breastfeeding rates were lower among all parturients and there was no difference between metformin and placebo groups (76.0% vs 66.7%, p=0.11). Also, there were no differences in partial or exclusive breastfeeding, breast cup or bra size, or breastfeeding challenges.</p><p><strong>Conclusion: </strong>Our data suggest no association between metformin use and breastfeeding patterns in those with type 2 or early diabetes in pregnancy. Antepartum metformin should not be recommended solely to improve breastfeeding success.</p>","PeriodicalId":520540,"journal":{"name":"Pregnancy (Hoboken, N.J.)","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12079847/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144082237","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}