American journal of perinatology最新文献

{"title":"Vascular air embolism in neonates: a literature review.","authors":"Qi Zhou, Shoo K Lee","doi":"10.1055/a-2508-2733","DOIUrl":"https://doi.org/10.1055/a-2508-2733","url":null,"abstract":"<p><p>Background Neonatal vascular air embolism is a rare but often fatal condition. The literature comprises mostly case reports and a few dated systematic reviews. Our objective was to review all case reports of neonatal vascular air embolism to date, and provide up-to-date information about patient characteristics, clinical presentations, outcomes, pathogenesis, diagnosis, prevention, treatment and prognosis. Methods We searched the literature for case reports of neonatal vascular air embolism, using MEDLINE, CINAHL and EMBASE, and key words \"neonatal\" and \"vascular air embolism\". Results were summarized. Results There were 117 cases of neonatal vascular air embolism, with mean gestational age 30.4 weeks (range 23-40), mean birth weight 1422 grams (range 830-3844), and median age of occurrence 2 days (range 1-540) after birth. The majority were preterm (75.2%), male (62.7%), on assisted respiratory support (90.5%), and had air leak syndrome (52.9%). The most common clinical presentation was sudden acute clinical deterioration, sometimes accompanied by crying, cardiac rhythm abnormalities, skin discoloration, and decrease in end tidal carbon dioxide concentration. Incidence of mortality and adverse neurological sequelae among survivors were 73.9% and 16.6% respectively overall, but significantly (p<0.05) higher among preterm infants (81.8% and 31.2% respectively) and lower among surgical infants (23.8% and 0% respectively). Diagnosis included visualizing air in infusion lines or retinal vessels, decrease in the end-tidal carbon dioxide levels, and radiographic, doppler ultrasound, transesophageal echocardiography or computed tomography (CT) imaging. Conclusions Prognosis for neonatal air embolism is poor, especially for preterm infants requiring mechanical ventilation. Prevention is key and treatment is supportive.</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2024-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142891410","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}

{"title":"Placenta Accreta Spectrum: Risk Factors for Unplanned Immediate Hysterectomy in Planned Uterine Preservation Surgery.","authors":"Lior Friedrich, Nitzan Mor, Alina Weissmann-Brenner, Eran Kassif, Shakad Noah Friedrich, Tal Weissbach, Elias Castel, Gabriel Levin, Raanan Meyer","doi":"10.1055/a-2486-9070","DOIUrl":"10.1055/a-2486-9070","url":null,"abstract":"<p><strong>Objective: </strong> Placenta accreta spectrum (PAS) is a term used to describe trophoblast invasion into the uterine wall. The condition can be FATAL: at labor due to a lack of spontaneous separation of the placenta from the uterine wall, leading to severe hemorrhage. In this study, we aim to evaluate preoperative risk factors for unplanned immediate hysterectomy in PAS uterine-preserving surgeries.</p><p><strong>Study design: </strong> Preoperative parameters of women who underwent successful uterine-preserving surgery were retrospectively compared with those who underwent an unplanned immediate hysterectomy during these surgeries. A multivariable regression analysis was conducted to identify independent factors associated with unplanned immediate hysterectomy.</p><p><strong>Results: </strong> Overall, 238 were included in the study's cohort. A total of 86.2% underwent successful uterine-preserving surgery, and 13.8% underwent an unplanned immediate hysterectomy. The number of previous cesarean deliveries (CDs) and the proportion of women with grade 3 preoperative PAS was significantly lower among the successful uterine-preserving group. The proportion of preoperative ultrasound lacunae detection, the number of lacunae observed, loss of clear zone detection, the length of clear zone loss, the proportion of retroplacental hypervascularity, bridging vessels detection, and bladder involvement were significantly lower in the successful uterine-preserving group. In a multivariable regression analysis, the presence of lacunae and loss of clear zone were independently associated with unplanned cesarean hysterectomy (adjusted odds ratio [aOR] = 3.18 [95% confidence interval (CI): 1.11-11.6], <i>p</i> = 0.047, and aOR = 3.67 [95% CI: 1.3-13.2], <i>p</i> = 0.025, respectively].</p><p><strong>Conclusion: </strong> Preoperative assessment of the applicability of a uterine-preserving surgery may be performed using the ultrasound parameters reported in this study.</p><p><strong>Key points: </strong>· Applicability of a uterine-preserving surgery may be performed using sonographic parameters.. · Sonographic presence of lacunae is associated with an unplanned hysterectomy.. · Sonographic loss of clear zone is associated with an unplanned hysterectomy..</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":"142724779","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":"Is Pregnancy a Risk Factor for Progression of Diabetic Retinopathy and Nephropathy in Type 1 Diabetes? A Matched Cohort Study.","authors":"Francis Mimouni, Jane C Khoury, Shelley Ehrlich, Galit Sheffer-Mimouni, Barak Rosenn, Menachem Miodovnik","doi":"10.1055/a-2489-4588","DOIUrl":"https://doi.org/10.1055/a-2489-4588","url":null,"abstract":"<p><strong>Objective: </strong> This study aimed to test the hypothesis that the development or deterioration of nephropathy and retinopathy over time is not affected by pregnancy in women with pregestational type 1 diabetes mellitus (T1DM).</p><p><strong>Study design: </strong> Prospective, observational study of nephropathy and retinopathy follow-up during pregnancy and in a subsequent period of 2 years in a group of pregnant women with T1DM (study group) that we compared with pair-matched non-pregnant women with T1DM (control group) who underwent similar intensive follow-up.