Pregnancy (Hoboken, N.J.)最新文献

{"title":"Interdisciplinary management of a viable term abdominal ectopic pregnancy.","authors":"Sarena Hayer, Natasha Q McGlaun, Katerina A Furman, Michael R Manuel, Gouri B Sadananda, Daniel Manzoor, Swati Bhardwaj, Tanu Patel, Sara Dayanim, John A Ozimek","doi":"10.1002/pmf2.70336","DOIUrl":"https://doi.org/10.1002/pmf2.70336","url":null,"abstract":"<p><strong>Introduction: </strong>Abdominal ectopic pregnancies are rare and associated with increased maternal morbidity and mortality. As the majority are diagnosed early in gestation, there are few reports of management of advanced abdominal ectopic pregnancies.</p><p><strong>Case: </strong>A 41-year-old gravida 2 para 1 presented with fatigue and a known left ovarian cyst. She was found to have a term, viable abdominal ectopic pregnancy and underwent exploratory laparotomy, abdominal delivery, left oophorectomy, and supracervical hysterectomy. The patient and her infant recovered well and were discharged home in stable condition.</p><p><strong>Conclusion: </strong>In this unusual case, multiple imaging modalities were needed to arrive at a diagnosis and plan for optimal surgical management. Interdisciplinary care planning at a well-resourced referral center allowed for the successful management of this complex case.</p>","PeriodicalId":520540,"journal":{"name":"Pregnancy (Hoboken, N.J.)","volume":"2 4","pages":"e70336"},"PeriodicalIF":0.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13344259/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148764591","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":"Low-frequency electroacupuncture attenuates insulin resistance in a rat model of diet-induced maternal obesity.","authors":"David J Carr, Elizabeth Kelley, Morgan Sekhon, Megan Kawasaki, Keara McElroy-Yaggy, R Chris Skinner, Paul D Taylor, Anna L David, Elisabet Stener-Victorin, Thomas L Jetton","doi":"10.1002/pmf2.70312","DOIUrl":"https://doi.org/10.1002/pmf2.70312","url":null,"abstract":"<p><strong>Introduction: </strong>Maternal obesity is highly prevalent worldwide, conferring elevated risks of maternal/fetal complications and adult-onset disease in offspring. Obesity and pregnancy are both states of insulin resistance. Percutaneous electrical stimulation of skeletal muscle, better known as electroacupuncture (EA), mitigates insulin resistance in polycystic ovarian syndrome and diabetes, but its efficacy in pregnancy is unknown. We aimed to determine if EA can attenuate insulin resistance in pregnant Wistar rats with high-fat, high-sucrose (HFS) diet-induced obesity.</p><p><strong>Methods: </strong>Nineteen HFS-exposed dams receiving 12-14 sessions of EA of rectus abdominis, tibialis anterior, soleus and gastrocnemius (3/15 Hz frequency, 10 mA intensity, 30 min) under isoflurane anesthesia (HFS+EA group) were compared with 19 untreated HFS-exposed dams receiving control anesthesia (HFS group) and 10 nonobese, nonpregnant controls (Ctrl group). On embryonic day (E)19 ± 1, insulin sensitivity was measured as the steady-state glucose infusion rate (GIR) during a gold-standard hyperinsulinemic-euglycemic clamp. Body composition, fasting blood glucose, fasting plasma insulin, serum corticosterone, blood pressure, pancreatic ß-cell mass and hepatic malonaldehyde/triglyceride content were determined.</p><p><strong>Results: </strong>Compared to the Ctrl group, the HFS group exhibited a decreased GIR (mean ± SEM = 13.3 ± 1.33 vs. 18.2 ± 1.37 mg/kg/min, <i>p</i> = 0.014)-reflecting insulin resistance-as well as increased pancreatic weight (1.31 ± 0.077 vs. 1.06 ± 0.111 g, <i>p</i> = 0.04) and increased hepatic malonaldehyde content (0.24 ± 0.041 vs. 0.12 ± 0.003 µM, <i>p</i> = 0.016). These changes were reversed by EA; compared to the HFS group, the HFS+EA group had a higher GIR (16.8 ± 1.01 mg/kg/min, <i>p</i> = 0.029), lower pancreatic weight (1.03 ± 0.051 g, <i>p</i> = 0.006) and lower hepatic malonaldehyde content (0.14 ± 0.016 µM, <i>p</i> = 0.019). Visceral adiposity, insulin, corticosterone and hepatic triglyceride content were increased in the model (<i>p</i> < 0.05) but not significantly impacted by EA. There were no measurable effects of pregnancy or EA on blood pressure or ß-cell mass, although there were significantly fewer small islets of Langerhans and significantly more large islets in HFS versus Ctrl groups. Raw fetal/placental weights did not differ; however, placental efficiency (fetal weight per unit placenta) was increased (4.09 ± 0.007 vs. 3.79 ± 0.006, <i>p</i> = 0.027) and litter size marginally decreased (median [interquartile range] = 16 [14-18] vs. 14 [11-16], <i>p</i> = 0.012) in HFS+EA versus HFS groups.