American journal of perinatology最新文献

{"title":"Repeat versus Single Course of Antenatal Corticosteroid in Management of Preterm Premature Rupture of Membranes: A Systematic Review and Meta-analysis.","authors":"Yosteline Da Costa, Veena Ramanathan, Juliana Almeida Oliveira, Joaquim Brito, Abdelrahman Yousif","doi":"10.1055/a-2708-5314","DOIUrl":"10.1055/a-2708-5314","url":null,"abstract":"<p><strong>Objective: </strong>A single course of antenatal corticosteroids is standard for women at risk of preterm birth, including those with ruptured membranes. The benefit of repeat courses in the setting of preterm premature rupture of membranes (PPROM) remains uncertain. This study aimed to assess the safety and effectiveness of repeat versus single course of corticosteroid in women with PPROM.</p><p><strong>Study design: </strong>We searched PubMed, Cochrane, and Embase databases from inception to September 17, 2025, with no language restrictions, using the terms related to PPROM and corticosteroids. Randomized and non-randomized clinical trials enrolling women with PPROM and comparing repeat with single course were included. Studies without PPROM or comparator group were excluded. Screening and quality assessment were performed by two authors, with a third author participation in case of disagreements. Statistical analysis used Review Manager 5.4 and R studio 4.5.0, with risk ratio (RR), random effects, Cochran Q test and I-squared statistics, and sensitivity analysis. This study was registered with PROSPERO (identifier: CRD420251069007).</p><p><strong>Results: </strong>Six studies comprising 2,434 patients were included. Sensitivity analysis showed that repeat course of corticosteroids increased the risk of endometritis compared to a single course (RR = 1.63; 95% CI: 1.10 to 2.43). In the subgroup analysis the mixed hours corticosteroid favored the outcome of chorioamnionitis (RR = 1.62; 95% CI: 1.12 to 2.36; <i>p</i> = 0.001) with no overall subgroup difference. No difference was observed for the outcomes of respiratory distress syndrome, neonatal sepsis, necrotizing enterocolitis, and intraventricular hemorrhage.</p><p><strong>Conclusion: </strong>Repeat corticosteroid courses in PPROM may increase maternal infections morbidity without clear neonatal benefit. Further large, well-designed randomized trials are needed to clarify safety.</p><p><strong>Key points: </strong>· Repeat course of corticosteroid might increase maternal infections morbidity.. · A cautious approach due to potential increase in maternal morbidity related to repeat corticoid use.. · No significant neonatal benefit was observed with repeat courses of antenatal corticosteroids..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":"925-932"},"PeriodicalIF":1.2,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145257224","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":"Racial Variation in Cerebral Near-Infrared Spectroscopy Accuracy among Infants in a Cardiac Intensive Care Unit.","authors":"Callie Marshall, Stephanie Diggs, Morgan Pfeiffer, Anna Gerst, Alexa Brumfiel, Zachary Vesoulis","doi":"10.1055/a-2714-3293","DOIUrl":"10.1055/a-2714-3293","url":null,"abstract":"<p><strong>Objective: </strong>Pulse oximeters overestimate arterial oxygen saturations in Black versus White adults, children, and infants. While race's impact on near-infrared spectroscopy (NIRS) accuracy is less studied, some adult research suggests decreased accuracy in Black patients. This study investigates the effect of race on NIRS accuracy in infants in a cardiac intensive care unit (CICU).</p><p><strong>Study design: </strong>A retrospective chart review was conducted for infants admitted to St. Louis Children's Hospital CICU from 2017 to 2023. Bland-Altman plots, Pearson correlations, and mean biases were analyzed.</p><p><strong>Results: </strong>About 254 infants (13% Black, 87% White) provided 3,687 central venous oxygen saturation (ScvO₂)-cerebral regional oxygen saturation (rScO₂) pairs. Measurement bias was -3.2% in Black infants and +0.1% in White infants (<i>p</i> < 0.01).</p><p><strong>Conclusion: </strong>Cerebral NIRS underestimates ScvO₂ in Black infants but maintains negligible measurement bias in White infants. This is the first study to assess race and NIRS accuracy in infants; the difference is statistically significant but not clinically relevant in most contexts.