</p><p><strong>Results: </strong> The rate of renal microvascular complications was similar at entry, 17.4% (4/23) in the study group and 21.7% (5/23) in the control group. At the last visit, both groups had nephropathy rates of 17.4% (4/23) and paired <i>p</i>-value of 1.00. Similarly, the rate of retinal microvascular complications of any grade was similar in both groups and remained so at the last follow-up examination.</p><p><strong>Conclusion: </strong> Pregnancy per se does not appear to increase the risk for the development of, or the acceleration of the progression of retinopathy and nephropathy during a follow-up of at least 2 years in relatively healthy T1DM patients. This information is important for counseling young women with T1DM who are considering becoming pregnant.</p><p><strong>Key points: </strong>· Retinopathy and nephropathy are major complications of T1DM.. · Pregnancy per se does not appear to cause major microvascular complications in T1DM.. · Pregnancy per se does not appear to aggravate retinopathy in T1DM..</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":"142885234","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 community characteristics as measured by social deprivation index score with prenatal care and obstetrical outcomes.","authors":"Alexa M Sassin, Natalie Osterlund, Haleh Sangi-Haghpeykar, Kjersti M Aagaard","doi":"10.1055/a-2507-7371","DOIUrl":"https://doi.org/10.1055/a-2507-7371","url":null,"abstract":"<p><p>Objective We aimed to determine the relationships between socioeconomic disadvantage, as measured by the Social Deprivation Index (SDI), and prenatal care (PNC) utilization, obstetrical outcomes, and neonatal complications. Study Design All spontaneously-conceived singleton deliveries of nulliparous gravidae with residence zip code available (n= 4,786) were identified in a population-based database. Deliveries were assigned SDI scores based on preconception zip code. SDI scores (1-100) are a composite measure of seven community demographic characteristics of poverty, education, transportation, employment, and household composition. SDI scores were categorized into quartiles and grouped for analysis [Q1 (n=1,342), Q2+3 (n=1,752), and Q4 (n=1,692)] with higher scores indicative of greater disadvantage. Statistical analysis was performed using a generalized linear mixed method. Results Among our cohort, gravidae in the lowest (least-deprived) SDI quartile (Q1) were older, had lower pre-pregnancy body mass indices, and were more likely to receive PNC from a physician specializing in Obstetrics and Gynecology. Gravidae residing in the highest (most-deprived) SDI quartile (Q4) attended fewer prenatal visits [mean (standard deviation) 11.17 (2.9)] than those living in Q1 [12.04 (2.3), p < 0.0001]. Gravidae in Q4 were less likely to receive sufficient PNC compared to those in Q1 (52 vs. 64.2%, p < 0.0001) and were more likely to fail to achieve appropriate gestational weight gain (GWG) (19.6 in Q4 vs. 15.9% in Q1, p < 0.01). No significant differences in composite maternal (CMM) or neonatal morbidity (CNM) were associated with SDI quartile. Conclusions Outer quartile social deprivation was associated with higher proportions of primigravidae not meeting recommendations for GWG and attending fewer prenatal visits, but it did not affect CMM or CNM. Improving care access and providing nutritional support to all gravidae are likely important steps toward health equity.</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":"142885232","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":"Daily versus Twice Daily Nifedipine for Blood Pressure Control in Pregnancy and Postpartum.","authors":"Jessica A Peterson, Isabelle C Band, Kelly Wang, Angela Bianco","doi":"10.1055/a-2486-8840","DOIUrl":"10.1055/a-2486-8840","url":null,"abstract":"<p><strong>Objective: </strong> The objective of this study was to compare 60 mg daily (QD) extended released (XR) nifedipine to 30 mg twice daily (BID) for blood pressure (BP) control antepartum and postpartum.</p><p><strong>Study design: </strong> This is a retrospective chart review conducted at the Mount Sinai Health System. Patients admitted from January 1, 2015, to April 30, 2021, diagnosed with a hypertensive disorder of pregnancy, who received nifedipine XR 30 mg BID or 60 mg QD for intrapartum or postpartum BP control were included. The primary outcome was the need for up-titration (i.e., the need for an increase in nifedipine dose or addition of another antihypertensive) after reaching one of the study doses (30 mg BID or 60 mg QD). Patients were excluded if they had preexisting renal disease or were already on oral antihypertensives. In a 1:1 ratio between single- and twice-daily dosing groups, the sample size needed to detect a 20% difference in up-titration rate to achieve 0.80 power is 97 patients per group, for a total of 194 patients. This is based on a Pearson chi-square test with a significance level of 0.05.</p><p><strong>Results: </strong> A total of 237 patients were included, 139 (59%) received 30 mg BID and 98 (41%) 60 mg QD. There was no statistically significant difference in the need for an increase in nifedipine dose or addition of another oral antihypertensive agent between those receiving 30 mg BID versus 60 mg QD (33.8 vs. 35.7%; adjusted odds ratio [aOR], 95% confidence interval [CI]: 0.90 [0.50-1.60]; <i>p</i> = 0.71). There was no difference in the need for emergency hypertensive treatment after reaching the study dose (<i>p</i> = 0.19) or readmission for BP control between groups (<i>p</i> > 0.99).</p><p><strong>Conclusion: </strong> These findings suggest that BID dosing does not confer better BP control in the antepartum or postpartum periods. Thus, daily dosing is reasonable and may be preferable for patient convenience and compliance.</p><p><strong>Key points: </strong>· Nifedipine metabolism may increase in pregnancy.. · nifedipine 30 mg BID versus 60 mg QD were compared.. · There was no difference in the need for additional medication.. · There was no difference in the need for readmission.. · Daily dosing may be preferable for convenience..</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":"142724754","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}