American journal of perinatology最新文献

{"title":"Prevalence and Risk Factors for Depression Among Parents of Children Born Preterm: A Systematic Review and Meta-Analysis of The Evidence Since 2000.","authors":"Megan Moorhouse, Piranavi Jeyagaran, George Okoli, James Bolton, Nicole Askin, Kristene Cheung, Lisa Lix, Allan Garland, Deepak Louis","doi":"10.1055/a-2568-1653","DOIUrl":"https://doi.org/10.1055/a-2568-1653","url":null,"abstract":"<p><strong>Objective: </strong>Previous reviews of depression among parents of preterm children were restricted to mothers within the first year of preterm delivery. We aimed to systematically review the prevalence and risk factors for depressive symptoms among mothers and fathers in the first five years following preterm birth.</p><p><strong>Study design: </strong>This systematic review was undertaken following the Cochrane Handbook for Systematic Reviews of Interventions Guidelines and reported using the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guideline. Peer reviewed, all language, observational studies from the year 2000 that assessed the prevalence and/or risk factors for depression among parents of children born preterm (<37 weeks gestation) in the first five years following preterm birth, using validated clinical scales, were included. Medline, Embase, Web of Science Core Collection, CINAHL, PsycINFO and Cochrane Central were searched on July 29, 2021. The NIH quality assessment tool was used. Meta-analysis was performed using inverse variance effects models to estimate prevalence and identify risk factors.</p><p><strong>Results: </strong>Seventy-eight studies were included. The majority were English language (n=71), European (n=32), cross sectional studies (n=44), using the EPDS scale (n=45). The prevalence of depressive symptoms among mothers was 25% (95% CI, 21%-31%; n=72) in the first year, and 20% (13%-30%; n=8) in the second to fifth year, while for fathers, the rates were 13% (8%-22%; n=15) and 11% (2%-50%; n=1) respectively. Eastern Mediterranean region had the highest prevalence of maternal depressive symptoms in the first year [48% (25%-72%; n=3)], while it was the Western Pacific region for fathers [17% (15%-19%)]. Low educational status [Odds ratio 3.5 (95% CI, 1.9-6.5; n=2)] was associated with depressive symptoms among mothers in the first year.</p><p><strong>Conclusion: </strong>Mothers and fathers had a high prevalence of depressive symptoms in the first five years following preterm birth, with region variations in the prevalence. (PROSPERO Registration# CRD42021260748).</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143742004","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":"Utility of abdominal near infrared spectroscopy (NIRS) in the management of neonates - A review.","authors":"Dipen Vyas, Jennifer Ware, Lauren Billington, Ricardo Rodriguez, Jeffrey Shenberger, Parvesh Mohan Garg","doi":"10.1055/a-2567-5178","DOIUrl":"https://doi.org/10.1055/a-2567-5178","url":null,"abstract":"<p><p>Near-infrared spectroscopy (NIRS) is a non-invasive technique which utilizes light in the near infrared spectrum to assess regional tissue oxygenation. Initial application of NIRS focused on measuring cerebral oxygenation. Recently, numerous studies focused on the utility of NIRS in measuring abdominal regional perfusion in preterm and full-term neonates - hepatic (right subcostal) and mesenteric (left lower quadrant/infra-umbilical probe). Abdominal NIRS, specifically the infraumbilical values obtained within the first week of life, is a useful tool for the evaluation of feeding intolerance and an early marker of the development of necrotizing enterocolitis (NEC) as changes in NIRS in the first 24 hours of abdominal symptoms helps define NEC severity. In addition, NIRS holds promise in identifying changes in abdominal regional perfusion with blood transfusion. The goal of this review is to summarize the current knowledge of factors affecting abdominal NIRS measurements, specifically alterations associated with feeding, blood transfusion, and necrotizing enterocolitis (NEC). We present information from the published clinical research in conjunction with information collected from an extensive search in the databases PubMed, EMBASE, and Scopus.