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Schmidt CN, Wen T, Friedman AM, D'Alton ME, Andrikopoulou M. Trends in Attempted Vaginal Delivery among Pregnancies Complicated by Gastroschisis, 2014 to 2020. Am J Perinatol 2024; 41:543-547. [PMID: 36452974 DOI: 10.1055/a-1990-8668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
OBJECTIVE Gastroschisis is a full-thickness congenital defect of the abdominal wall through which intestines and other organs may herniate. In a prior analysis, attempted vaginal delivery with fetal gastroschisis appeared to increase through 2013, although cesarean delivery remained common. The objective of this analysis was to update current trends in attempted vaginal birth among pregnancies complicated by gastroschisis. STUDY DESIGN We performed an updated cross-sectional analysis of live births from 2014 and 2020 using data from the U.S. National Vital Statistics System and evaluated trends in attempted vaginal deliveries among births with gastroschisis. Trends were evaluated using joinpoint regression. We constructed logistic regression models to evaluate the association between demographic and clinical variables and attempted vaginal delivery in the setting of gastroschisis. RESULTS Among 5,355 deliveries with gastroschisis meeting inclusion criteria, attempted vaginal delivery increased significantly from 68.9% to 75.1%, an average annual percent change of 1.7% (95% confidence interval [CI], 0.8-2.5). Among gastroschisis-complicated pregnancies, patients 35 to 39 years old (adjusted odds ratio [aOR], 0.53; 95% CI, 0.37-0.79) and Hispanic race/ethnicity (aOR, 0.69; 95% CI, 0.58-0.62) were at lower likelihood of attempted vaginal delivery in adjusted analyses. CONCLUSION These findings suggest that vaginal delivery continues to increase in the setting of gastroschisis. Further reduction of surgical delivery for this fetal defect may be possible. KEY POINTS · Vaginal deliveries increased among gastroschisis pregnancies.. · Hispanic patients were less likely to attempt vaginal delivery.. · Some gastroschisis pregnancies still deliver surgically..
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Affiliation(s)
| | - Timothy Wen
- Division of Maternal Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, California
| | - Alexander M Friedman
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, New York
| | - Mary E D'Alton
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, New York
| | - Maria Andrikopoulou
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, New York
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Osinga JAJ, Liu Y, Männistö T, Vafeiadi M, Tao FB, Vaidya B, Vrijkotte TGM, Mosso L, Bassols J, López-Bermejo A, Boucai L, Aminorroaya A, Feldt-Rasmussen U, Hisada A, Yoshinaga J, Broeren MAC, Itoh S, Kishi R, Ashoor G, Chen L, Veltri F, Lu X, Taylor PN, Brown SJ, Chatzi L, Popova PV, Grineva EN, Ghafoor F, Pirzada A, Kianpour M, Oken E, Suvanto E, Hattersley A, Rebagliato M, Riaño-Galán I, Irizar A, Vrijheid M, Delgado-Saborit JM, Fernández-Somoano A, Santa-Marina L, Boelaert K, Brenta G, Dhillon-Smith R, Dosiou C, Eaton JL, Guan H, Lee SY, Maraka S, Morris-Wiseman LF, Nguyen CT, Shan Z, Guxens M, Pop VJM, Walsh JP, Nicolaides KH, D'Alton ME, Visser WE, Carty DM, Delles C, Nelson SM, Alexander EK, Chaker L, Palomaki GE, Peeters RP, Bliddal S, Huang K, Poppe KG, Pearce EN, Derakhshan A, Korevaar TIM. Risk Factors for Thyroid Dysfunction in Pregnancy: An Individual Participant Data Meta-Analysis. Thyroid 2024. [PMID: 38546971 DOI: 10.1089/thy.2023.0646] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
Background: International guidelines recommend targeted screening to identify gestational thyroid dysfunction. However, currently used risk factors have questionable discriminative ability. We quantified the risk for thyroid function test abnormalities for a subset of risk factors currently used in international guidelines. Methods: We included prospective cohort studies with data on gestational maternal thyroid function and potential risk factors (maternal age, body mass index [BMI], parity, smoking status, pregnancy through in vitro fertilization, twin pregnancy, gestational age, maternal education, and thyroid peroxidase antibody [TPOAb] or thyroglobulin antibody [TgAb] positivity). Exclusion criteria were pre-existing thyroid disease and use of thyroid interfering medication. We analyzed individual participant data using mixed-effects regression models. Primary outcomes were overt and subclinical hypothyroidism and a treatment indication (defined as overt hypothyroidism, subclinical hypothyroidism with thyrotropin >10 mU/L, or subclinical hypothyroidism with TPOAb positivity). Results: The study population comprised 65,559 participants in 25 cohorts. The screening rate in cohorts using risk factors currently recommended (age >30 years, parity ≥2, BMI ≥40) was 58%, with a detection rate for overt and subclinical hypothyroidism of 59%. The absolute risk for overt or subclinical hypothyroidism varied <2% over the full range of age and BMI and for any parity. Receiver operating characteristic curves, fitted using maternal age, BMI, smoking status, parity, and gestational age at blood sampling as explanatory variables, yielded areas under the curve ranging from 0.58 to 0.63 for the primary outcomes. TPOAbs/TgAbs positivity was associated with overt hypothyroidism (approximate risk for antibody negativity 0.1%, isolated TgAb positivity 2.4%, isolated TPOAb positivity 3.8%, combined antibody positivity 7.0%; p < 0.001), subclinical hypothyroidism (risk for antibody negativity 2.2%, isolated TgAb positivity 8.1%, isolated TPOAb positivity 14.2%, combined antibody positivity 20.0%; p < 0.001) and a treatment indication (risk for antibody negativity 0.2%, isolated TgAb positivity 2.2%, isolated TPOAb positivity 3.0%, and combined antibody positivity 5.1%; p < 0.001). Twin pregnancy was associated with a higher risk of overt hyperthyroidism (5.6% vs. 0.7%; p < 0.001). Conclusions: The risk factors assessed in this study had poor predictive ability for detecting thyroid function test abnormalities, questioning their clinical usability for targeted screening. As expected, TPOAb positivity (used as a benchmark) was a relevant risk factor for (subclinical) hypothyroidism. These results provide insights into different risk factors for gestational thyroid dysfunction.
