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Li Z, Tucker CM, Odahowski CL, Eichelberger KY, Zhang J, Hung P. Co-occurrence of mental illness and substance use among US pregnant individuals, 2012-2021. Psychiatry Res 2024; 334:115820. [PMID: 38422868 DOI: 10.1016/j.psychres.2024.115820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 02/19/2024] [Accepted: 02/23/2024] [Indexed: 03/02/2024]
Abstract
AIM Substance use disorders are increasingly prevalent among pregnant individuals, with evident risks of adverse perinatal outcomes. This study examines substance use (tobacco, alcohol and marijuana) among pregnant individuals with mental illness. METHODS A national representative sample of pregnant individuals were derived from 2012 to 2021 National Survey of Drug Use and Health data. Associations of past-year mental illness with past-month polysubstance use and each substance use were analyzed by logistic regression models, with complex sampling weights and survey year. RESULTS Among 6801 pregnant individuals, 16.4% reported having any mental illness (AMI) in 2012 and 2013, increasing to 23.8% in 2020-2021; and SMI increased from 3.3% to 9.4%. Polysubstance use increased disproportionately among those with severe mental illness (SMI), from 14.0% to 18.6%. Pregnant individuals with greater severity of mental illness had higher odds of polysubstance use (Adjusted Odds Ratio, 95% CI: AMI but no SMI vs. without AMI: 1.59 [1.04, 2.44]; SMI vs. without AMI: 5.48 [2.77, 10.82]). CONCLUSIONS Pregnant individuals with greater severity of mental illness were more likely to engage in substance use. Evidence-based educational, screening and treatment services, and public policy changes are warranted to mitigate the harmful health outcomes of substance use among US pregnant individuals with mental illness.
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Affiliation(s)
- Zhong Li
- Department of Public Administration, School of Health Policy and Management, Nanjing Medical University, Nanjing, Jiangsu, China; Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Curisa M Tucker
- Department of Biobehavioral Health & Nursing Science, College of Nursing, University of South Carolina, Columbia, SC, USA
| | - Cassie L Odahowski
- Rural and Minority Health Research Center, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Kacey Y Eichelberger
- Department of Obstetrics and Gynecology, University of South Carolina School of Medicine Greenville, Prisma Health, Greenville, SC, USA
| | - Jiajia Zhang
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Peiyin Hung
- Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA; Rural and Minority Health Research Center, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA.
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Cochrane AC, Batson R, Aragon M, Bedenbaugh M, Self S, Eichelberger KY, Isham K. Impact of restricting early-term deliveries on adverse neonatal outcomes: a statewide analysis. Am J Obstet Gynecol MFM 2023; 5:100797. [PMID: 36368513 DOI: 10.1016/j.ajogmf.2022.100797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 10/11/2022] [Accepted: 11/03/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND The "39-Week Rule" was adopted by the American College of Obstetricians and Gynecologists in 2009 to eliminate nonmedically indicated (elective) deliveries before 39 weeks in an effort to improve neonatal outcomes. OBJECTIVE Our primary objective was to quantify the effect of this policy change on adverse neonatal outcomes among a cohort of term births in South Carolina. STUDY DESIGN Deidentified data from all births in the state of South Carolina from 2000 to 2008 (before the 39-week rule) and from 2013 to 2017 (after statewide implementation and enforcement of the rule) were obtained from the South Carolina Revenue and Fiscal Affairs Office. Demographic data and International Statistical Classification of Diseases and Related Health Problems Ninth/Tenth Revision codes were obtained for each birth. Our primary outcome was admission to a neonatal intensive care unit. Our secondary outcomes were respiratory morbidities (including respiratory distress syndrome and transient tachypnea of the newborn), hypoxic-ischemic encephalopathy, seizure, sepsis, birth injuries, hyperbilirubinemia, hypoglycemia, and feeding difficulties. Propensity score analysis was used to control for maternal age, body mass index, race, gestational hypertension, infection, placental abruption, and gestational and pregestational diabetes mellitus. After stratification by propensity score, the Cochran-Mantel-Haenszel test was used to compare groups. RESULTS A total of 620,121 infants were liveborn at term during the 2 study periods. After implementation of the 39-week rule, there was a significant reduction in early-term deliveries. In adjusted analyses, neonatal intensive care unit admission was significantly more common in the postimplementation period. Respiratory morbidities were also significantly more common postimplementation. In contrast, there were significant reductions in birth injuries and hyperbilirubinemia in the postimplementation period. CONCLUSION Implementation of the 39-week rule was associated temporally with an increase in adverse neonatal outcomes. The outcomes intended to be reduced by the 39-week rule, including neonatal intensive care unit admission and respiratory morbidity, seem to have increased in incidence despite adherence to the proposed guidelines.
