American journal of perinatology最新文献

{"title":"Maternal Prepregnancy Body Mass Index and Risk of Preterm Birth: The Role of Weight Gain during Pregnancy, Race, and Ethnicity.","authors":"Wendemi Sawadogo, Medhin Tsegaye, Andinet Gizaw, Hunter Newland, Tilahun Adera","doi":"10.1055/a-2494-2080","DOIUrl":"10.1055/a-2494-2080","url":null,"abstract":"<p><strong>Objective: </strong> Preterm birth (PTB) is one of the leading causes of infant and neonatal mortality. Prepregnancy body mass index (BMI; kg/m²) has been linked to PTB but the evidence of this association by weight gain during pregnancy, race, and ethnicity is limited. This study aimed to assess the association between maternal prepregnancy BMI and PTB stratified by weight gain during pregnancy, race, and ethnicity.</p><p><strong>Study design: </strong> The U.S. natality data from 2017 to 2021 were used. In this analysis, we included mothers who had a live singleton birth and available data for prepregnancy BMI, gestational age at birth, weight gain during pregnancy, race, and ethnicity. Logistic regression models were used to assess the association between prepregnancy BMI categories and PTB stratified by weight gain during pregnancy, race, and ethnicity.</p><p><strong>Results: </strong> A total of 17,311,509 singleton live births were included of which 1,393,889 (8.05 %) were PTBs. After adjusting for confounders, compared with normal prepregnancy BMI mothers (18.5-24.9), those with underweight BMI (<18.5) were at increased odds of PTB regardless of weight gain during pregnancy, race, and ethnicity. However, for mothers with a prepregnancy BMI above the normal weight (≥25), the association between prepregnancy BMI and PTB differs by weight gain during pregnancy, race, and ethnicity. Asian mothers with obesity II (35.0-39.9) had 93% (odds ratio [OR] = 1.93, 95% confidence interval [CI]: 1.62-2.30) increased odds of PTB for weight gain during pregnancy of 31 to 40 pounds. Their White, Hispanic, and Black counterparts experienced lower odds of PTB for similar weight gain during pregnancy (White: OR = 1.56, 95% CI: 1.51-1.60; Hispanic: OR = 1.48, 95% CI: 1.41, 1.54; and Black: OR = 1.22, 95% CI: 1.17-1.27).</p><p><strong>Conclusion: </strong> Mothers with underweight BMI were at increased risk of PTB regardless of weight gain during pregnancy, race, and ethnicity. However, the association between high prepregnancy BMI and PTB varied by weight gain during pregnancy, race, and ethnicity.</p><p><strong>Key points: </strong>· The association between prepregnancy BMI categories and PTB had a \"J\" shape, with lower odds in the normal weight group.. · Low prepregnancy BMI was associated with increased risk of PTB regardless of weight gain during pregnancy, race, and ethnicity.. · The association between high prepregnancy BMI and PTB varies by weight gain during pregnancy, race, and ethnicity..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2024-12-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142765514","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":"Relationship between Intrapartum Continuous Glucose Monitoring Values and Neonatal Hypoglycemia in Individuals with Diabetes.","authors":"Michal Fishel Bartal, Sarah A Nazeer, Joycelyn Ashby Cornthwaite, Ghamar Bitar, Sean C Blackwell, Claudia Pedroza, Suneet P Chauhan, Antonio Saad, George Saade, Baha M Sibai","doi":"10.1055/a-2494-2157","DOIUrl":"10.1055/a-2494-2157","url":null,"abstract":"<p><strong>Objective: </strong> We aimed to evaluate the relationship between intrapartum continuous glucose monitoring (CGM) and neonatal hypoglycemia (NH) in individuals with diabetes.</p><p><strong>Study design: </strong> a multicenter prospective study (November 2021-December 2022) of laboring individuals with pregestational or gestational diabetes at ≥34 weeks. Cohorts had a blinded CGM placed from admission through delivery and were monitored with fingerstick (FS) according to usual care. The primary outcome was NH. Secondary neonatal outcomes included neonatal intensive care unit (NICU) length of stay, need for intravenous (IV) glucose therapy, hyperbilirubinemia, respiratory distress, or respiratory distress syndrome. Time in the target range (TIR; range 70-110 mg/dL) and time above the target range (TAR; >110 mg/dL) were expressed as a percentage of all CGM readings, and mean glucose was obtained. Youden index was used to choose the cut point for TAR and prediction of NH.