American journal of perinatology最新文献

{"title":"The Yield of Amnioinfusion in the Prevention of Postpartum Hemorrhage.","authors":"Keren Zloto, Eyal Sivan, Rakefet Yoeli-Ullman, Shali Mazaki-Tovi, Suneet P Chauhan, Michal Fishel Bartal","doi":"10.1055/a-2535-8109","DOIUrl":"https://doi.org/10.1055/a-2535-8109","url":null,"abstract":"<p><strong>Objective: </strong>Though amnioinfusion decreases the rate of uterine atony, its effect on postpartum hemorrhage (PPH) is uncertain. This study aimed to assess whether amnioinfusion reduces the risk of PPH in laboring individuals.</p><p><strong>Study design: </strong>A retrospective study of all laboring singletons at a tertiary center between 01/2013 and 12/2022 at ≥ 34 weeks. Individuals with known major fetal anomalies, stillbirths, or missing delivery records were excluded. The primary outcome was PPH. Neonatal and secondary maternal outcomes were also explored. Adjusted odds ratios (aOR) were estimated using multivariable regression models.</p><p><strong>Results: </strong>Out of 113,816 deliveries during the study period, 83,152 (77.1%) met inclusion criteria, and among them 4,597 (4.03%) had amnioinfusion. Laboring individuals with amnioinfusion were more commonly nulliparous, had more polyhydramnios, oligohydramnios, preeclampsia, gestational diabetes, and fetal growth restriction. Furthermore, individuals with amnioinfusion had a higher rate of labor induction (54.54% vs. 27.8%; P<0.01) and a higher cesarean rate (36.9% vs. 9.5%; P<0.01). Following multivariable regression, there was no significant difference in the rate of PPH among individuals who had an amnioinfusion (2.6%) versus those who did not (3.1%; aOR 0.95, 95% CI 0.87, 1.27). The rates of endometritis (aOR 1.4; 95% CI 1.04-1.89) and postpartum fever (aOR 1.70; 95% CI 1.36-2.12), were higher in those who had amnioinfusion compared to those that did not.</p><p><strong>Conclusion: </strong>Among laboring individuals ≥ 34 weeks, intrapartum amnioinfusion was not associated with a reduction in the rate of postpartum hemorrhage and was associated with a higher likelihood of infectious morbidity.</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143389613","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of Coronavirus Disease 2019 on the Incidence of No Prenatal Care.","authors":"Takaki Tanamoto, Misa Hayasaka, Lindsay Speros Robbins, George Saade, Tetsuya Kawakita","doi":"10.1055/a-2535-8309","DOIUrl":"https://doi.org/10.1055/a-2535-8309","url":null,"abstract":"<p><strong>Objective: </strong>To examine the impact of COVID-19 on the racial disparity in prenatal care utilization in the United States before and during the pandemic.</p><p><strong>Study design: </strong>This was a cross-sectional study using the National Vital Statistics Data from 2018 to 2022. Our focus was on low-risk individuals who delivered singleton pregnancies at term. The analysis was restricted to Black and White individuals to explore racial disparities. The study periods based on the last menstrual period (LMP) were pre-pandemic (March 2018-February 2020) and pandemic (March 2020-February 2022). The primary outcome was the rate of no prenatal care. We employed interrupted time series analysis (ITSA), negative binomial regression models, adjusting for confounders, seasonality, and autocorrelation. We conducted post-estimation analyses to calculate the counterfactual and actual incidences of outcomes for individuals with an LMP in March 2020 and February 2022. Difference-in-difference (DID) with 95% confidence intervals (95% CI) was estimated.</p><p><strong>Results: </strong>The analysis included 3,511,813 individuals in the pre-pandemic period and 5,163,486 in the pandemic period. For individuals with LMP in March 2020, the actual incidences of no prenatal care per 100 births were 3.2 (95% CI 3.0, 3.3) for Black individuals and 1.6 (95% CI 1.2, 2.0) for White individuals. The difference between counterfactual and actual no prenatal care rates per 100 births for Black individuals was 0.4 (95% CI 0.2, 0.5), indicating a significant increase in no prenatal care. Conversely, there was no significant difference for White individuals. DID analysis further demonstrated that this increase was greater in Black individuals compared to White individuals (DID per 100 births 0.3 [95% CI 0.1, 0.5]). For individuals with LMP in February 2022, this difference in disparity further worsened (DID per 100 births 0.8 [95% CI 0.4, 1.2]).