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Affiliation(s)
- A Caroline Cochrane
- Prisma Health-Upstate, Greenville, SC (Drs Cochrane, Batson, Aragon, and Isham).
| | - Ryan Batson
- Prisma Health-Upstate, Greenville, SC (Drs Cochrane, Batson, Aragon, and Isham)
| | - Meredith Aragon
- Prisma Health-Upstate, Greenville, SC (Drs Cochrane, Batson, Aragon, and Isham)
| | - Molly Bedenbaugh
- University of South Carolina School of Medicine, Columbia, SC (Dr Bedenbaugh)
| | - Stella Self
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC (Dr Self)
| | | | - Katheryn Isham
- Prisma Health-Upstate, Greenville, SC (Drs Cochrane, Batson, Aragon, and Isham)
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Cochrane AC, Batson R, Aragon M, Bedenbaugh M, Self S, Isham K, Eichelberger KY. Impact of the "39-week rule" on adverse pregnancy outcomes: a statewide analysis. Am J Obstet Gynecol MFM 2023; 5:100879. [PMID: 36708964 DOI: 10.1016/j.ajogmf.2023.100879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 12/26/2022] [Accepted: 01/20/2023] [Indexed: 01/26/2023]
Abstract
BACKGROUND The "39-week rule," adopted by the American College of Obstetricians and Gynecologists circa 2009, discouraged routine elective induction of labor in early-term gestations (37 weeks 0 days-38 weeks 6 days) to decrease the risk of adverse neonatal outcomes. However, little research exists regarding any unintended adverse pregnancy outcomes associated with this policy shift. OBJECTIVE This study aimed to quantify the difference in incidence of adverse pregnancy outcomes before and after the implementation of the 39-week rule. STUDY DESIGN Deidentified data from all births in the state of South Carolina from 2000 to 2008 (before the 39-week rule) and from 2013 to 2017 (after statewide implementation and enforcement of the rule) were obtained from the South Carolina Revenue and Fiscal Affairs Office. Demographic data and International Classification of Diseases 9/10 codes were obtained for each birth. Our primary outcome was the incidence of any of the following adverse pregnancy outcomes: cesarean delivery, hypertensive disorders, chorioamnionitis, postpartum hemorrhage, high-degree lacerations, placental abruption, and intensive care unit admission. Propensity score analysis was used to control for age, body mass index, and race. After stratification by propensity score, the Cochran-Mantel-Haenszel test was used to compare the prerule and postrule groups. RESULTS A total of 633,985 births were eligible for inclusion-412,632 from 2000 to 2008, and 221,353 from 2013 to 2017. There was a significant increase in the primary outcome in the postrule period (39.94% pre vs 42.76% post; P<.01). The incidence of all hypertensive disorders was significantly increased in the postrule period compared with the prerule period (7.75% pre vs 10.1% post; P<.01). The incidence of chorioamnionitis and cesarean delivery also increased in the postrule period (1.45% pre vs 1.92% post; P<.01; 29.6% pre vs 31.82% post; P<.01; respectively). CONCLUSION There was a significant increase in the primary outcome following the implementation of the 39-week rule. Although the policy shift was driven by a desire to decrease adverse neonatal outcomes, aggregate benefit was not observed for pregnancy outcomes.