</p><p><strong>Key points: </strong>· Light-based measures of oxygen saturation risk interference from melanin.. · Bias of cerebral NIRS is low (-0.6%) against central venous oxygenation.. · Cerebral NIRS error is disproportionate by race, with an underestimate of 3.2% in Black infants..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":"963-971"},"PeriodicalIF":1.2,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145224645","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":"Chlorothiazide Is Associated with a Weaker Diuretic Response than Furosemide in Infants with Bronchopulmonary Dysplasia.","authors":"Timothy D Nelin, Matthew Huber, Heidi Morris, Erik A Jensen, Kathleen Gibbs, Sara B DeMauro, Avery W Zierk, Nicolas P Goldstein Novick, David M Rub, Anna O'Brien, Scott A Lorch, Nicolas A Bamat","doi":"10.1055/a-2714-3368","DOIUrl":"10.1055/a-2714-3368","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to compare the acute diuretic effect of furosemide versus chlorothiazide in preterm infants with high-grade bronchopulmonary dysplasia (BPD).</p><p><strong>Study design: </strong>We conducted a retrospective cohort study of infants with grade 2 or 3 BPD admitted to a level IV NICU between 36 and 60 weeks postmenstrual age. Novel diuretic exposures were defined as administration of furosemide or chlorothiazide without prior exposure to the same agent in the preceding 7 days. The primary outcome was the within-subject change in net fluid balance (mL/kg) in the 24 hours before and after diuretic initiation. Multivariable linear regression was performed adjusted for diuretic dosing, route, frequency, and clinical covariates.</p><p><strong>Results: </strong>Among 300 infants contributing 136 furosemide and 215 chlorothiazide exposures, furosemide was most often dosed every 24 hours (73%) and chlorothiazide every 12 hours (90%). After covariate adjustment, furosemide was associated with a threefold greater reduction in net fluid balance compared to chlorothiazide (-32.0 vs. -10.5 mL/kg; <i>p</i> < 0.001). More frequent dosing (every 12 hours) was associated with greater diuretic effect than every 24-hour dosing for both agents (-22.4 vs. -11.3 mL/kg; <i>p</i> = 0.032). Concomitant use of both agents was common, yet the order of administration did not significantly influence fluid balance. No other clinical or biochemical characteristics were significantly associated with diuretic response.</p><p><strong>Conclusion: </strong>Furosemide has a significantly greater acute diuretic effect than chlorothiazide in infants with high-grade BPD. These findings may inform short-term fluid management strategies and support further investigation into optimal diuretic selection and dosing in this population.</p><p><strong>Key points: </strong>· Furosemide has a greater acute diuretic effect than chlorothiazide in infants with grade 2/3 BPD.. · More frequent dosing was associated with greater diuretic effect than daily dosing for both agents.. · Concomitant use of both agents was common; the order of administration did not impact fluid balance..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":"972-978"},"PeriodicalIF":1.2,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12750022/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145224591","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Progress in Preclinical Research on Mesenchymal Stem Cell-Derived Exosomes for the Treatment of Bronchopulmonary Dysplasia.","authors":"Shimeng Zhao, Shuang Han","doi":"10.1055/a-2704-7823","DOIUrl":"10.1055/a-2704-7823","url":null,"abstract":"<p><p>Bronchopulmonary dysplasia (BPD) is the most common chronic respiratory disease in premature infants and affects their survival rate and quality of life. There are no reliable interventions for the prevention or treatment of BPD, but the emergence of mesenchymal stem cell (MSC) therapies has brought new hope. Research has shown that paracrine may be the therapeutic mechanism of action underlying physiological improvements in the lungs of BPD patients treated with MSC therapy. The therapeutic vector in the MSC secretome comprises exosomes with low immunogenicity and stability, and that can easily cross the blood-brain barrier. In the future, exosomes may become the preferred treatment for BPD in clinical settings. Here, we review the progress of preclinical research on the use of MSC-derived exosomes as a promising treatment option for BPD. · There is a lack of effective treatment for BPD.. · MSCs' therapeutic effect is exerted through paracrine.. · MSC-derived exosomes (MSC-Exos) possess similar biological functions to MSCs.. · MSC-Exos can repair lung injury in BPD animal models..