</p><p><strong>Results: </strong> Of 9,479 deliveries during the study period, 202 (2.1%) met the inclusion criteria, and 112 (56%) participants were enrolled (<i>n</i> = 7 did not have available CGM data). Of the study participants, 45 (40%) had pregestational diabetes, and 67 (60%) had gestational diabetes. The mean glucose in labor using a CGM was 102.6 mg/dL (interquartile range [IQR]:89.9, 113.5 mg/dL), and the average percentage of TIR was 62.1% (IQR, 36.9, 85.6). CGM and FS were poor predictors of NH, with no differences in area under the curve (AUC) of mean glucose as a predictor (0.64, 95% CI: 0.48-0.23 vs. 0.53, 95% CI: 0.4-0.6, respectively). The best cut-off for the prediction of NH was a TAR of 61%, with 23% (<i>n</i> = 24) being above the threshold. The rate of NH for TAR >61% versus ≤61% was 45.8 versus 25.9% (<i>p</i> = 0.06). Neonates born to individuals with TAR >61% were more likely to require continuous positive airway pressure after delivery and had a higher cord c-peptide level.</p><p><strong>Conclusion: </strong> In this prospective study of laboring individuals with diabetes, intrapartum CGM TAR was associated with a higher rate of NH.</p><p><strong>Key points: </strong>· CGM use in labor is feasible with a complete glucose profile in the various stages of labor.. · Best cut-off for predicting NH was a time above range (≥110 mg/dl) of >61%.. · CGM and FS were poor predictors of NH..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2024-12-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142765515","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":"Social Determinants of Health Associated with Intimate Partner Violence in an Urban Obstetric Population.","authors":"Christina R Kuhrau, Elizabeth Kelly, Emily A DeFranco","doi":"10.1055/a-2491-4269","DOIUrl":"10.1055/a-2491-4269","url":null,"abstract":"<p><strong>Objective: </strong> Intimate partner violence (IPV) is pervasive and can lead to severe health consequences. In the United States, 25% of women have experienced sexual violence, physical violence, and/or stalking by an intimate partner. However, less is known about the frequency and risk factors for IPV in the obstetric population.</p><p><strong>Study design: </strong> Nested case-control study from a prospective cohort study of 606 parturients at a single academic medical center from 2011 to 2022. Structured questionnaires were administered to randomly chosen, consented patients during their postpartum hospital stay to gather information on social determinants of health (SDoH) and birth outcomes. The case group included participants who reported forced sex causing pregnancy, verbal abuse before or during pregnancy, or physical abuse during pregnancy. The control group reported none of these. Odds ratios were used to quantify the relationship between IPV and maternal sociodemographic characteristics, pregnancy factors, and levels of perceived support and discrimination.</p><p><strong>Results: </strong> Of 606 study participants, 568 (94%) provided data on IPV. Of those, 20.4% reported IPV (case) and 80.6% reported no IPV (control). In total, 74.6% of the study population was enrolled prepandemic. Unmarried status, low income, food insecurity, housing insecurity, substance use during pregnancy, higher gravidity, unintended pregnancy, low social support, and racial and gender discrimination were all significantly associated with IPV; maternal race and pregnancy during the COVID-19 pandemic were not.</p><p><strong>Conclusion: </strong> IPV is common, reported by one in five parturients in our population. Although maternal race was not associated with IPV in this perinatal cohort, experiencing racism was. Initiatives aimed to address SDoH such as substance use, family planning, and access to food and housing remain key opportunities to support pregnant patients experiencing IPV. The connection between perceived discrimination and IPV found here highlights the importance of addressing the influence of racism and gender-based discrimination on adverse birth outcomes in the United States.</p><p><strong>Key points: </strong>· One in five parturients disclosed IPV.. · Racial discrimination was correlated with IPV.. · Food and housing insecurity increase IPV risk.. · COVID-19 did not increase the rate of IPV.. · Psychosocial support is vital during pregnancy..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2024-12-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142754567","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":"CircTLK1 Knockdown Alleviates Cell Inflammation and Apoptosis by Regulating Elavl1/Nox4 Axis in Neonatal Sepsis-Induced Lung Injury in Mice.","authors":"Hongxia Li, Jiansheng Li, Jin Zhang","doi":"10.1055/a-2463-4275","DOIUrl":"https://doi.org/10.1055/a-2463-4275","url":null,"abstract":"<p><strong>Objective: </strong> Septic acute lung injury (ALI) is a common complication of sepsis with high morbidity and mortality but lacks specific treatment. This study aimed to elucidate the role of circular RNA TLK1 (circTLK1) in neonatal septic ALI.