</p><p><strong>Conclusion: </strong>EA attenuated insulin resistance in this rat model of maternal obesity. The effects of EA on fetoplacental growth and litter size require further investigation, especially given the latter observation could signal a potential safety issue.</p>","PeriodicalId":520540,"journal":{"name":"Pregnancy (Hoboken, N.J.)","volume":"2 4","pages":"e70312"},"PeriodicalIF":0.0,"publicationDate":"2026-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13344270/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148765864","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":"Targeted regulation of abortion providers and infant mortality.","authors":"Madeline F Perry, Joe Feinglass, Lynn M Yee","doi":"10.1002/pmf2.70320","DOIUrl":"https://doi.org/10.1002/pmf2.70320","url":null,"abstract":"<p><strong>Introduction: </strong>Abortion restrictions on pregnant people, such as those that limit gestational age or ban abortion altogether, have been associated with infant mortality, but little is known about whether laws restricting abortion providers and clinics providing abortions have similar associations. This study examines the association between laws that restrict abortion providers, known as TRAP (targeted regulations of abortion providers) laws, and infant mortality on a state level.</p><p><strong>Methods: </strong>This cross-sectional analysis was performed utilizing 2016-2021 Phase 8 data from the Pregnancy Risk Assessment Monitoring System (PRAMS). PRAMS data were linked with Guttmacher Institute data about state TRAP laws from 2016 to 2021. Infant death rates were calculated using PRAMS data of self-reported infant deaths. Multivariable Poisson regression testing the association between the existence of TRAP laws in a state and infant mortality was performed, adjusting for individual-level sociodemographic factors available in PRAMS. The exposure was defined as the existence of at least one TRAP law in a state during the study period.</p><p><strong>Results: </strong>Among 178,210 participants, representing a weighted population of 9,099,586 birthing people, 47.5% people lived in states (<i>n</i> = 19) that had at least one TRAP law during the study period. Overall, 0.4% of participants reported an infant death. In adjusted analysis, there was a 36% greater likelihood of infant mortality (adjusted incident rate ratio [aIRR], 1.36; 95% confidence interval [CI], 1.13-1.63) in states with TRAP laws in comparison to those without TRAP laws.</p><p><strong>Conclusions: </strong>TRAP laws are associated with a greater likelihood of infant mortality, even after accounting for potential individual-level confounders. Restricted access to abortion may result in people with high-risk maternal or fetal health conditions continuing pregnancy rather than receiving desired abortion services.</p>","PeriodicalId":520540,"journal":{"name":"Pregnancy (Hoboken, N.J.)","volume":"2 4","pages":"e70320"},"PeriodicalIF":0.0,"publicationDate":"2026-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13344207/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148763834","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":"Patient feedback on an educational tool to empower patients after hypertensive pregnancy.","authors":"Ann C Celi, Emma M Anghel, Skylar N Smith, Sharlay K Butler, Saba H Berhie, Giselle Chiprez Ramirez, Jill C Doyle, Michelle C Lara, Margot Stone-Condry, Raquel M Vargas-Vila, Barbara E Wilkinson, Chloe A Zera","doi":"10.1002/pmf2.70315","DOIUrl":"10.1002/pmf2.70315","url":null,"abstract":"<p><strong>Introduction: </strong>Hypertensive disorders of pregnancy (HDPs) are a leading contributor to preventable maternal morbidity and mortality and are associated with increased risk of cardiovascular disease. The postpartum period represents a critical opportunity to improve engagement in follow-up care and support cardiovascular disease prevention after HDP; however, few patient-facing, postpartum educational tools about HDP have been studied. We sought to develop and evaluate a patient educational discussion guide to support postpartum recovery and promote heart-healthy behavior after a hypertensive pregnancy.