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":"863-868"},"PeriodicalIF":1.2,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145091034","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":"Perspectives on Clinicians' Roles and Postpartum Opioid Pain Management: A Qualitative Analysis.","authors":"Tazim Merchant, Julia D DiTosto, Elizabeth Soyemi, Lynn M Yee, Nevert Badreldin","doi":"10.1055/a-2704-7765","DOIUrl":"10.1055/a-2704-7765","url":null,"abstract":"<p><strong>Objective: </strong>Pain is a common postpartum complaint, yet data suggest that approaches to postpartum pain management vary widely. Given the goal of improving quality and equity in postpartum pain management, we aimed to examine whether and how clinicians' perspectives on postpartum pain management differed by clinician roles.</p><p><strong>Study design: </strong>This is a qualitative study at a large, tertiary, and academic medical center. From November 2021 to June 2022, obstetric clinicians, including attending physicians, trainee physicians, and advanced practice providers (APPs), were recruited to complete in-depth interviews regarding their clinical experience managing postpartum pain using a semi-structured interview guide. Participants were asked to reflect both on their own role and that of the other clinician types. Purposive sampling was used to enroll a cohort representative of the institutional workforce in terms of clinician type and demographics. Data were analyzed using the constant comparative method.</p><p><strong>Results: </strong>Of 46 participants, 47.8% (<i>n</i> = 22) were attending physicians, and 91% (<i>n</i> = 42) were female. Emergent themes were both self-reflected and externally directed. Data demonstrated that postpartum pain management differs by clinician type and level of experience. Themes related to the role of attending physicians included responsibilities as teachers for trainees, supervisory roles, and perceptions that attendings have greater comfort with prescribing opioids. Themes related to the role of trainee physicians included the impact of patient load on trainees' management, limitations of morning rounds, familiarity with emerging data, and perceptions of hesitancy to prescribe opioids. Themes related to the role of APPs included less reliance on opioids for postpartum pain management and emphasis on nonpharmacological approaches.</p><p><strong>Conclusion: </strong>Perspectives on postpartum pain management vary by clinician role. Consideration of these differences and the interplay between roles is essential when examining opioid prescribing patterns and developing interventions to improve postpartum pain management.</p><p><strong>Key points: </strong>· Pain management differs by role and experience.. · Attendings have more comfort with opioid prescriptions.. · Trainees are perceived as more hesitant to prescribe opioids.. · APPs rely more on nonopioid management strategies..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":"995-997"},"PeriodicalIF":1.2,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145243626","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":"Antihypertensive Treatment in the Postpartum Care of Preeclampsia: A Hemodynamic-Based Approach.","authors":"Ifeoma Ogamba-Alphonso, Erin Miller, Tudi-Max Brown-Thomas, Ioanna Katehis, Saige Gitlin, Delphina Maldonado, Gabriella Fernandez De Salvo, Tony Asfour, Izzy Ginsberg, Silpaa Gunabalan, Anand Rajan, Keya Shah, Mehak Kapoor, George Gubernikoff, Wendy Kinzler, Martin Chavez, Hye Heo, Patricia Rekawek","doi":"10.1055/a-2708-5020","DOIUrl":"10.1055/a-2708-5020","url":null,"abstract":"<p><strong>Objective: </strong>Labetalol and nifedipine are first-line antihypertensives for hypertensive disorders of pregnancy. However, there is limited research comparing their effectiveness based on hemodynamic profiles seen in preeclampsia, such as high cardiac output (CO) and high systemic vascular resistance (SVR). This study assesses whether concordance of antihypertensive treatment with the hemodynamic status on echocardiogram reduces time to achieve target postpartum blood pressure (BP) before discharge.