</p><p><strong>Study design: </strong> Murine cecal slurry was used to induce neonatal sepsis-induced ALI model in vivo. Hematoxylin and eosin staining was performed to detect the pathological changes in lung tissues. Pulmonary microvascular endothelial cells were treated with lipopolysaccharide (LPS) to induce neonatal sepsis-induced ALI model in vitro. The levels of IL-1β and IL-6 were detected by enzyme-linked immunosorbent assay. A lactate dehydrogenase (LDH) detection kit was used to detect LDH activity. Cell Counting Kit-8 assay and flow cytometry detected cell viability and apoptosis. The genes' expression was measured by quantitative real-time reverse-transcription polymerase chain reaction and western blot. The relationship between circTLK1 and Elavl1 or Elavl1 and Nox4 was detected using RNA immunoprecipitation assay.</p><p><strong>Results: </strong> Our results illustrated that circTLK1 was highly expressed in neonatal sepsis-induced ALI model, and circTLK1 knockdown alleviated cell inflammation and apoptosis in neonatal sepsis-induced ALI model. Similarly, we found that circTLK1 knockdown alleviated neonatal sepsis-induced ALI. Mechanically, circTLK1 mediated Elavl1 binding to Nox4 messenger RNA and increased its stability. Functionally, circTLK1 knockdown alleviated cell inflammation and apoptosis by regulating Nox4 in the neonatal sepsis-induced ALI model.</p><p><strong>Conclusion: </strong> CircTLK1 knockdown alleviated cell inflammation and apoptosis by the Elavl1/Nox4 axis in neonatal sepsis-induced ALI. Our research provided a novel direction for the treatment of neonatal sepsis-induced ALI.</p><p><strong>Key points: </strong>· CircTLK1 knockdown relieved neonatal septic ALI.. · CircTLK1 mediated Elavl1 binding to Nox4 mRNA..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2024-12-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142891398","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":"Surgical Morbidity following Planned Hysterectomy versus Conservative Management for Placenta Accreta Spectrum: A Systematic Review and Meta-analysis.","authors":"Itamar D Futterman, Cintia Gomes, Olivia Sher, Julia Fisher, Rodney A McLaren, Shoshana Haberman, Scott Chudnoff","doi":"10.1055/a-2491-4328","DOIUrl":"https://doi.org/10.1055/a-2491-4328","url":null,"abstract":"<p><strong>Objective: </strong> In recent years, the management of placenta accreta spectrum (PAS) has fallen into two categories: planned hysterectomy and conservative management to preserve fertility. However, optimal management remains unclear. Therefore, we conducted a systematic review and meta-analysis comparing the two to evaluate which approach was associated with lower surgical morbidity.</p><p><strong>Study design: </strong> MEDLINE, Scopus, Cochrane Library, and ClinicalTrials.gov were searched from inception to July 31, 2023, for trials comparing conservative management versus planned hysterectomy. We included all prospective or retrospective cohort studies, case-control studies, and randomized control studies that reported outcomes related to surgical morbidity in cases of PAS. Surgical morbidity was defined as rates of intensive care unit (ICU) admission, disseminated intravascular coagulation (DIC)/coagulopathy, bladder injury, number of units of packed red blood cells (PRBCs) transfused, estimated blood loss (EBL), and maternal mortality.</p><p><strong>Results: </strong> Odds ratios (ORs) were computed with 95% confidence intervals (CIs) using a fixed or random effects model. Among 839 studies initially retrieved, 12 were included with a total of 1,167 patients. Of these, 669 (57.3%) underwent conservative management and 498 (42.7%) underwent a planned hysterectomy. Conservative management resulted in lower rates of ICU admission (OR = 0.11; 95% CI: 0.04, 0.35), lower rates of bladder injury (OR = 0.31; 95% CI: 0.2, 0.48), lower incidence of DIC or coagulopathy (OR = 0.22; 95% CI: 0.10, 0.48), lower mean difference EBL (-1,292.81 mL; 95% CI: -1,922.16 to -593.46), as well as lower number of PRBC units transfused (-1.54 units; 95% CI: -2.29 to -0.78).</p><p><strong>Conclusion: </strong> Our findings suggest that conservative management of PAS may be associated with reduced surgical morbidity.</p><p><strong>Key points: </strong>· management of PAS has fallen into two categories: planned hysterectomy and conservative management.. · Optimal management for PAS remains unclear.. · conservative management of PAS may be associated with reduced surgical morbidity..