</p><p><strong>Methods: </strong>We developed an updated three-page educational discussion guide, \"My Health Beyond Pregnancy,\" in collaboration with national professional societies and patient advocacy organizations. The guide was designed at a sixth-grade reading level and in English and Spanish. Postpartum patients with HDP were recruited from an urban academic medical center and affiliated community health centers. Participants reviewed the guide and completed an anonymous survey assessing acceptability, appropriateness, and feasibility using validated measures (AIM, IAM, FIM, respectively) and open-ended qualitative feedback. Quantitative data were analyzed using non-parametric tests and qualitative responses were analyzed within the COM-B framework to determine how the educational tool may impact behavior change.</p><p><strong>Results: </strong>A total of 100 postpartum patients with HDP participated. The cohort was racially and ethnically diverse, with the majority publicly insured and nearly half having less than a college education. Participants agreed or strongly agreed that the guide was acceptable (95%), appropriate (96%), and feasible (97%). Perceptions did not differ by race, ethnicity, language, education, or insurance type. Qualitative analysis of free-response questions demonstrated that the guide enhanced behavioral determinants, including psychological capability and reflective motivation by improving understanding of postpartum hypertension and supporting self-advocacy.</p><p><strong>Conclusion: </strong>The \"My Health Beyond Pregnancy\" educational discussion guide was perceived as highly acceptable, appropriate, and feasible among a diverse population of postpartum patients with HDP. By addressing key behavioral determinants and remaining useful across patient populations, the guide shows promise as a scalable tool to support equitable postpartum engagement and cardiovascular risk prevention. Future research should assess its impact on long-term health behaviors, care engagement, and clinical outcomes.</p>","PeriodicalId":520540,"journal":{"name":"Pregnancy (Hoboken, N.J.)","volume":"2 4","pages":"e70315"},"PeriodicalIF":0.0,"publicationDate":"2026-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13344324/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148764254","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":"In utero ventriculosubgaleal shunt placement in a fetal lamb model: Phase 1 technical insights.","authors":"Shohra Qaderi, Weston T Northam, Soner Duru, Eyal Krispin, Nikan Zargarzadeh, Ali Javinani, Jose L Peiro, Hamidreza Forourtan, Braxton Forde, Syril James, Scott A Shainker, Arthur Nedder, Brittany Pattison, Lana Vasung, Lucas Peiro, Ryne A Didier, Michaela K Farber, Sebastian Seifert, Darren B Orbach, P Ellen Grant, Ramen H Chmait, Benjamin C Warf, Kjersti Aagaard, Yves Ville, Alireza A Shamshirsaz","doi":"10.1002/pmf2.70328","DOIUrl":"https://doi.org/10.1002/pmf2.70328","url":null,"abstract":"<p><strong>Background: </strong>Progressive ventriculomegaly and the resulting irreversible brain damage may be mitigated through timely diversion prenatal intervention. While ventriculosubgaleal shunt (VSGS) is commonly performed postnatally in premature infants, in utero placement is unexplored.</p><p><strong>Objectives: </strong>We evaluated the feasibility of intrauterine placement of VSGS using a fetal lamb obstructive hydrocephalus model.