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Affiliation(s)
| | - Ryan Batson
- Prisma Health-Upstate, Greenville, SC (Drs Batson, Aragon, Isham, and Eichelberger)
| | - Meredith Aragon
- Prisma Health-Upstate, Greenville, SC (Drs Batson, Aragon, Isham, and Eichelberger)
| | - Molly Bedenbaugh
- University of South Carolina School of Medicine, Columbia, SC (Dr Bedenbaugh)
| | - Stella Self
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC (Dr Self)
| | - Katheryn Isham
- Prisma Health-Upstate, Greenville, SC (Drs Batson, Aragon, Isham, and Eichelberger)
| | - Kacey Y Eichelberger
- Prisma Health-Upstate, Greenville, SC (Drs Batson, Aragon, Isham, and Eichelberger)
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Charron E, Tahsin F, Balto R, Eichelberger KY, Dickes L, Simonsen SE, Mayo RM. Provider Perspectives of Barriers to Contraceptive Access and Use among Women with Substance Use Disorders. Womens Health Issues 2021; 32:165-172. [PMID: 34930641 DOI: 10.1016/j.whi.2021.11.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Revised: 10/17/2021] [Accepted: 11/23/2021] [Indexed: 12/14/2022]
Abstract
OBJECTIVES Previous studies conducted from the patient perspective indicate that women with substance use disorders (SUDs) experience extensive barriers to contraceptive access and use (CAU), but there is limited research investigating this topic from the provider perspective. We explored provider perspectives on the barriers to CAU for women with SUDs. As a secondary objective, we highlighted provider contraceptive counseling strategies to address patient CAU barriers. METHODS We conducted 24 qualitative interviews with a purposeful sample of women's health providers, including medical doctors, nurse practitioners, and certified nurse-midwives. We used thematic analysis to code the interviews with inductive codes and organized findings according to levels of influence within the Dahlgren and Whitehead rainbow model, a socioecological model of health. RESULTS Provider-reported barriers to CAU were identified at four levels of socioecological influence and included reproductive misconceptions; active substance use; trauma, interpersonal violence, and reproductive coercion; limited social support; lack of housing, employment, health insurance, and transportation; stigma; discrimination; and punitive prenatal substance use policies and child welfare reporting requirements. Strategies for addressing CAU barriers mainly focused on patient-centered communication, including open information exchange, shared decision-making, and relationship building. However, providers described disproportionately highlighting the benefits of long-acting reversible contraception (LARC) and directing conversations toward LARC when they perceived that such methods would help patients to overcome adherence and other challenges related to active substance use or logistical barriers. Notably, there was no mention of CAU facilitators during the interviews. CONCLUSIONS Providers perceived that women with SUDs experience a range of CAU barriers, which they addressed within the clinical setting through use of both patient-centered communication and highlighting the benefits of LARC when they perceived that such methods would help clients to overcome barriers. Improving CAU for women with SUDs will require multidisciplinary, multipronged strategies that prioritize reproductive autonomy and are implemented across clinical, community, and policy settings.
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Affiliation(s)
- Elizabeth Charron
- Program of Addiction Research, Clinical Care, Knowledge, and Advocacy (PARCKA), Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah.
| | - Farah Tahsin
- Department of Political Science, Clemson University, Clemson, South Carolina
| | - Rwina Balto
- University of Utah College of Nursing, Salt Lake City, Utah
| | | | - Lori Dickes
- Department of Political Science, Clemson University, Clemson, South Carolina
| | | | - Rachel M Mayo
- Department of Public Health Sciences, Clemson University, Clemson, South Carolina
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White AW, Chambers CN, Ertel MC, Gennaro TR, Chen L, Friedman AM, Eichelberger KY. Is a 'guideline-compliant' primary cesarean delivery associated with a modified risk for maternal and neonatal morbidity?: a clinical evaluation of the 2014 ACOG/SMFM obstetric care consensus statement. BMC Pregnancy Childbirth 2021; 21:580. [PMID: 34420526 PMCID: PMC8381590 DOI: 10.1186/s12884-021-04048-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 08/12/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND It is currently unknown whether primary CDs performed in compliance with the 2014 ACOG/SMFM Obstetric Care Consensus Statement guidelines ("guideline-compliant") are associated with a modified risk of maternal and neonatal morbidity, when compared to primary CDs performed outside the guidelines ("guideline-noncompliant"). Our primary objective was to determine if a guideline-compliant primary CD is associated with a modified risk for maternal or neonatal morbidity, when compared to guideline-noncompliant primary CD. METHODS A retrospective cohort study of all primary CDs at one tertiary referral center in the calendar year following publication of the Consensus Statement. Logistic regression was performed to calculate the risk of adverse maternal and neonatal outcomes for guideline-compliant primary CDs, when compared to guideline-noncompliant and guideline-not addressed, and when adjusted for maternal age, BMI, hypertension, gestational age at delivery, insurance carrier, and provider practice. RESULTS Eight hundred twenty-seven primary CDs were included during the study period, of which 34.8, 26.0, and 39.2% were guideline compliant, guideline-noncompliant, and guideline-not addressed. No statistically significant differences in the frequency of adverse maternal outcomes across these three groups were observed with the exception of maternal ICU admission, which was significantly associated with a guideline-not addressed primary CD (p = 0.0002). No statistical difference in rates of NICU admissions, 5 min APGAR < 5, or umbilical artery cord pH < 7 were observed between guideline-compliant and guideline-noncompliant primary CDs. CONCLUSION Women undergoing guideline-compliant primary CDs were not significantly more likely to experience a maternal or neonatal morbidity when compared to guideline-noncompliant primary CDs.