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2024-12-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142891399","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":"Adverse Outcomes Associated with Progressive Intrahepatic Cholestasis of Pregnancy.","authors":"Minhazur R Sarker, Dana Canfield, Lauren Ferrara, Gladys A Ramos, Chelsea A DeBolt","doi":"10.1055/a-2483-5910","DOIUrl":"10.1055/a-2483-5910","url":null,"abstract":"<p><strong>Objective: </strong> This study aimed to assess the association between increasing bile acid levels in pregnancies with cholestasis and adverse outcomes.</p><p><strong>Study design: </strong> This is a retrospective cohort study of singleton, non-anomalous gestations complicated by cholestasis delivered at a single academic medical center from 2005 to 2019. We compared rates of adverse outcomes in pregnancies complicated by mild cholestasis (initial total bile acid [TBA] <40 μmol/L and peak TBA <40 μmol/L), progressive cholestasis (initial TBA <40 μmol/L and peak TBA ≥40 μmol/L), and severe cholestasis (initial TBA ≥40 μmol/L). Our primary outcome was a composite adverse outcome including spontaneous preterm labor and delivery, umbilical artery pH <7.20, 5-minute Apgar <7, cesarean delivery for nonreassuring fetal heart rate tracing, meconium-stained amniotic fluid, and neonatal intensive care unit (NICU) admission. Analyses were performed using mild cholestasis as the base comparator and a second analysis using severe cholestasis as the base comparator.</p><p><strong>Results: </strong> Of the 1,182 pregnancies complicated by cholestasis, 732 (61.9%) had mild cholestasis, 78 (6.6%) had progressive cholestasis, and 372 (31.5%) had severe cholestasis. After adjusting for confounders including gestational age at diagnosis and using mild cholestasis as the base comparator, both progressive and severe cholestasis were associated with the composite adverse outcome (progressive intrahepatic cholestasis of pregnancy [ICP] OR 1.70; 95% CI 1.04-2.78 and severe ICP OR 1.60; 95% CI 1.24-2.06). When using progressive cholestasis as the base comparator, there were no statistically significant differences in the primary or secondary outcomes between progressive cholestasis and severe cholestasis.</p><p><strong>Conclusion: </strong> This study highlights the significance of monitoring peak bile acid levels and that some cases of cholestasis may progress in pregnancy and the adverse associations are better reflected by the peak TBA level and not the cholestasis severity at initial diagnosis.</p><p><strong>Key points: </strong>· Outcomes with worsening cholestasis severity (progressive) are unknown.. · Retrospective study comparing mild to progressive to severe cholestasis.. · Progressive cholestasis outcomes are more similar to severe cholestasis.. · Clinical utility of trending bile acids warrants further study..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2024-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142724732","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":"COVID-19 Serostatus Does Not Affect the Intrauterine Transfer of Micronutrients and Fatty Acids or Maternal-fetal Lymphocyte Cell Composition: An Observational Study.","authors":"Mullapudi V Surekha, Gargi Meur, Nadimpalli Suneetha, Nagalla Balakrishna, Putcha U Kumar, Bhukya Tulja, K Suryam Reddy, Ahmed Ibrahim, Pratha Sunitha","doi":"10.1055/a-2480-5329","DOIUrl":"https://doi.org/10.1055/a-2480-5329","url":null,"abstract":"<p><strong>Objective: </strong> Studies on the effects of coronavirus disease 2019 (COVID-19) on pregnant mothers and their newborns, specifically in relation to their micronutrient status, fatty acids (FAs), and inflammatory status are sparse. We hypothesized that COVID-19 infection would adversely affect the transfer of nutrients, and FAs from mothers to their fetuses via the umbilical cord and maternal-fetal distribution of inflammatory cells. This study aimed to determine the effect of COVID-19 on micronutrients, inflammatory markers, and FAs profiles in pregnant mothers and their newborns' cord blood.</p><p><strong>Study design: </strong> This was a cross-sectional study of 212 pregnant mothers in the third trimester and their newborns, recruited after testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) serostatus. Peripheral blood of mothers and cord blood were collected at birth and analyzed for vitamin B12 (Vit B12), folic acid, 25(OH)D3, FAs, and peripheral blood mononuclear cells. Student's <i>t</i>-test or analysis of variance (ANOVA) was used to express statistical significance. Non-normal data were tested using the Mann-Whitney <i>U</i> test and Kruskal-Wallis test, with proportions compared with the chi-square test.