</p><p><strong>Conclusion: </strong>The COVID-19 pandemic increased the incidence of no prenatal care, which disproportionately affected Black individuals.</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143389802","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Impact of Antibiotics on Latency When Given at the Time of Membrane Rupture Before Viability.","authors":"Katherine A Lambert, Jennifer Cate, Anne West Honart, Matthew R Grace, Sarah K Dotters-Katz","doi":"10.1055/a-2516-1911","DOIUrl":"10.1055/a-2516-1911","url":null,"abstract":"<p><strong>Objective: </strong> It is well established that antibiotics administered in preterm prelabor rupture of membranes increase latency to delivery. While data are limited for membrane rupture prior to viability, antibiotics may also increase latency in this population. This study aimed to assess the effect of prophylactic antibiotics on the duration of latency in individuals with previable prelabor rupture of membranes.</p><p><strong>Study design: </strong> Retrospective cohort of pregnancies with previable prelabor rupture of membranes prior to 23^0/7 weeks in a single health system (2013-2022). Patients opting for termination or with a contraindication to expectant management were excluded. The primary outcome was latency from previable prelabor rupture of membranes diagnosis to delivery. Secondary outcomes included subanalysis by gestational age as well as maternal and neonatal morbidity and mortality. Bivariate statistics compared patients who did and did not receive antibiotics (ampicillin, gentamicin). Kaplan-Meier/Cox proportional hazards ratios using significant covariates (<i>p</i> < 0.1) in bivariate analysis models examined antibiotic impact on latency.</p><p><strong>Results: </strong> Of 115 patients, 46 (40%) met inclusion criteria, of whom 34 (74%) received latency antibiotics. Median latency did not differ with antibiotic receipt (1 [0.4, 2.6] vs. 0.6 weeks [0.3, 0.9], <i>p</i> = 0.27). When adjusted for gestational age at rupture of membranes, antibiotics were not associated with longer latency (hazard ratio = 1.33 [0.91, 1.93]). Antibiotic receipt was associated with lower rates of previable delivery (23.0, [22.7, 24.0] vs. 21.3 weeks [20.5, 23.1], <i>p</i> = 0.006). Adjusted odds of previable delivery remained lower with receipt of antibiotics (adjusted odds ratio = 0.20, [0.04, 0.90]). Antibiotics were associated with longer latency in patients with rupture of membranes at less than 22 weeks gestation (2.4 [1.3,4.4] vs. 0.6 weeks [0.1,0.9], <i>p</i> = 0.02).</p><p><strong>Conclusion: </strong> Antibiotic administration at the time of previable prelabor rupture of membranes was associated with longer latency prior to 22 weeks gestation. Antibiotic administration increased the odds of delivering after viability. Further study should address optimal antibiotic strategies for this unique population.</p><p><strong>Key points: </strong>· No significant increase in latency after antibiotics with rupture of membranes prior to 23 weeks.. · Significantly longer latency after antibiotics with rupture of membranes before 22 weeks.. · Antibiotic receipt associated with increased likelihood of delivering after viability..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142998622","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Use of Premedication for Intubating Very Low Birth Weight Infants in the Neonatal Intensive Care Unit: Results of a National Survey.","authors":"Cassandra DeMartino, Sara Neches, Megan M Gray, Taylor Sawyer, Lindsay Johnston","doi":"10.1055/a-2521-1118","DOIUrl":"10.1055/a-2521-1118","url":null,"abstract":"<p><strong>Objective: </strong> This study aimed to explore barriers and perspectives of premedication use for non-emergent intubations of very low birth weight (VLBW) infants (<1,500 g).</p><p><strong>Study design: </strong> A cross-sectional, online survey was distributed from January to April 2023 to members of the American Academy of Pediatrics Section on Neonatal-Perinatal Medicine. Data was analyzed using descriptive statistics and chi-square tests.