</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143727466","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":"Anemia Biomarkers in Pregnant People with Pyelonephritis.","authors":"Noor K Al-Shibli, Kristin E Weaver, Matthew R Grace, Jeffrey A Kuller, R Phillips Heine, Shakthi Unnithan, Sarah K Dotters-Katz","doi":"10.1055/a-2547-4135","DOIUrl":"https://doi.org/10.1055/a-2547-4135","url":null,"abstract":"<p><p>Anemia is observed in 30% of pregnancies with pyelonephritis, yet little is known about the underlying etiology. Erythropoietin (EPO) is renally produced in response to hypoxic and inflammatory conditions. Changes in serum EPO have been demonstrated in infectious conditions in the nonpregnant population. EPO levels have been measured in healthy pregnancy cohorts, but little is known about patterns in the setting of renal inflammation. Our primary objective was to compare EPO levels in pregnant patients at diagnosis of acute pyelonephritis to established trimester-specific norms. Secondary objectives included assessing iron deficiency and hemolysis markers as alternate etiologies of anemia.Prospective cohort study of pregnant people aged ≥ 18 years diagnosed with pyelonephritis, defined as the presence of urinary tract infection symptoms plus flank pain, fever, or nausea/vomiting. Blood samples including EPO, iron, transferrin, lactate dehydrogenase (LDH), and haptoglobin were obtained within 72 hours of diagnosis. Demographics and clinical data were abstracted from medical records. Wilcoxon Signed-Rank test compared study EPO levels to noninfected pregnancy values established in the literature. Secondary outcomes included number of patients with iron/hemolysis laboratories within trimester-specific reference ranges.The study cohort included 17 patients with pyelonephritis in the second or third-trimester. There were no eligible first-trimester patients during the study period. Anemia was present on admission in 35.3% (6/17) of patients. EPO levels were significantly higher in pyelonephritis patients during the second-trimester compared with literature-established EPO levels in noninfected controls: 48.6 versus 10.6 mU/mL, (<i>p</i> = 0.0001). Secondary analysis demonstrated normal iron and haptoglobin levels in most patients, and normal LDH in all patients.EPO levels in pregnant pyelonephritis patients were significantly higher compared with trimester-specific normative levels established in the literature. Evaluation of iron and hemolysis studies showed inconsistent results but were often normal. This pilot study may suggest a relationship between ineffective erythropoiesis and renal inflammation in pregnancies complicated by pyelonephritis. · Anemia is present in 30 to 50% of pregnant patients with pyelonephritis.. · EPO was higher in the pyelonephritis cohort compared with normal pregnancy values.. · Iron and haptoglobin were normal in most patients, LDH was normal in all patients..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143727429","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":"Risk Factors, Trends, and Outcomes Associated with Rural Delivery Hospitalizations Complicated by Hypertensive Disorders of Pregnancy.","authors":"Mary M Carmack, Joel Agarwal, Timothy Wen, Yongmei Huang, Alexander M Friedman","doi":"10.1055/a-2547-4267","DOIUrl":"10.1055/a-2547-4267","url":null,"abstract":"<p><p>Hypertensive disorders of pregnancy (HDP) may account for a considerable and growing clinical burden at rural hospitals which have been providing fewer obstetric services over the past two decades. The objectives of this analysis were to evaluate trends, risk factors, and outcomes associated with HDP during delivery hospitalizations at rural hospitals in the United States.The 2000 to 2020 National Inpatient Sample was used for this repeated-cross sectional analysis. Delivery hospitalizations at rural hospitals to women 15 to 54 years of age with and without HDP (including preeclampsia and gestational hypertension) were identified. Trends in HDP were characterized with joinpoint regression and estimated as the average annual percent change (AAPC) with 95% confidence intervals (CIs). The associations between (i) HDP risk factors and HDP and (ii) HDP and adverse maternal outcomes were estimated with adjusted logistic regression models.Among 8,885,683 deliveries that occurred at rural hospitals, the proportion with a HDP diagnosis increased significantly from 6.0% in 2000 to 11.1% in 2020 (AAPC: 3.1%; 95% CI: 2.8 and 3.4%). Preeclampsia with severe features (AAPC: 5.5%; 95% CI: 4.8 and 6.2%) and superimposed preeclampsia (AAPC: 6.5%; 95% CI: 5.6 and 7.5%) underwent the largest relative increases over the study period. Obesity, pregestational diabetes, chronic hypertension, multiple gestation, and chronic kidney disease were all associated with increased adjusted odds of HDP. HDP diagnoses were significantly associated with severe maternal morbidity (SMM), transfusion, stroke, and disseminated intravascular coagulation. The proportion of overall delivery SMM associated with HDP more than doubled from 11.3% in 2000 to 24.7% in 2020.Among delivery hospitalizations at rural hospitals, HDP, and associated risk factors increased significantly over the study period. Deliveries with HDP accounted for an increasing proportion of population-level SMM. HDP is a major, growing contributor to maternal risk and adverse outcomes during deliveries at rural hospitals. · Hypertensive disorders accounted for an increasing proportion of population-level severe morbidity.. · Hypertensive disorders increased among rural delivery hospitalizations.. · Risk factors associated with hypertensive disorders increased among rural delivery hospitalizations..