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Affiliation(s)
- Andrew W White
- Department of Obstetrics and Gynecology, Prisma Health Upstate/University of South Carolina School of Medicine Greenville, West Faris Road, Suite 470, Greenville, SC, 29605, USA
| | - Charis N Chambers
- Division of Pediatric and Adolescent Gynecology, Department of Obstetrics and Gynecology, Baylor University, 1 Baylor Plaza, Houston, TX, 77030, USA
| | - Michelle C Ertel
- Department of Obstetrics and Gynecology, University of North Carolina Chapel Hill, 3009 Old Clinic Building CB 7570, Chapel Hill, NC, 27599, USA
| | - Taylor R Gennaro
- University of South Carolina School of Medicine, 6311 Garners Ferry Road, Columbia, SC, 29209, USA
| | - Ling Chen
- Department of Obstetrics and Gynecology, Columbia University, 622 W 168th St, New York, NY, 10032, USA
| | - Alexander M Friedman
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Columbia University, 622 W 168th St, New York, NY, 10032, USA
| | - Kacey Y Eichelberger
- Division of Mater nal-Fetal Medicine, Department of Obstetrics and Gynecology, Prisma Health Upstate/University of South Carolina School of Medicine Greenville, 890 West Faris Road, Suite 470, Greenville, SC, 29605, USA.
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Charron E, Rennert L, Mayo RM, Eichelberger KY, Dickes L, Truong KD. Contraceptive initiation after delivery among women with and without opioid use disorders: A retrospective cohort study in a statewide Medicaid population, 2005-2016. Drug Alcohol Depend 2021; 220:108533. [PMID: 33513446 DOI: 10.1016/j.drugalcdep.2021.108533] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 12/14/2020] [Accepted: 12/16/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND This study examined contraceptive initiation patterns in the 12 months following childbirth among women with opioid use disorder (OUD), women with non-opioid substance use disorders (SUDs), and women without SUDs. METHODS We conducted a retrospective cohort study using claims data from South Carolina Medicaid-enrolled women aged 15-44 who had singleton live birth between January 2005 and December 2016. Study outcomes were initiation of most or moderately effective (MME) contraceptive methods. Using multivariable and propensity score-weighted logistic regression, we analyzed the relationship between OUD and contraceptive initiation within 12 months after delivery. RESULTS We identified 71,283 live birth deliveries during the study period. In multivariable analysis, women with non-opioid SUDs and women without SUDs compared to women with OUD were more likely to initiate a MME method vs a least effective method or no method by 3 months (non-opioid SUDs: odds ratio [OR] = 1.32, 95 % confidence interval [CI] = 1.14-1.52; no SUDs: OR = 1.55, 95 % CI = 1.36-1.77) and 12 months (non-opioid SUD: OR = 1.23, 95 % CI = 1.06-1.42; no SUD: OR = 1.46, 95 % CI = 1.27-1.66) after delivery. With regards to the timing of initiation, women with non-opioid SUDs and women without SUDs were more likely than women with OUD to initiate a MME method vs a least effective method or no method after the immediate postpartum period through 3 months following delivery (non-opioid SUDs: OR = 1.41, 95 % CI = 1.18-1.68; no SUDs: OR = 1.87, 95 % CI = 1.59-2.21). We detected the similar patterns in analyses that used propensity score weighting. CONCLUSION OUD was associated with decreased likelihood of initiating a MME contraceptive method within 12 months after delivery.
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Affiliation(s)
- Elizabeth Charron
- Department of Public Health Sciences, 503 Edwards Hall, Clemson University, Clemson, SC 29634, USA; Program of Addiction Research, Clinical Care, Knowledge, and Advocacy (PARCKA), Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, 295 Chipeta Way, Salt Lake City, UT 84132, USA.