</p><p><strong>Results: </strong> Vit B12 levels were significantly low and adrenic acid levels significantly high in COVID-19 seropositive mothers while 25(OH)D3 was significantly low in seropositive cord blood. Irrespective of COVID-19 serostatus, folate, vit B12, saturated FA levels were significantly high in cord blood indicating their increased transfer from mothers to the fetus. However, monounsaturated (MUFA) and polyunsaturated fatty acid (PUFA) levels were significantly lower in cord blood. Irrespective of COVID-19 serostatus, CD4⁺ T helper cells (percentage of lymphocytes) were significantly higher in cord blood, while NK cells, NK-T cells, and CD8⁺ T-cytotoxic cells-percentage of lymphocytes-were significantly lower in cord blood when compared with corresponding mother's blood.</p><p><strong>Conclusion: </strong> The results indicate that while COVID-19 did not impede the transfer of essential nutrients such as MUFA and PUFA from mother to fetus, or affect maternal-fetal immune cell responses, it did appear to affect the levels of vit B12, vitamin D, and adrenic acid.</p><p><strong>Key points: </strong>· COVID-19 did not impede essential fatty acids transfer through cord blood.. · COVID-19 affected maternal-fetal immune responses.. · COVID-19 affected vitB12, vitamin D and adrenic acid levels..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2024-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142885233","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":"Transverse versus Vertical Incision in the Surgical Management of Placenta Accreta Spectrum.","authors":"Austin Oberlin, Katherine Yoh, Eve Overton, Whitney A Booker, John G Ilagan, Dib Sassine, Alexandra Diggs, Sherelle Laifer-Narin, Adela Cimic, Laurence E Ring, Maria Sheikh, Caryn St Clair, June Hou, Alexandre Buckley De Meritens, Jason D Wright, Mary D'Alton, Chia-Ling Nhan Chang, Mirella Mourad, Fady Khoury-Collado","doi":"10.1055/a-2479-2604","DOIUrl":"10.1055/a-2479-2604","url":null,"abstract":"<p><strong>Objectives: </strong> Traditionally, midline vertical skin incisions have been utilized during surgery for placenta accreta spectrum (PAS), as it is considered to maximize exposure and allow for a uterine incision to avoid the placenta. However, literature directly comparing outcomes of vertical versus transverse incisions in PAS is sparse. Our objective was to compare maternal outcomes between patients who underwent a vertical versus a transverse skin incision for PAS.</p><p><strong>Study design: </strong> Retrospective review of patients with pathologically confirmed PAS undergoing scheduled surgery at our institution between September 2019 and November 2023. Starting in October 2021, select patients were offered a transverse skin approach. Patients were eligible if the surgery was scheduled, and the placenta was not entirely covering the anterior uterine wall. The transverse skin incision was approximately 18 to 20 cm and used the patient's prior scar. Primary outcomes included the rate of maternal transfusion >4 units of packed red blood cells (PRBCs), the incidence of surgical complications, and the need for conversion to general anesthesia (GETA).</p><p><strong>Results: </strong> Seventy patients underwent scheduled surgery for PAS. Thirty-three patients had a vertical skin incision, and 37 had a transverse incision. After initiation of the transverse incision approach, 37/43 (86%) had a transverse incision and none required conversion to a vertical incision intraoperatively. The two groups were similar with regard to age, body mass index (BMI; kg/m²), and severity of PAS. There was no difference in the rate of transfusion of >4 units of PRBCs (vertical 12% vs. transverse 22%, <i>p</i> = 0.29), or in the rate of intraoperative complications (i.e., cystotomy; vertical 3% vs. transverse 14%, <i>p</i> = 0.20). In patients with a transverse incision, a significantly lower number of patients required conversion to GETA intraoperatively (vertical 70% vs. transverse 24%, <i>p</i> < 0.001).</p><p><strong>Conclusion: </strong> In appropriately selected patients, a transverse skin incision was associated with lower conversion to GETA without any difference in intraoperative outcomes.</p><p><strong>Key points: </strong>· Transverse incision for PAS has equivalent surgical outcomes.. · Fewer patients require GETA with a transverse incision.. · Transverse incision for PAS may need fewer narcotics..