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143522422","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":"Comparison of Infants Discharged from Birth Hospitalization with Gastrostomy versus Nasogastric Feeding Tube.","authors":"Hartlee Lidsky, Emily Anderson, Neal A deJong, Adriana Herrera, Ashley G Sutton","doi":"10.1055/a-2550-5510","DOIUrl":"10.1055/a-2550-5510","url":null,"abstract":"<p><p>Many infants, particularly those born premature or with medical complexity, require supplemental enteral nutrition upon discharge from birth hospitalization. Recent literature supports the safety of discharging infants with nasogastric tube (NG) feeding. However, further evidence is needed to characterize populations suited for home NG feeding compared to gastrostomy tube (GT) placement. This study aimed to describe demographic and clinical differences between infants discharged from birth hospitalization with NG versus GT feeding.This retrospective cohort study included infants discharged from birth hospitalization with NG or GT feeding between April 2014 and December 2022 at a single quaternary care hospital with a neonatal intensive care unit (NICU). Routinely collected health data were used to investigate associations between patient characteristics and discharge feeding modality, as well as assess feeding outcomes 12 months after discharge.Of 346 infants, 72 (20.8%) were discharged with NG and 274 (79.2%) with GT. Infants with GT were more often discharged from the NICU (71.2 vs. 26.4%) with lower birth weights (median 2.40 vs. 2.92 kg) and longer hospitalizations (median 84 vs. 51.5 days). Twelve months after discharge, 77.4% of NG infants achieved full oral feeding compared to 16.6% of GT infants with earlier tube discontinuation in NG infants (19 vs. 236 days).Home NG feeding is a viable, less invasive alternative to GT for selected infants, particularly those with less medical complexity. Prospective studies are needed to further delineate optimal discharge feeding modalities for various infant subpopulations. · Infants discharged with gastrostomies had lower birth weights.. · More NG tube infants achieved oral feeding than gastrostomy infants.. · NG tubes were removed much sooner than GT.. · Home NG feeding is an alternative to gastrostomy for less medically complex infants..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143555477","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":"Early versus Late Brain Magnetic Resonance Imaging and Spectroscopy in Infants with Neonatal Encephalopathy following Therapeutic Hypothermia.","authors":"Tatiana A Nuzum, Pradeep Mally, Elena V Wachtel","doi":"10.1055/a-2540-2956","DOIUrl":"https://doi.org/10.1055/a-2540-2956","url":null,"abstract":"<p><p>This study aimed to evaluate the utility of early and late magnetic resonance imaging (MRI) in infants with neonatal encephalopathy (NE) after therapeutic hypothermia (TH), and to determine the concordance between magnetic resonance spectroscopy (MRS) and early MRI findings.We conducted a retrospective, observational study including encephalopathic neonates born between 2017 and 2023 at two regional perinatal centers. All subjects underwent early diffusion-weighted MRI (DWI) with or without MRS (day: 4-5), and late conventional T1/T2-weighted MRI (day: 12-14). Both MRIs were assigned an injury severity score based on the National Institute of Child Health and Human Development (NICHD) neonatal research network (NRN) pattern of injury, reflecting the injury apparent on the MR modality obtained. MRS injury was defined as the presence of a lactate peak.The majority of the cohort (<i>n</i> = 98) was moderately encephalopathic (78%). Early and late MR imaging was performed at an average of 5.7 and 13.6 days, respectively. Fifteen percent of infants had evidence of hypoxic-ischemic (HI) injury on early imaging only, and 6% on late imaging only. Forty percent of infants exhibited a change in NICHD score severity between early and late MRI. Twenty-three infants (24%) were found to have a milder injury and 16 (16%) were found to have more severe injury on late imaging, when scores were compared with early imaging scores. The concordance of injury between early MRS and MRI was 62.5%. Among the cases of discordant MRI/MRS, MRS detected additional injury in 70% of cases, and MRI detected additional injury in 30% of cases.Both early and late imaging are important to fully define injury and provide accurate neurodevelopmental prognoses in cases of encephalopathic infants following TH. Failure to perform imaging at two intervals would have potentially resulted in missed diagnoses in 6 to 15% of cases and misestimation of injury in up to 40% of cases. · Early and late neuroimaging is important for accurate neurodevelopmental prognostication of encephalopathic neonates.. · The NICHD NRN MRI scoring system is a helpful tool for clinical practice.. · MR spectroscopy shows promise for HI injury but requires more validation..