</p><p><strong>Study design: </strong>Hydrocephalus was induced in 14 fetal lambs by injecting 1-1.5 mL of BioGlueⓇ into the cisterna magna between Days 80 and 90 of gestation. Ten to 16 days later, ultrasound was performed to confirm hydrocephalus. Afterward, VSGS was surgically placed by creating a fetal subgaleal pocket, inserting a standard ventricular catheter, tunneling under the scalp, and securing with a silk suture, with the other end into a lateral ventricle. Near term, the ewes were sacrificed. Hysterotomy was performed to extract the lambs. Lambs were evaluated through gross inspection. Postmortem magnetic resonance imaging and pathology evaluations were performed. To assess the presence of activated microglia and astroglia, selected brain sections were immuno-stained with ionized calcium-binding adaptor molecule 1 (Iba1) and glial fibrillary acidic protein (GFAP), respectively.</p><p><strong>Results: </strong>Ten ewes with 14 fetuses (four twins) underwent hydrocephalus induction (median 86 days) by maternal laparotomy and either hysterotomy (two out of 14) or transuterine (12 out of 14) methods. Two fetuses were found demised at the time of shunt placement; hydrocephalus was confirmed in 11/12 surviving fetuses (three severe, four moderates, and four mild). A VSGS was successfully placed in all 12 surviving fetuses (median 104 days) employing open uterus fetal surgery. After shunt placement, one case died immediately from severe hydrocephalus, three were aborted, and one intrauterine fetal demise was found during cesarean delivery. Of the remaining seven lambs, seven out of seven VSGS remained under the scalp without catheter migration, and all demonstrated full scalp healing. Pathologic analyses by gross and histological methods confirmed typical hydrocephalic changes, including altered and denuded ependyma. However, more than half of the catheters were macroscopically obstructed with tissue debris and fibrin (four out of seven).</p><p><strong>Conclusion: </strong>Prenatal placement of the VSGS was technically successful in all cases, meaning the shunt could be inserted in 100% of fetuses. Survival to cesarean delivery was 58% (seven out of 12). Among survivors, no hardware migration or scalp breakdown occurred. Future studies should further explore the safety of the shunt.</p>","PeriodicalId":520540,"journal":{"name":"Pregnancy (Hoboken, N.J.)","volume":"2 4","pages":"e70328"},"PeriodicalIF":0.0,"publicationDate":"2026-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13344377/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148763762","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":"Utility of ultrasound surveillance of fetal growth in patients with marginal or velamentous cord insertion.","authors":"Madeline Pence, Anna Madden-Rusnak, Jermiah Crowder, Madeline Petrikas, Kobina Ghartey, Alison G Cahill, Lorie M Harper","doi":"10.1002/pmf2.70329","DOIUrl":"https://doi.org/10.1002/pmf2.70329","url":null,"abstract":"<p><strong>Introduction: </strong>Abnormal cord insertion into the placenta (marginal and velamentous) has been associated with fetal growth restriction (FGR), leading some to recommend evaluation of fetal growth in the third trimester. The purpose of this study was to evaluate the timing of ultrasound surveillance in patients with marginal cord insertion (MCI) or velamentous cord insertion (VCI).</p><p><strong>Methods: </strong>Retrospective cohort of singleton pregnancies diagnosed with isolated MCI or VCI prior to 24 weeks at a single center from September 2021 to May 2025. Outcomes considered were diagnosis of FGR (estimated fetal weight [EFW] or abdominal circumference [AC] <10 percentile) and oligohydramnios (amniotic fluid index [AFI] ≤ 5 cm). The number of ultrasound scans needed to identify one abnormality (NNS) and 95% confidence interval (CI) were calculated for scans performed at 24+0-31+6 weeks and ≥ 32 weeks.