| | - Lior Rennert
- Department of Public Health Sciences, 503 Edwards Hall, Clemson University, Clemson, SC 29634, USA
| | - Rachel M Mayo
- Department of Public Health Sciences, 503 Edwards Hall, Clemson University, Clemson, SC 29634, USA
| | - Kacey Y Eichelberger
- University of South Carolina School of Medicine Greenville/Prisma Health Upstate, 701 Grove Road, Greenville, SC 29605, USA
| | - Lori Dickes
- Department of Parks, Recreation and Tourism Management, 263 Lehotsky Hall, Clemson University, Clemson, SC 29634, USA
| | - Khoa D Truong
- Department of Public Health Sciences, 503 Edwards Hall, Clemson University, Clemson, SC 29634, USA
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Charron E, Mayo RM, Heavner-Sullivan SF, Eichelberger KY, Dickes L, Truong KD, Rennert L. “It’s a very nuanced discussion with every woman”: Health care providers’ communication practices during contraceptive counseling for patients with substance use disorders. Contraception 2020; 102:349-355. [DOI: 10.1016/j.contraception.2020.09.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 09/01/2020] [Accepted: 09/06/2020] [Indexed: 10/23/2022]
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Nguyen MW, Heberlein E, Covington-Kolb S, Gerstner AM, Gaspard A, Eichelberger KY. Assessing Adverse Childhood Experiences during Pregnancy: Evidence toward a Best Practice. AJP Rep 2019; 9:e54-e59. [PMID: 30854244 PMCID: PMC6406025 DOI: 10.1055/s-0039-1683407] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Accepted: 09/08/2018] [Indexed: 11/23/2022] Open
Abstract
Objective To quantify the prevalence of adverse childhood experiences (ACEs) among a diverse urban cohort of pregnant women. Study Design The ACE survey was self-administered to 600 women categorized evenly between the waiting room, private examination rooms, and CenteringPregnancy group spaces. The percentage of women willing to complete the survey per location was compared using chi-square tests, and the mean ACE score per arm was compared using Wilcoxon's rank-sum test. Results Of the 660 women approached for participation, 5% declined; 67% reported ≥ 1 ACE exposure and 19% reported an ACE score of ≥ 4. By domain, 59% experienced household dysfunction, 25% abuse, and 25% neglect. Women in the waiting room were more likely to decline participation ( p < 0.01), and those participating in the postpartum inpatient arm had a significantly lower proportion affirming 8 of 10 ACE questions, were less likely to report ≥1 ACE, and had a lower mean ACE score when compared with the outpatient arm ( p < 0.01). Conclusion The prevalence of ACEs in this diverse pregnant cohort was high. The ideal locations to distribute the survey are the outpatient examination rooms.
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Affiliation(s)
- Megan W Nguyen
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of South Carolina School of Medicine Greenville/Greenville Health System, Greenville, South Carolina
| | - Emily Heberlein
- Georgia Health Policy Center, Georgia State University, Atlanta, Georgia
| | - Sarah Covington-Kolb
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of South Carolina School of Medicine Greenville/Greenville Health System, Greenville, South Carolina
| | - Anne M Gerstner
- University of South Carolina School of Medicine Greenville/Greenville Health System, Greenville, South Carolina
| | - Amber Gaspard
- University of South Carolina School of Medicine Greenville/Greenville Health System, Greenville, South Carolina
| | - Kacey Y Eichelberger
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of South Carolina School of Medicine Greenville/Greenville Health System, Greenville, South Carolina
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Eichelberger KY. The association between assisted reproduction technology (ART) and abnormal placentation. BJOG 2018; 126:219. [PMID: 29900643 DOI: 10.1111/1471-0528.15262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- K Y Eichelberger
- Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, University of South Carolina School of Medicine/Greenville Health Systems, Greenville, SC, USA
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10
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Slizewski DH, Heberlein E, Meredith JF, Jobe LB, Eichelberger KY. Impact of home versus hospital dressing on bacterial contamination of surgical scrubs in the obstetric setting: A randomized controlled trial. Am J Infect Control 2018; 46:379-382. [PMID: 29056327 DOI: 10.1016/j.ajic.2017.09.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Revised: 09/05/2017] [Accepted: 09/05/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND The impact of the site where an obstetrician dresses in their surgical scrubs, home versus hospital, on total bacterial burden remains unknown. Therefore, our objective was to quantify the effect of dressing in surgical scrubs at home versus at the hospital on the bacterial contamination at the beginning of a scheduled shift. METHODS This was a single blind randomized controlled trial. Eligible participants were resident physicians assigned to labor and delivery at a single institution during the study period, and participants were randomized daily to 1 of 4 arms based on the site where their scrubs were laundered (A) and where the resident dressed (B) (A/B): home/home, home/hospital, hospital/home, and hospital/hospital. At the beginning of the assigned shift, microbiologic samples from the chest pocket and pants' tie were collected with a sterile culture swab. Samples were plated on trypticase soy agar with 5% sheep blood before being incubated at 35°C-37°C for 48 hours, with observation every 24 hours. The primary outcome was total bacterial burden, defined as the sum of the colony forming units (CFUs) from the 2 sampling sites. RESULTS There were 21 residents randomized daily for 4 days to 1 of 4 study arms, resulting in 84 observations. There were no baseline differences between the home- and hospital-dressed cohorts. Overall, 68% of sampled scrubs demonstrated some bacterial growth. There was no difference between the home- and hospital-dressed cohorts in percentage of samples demonstrating any bacterial growth after 72 hours (60% vs 76%, P = .14), nor in median bacterial burden at the beginning of a shift (2 [interquartile range, 0-7] vs 1 [interquartile range, 1-5] CFUs, P = .62). Finally, there was no difference in total bacterial burden at the beginning of a shift between the home- and hospital-dressed cohorts when stratified by site where the scrubs were laundered. CONCLUSIONS There was no significant difference in total bacterial burden of surgical scrubs at the start of a shift between cohorts who dressed at home versus at the hospital.