</p><p><strong>Results: </strong> Of the 521 respondents, the majority (81%, <i>n</i> = 415) were neonatologists. Over half of respondents (69%, <i>n</i> = 359) consider patient weight when selecting premedication. Most providers (78%, <i>n</i> = 407) agreed that premedication should be used for non-emergent intubation of VLBW infants, while only 41% (<i>n</i> = 216) felt similarly that muscle relaxants should be used. For infants over 1,500 g, 43% (<i>n</i> = 153) reported frequent or regular muscle relaxant use compared with 28% (<i>n</i> = 101) for VLBW infants. The most cited barrier to muscle relaxant use was surfactant delivery with a planned return to non-invasive support. Unit guidelines were associated with significantly more premedication and muscle relaxant use (56 vs. 44%; odds ratio [OR] = 5.2, 95% confidence interval [CI]: 3.4-7.7, <i>p</i> < 0.0001).</p><p><strong>Conclusion: </strong> Most neonatal providers favor premedication for non-emergent intubation but are hesitant to use muscle relaxants for VLBW infants. Premedication guidelines may facilitate the use of both premedication and muscle relaxants for this population.</p><p><strong>Key points: </strong>· Study of intubation premedication perceptions and practices for VLBW infants.. · Premedication is used less for intubation of VLBW infants compared to their larger peers.. · Unit premedication guidelines and available intubation backup may facilitate premedication use..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142997831","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ambulation during Neuraxial Analgesia in Obese Patients: A Pilot Study.","authors":"Sunitha Suresh, F Arran Seiler, David Arnolds, Maritza Gonzalez, Naida Cole, Richard Silver, Barbara Scavone, Annie Dude","doi":"10.1055/a-2516-2292","DOIUrl":"https://doi.org/10.1055/a-2516-2292","url":null,"abstract":"<p><strong>Objective: </strong> Prior studies have yielded mixed results regarding ambulation with neuraxial analgesia and labor outcomes, and studies did not include a significant obese population. We sought to evaluate the feasibility of ambulation with optimized neuraxial analgesia in laboring nulliparous obese patients.</p><p><strong>Study design: </strong> This was a pilot study at the University of Chicago (approval no.: IRB 19-1600, CT NCT04504682). Inclusion criteria were delivery BMI of ≥35 kg/m², nulliparity, and term gestation. Contraindications to ambulation or vaginal delivery conferred ineligibility. Combined spinal-epidural analgesia was initiated per our institution's policy. Following epidural catheter placement, serial blood pressure measurements and motor assessments including a straight leg test and a step stool test were completed per safety protocol. Patients who passed these assessments were enrolled. Patients were encouraged to ambulate for 20 minutes every hour while on fetal and uterine telemetry. Ambulation was discouraged after complete dilation. Demographics and delivery outcomes were collected. Our primary objective was to evaluate feasibility through acceptability, and safety via the number of falls, and percentage of patients with any ambulation. The study was closed early due to enrollment difficulties and in the setting of the COVID-19 pandemic.</p><p><strong>Results: </strong> A total of 105 patients were identified for the trial: 20 were ineligible for the study, 20 could not be approached, and 40 declined study participation, leaving 25 patients who consented. Of those 25, 14 completed the study. Out of 14 participants, 11 were ambulated. The average BMI of these participants was 43 kg/m². No patients fell during the trial.</p><p><strong>Conclusion: </strong> A pilot trial of ambulation during neuraxial analgesia among an obese nulliparous population demonstrated no safety concerns, but with concern regarding feasibility as there was low acceptance.</p><p><strong>Key points: </strong>· Pilot trial of ambulation with neuraxial analgesia among obese patients had limited enrollment.. · Trial of ambulation with epidural among obese nulliparous patients demonstrated no safety concerns.. · Further studies are needed for efficacy..