</p><p><strong>Results: </strong>Among 248 patients with MCI meeting inclusion criteria, 710 ultrasounds were performed ≥ 24 weeks. A total of eight (3.2%) cases of FGR were diagnosed. Prior to 32 weeks, four cases of FGR were diagnosed (NNS 37.2, 95% CI, 14.9-135.8); however, half of these resolved on follow-up ultrasound. After 32 weeks, the NNS to identify one case of FGR was 80.5 (95% CI, 31.7-294.6); FGR persisted on subsequent ultrasound(s) for all of these cases. Among 65 patients with VCI meeting inclusion criteria, 151 ultrasounds were performed. Two cases of FGR were diagnosed, both ≤ 32 weeks. The NNS to diagnose one case from 24+0-31+6 weeks was 26.5 (95% CI, 7.7-217.2). There were no cases of oligohydramnios diagnosed in either sample.</p><p><strong>Conclusion: </strong>For patients with MCI, half of FGR cases diagnosed ≤32 weeks resolved prior to delivery and were thus likely false-positives, while all cases of FGR diagnosed ≥32 weeks persisted; thus, a single ultrasound at 32-36 weeks may be considered as a resource-efficient monitoring approach. Among patients with VCI, both FGR cases (<i>n</i> = 2) were diagnosed at 30-32 weeks; initiation of growth ultrasounds after 28 weeks is recommended, although recommendations cannot be made regarding frequency based on our study.</p>","PeriodicalId":520540,"journal":{"name":"Pregnancy (Hoboken, N.J.)","volume":"2 4","pages":"e70329"},"PeriodicalIF":0.0,"publicationDate":"2026-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13344208/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148764271","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":"Heat exposure in pregnancy: A gap between evidence and public health messaging.","authors":"Carrie J Ngongo, Tidiane Gadiaga, Pierre Zalagile Akilimali","doi":"10.1002/pmf2.70325","DOIUrl":"https://doi.org/10.1002/pmf2.70325","url":null,"abstract":"","PeriodicalId":520540,"journal":{"name":"Pregnancy (Hoboken, N.J.)","volume":"2 4","pages":"e70325"},"PeriodicalIF":0.0,"publicationDate":"2026-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13344205/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148765919","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":"Disparities in indication for primary cesarean delivery before and after implementation of quality initiatives.","authors":"Anna Marie Pacheco Young, Bethany Stetson, Nicola Lancki, Melissa Bak, Kaeli Heidenreich, Lane Patterson, Nigel Madden","doi":"10.1002/pmf2.70314","DOIUrl":"https://doi.org/10.1002/pmf2.70314","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Racial and ethnic disparities exist in the rates of and indication for cesarean delivery, prompting the implementation of quality initiatives designed to target the drivers of these inequities. Few studies have assessed the impact of these initiatives on reducing these disparities.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;To determine the rates of and indications for cesarean delivery before and after the implementation of perinatal quality improvement (QI) initiatives.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design: &lt;/strong&gt;Retrospective cohort study of 3629 nulliparous individuals with full-term live-born, singleton gestations in vertex position (NTSV) who delivered at a large academic tertiary care center in the United States from October 2019 through December 2022. Perinatal QI initiatives, designed to promote vaginal birth and improve equity in birth outcomes, were implemented during this period. This included the Promoting Vaginal Birth (PVB) initiative implemented in October 2020, followed by the Birth Equity (BE) initiative in May 2021. An interrupted time series analysis was performed to examine the relationship between the implementation of perinatal QI initiatives and trends in cesarean delivery rates. Distributions of demographic, clinical, and structural characteristics were examined by indication for cesarean and race and ethnicity. Multivariable multinomial logistic regression models assessed the independent association between race and ethnicity and indication for cesarean delivery after adjusting for maternal, perinatal, and system-level risk factors before and after implementation of perinatal quality initiatives.