</p><p><strong>Study design: </strong>This retrospective cohort study included patients with preeclampsia with severe features who received a postpartum echocardiography, excluding patients with cardiac etiology. Antihypertensive choices were provider-dependent. The CO and SVR were calculated retrospectively from the echocardiogram in collaboration with cardiology. Concordance was defined as patients with high CO (>6 L/min) started on labetalol and high SVR (>1,200 dynes·sec·cm⁵) started on nifedipine; opposite pairings were discordant. The primary outcome was time to achieve target BP, defined as the period from the start of antihypertensive therapy to when no titration was needed to sustain BPs of less than 140/90 mm Hg. Chi-square and Fisher's tests were used for categorical variables, and Mann-Whitney U test for continuous variables.</p><p><strong>Results: </strong>Of 298 patients, 155 (52%) received concordant therapy and 143 (48%) discordant. Of the cohort, 229 (76.8%) had high SVR and 69 (23.2%) had high CO. Median time to target BP was not significantly different (concordant: 32 hours [interquartile range, IQR: 0-61], discordant: 41 hours [IQR: 4-75], <i>p</i> = 0.13). The concordant group needed fewer titrations to achieve target BP (1 [IQR: 0-2] vs. 2 [IQR: 1-3]; <i>p</i> = 0.008) and were less likely to be discharged home on multiple antihypertensive medications compared with the discordant group (28.9 vs. 42.7%, <i>p</i> = 0.014). Maternal demographics were similar between groups.</p><p><strong>Conclusion: </strong>While time to target BP did not differ, concordance of antihypertensive therapy to postpartum hemodynamics in patients with severe preeclampsia reduced medication adjustments and increased the likelihood of discharge on a single-agent regimen.</p><p><strong>Key points: </strong>· Echocardiography can be used to assess maternal hemodynamics.. · Aligning BP meds to hemodynamics cuts the need for a second agent.. · Aligning BP meds to hemodynamics reduces dose adjustments..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":"933-939"},"PeriodicalIF":1.2,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145249304","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 Morbidity following Periviable Prelabor Rupture of Membranes after Texas Senate Bill 8.","authors":"Danna Ghafir, Emily Fahl, Nancy Ukoh, Han-Yang Chen, Sean C Blackwell, Julie Gutierrez, Irene A Stafford","doi":"10.1055/a-2712-5549","DOIUrl":"10.1055/a-2712-5549","url":null,"abstract":"<p><strong>Objective: </strong>Standard practice prior to Texas Senate Bill 8 (SB 8) for those with periviable prelabor rupture of membranes (PROM) without contraindications to expectant management was to offer termination of pregnancy or expectant management. After SB 8 went into effect, pregnancy termination was only offered for these patients after the development of chorioamnionitis or clinically significant maternal hemorrhage. The aim of this study was to compare maternal outcomes of periviable PROM before and after SB 8 in Houston, TX.</p><p><strong>Study design: </strong>This retrospective cohort study compared outcomes of periviable PROM less than 22 weeks of gestational age before and after SB 8 at three tertiary care hospitals from January 1, 2018, to March 31, 2023. Our primary outcome was a composite of adverse maternal outcomes: Sepsis, transfusion, and intensive care unit (ICU) admission. Secondary outcomes included intraamniotic infection, postpartum hemorrhage, abruption, septic shock, hospital length of stay, time from rupture of membranes to delivery, and neonatal survival.</p><p><strong>Results: </strong>Over the 5-year study period, 161 women met the inclusion criteria (96 pre-SB 8 vs. 65 post-SB8). Approximately half (54%) of those with periviable PROM opted for termination prior to SB8. Post-SB8, women were more likely to develop an adverse outcome (22.9 vs. 35.4%; aRR = 1.69, 95% confidence interval [CI]: 1.03-2.78), and were more likely to develop sepsis (9.4 vs. 29.2%; adjusted relative risk [aRR] = 2.97, 95% CI: 1.43-6.17). Five neonates survived to hospital discharge post-SB8, and one survived prior to SB8. Additionally, those expectantly managed post-SB8, compared with those expectantly managed pre-SB8, experienced a longer time from rupture of membranes to delivery (6.5 days post [2-14] vs. 3 days pre [1-7.5]), and a higher rate of sepsis (18 post [30.0%] vs. 6 pre [15.0%]).</p><p><strong>Conclusion: </strong>These results provide evidence that periviable PROM alone is a life-threatening condition with a serious risk of maternal harm. Waiting for maternal infection or hemorrhage to develop before offering pregnancy termination increases the risks of serious maternal morbidity.