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Eichelberger KY, Doll K, Ekpo GE, Zerden ML. Black Lives Matter: Claiming a Space for Evidence-Based Outrage in Obstetrics and Gynecology. Am J Public Health 2018; 106:1771-2. [PMID: 27626348 DOI: 10.2105/ajph.2016.303313] [Citation(s) in RCA: 65] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Kacey Y Eichelberger
- Kacey Y. Eichelberger is with the Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of South Carolina Greenville School of Medicine/Greenville Health System. Kemi Doll is with the Department of Health Policy and Management, Gillings School of Public Health, and the Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill. Geraldine E. Ekpo is with the Laurel Fertility Center, and the Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco. Matthew L. Zerden is with the WakeMed North Family Health & Women's Hospital and is also with Planned Parenthood South Atlantic, Raleigh, NC
| | - Kemi Doll
- Kacey Y. Eichelberger is with the Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of South Carolina Greenville School of Medicine/Greenville Health System. Kemi Doll is with the Department of Health Policy and Management, Gillings School of Public Health, and the Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill. Geraldine E. Ekpo is with the Laurel Fertility Center, and the Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco. Matthew L. Zerden is with the WakeMed North Family Health & Women's Hospital and is also with Planned Parenthood South Atlantic, Raleigh, NC
| | - Geraldine E Ekpo
- Kacey Y. Eichelberger is with the Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of South Carolina Greenville School of Medicine/Greenville Health System. Kemi Doll is with the Department of Health Policy and Management, Gillings School of Public Health, and the Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill. Geraldine E. Ekpo is with the Laurel Fertility Center, and the Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco. Matthew L. Zerden is with the WakeMed North Family Health & Women's Hospital and is also with Planned Parenthood South Atlantic, Raleigh, NC
| | - Matthew L Zerden
- Kacey Y. Eichelberger is with the Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of South Carolina Greenville School of Medicine/Greenville Health System. Kemi Doll is with the Department of Health Policy and Management, Gillings School of Public Health, and the Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill. Geraldine E. Ekpo is with the Laurel Fertility Center, and the Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco. Matthew L. Zerden is with the WakeMed North Family Health & Women's Hospital and is also with Planned Parenthood South Atlantic, Raleigh, NC
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Affiliation(s)
- K Y Eichelberger
- University of South Carolina School of Medicine Greenville/Greenville Health System, Greenville, SC, USA
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Fryer K, Keiser S, Trofatter K, Eichelberger KY, Heberlein E. The role of race/ethnicity in cerclage efficacy. J Matern Fetal Neonatal Med 2016; 30:2382-2385. [PMID: 27774834 DOI: 10.1080/14767058.2016.1249843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To measure the impact of race/ethnicity on cerclage efficacy, as measured by the prevalence of spontaneous preterm birth (PTB), in a cohort of patients with history-indicated, ultrasound-indicated and physical-exam indicated cerclages. METHODS We conducted a retrospective cohort study of patients undergoing history-indicated, ultrasound-indicated and physical-exam indicated cerclage placement from January 2003 to July 2013 at a tertiary care hospital. Patients' race/ethnicity was self-declared. Our primary outcome was spontaneous preterm birth (SPTB) < 37 weeks. Subgroup analyses were performed for each of the three indications for cerclage. RESULTS One hundred and eighty-one subjects met inclusion criteria. Forty-seven percent self-identified as non-Hispanic black (NHB), 12% as Hispanic and 41% as non-Hispanic white (NHW). There was no significant difference in the prevalence of SPTB < 37 weeks between the three race/ethnicity groups (33% versus 19% versus 40%, respectively, p = 0.22), nor for SPTB less than 34 or 28 weeks. Finally, there was no difference in SPTB prevalence by race after controlling for smoking, history of CKC/LEEP, and 17-OHPC with logistic regression. CONCLUSION Race/ethnicity does not appear to be associated with cerclage efficacy, as measured by the risk of SPTB, in a cohort of patients with history-indicated, ultrasound-indicated and physical-exam indicated cerclages.