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The rate of NTSV deliveries increased immediately following the start of quarter I (step-change &lt;i&gt;β&lt;/i&gt; = 3.6%, 95% confidence interval [CI], 1.4%-5.8%, &lt;i&gt;p&lt;/i&gt; = 0.004). However, across the study period, the rate of NTSV cesarean deliveries decreased compared to the estimated trend prior to the initiatives for a difference in slope per quarter of -0.6% (95% CI, -1.0 to -0.1, &lt;i&gt;p&lt;/i&gt; = 0.019). Non-Hispanic (NH) Black pregnant people had the highest cesarean delivery rate: 29% compared to a range of 21%-23% in other racial and ethnic groups (&lt;i&gt;p&lt;/i&gt; &lt; 0.001). NH Black individuals had higher relative proportions of NTSV cesarean delivery for non-reassuring fetal status as compared to NH White individuals (38.1% vs. 25.9%), and Hispanic individuals had higher relative proportions of NTSV cesarean delivery for arrest of dilation as compared to NH White individuals (33.4% vs. 24.5%). After adjusting for maternal, perinatal, and systems-level risk factors, NH Black individuals had a higher risk of NTSV cesarean delivery for non-reassuring fetal status compared to NH White pregnant people over the entire study period (relative risk ratio [RRR] 1.91, 95% CI, 1.27-2.86). The association between race and indication for cesarean delivery did not differ by the implementation period of QI ","PeriodicalId":520540,"journal":{"name":"Pregnancy (Hoboken, N.J.)","volume":"2 3","pages":"e70314"},"PeriodicalIF":0.0,"publicationDate":"2026-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13344202/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148764327","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":"Perinatal outcomes associated with magnesium sulfate for preeclampsia without severe features.","authors":"Samantha E Howell, Christina T Blanchard, Morgan Jenkins, Grace Lee, Macie L Champion, Michelle Lu, Ashley N Battarbee, Brian M Casey, Akila Subramaniam","doi":"10.1002/pmf2.70309","DOIUrl":"https://doi.org/10.1002/pmf2.70309","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate neonatal outcomes in patients with preeclampsia without severe features who received magnesium for seizure prophylaxis.</p><p><strong>Methods: </strong>Retrospective cohort study of patients with preeclampsia without severe features delivering ≥32 weeks' gestation at our institution (November 2021-May 2023). The primary outcome was a composite of adverse neonatal outcomes (neonatal intensive care unit [NICU] admission, umbilical artery pH < 7.1, umbilical artery base deficit ≥12, 5-min Apgar <3, neonatal death, culture proven sepsis, and mechanical ventilation). Secondary outcomes included the individual components of the neonatal composite and a maternal bleeding composite. Patients were categorized into those who received intrapartum magnesium and those who did not. Baseline characteristics and outcomes were compared between groups. Multivariable logistic regression estimated the association between magnesium and outcomes, adjusting for characteristics that differed between groups.</p><p><strong>Results: </strong>Of 5327 individuals included in our analysis, 583 met study criteria-439 (75%) received magnesium and 144 (25%) did not. Patients who received magnesium were more likely to have public insurance, medical comorbidities, antenatal aspirin use, earlier gestational age (GA) at delivery, and chorioamnionitis. The odds of composite adverse neonatal outcome were higher in patients who received magnesium (53% vs. 29%; adjusted odds ratio [aOR], 1.85; 95% confidence interval [CI], 1.13-3.04) than those who did not. This was primarily driven by increased odds of NICU admission (aOR, 2.46; 95% CI, 1.46-4.14). When excluding NICU admission from the neonatal composite, there was a significant reduction in the neonatal adverse composite among the magnesium cohort (aOR, 0.43; 95% CI, 0.21-0.88). In addition, the odds of neonatal acidemia were also lower in those who received magnesium (aOR, 0.36; 95% CI, 0.15-0.88).