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143727446","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":"Mode of Delivery Outcomes of Induced versus Spontaneous Labor in Individuals with Dichorionic Twins.","authors":"Manasa G Rao, Chelsea A DeBolt, Kelly Wang, Alexandra Mills, Sonia G Khurana, Isabelle Band, Elianna Kaplowitz, Andrei Rebarber, Nathan S Fox, Joanne Stone","doi":"10.1055/a-2547-4074","DOIUrl":"10.1055/a-2547-4074","url":null,"abstract":"<p><p>This study aimed to investigate odds of vaginal delivery comparing induced versus spontaneous labor in nulliparas and multiparas with dichorionic twins.A retrospective review of dichorionic twin pregnancies from 2008 to 2021. Those with scheduled or elective cesarean, malpresentation, prior uterine surgery, fetal anomaly, gestational age (GA) at delivery <34 weeks, and multifetal reduction were excluded. Nulliparas and multiparas were analyzed separately. The primary outcome was vaginal delivery of both twins. Secondary outcomes included preterm delivery, postpartum hemorrhage, and hypertensive disorders of pregnancy (HDP). Outcomes were compared among induced versus spontaneous labor and assessed using univariable and multivariable logistic regression.Among 258 nulliparas, 176 (68.2%) were induced, and 82 (31.8%) spontaneously labored. Induced patients were older (<i>p</i> = 0.048), had a higher proportion of intrahepatic cholestasis of pregnancy (IHCP; <i>p</i> = 0.04), HDP (<i>p</i> < 0.0001), and later GA at delivery (<i>p</i> < 0.0001). Patients who spontaneously labored had a higher proportion of preterm delivery at <37 weeks (<i>p</i> < 0.0001) and a higher proportion of at least one twin admitted to the neonatal intensive care unit (<i>p</i> = 0.01). On univariable analysis, induction was associated with decreased likelihood of vaginal delivery of both twins (<i>p</i> = 0.01). However, after adjusting for augmentation, GA at delivery, gestational diabetes, and HDP/chronic hypertension, this was no longer statistically significant (<i>p</i> = 0.14). Among 239 multiparas, 108 (45.2%) were induced, and 131 (54.8%) spontaneously labored. Induced patients had a higher proportion of IHCP (<i>p</i> = 0.02), chronic hypertension (<i>p</i> = 0.02), HDP (<i>p</i> < 0.0001), and later GA at delivery (<i>p</i> < 0.0001). Spontaneous labor patients had higher proportion of preterm delivery at <37 weeks (<i>p</i> < 0.0001). There was no significant difference in odds of vaginal delivery between spontaneous versus induced labor on univariate (<i>p</i> = 0.74) or adjusted analysis after controlling for augmentation, GA at delivery, gestational diabetes and HDP/chronic hypertension (<i>p</i> = 0.40) among multiparas.Among nulliparas and multiparas with dichorionic twins, induction of labor does not appear to be associated with decreased odds of vaginal delivery. · Spontaneous labor patients had a higher proportion of preterm delivery <37 weeks.. · Induction of labor and spontaneous labor had similar odds of vaginal delivery.. · Induction of labor may be offered as a safe option in delivery counseling of DCDA twins..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143522407","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":"Association of pre-pregnancy obesity versus excessive gestational weight gain with adverse neonatal outcomes in the United States.","authors":"Rodney McLaren, Deepa Rastogi, Shantanu Rastogi","doi":"10.1055/a-2565-1687","DOIUrl":"https://doi.org/10.1055/a-2565-1687","url":null,"abstract":"<p><strong>Objective: </strong>Pre-pregnancy obesity (PPO) and excessive gestational weight gain (eGWG) during pregnancy, both are associated with adverse neonatal outcomes. The objective of this study was to compare the independent associations of PPO and eGWG with adverse neonatal outcomes.</p><p><strong>Methods: </strong>This was a retrospective cohort study of singleton, live births in the United States in 2018 using National Vital Statistics System data. These were divided into four groups: 1) normal pre-pregnancy BMI and normal GWG, 2) normal pre-pregnancy BMI and eGWG, 3) pre-pregnancy BMI >30 kg/m2 (PPO) and normal GWG and 4) PPO and eGWG. The adverse neonatal outcomes, including preterm delivery, large for gestational age (LGA) infants, assisted neonatal ventilation, low 5-minute Apgar scores, neonatal intensive care unit (NICU) admissions, and surfactant use were studied. These outcomes were compared among groups using ANOVA and multivariable analyses.