</p><p><strong>Key points: </strong>· Pre-SB8, 54% of women with periviable PROM chose termination.. · Increased rates of sepsis were observed post-SB8.. · Longer rupture of membranes to delivery times were observed post-SB8..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":"949-954"},"PeriodicalIF":1.2,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145190728","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":"Nutrition Pattern and Adverse Pregnancy Outcomes in Nulliparous Individuals: A Cluster Analysis.","authors":"Tetsuya Kawakita, Yara H Diab, Kazuma Onishi, George Saade","doi":"10.1055/a-2712-5518","DOIUrl":"10.1055/a-2712-5518","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to develop a k-means clustering algorithm to identify distinct food intake patterns through cluster analysis.</p><p><strong>Study design: </strong>This was a secondary analysis of the Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-Be (nuMoM2b), including nulliparous individuals with singleton pregnancies. Dietary intake data from the 3 months preceding pregnancy were collected using a validated questionnaire. The primary outcome was a composite measure including preterm birth, stillbirth, preeclampsia, eclampsia, gestational diabetes, and small for gestational age. Clusters were formed using a k-means clustering algorithm with Euclidean distance, based on 335 dietary variables. The association between dietary clusters and adverse pregnancy outcomes (APOs) was assessed. Relative risks with 95% confidence intervals (95% CIs) were calculated using modified Poisson regression, adjusting for predefined confounders. A random forest model was also employed to identify features predictive of cluster allocation.</p><p><strong>Results: </strong>The analysis included 7,599 participants, distributed across three clusters: Cluster 1 (<i>n</i> = 4,243, 55.8%), Cluster 2 (<i>n</i> = 2,768, 36.4%), and Cluster 3 (<i>n</i> = 588, 7.7%). Cluster 2, which serves as the referent cluster, is characterized by a higher intake of vitamin E as α-tocopherol, vitamin A retinol activity equivalents, vegetables, and fruits, aligning most closely with a healthy diet pattern. Compared with Cluster 2, Cluster 1, characterized by a lower intake of the same nutrients, did not show a significant association with increased odds of APOs (22.7 vs. 25.4%; adjusted relative risk [aRR], 1.07 [95% CI: 0.98-1.18]). In contrast, Cluster 3, characterized by higher intake of trans fats, dietary polyunsaturated fatty acids 20:4, red meat, and sugary beverages, was significantly associated with APOs compared with Cluster 2 (31.0 vs. 22.7%; aRR, 1.19 [95% CI: 1.01-1.39]).</p><p><strong>Conclusion: </strong>A dietary pattern characterized by a high intake of trans fats, polyunsaturated fatty acids, red meat, and sugary beverages is significantly associated with an increased risk of APOs.</p><p><strong>Key points: </strong>· Diets high in trans fats, polyunsaturated fatty acids, red meat, and sugary beverages are associated with increased APOs.. · Diets rich in vitamin E, vitamin A, vegetables, and green salads are linked to a lower risk of these outcomes.. · This study underscores the significant role of nutrition in influencing APOs..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":"955-962"},"PeriodicalIF":1.2,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145190757","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":"Prospective Economic Evaluation Alongside the Telephone-Based Nurse-Delivered Interpersonal Psychotherapy for Postpartum Depression Trial.","authors":"Susanne Hay, Cindy-Lee Dennis, Paula Ravitz, Sophie Grigoriadis, Elise Maddalone, Dmitry Dukhovny, John Zupancic","doi":"10.1055/a-2708-5194","DOIUrl":"10.1055/a-2708-5194","url":null,"abstract":"<p><strong>Objective: </strong>In a previously reported, multi-site, randomized controlled trial in women with postpartum depression (PPD), telephone-based, nurse-delivered, interpersonal psychotherapy (IPT) compared with standard postpartum care showed a reduction of 24% in the incidence of PPD (Dennis et al, <i>British Journal of Psychiatry</i>, 2020). The economic implications of this therapy have not been explored. We aimed to determine the cost-effectiveness of telephone-based, nurse-delivered IPT compared with standard postpartum care, using resource utilization data collected alongside the clinical study.