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Tollånes MC, Strandberg-Larsen K, Eichelberger KY, Moster D, Lie RT, Brantsæter AL, Meltzer HM, Stoltenberg C, Wilcox AJ. Intake of Caffeinated Soft Drinks before and during Pregnancy, but Not Total Caffeine Intake, Is Associated with Increased Cerebral Palsy Risk in the Norwegian Mother and Child Cohort Study. J Nutr 2016; 146:1701-6. [PMID: 27489007 PMCID: PMC4997283 DOI: 10.3945/jn.116.232272] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Accepted: 06/24/2016] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Postnatal administration of caffeine may reduce the risk of cerebral palsy (CP) in vulnerable low-birth-weight neonates. The effect of antenatal caffeine exposure remains unknown. OBJECTIVE We investigated the association of intake of caffeine by pregnant women and risk of CP in their children. METHODS The study was based on The Norwegian Mother and Child Cohort Study, comprising >100,000 live-born children, of whom 222 were subsequently diagnosed with CP. Mothers reported their caffeine consumption in questionnaires completed around pregnancy week 17 (102,986 mother-child pairs), week 22 (87,987 mother-child pairs), and week 30 (94,372 mother-child pairs). At week 17, participants were asked about present and prepregnancy consumption. We used Cox regression models to estimate associations between exposure [daily servings (1 serving = 125 mL) of caffeinated coffee, tea, and soft drinks and total caffeine consumption] and CP in children, with nonconsumers as the reference group. Models included adjustment for maternal age and education, medically assisted reproduction, and smoking, and for each source of caffeine, adjustments were made for the other sources. RESULTS Total daily caffeine intake before and during pregnancy was not associated with CP risk. High consumption (≥6 servings/d) of caffeinated soft drinks before pregnancy was associated with an increased CP risk (HR: 1.9; 95% CI: 1.2, 3.1), and children of women consuming 3-5 daily servings of caffeinated soft drinks during pregnancy weeks 13-30 also had an increased CP risk (HR: 1.7; 95% CI: 1.1, 2.8). A mean daily consumption of 51-100 mg caffeine from soft drinks during the first half of pregnancy was associated with a 1.9-fold increased risk of CP in children (HR: 1.9; 95% CI: 1.1, 3.6). CONCLUSIONS Maternal total daily caffeine consumption before and during pregnancy was not associated with CP risk in children. The observed increased risk with caffeinated soft drinks warrants further investigation.
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Affiliation(s)
- Mette C Tollånes
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway; Domain for Health Data and Digitalisation, Norwegian Institute of Public Health, Bergen, Norway;
| | | | - Kacey Y Eichelberger
- Department of Obstetrics and Gynecology, Greenville Health System, University of South Carolina School of Medicine Greenville, Greenville, SC
| | - Dag Moster
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway;,Domain for Health Data and Digitalisation, Norwegian Institute of Public Health, Bergen, Norway;,Department of Pediatrics, Haukeland University Hospital, Bergen, Norway
| | - Rolv Terje Lie
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | | | | | - Camilla Stoltenberg
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway;,Director General, Norwegian Institute of Public Health, Oslo, Norway; and
| | - Allen J Wilcox
- National Institutes of Environmental Health Sciences, Durham, NC
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Eichelberger KY, Manuck TA. Progesterone has no place in the prevention of preterm delivery: AGAINST: A call for a measured response to the OPPTIMUM trial. BJOG 2016; 123:1511. [DOI: 10.1111/1471-0528.14161] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Kacey Y Eichelberger
- Division of Maternal-Fetal Medicine; Department of OB/GYN; University of South Carolina Greenville School of Medicine/Greenville Health System; USA
| | - Tracy A Manuck
- Division of Maternal-Fetal Medicine; Dept. of OB/GYN; University of North Carolina; USA
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Affiliation(s)
- K Y Eichelberger
- University of South Carolina, Greenville School of Medicine/Greenville Health Systems, Greenville, SC, USA
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Eichelberger KY, Morse JE, Connolly A, Autry M. Opportunities and barriers in global women's health training during obstetrics and gynecology residencies in the USA. Int J Gynaecol Obstet 2014; 128:148-51. [PMID: 25476152 DOI: 10.1016/j.ijgo.2014.08.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2014] [Revised: 08/07/2014] [Accepted: 10/02/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To systematically measure the scope and breadth of global women's health (GWH) training opportunities during obstetrics and gynecology residencies in the USA, as described by program directors (PDs). METHODS In a questionnaire-based study, PDs were asked to complete a web-based survey between January 1 and March 15, 2013. Information about the residency program and GWH opportunities was obtained. RESULTS Among 236 PDs contacted, 105 (44.5%) responded. Overall, 82 (78.1%) reported that at least one resident had participated in a GWH rotation during the past 5 years, 36 (34.3%) offered formal didactics, and 29 (27.6%) offered a formal rotation in GWH. Among all respondents, 43 (42.2%) reported having at least one faculty member for whom GWH is a dedicated part of their practice. Programs with dedicated GWH faculty were more likely to offer formal GWH didactics (relative risk [RR] 1.84; 95% confidence interval [CI] 1.07-3.14; P=0.03), but were not significantly more likely to offer a formal GWH rotation (RR 1.91; 95% CI 0.97-3.70; P=0.06). CONCLUSION Many residency programs provide opportunities for GWH training, but few offer formal didactics or a formal rotation.