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2024-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142680589","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 Pregestational Diabetes on Maternal Morbidity and Mortality: Trends, Challenges, and Future Directions.","authors":"Ellen M Murrin, Antonio F Saad, Scott Sullivan, Menachem Miodovnik","doi":"10.1055/a-2489-4539","DOIUrl":"10.1055/a-2489-4539","url":null,"abstract":"<p><p>Maternal mortality in the United States is on the rise, demonstrating a concerning trend that stands in stark contrast to the falling rates in other developed countries. A key challenge facing the improvement of maternal care is the mounting prevalence of chronic health conditions such as hypertension and diabetes, which are often linked to poor diet and sedentary lifestyle. Pregestational diabetes now impacts 1 to 2% of pregnancies, while gestational diabetes affects another 7.8%. Both type 1 and type 2 diabetes elevate the risk of severe maternal morbidity and mortality (SMM), including severe cardiac morbidity, hypertensive disorders of pregnancy, hemorrhage, infection, and mental health conditions. The increase in diabetes is thought to account for 17% of the increase in maternal mortality between 1997 and 2012. Another critical issue facing maternal care is the significant disparity in pregnancy outcomes among populations facing greater burdens of adverse social determinants of health, including socioeconomic characteristics, chronic stress, and systemic racism. For example, non-Hispanic Black women are 2.5 times more likely to die during pregnancy and the postpartum period than non-Hispanic White women. Vulnerable populations, often minorities, are also more likely to develop risk factors for SMM, such as type 2 diabetes. As pregestational diabetes is a particularly morbid condition in pregnancy, examining its complications and evidence-based treatments could significantly impact both maternal mortality rates and disparities in pregnancy outcomes in the United States. This review explores the relationship between pregestational diabetes and SMM, how the risk of SMM can be modified by disparities, and avenues for advancing care through future research. KEY POINTS: · Diabetes during pregnancy greatly increases the risk of SMM.. · Comprehensive care can improve outcomes in high-risk pregnancies with diabetes.. · Adverse social determinants of health worsen outcomes in pregnancies affected by diabetes.. · Improving diabetes care in pregnancy offers an opportunity to enhance maternal outcomes..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2024-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142724780","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 Cannabis Legalization on Umbilical Cord Tissue Tetrahydrocannabinol Levels.","authors":"Kimberly Spence, Sarah Milota, Paula Buchanan, Nirja Acharya, Amit M Mathur","doi":"10.1055/a-2480-3163","DOIUrl":"10.1055/a-2480-3163","url":null,"abstract":"<p><strong>Objective: </strong> This study aimed to assess the impact of cannabis legalization on both qualitative and quantitative umbilical cord tissue tetrahydrocannabinol (THC) rates and concentrations as a proxy for fetal exposure.</p><p><strong>Study design: </strong> This is a retrospective, observational study of umbilical cord tissue THC levels in a single center, comparing THC exposure rates and concentration levels before and after cannabis legalization in the state of Illinois, Epoch 1 (October 1, 2018-June 30, 2019, pre-legalization) and Epoch 2 (July 1, 2019-August 31, 2021, post-legalization).</p><p><strong>Results: </strong> A total of 811 umbilical cords were analyzed during epoch 1 and 2,170 during epoch 2. A higher percentage of umbilical cord tissue tested positive for THC in Epoch 2 compared with Epoch 1 (46.2% vs. 40.6%; <i>p</i> < 0.01). Mean THC levels were 51% higher in umbilical cord tissue in Epoch 2 versus Epoch 1 (6.2 ng/g vs. 4.1 ng/g; <i>p</i> < 0.001).</p><p><strong>Conclusion: </strong> Legalization of recreational cannabis was associated with more fetuses exposed to THC and in higher concentrations.</p><p><strong>Key points: </strong>· THC concentration can be measured in umbilical cord tissue after birth.. · THC positivity in umbilical cord tissue can be used as a proxy for fetal exposure to cannabis.. · Umbilical cord tissue THC concentration and rates of positivity increased with the legalization of cannabis..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2024-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142685849","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}