</p><p><strong>Conclusion: </strong>While we found an increase in overall adverse neonatal outcomes in patients receiving magnesium for seizure prophylaxis for preeclampsia without severe features, we also noted discordant findings of decreased neonatal acidemia and neonatal morbidity when excluding NICU admission. As there is no consensus for intrapartum magnesium administration for patients with preeclampsia without severe features, these results suggest further study of risks and benefits of intrapartum magnesium sulfate is warranted.</p>","PeriodicalId":520540,"journal":{"name":"Pregnancy (Hoboken, N.J.)","volume":"2 3","pages":"e70309"},"PeriodicalIF":0.0,"publicationDate":"2026-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13344299/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148763916","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":"Factors associated with postpartum depression symptoms following antepartum hospitalization.","authors":"Alison N Goulding, Daniel Palacios, Sukru Aras, Hu Chen, Sasidhar Pasupuleti, Marika Toscano, Nicole Cirino, Israel C Christie, Zhandong Liu, Emily S Miller, Terri L Fletcher","doi":"10.1002/pmf2.70319","DOIUrl":"10.1002/pmf2.70319","url":null,"abstract":"<p><strong>Background: </strong>Hospitalized antepartum patients are at increased risk for postpartum depression (PPD). Developing approaches to identify those at highest risk for PPD would enable timely and targeted intervention.</p><p><strong>Objective: </strong>We aimed to identify factors associated with the development of PPD symptoms in hospitalized antepartum patients and to assess their predictive utility.</p><p><strong>Study design: </strong>This retrospective cohort study included pregnant individuals hospitalized in a regional referral center due to medical or obstetric complications between 2012 and 2025. Data were extracted from the electronic health record, including demographics, medical and obstetric history, hospitalization characteristics, and postpartum Edinburgh Postnatal Depression Scale (EPDS) scores collected within 8 weeks of delivery. Primary outcome was EPDS score ≥10, indicating PPD symptoms. We performed bivariate analyses and multivariable logistic regression modeling. Receiver operating characteristic (ROC) curve analyses assessed model discriminatory ability.</p><p><strong>Results: </strong>Among 4161 included hospitalized antepartum patients, 1291 (31%) reported PPD symptoms within 8 weeks of delivery. Multivariable logistic regression modeling showed that certain demographic and clinical factors were associated with PPD symptoms: single or other marital status, pregestational diabetes, multiple chronic medical conditions, prior anxiety or depression, admission gestational age <28 weeks, preterm prelabor rupture of membranes, placenta accreta spectrum, and pharmacologic treatment for anxiety or depression during antepartum hospitalization. The strongest predictors for the presence of PPD symptoms were prior history of anxiety or depression (adjusted odds ratio [aOR], 2.04; 95% confidence interval [CI], 1.75-2.38) and pharmacologic treatment for anxiety or depression during antepartum hospitalization (aOR, 2.33; 95% CI, 1.86-2.90). Discriminatory ability of the multivariable model was fair, with area under the receiver operating characteristic curve (AUC) of 0.67 (95% CI, 0.65-0.69), positive predictive value of 58%, and negative predictive value of 72%.</p><p><strong>Conclusions: </strong>One in three individuals who experienced antepartum hospitalization at our referral center went on to report PPD symptoms. While certain demographic and clinical factors were associated with PPD symptoms, their overall ability to accurately identify those at increased risk was limited, reducing their utility in guiding targeted interventions. These findings support that postpartum mental health services are broadly needed for individuals who experience antepartum hospitalization, highlighting the need for universal mental health service provision for this high-risk population.</p>","PeriodicalId":520540,"journal":{"name":"Pregnancy (Hoboken, N.J.)","volume":"2 3","pages":"e70319"},"PeriodicalIF":0.0,"publicationDate":"2026-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13344247/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148765780","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}