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Affiliation(s)
- Kacey Y Eichelberger
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Greenville Health Systems, University of South Carolina School of Medicine, Greenville, SC, USA.
| | - Jessica E Morse
- Division of Family Planning, Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - AnnaMarie Connolly
- Division of Urogynecology, Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Meg Autry
- Department of Obstetrics and Gynecology, University of California, San Francisco, San Francisco, CA, USA
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Eichelberger KY, Bengtson AM, Tolleson-Rinehart S, Menard MK. Training needs in operative obstetrics for maternal-fetal medicine fellows. J Matern Fetal Neonatal Med 2014; 28:1467-70. [DOI: 10.3109/14767058.2014.957669] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Eichelberger KY, Leung EYL. A report from #BlueJC: does choice of intramuscular analgesics in labour matter? BJOG 2014; 121:1048. [PMID: 24958573 DOI: 10.1111/1471-0528.12894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abstract
Fulminant herpes hepatitis with disseminated extrahepatic involvement in pregnancy is rare and carries a high mortality risk. Although acyclovir remains standard first-line therapy, effective management of acyclovir-resistant disseminated herpes simplex virus (HSV) in pregnancy remains elusive. We present a case of disseminated HSV resistant to both acyclovir and foscarnet, the first double-agent resistant case in pregnancy reported in the literature to date. In this case, therapeutic delivery was the ultimate treatment resulting in full recovery.
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Affiliation(s)
- Christina A Herrera
- Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, North Carolina
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Abstract
OBJECTIVE To characterize the safety and feasibility of robotic adnexal surgery during pregnancy, and to compare surgical and obstetric outcomes for robotic versus laparoscopic treatment of adnexal masses during pregnancy. STUDY DESIGN A retrospective cohort study of all cases of robotic resection of adnexal masses in gravid patients performed at our institution between 2006 and 2009 compared with 50 consecutive historic laparoscopic controls performed between 1999 and 2007. RESULTS During the study period, 19 parturients underwent planned robotic resection of adnexal masses, all of which were uncomplicated. Compared with 50 consecutive laparoscopic controls, no differences in operative time, conversion to laparotomy, intraoperative or postoperative complications, or observed obstetric outcomes were apparent. The robotic cohort had a significantly shorter length of hospital stay (p < 0.01) and estimated blood loss (p = 0.02). CONCLUSION Robotic resection of adnexal masses during pregnancy appears both safe and feasible, with similar surgical outcomes when compared with a historic laparoscopic cohort.
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Affiliation(s)
- Kacey Y Eichelberger
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, NC 27599, USA.
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Eichelberger KY, Devers PL, Strauss RA, Chescheir NC. Pitfalls in prenatal diagnosis of a fixed retroflexed fetal head. Ultrasound Obstet Gynecol 2012; 40:726-727. [PMID: 22350930 DOI: 10.1002/uog.11143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Affiliation(s)
- K Y Eichelberger
- Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
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Eichelberger KY, Haeri S, Kessler DC, Swartz A, Herring A, Wolfe HM. Placenta previa in the second trimester: sonographic and clinical factors associated with its resolution. Am J Perinatol 2011; 28:735-9. [PMID: 21660901 PMCID: PMC3175253 DOI: 10.1055/s-0031-1280853] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
We identify characteristics that predict resolution of placenta previa and develop a clinical model for likelihood of resolution. We conducted a retrospective study of 366 singleton pregnancies complicated by placenta previa diagnosed with resolution of the previa as the primary outcome. Regression analyses were performed to determine variables associated with resolution and optimal timing for repeat sonographic evaluation. A likelihood of resolution model was created using a parametric survival model with Weibull hazard function. Of the 366 cases, 84% of complete placentae previae and 98% of marginal placentae previae resolved at a mean gestational age of 28.6 ± 5.3 weeks. Only gestational age and distance from the internal cervical os at the time of diagnosis were significantly associated with resolution ( P < 0.01). Likelihood of resolution was not significantly associated with any other variables. Marginal previae diagnosed in the second trimester do not appear to warrant repeat ultrasound evaluation for resolution.
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Affiliation(s)
- Kacey Y Eichelberger
- Division of Maternal-Fetal Medicine, Department of Obstetrics & Gynecology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina 27599-7516, USA.
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