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143389798","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Enteral Feeding in Neonatal Hypoxic-Ischemic Encephalopathy.","authors":"Helen Martinovski, Luna Khanal, Debra Kraft, Girija Natarajan","doi":"10.1055/a-2510-1543","DOIUrl":"https://doi.org/10.1055/a-2510-1543","url":null,"abstract":"<p><strong>Objective: </strong> This study aimed to describe feeding outcomes in neonates with hypoxic-ischemic encephalopathy (HIE) and compare characteristics and outcomes in groups discharged home on oral, total/partial nasogastric, and gastrostomy tube feedings.</p><p><strong>Study design: </strong> This was a retrospective, single-center cohort study of infants diagnosed with moderate or severe HIE using standard criteria who underwent cooling from January 2017 to June 2022. Data were abstracted from hospital course as well as until 6 months follow-up. Statistical analysis included chi-square test and ANOVA with post hoc Bonferroni correction for between-group comparisons.</p><p><strong>Results: </strong> Among 123 included infants, 95 (77%) fed orally, 11 (9%) required total/partial nasogastric feeds and 17 (14%) had gastrostomy tubes at discharge. A significantly greater proportion of infants with gastrostomy-tube feeds at discharge had intrapartum complications, Apgar scores <5 at 5 and 10 minutes, severe rather than moderate HIE, and seizures. They also had a longer hospital stay, prolonged respiratory support and intubated days, and delayed initiation of feeding. Infants discharged on nasogastric feeds all attained oral feeds at a median (IQR) duration of 54 (6-178) days follow-up. Among the 106 (86%) infants with follow-up data, the gastrostomy group had significantly lower median weight and head circumference centiles compared to the others. Criteria for gavage eligibility were met before discharge in 98 (80%) of the cohort; 42% stayed beyond this benchmark.</p><p><strong>Conclusion: </strong> Earlier identification of eventual gastrostomy tube insertion as well as discharge home on nasogastric feedings may reduce duration of hospitalization in infants with HIE. Our data may provide insights to guide practice improvement for enteral feedings in this population.</p><p><strong>Key points: </strong>· In neonatal encephalopathy, impaired oral feedings is common.. · Antepartum complications and HIE severity are associated with gastrostomy insertion.. · Discharge home on gavage feeds could shorten hospital stay..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143389800","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intrapartum Glycemic Control with Insulin Infusion versus Rotating Fluids: A Randomized Controlled Trial.","authors":"Maranda Sullivan, Kajal Angras, Victoria Boyd, Amanda J Young, A Dhanya Mackeen, Michael J Paglia","doi":"10.1055/a-2510-4906","DOIUrl":"https://doi.org/10.1055/a-2510-4906","url":null,"abstract":"<p><strong>Objective: </strong> This study aimed to evaluate rotating intravenous (IV) fluids compared with insulin infusion for maternal intrapartum glycemic control of neonatal blood glucose within 2 hours of birth.</p><p><strong>Study design: </strong> This randomized controlled trial compared the use of rotating IV fluids to continuous insulin infusion for intrapartum glycemic control for patients with type II diabetes mellitus (DM) or medication-controlled gestational diabetes (A2GDM). A sample size of 74 participants was studied to detect a 10-mg/dL difference in neonatal blood glucose within 2 hours of birth between the groups with a standard deviation of 15, 80% power, and α 0.05. Secondary neonatal outcomes included neonatal blood glucose within 24 hours after birth, Apgar < 7 at 5 minutes, and a composite including neonatal hypoglycemia, NICU admission, hyperbilirubinemia, and respiratory distress syndrome. Secondary maternal outcomes included intrapartum hypoglycemia, blood glucose immediately prior to delivery, mode of delivery, and postpartum complications. Both intention-to-treat (ITT) and per-protocol (PP) analyses were performed.