</p><p><strong>Results: </strong>Of the 1,477,062 births included, 21.8%, 41.6%, 10.4% and 26.3% were in Groups 1-4 respectively. With Group 1 as the reference group after correcting for significant factors, groups 2-4 had higher risk (aOR with 95% CI), for preterm delivery of <37 weeks 1.17 (1.14-1.20), 1.05 (1.02-1.09) and 1.14 (1.11-1.18) and for LGA infants 2.38 (2.31-2.44), 2.37 (2.29-2.45), 3.91 (3.80-4.02) in groups 2-4 respectively. Further, patients with PPO with and without eGWG also had increased risk of immediate assisted neonatal ventilation 1.07 (1.02-1.12) and 1.16 (1.12-1.218), for 5-minute Apgar score <3 1.40 (1.19-1.65), 1.38 (1.20-1.58), and for NICU admission in 1.04, (1.01-1.08), 1.12 (1.09-1.15) for Groups 3 and 4 respectively.</p><p><strong>Conclusion: </strong>Both PPO and eGWG were independently associated with preterm delivery and LGA infants. PPO with or without excessive GWG was also associated with low Apgar scores, more NICU admission and higher need for immediate ventilatory support. This data supports the importance of pre-pregnancy weight loss to prevent or decrease adverse neonatal outcomes.</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143708178","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":"Improving Understanding of Macrosomia with a Graphics-Based Educational Tool: A Randomized Controlled Trial (MATE).","authors":"Kristen Cagino, Myra Kurjee, Emily Hyde, Han-Yang Chen, Hector Mendez-Figueroa, Suneet P Chauhan","doi":"10.1055/a-2565-1836","DOIUrl":"https://doi.org/10.1055/a-2565-1836","url":null,"abstract":"<p><strong>Objective: </strong>We aimed to determine if a graphics-based education tool (GBET) leads to improved macrosomia knowledge on risk factors/complications (RF/C) and management options (MO) for macrosomia among pregnant individuals compared to routine care.</p><p><strong>Study design: </strong>We conducted a randomized control trial (NCTO6281301). Inclusion criteria were individuals at 18-55 years, with singleton pregnancy delivering at > 36 weeks. After consent, participants were randomized to either routine care or GBET. To assess knowledge of macrosomia, a questionnaire consisting of 17 questions relating to the RF/C (11 questions) and MO (6 questions) of suspected macrosomic fetuses was administered to participants one time either directly after consent (if routine care) or directly following review of GBET. The primary outcome was the overall score on the questionnaire. Secondary outcomes were summary scores on the RF/C and MO. Descriptive statistics were used for baseline characteristics and outcomes. Chi-squared test or Fisher's exact test was used to compare categorical variables and Student's t-test for continuous variables.</p><p><strong>Results: </strong>From January to July 2023, 232 eligible individuals were approached and 196 (84%) agreed to participate; of them, 98 received the GBET, while 98 received routine care. Baseline demographics were similar. The majority (42%) of respondents were non-Hispanic Black, 60% were employed, 56% had some level of college education, and 30% lived below the poverty line. There were 41% nulliparous, 67% with a BMI > 30 kg/m2 and 16% with diabetes. The primary outcome was significantly higher in those who received the GBET (70% versus 64%, p <0.001). The RF/C scores were also higher in the GBET group (72% versus 63%, p = 0.001); however, the MO scores were similar between groups (65% versus 68%, p=0.084).</p><p><strong>Conclusion: </strong>In our population, a graphics-based education tool improved participant knowledge on the risk factors / complications for macrosomia, but not their management options.</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143708127","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 Universalizing Aspirin Prophylaxis on Treatment Provision for High-Risk Pregnant Patients.","authors":"Adina Rachel Kern-Goldberger, Kirat Sandhu, Cara D Dolin, Antonio Bajan, Elizabeth Raiff, Justin R Lappen","doi":"10.1055/a-2565-9272","DOIUrl":"https://doi.org/10.1055/a-2565-9272","url":null,"abstract":"<p><p>Low-dose aspirin is an established preventive strategy for reducing risk of preeclampsia in patients with designated risk factors. This prospective observational study evaluated trends in aspirin prescription rates in a multi-hospital health system over a 10-month period during which a policy to offer low dose aspirin universally was instituted. 11,382 patients were included and interrupted time series was used to analyze rates of aspirin prescriptions ordered by 16w0d before and after implementation of the universal policy. There were statistically significant increases in aspirin prescription rates for the entire cohort (incidence rate ratio [IRR] of 2.93, 95% CI 2.13-4.04) and for a high-risk sub-cohort including patients with chronic hypertension, pre-gestational diabetes, and/or multiple gestation (IRR 1.48, 95% CI 1.26-1.76).</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143708190","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}