</p><p><strong>Study design: </strong>We conducted a prospectively planned economic evaluation using patient-level data from the IPT trial, which enrolled 241 mothers with PPD. We considered costs from a societal perspective, measuring direct medical costs from study logs and secondary sources, as well as evaluating costs borne by the mother and family (including both medical and non-medical expenditures) and wage losses through questionnaires. We used a time horizon of 12 weeks post-randomization, corresponding to the endpoint of the clinical trial. Costs are reported in (2022) Canadian dollars.</p><p><strong>Results: </strong>Patients in the IPT group had more phone calls with public health nurses external to those provided by the study protocol (IPT 73% versus control 55%, <i>p</i> = 0.007) and fewer visits to psychiatrists (9% versus 22%, <i>p</i> = 0.008). However, there were no statistically significant differences in any of the cost categories or total societal expenditures (IPT group $6,653, control group $5,336, <i>p</i> = 0.234). When costs and effects were combined, the societal expenditure was $5,397 for each additional patient without PPD.</p><p><strong>Conclusion: </strong>Telephone-based, nurse-delivered IPT, as employed in this trial, showed no statistically significant differences in costs compared with standard care but resulted in improved clinical outcomes. Although associated with moderate uncertainty, the resulting incremental cost-effectiveness was well within the acceptable range for medical interventions in this population, and telephone-based, nurse-delivered IPT should be considered for patients with PPD.</p><p><strong>Key points: </strong>· Telephone-based, nurse-delivered IPT is effective in treating PPD.. · We performed an economic evaluation alongside a randomized controlled trial of IPT, using patient-level data and considering costs from a societal perspective.. · Patients in the IPT group had more phone calls with public health nurses and fewer visits to psychiatrists, with overall similar costs between the two groups.. · The societal expenditure was $5,397 for each additional patient without PPD, which is well within the acceptable range for medical interventions in this population.. · Telephone-based, nurse-delivered IPT should be considered for cost-effective care of patients with PPD..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":"900-906"},"PeriodicalIF":1.2,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145257265","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":"Postpartum Presentation of a Variant of Uncertain Significance in COL3A1: A Case Report.","authors":"Fatima Zohra Khamissi, Catherine Bachur, Anna Palatnik, Melissa Russo, Matthew A Shanahan, Brock E Polnaszek","doi":"10.1055/a-2722-8222","DOIUrl":"10.1055/a-2722-8222","url":null,"abstract":"<p><strong>Objective: </strong>Vascular Ehlers-Danlos syndrome (vEDS) is a rare inherited connective tissue disorder associated with significant maternal morbidity and mortality during pregnancy. Conflicting recommendations exist for management, particularly in patients with variant of uncertain significance (VUS).</p><p><strong>Study design: </strong>We present a 39-year-old G2P1011 with a strong family history suggestive of vEDS who experienced an uncomplicated vaginal delivery followed by a large retroperitoneal hematoma requiring interventional radiology embolization and intensive care management for a postprocedural femoral pseudoaneurysm.</p><p><strong>Results: </strong>Postpartum genetic testing revealed a heterozygous VUS in <i>COL3A1</i> (c.1297G>A [p.Glu433Lys]).</p><p><strong>Conclusion: </strong>This case illustrates the challenges of counseling and managing pregnancy in patients with suspected vEDS and VUS, highlighting the importance of risk mitigation strategies, multidisciplinary care, and nuanced interpretation of genetic results.</p><p><strong>Key points: </strong>· Risk stratification imaging: Whole-body vascular imaging beyond echocardiography may identify silent arterial lesions.. · Variant reclassification: Reporting pregnancy phenotypes linked to VUS in databases (ClinVar, LOVD) can accelerate variant reclassification and improve counseling.. · Structured counseling for uncertainty: Use a systematic approach when counseling patients with both a suspicious phenotype and a VUS, incorporating multidisciplinary perspectives and clearly communicating knowns and unknowns..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":"1003-1006"},"PeriodicalIF":1.2,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145421002","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}