</p><p><strong>Results: </strong> A total of 114 patients were randomized, 57 in each arm. For the PP analysis, 51 patients were analyzed in the rotating IV fluids arm and 32 patients in the insulin infusion arm. There was no significant difference in neonatal blood glucose within 2 hours of birth when rotating IV fluids were used (ITT: 54.5 mg/dL [IQR: 42.5, 72.5], PP: 56.0 mg/dL [IQR: 42.0, 76.0]) when compared with an insulin infusion (ITT: 59.0 mg/dL [IQR: 41.0, 69.0], PP: 62.5 mg/dL [IQR: 44.5, 68.5], <i>p</i> = 0.89 [ITT] and <i>p</i> = 0.68 [PP]). No significant differences were noted in secondary outcomes. The median intrapartum maternal blood glucose was 98.5 mg/dL (IQR: 90.5, 105.0) in the rotating fluids arm and 96.3 mg/dL (IQR: 90.0, 108.5) in the insulin infusion arm (<i>p</i> = 0.96), and the rate of neonatal hypoglycemia was 11.8 versus 15.6%, respectively (<i>p</i> = 0.61) in the PP analysis.</p><p><strong>Conclusion: </strong> There was no difference in neonatal blood glucose within 2 hours of birth when rotating IV fluids were used for intrapartum glycemic control compared with a continuous insulin infusion.</p><p><strong>Key points: </strong>· There is no optimal option for maternal glycemic control in labor.. · Maternal glycemic control was comparable in the two study arms.. · There was no difference in neonatal blood glucose between study arms..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143389589","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Maternal and Neonatal Risk Factors Associated with Positive Toxicology Results.","authors":"Hannah Pee, Karen Hussein, Gina DeSalvio, Prabhakar Kocherlakota","doi":"10.1055/a-2535-5895","DOIUrl":"https://doi.org/10.1055/a-2535-5895","url":null,"abstract":"<p><strong>Background: </strong>The incidence of substance use disorder (SUD) during pregnancy continues to increase; however, the identification of SUD is challenging. The significance of individual risk factors and their association with toxicology is contentious.</p><p><strong>Objective: </strong>To identify maternal and neonatal risk factors associated with positive toxicology results for non-prescribed substance use during pregnancy.</p><p><strong>Design/methods: </strong>This retrospective study included pregnant persons and their infants, who were screened for predetermined risk factors for SUD during pregnancy. The toxicology test results of pregnant persons' urine and infants' urine, meconium/umbilical cord, were correlated with risk factors.</p><p><strong>Results: </strong>Maternal risk factors (history of pre-pregnancy or current SUD, on medication for opioid use disorders, insufficient prenatal care, sexually transmitted and blood-borne infections) and neonatal risk factors (neonatal opioid withdrawal syndrome, intrauterine growth restriction) showed a correlation with toxicology results.</p><p><strong>Conclusion: </strong>Combining maternal and neonatal risk factors with toxicology testing may accurately identify SUD in pregnancy.</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143389593","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Relationship between Various Measures of Perinatal Quality.","authors":"Nansi S Boghossian, Lucy T Greenberg, Jeffrey S Buzas, Ciaran S Phibbs, Molly Passarella, Jeannette Rogowski, George R Saade, Scott A Lorch","doi":"10.1055/a-2517-2501","DOIUrl":"10.1055/a-2517-2501","url":null,"abstract":"<p><strong>Objective: </strong> This study aimed to examine the correlations between pairs of maternal, infant, and maternal-infant dyad quality measures to provide a comprehensive assessment of perinatal care.</p><p><strong>Study design: </strong> In a retrospective cohort study using birth and fetal death certificates linked to hospital discharge data from Michigan, Oregon, Pennsylvania, and South Carolina (2016-2018), we examined correlations between pairs of maternal, infant, and maternal-infant dyad quality measures. Maternal quality measures included nulliparous term singleton vertex (NTSV) cesarean birth, nontransfusion severe maternal morbidity (SMM), and a composite maternal outcome. Infant quality was assessed with a composite outcome measure, whereas the dyad measure combined maternal and infant outcomes.</p><p><strong>Results: </strong> Among 955,904 dyads across 266 hospitals, 25.9% had NTSV, 0.7% had nontransfusion SMM, 12.3% had the composite infant measure, and 19.3% had the dyad measure. The correlation between nontransfusion SMM and the dyad measure was 0.12, whereas the correlation between the composite infant measure and the dyad measure was 0.86, which was higher than the correlation between the composite maternal measure and the dyad measure (0.47).</p><p><strong>Conclusion: </strong> We observed minimal correlations among these perinatal quality measures, especially when aggregated beyond individual outcomes.</p><p><strong>Key points: </strong>· There are minimal correlations among different perinatal quality measures.. · Quality is multifaceted, and hospitals vary in the level of quality they achieve.. · Assessing hospital care for pregnant patients and infants requires multiple quality measures..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142997707","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of Coronavirus Disease-2019 on Influenza and Tdap Vaccination Rates in Pregnant Patients.","authors":"Ravyn Njagu, Katherine Freedy, Amanda Brucker, Kelvin Feng, Siera Lunn, Melissa Greene, Geeta K Swamy, Sarah Dotters-Katz","doi":"10.1055/a-2510-3783","DOIUrl":"https://doi.org/10.1055/a-2510-3783","url":null,"abstract":"<p><strong>Objective: </strong> Influenza and tetanus toxoid reduced diphtheria toxoid, and acellular pertussis (Tdap) are safe and effective vaccines that are recommended in pregnancy. Despite this, significant vaccine hesitancy exists in pregnancy. However, impact of the coronavirus disease 2019 (COVID-19) pandemic on vaccine hesitancy is not well understood. Thus, we sought to describe impact of the COVID-19 pandemic on influenza and Tdap vaccination rates in pregnant patients.</p><p><strong>Study design: </strong> Retrospective cohort study of patients delivering at single academic center from October 1, 2017 to August 31, 2021. Patients with missing vaccine data or delivering before 28 weeks (Tdap range) excluded. Patients delivering pre-COVID (October 1, 2017-August 31, 2019) compared with those delivering mid-COVID (October 1, 2020-August 31, 2021). Primary outcomes were vaccination rates for Tdap and influenza. Secondary outcome was rate of dual vaccination (receiving both) and variation by race/ethnicity. Chi-square tests and logistic regression were used to test for changes in vaccination rates.</p><p><strong>Results: </strong> Of 8,650 unique patient pregnancies, 5,925(68.5%) occurred pre-COVID. Median patient age (30 years) and gestational age at delivery (39 weeks) not clinically different between groups. Patients in mid-COVID group had lower numbers of government-assisted insurance (47.3%) and higher non-Hispanic Black compared with pre-COVID (31.5%). The rate of influenza vaccination decreased 8.2 percentage points from pre-COVID to mid-COVID (69.9 vs. 61.7%, <i>p</i> < 0.001). Tdap vaccination rates also decreased, although less-so (88.5 vs. 85.1%, <i>p</i> < 0.001). The rate of patients receiving both vaccines during pregnancy decreased from 66.0 to 58.4% (<i>p</i> < 0.001). Significant decreases in influenza vaccination rates mid-COVID versus pre-COVID was seen in all race-ethnicity groups except non-Hispanic White patients. For Tdap vaccinations, the effect of COVID on the odds of receiving Tdap did not differ across race-ethnicity groups.</p><p><strong>Conclusion: </strong> Rates of influenza, Tdap, and dual vaccination in pregnancy dropped significantly during the COVID-19 pandemic. For influenza, these were most pronounced in all race-ethnicities included with exception of non-Hispanic White. These data emphasize the importance of continued counseling and education on vaccinations in pregnancy and raise important questions regarding vaccine access and patient hesitancy during pandemic-mediated prenatal care.</p><p><strong>Key points: </strong>· Influenza vaccination decreased with COVID-19.. · Tdap vaccination decreased with COVID-19.. · Decrease in flu vaccination in most race-ethnicity groups..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143370117","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}