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Affiliation(s)
- Joris A J Osinga
- Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
- Academic Center for Thyroid Diseases, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Yindi Liu
- Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
- Academic Center for Thyroid Diseases, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Tuija Männistö
- Northern Finland Laboratory Center Nordlab and Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Marina Vafeiadi
- Department of Social Medicine, School of Medicine, University of Crete, Heraklion, Crete, Greece
| | - Fang-Biao Tao
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, Anhui, China; Anhui Provincial Key Laboratory of Population Health and Aristogenics, Hefei, Anhui, China
| | - Bijay Vaidya
- Department of Endocrinology, Royal Devon and Exeter Hospital NHS Foundation Trust, University of Exeter Medical School, Exeter, United Kingdom
| | - Tanja G M Vrijkotte
- Department of Public and Occupational Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Lorena Mosso
- Departments of Endocrinology, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - Judit Bassols
- Maternal-Fetal Metabolic Research Group, Girona Biomedical Research Institute (IDIBGI), Dr. Josep Trueta Hospital, Girona, Spain
| | - Abel López-Bermejo
- Pediatric Endocrinology Research Group, Girona Biomedical Research Institute (IDIBGI), Dr. Josep Trueta Hospital, Girona, Spain
- Departament de Ciències Mèdiques, Universitat de Girona, Girona, Spain
| | - Laura Boucai
- Division of Endocrinology, Department of Medicine, Memorial Sloan-Kettering Cancer Center, Weill Cornell University, New York, New York, USA
| | - Ashraf Aminorroaya
- Isfahan Endocrine and Metabolism Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ulla Feldt-Rasmussen
- Department of Medical Endocrinology and Metabolism, Copenhagen University Hospital, Rigshospitalet, and Department of Clinical Medicine, Faculty of Health and Clinical Sciences, Copenhagen University, Copenhagen, Denmark
| | - Aya Hisada
- Center for Preventive Medical Sciences, Chiba University, Chiba, Japan
| | - Jun Yoshinaga
- Faculty of Life Sciences, Toyo University, Gunma, Japan
| | - Maarten A C Broeren
- Laboratory of Clinical Chemistry and Haematology, Máxima Medical Centre, Veldhoven, The Netherlands
| | - Sachiko Itoh
- Center for Environmental and Health Sciences, Hokkaido University, Sapporo, Japan
| | - Reiko Kishi
- Center for Environmental and Health Sciences, Hokkaido University, Sapporo, Japan
| | - Ghalia Ashoor
- Harris Birthright Research Center for Fetal Medicine, King's College Hospital, London, United Kingdom
| | - Liangmiao Chen
- Department of Endocrinology and Rui'an Center of the Chinese-American Research Institute for Diabetic Complications, Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Flora Veltri
- Endocrine Unit, Centre Hospitalier Universitaire Saint-Pierre, Université Libre de Bruxelles, Brussels, Belgium
| | - Xuemian Lu
- Department of Endocrinology and Rui'an Center of the Chinese-American Research Institute for Diabetic Complications, Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Peter N Taylor
- Thyroid Research Group, Systems Immunity Research Institute, Cardiff University School of Medicine, Cardiff, United Kingdom
| | - Suzanne J Brown
- Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - Leda Chatzi
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Polina V Popova
- Institute of Endocrinology, Almazov National Medical Research Centre, Saint Petersburg, Russia
| | - Elena N Grineva
- Department of Endocrinology, First Medical University, Saint Petersburg, Russia
| | - Farkhanda Ghafoor
- Department of Research and Innovation, Shalamar Institute of Health Sciences, Lahore, Pakistan
| | | | - Maryam Kianpour
- Isfahan Endocrine and Metabolism Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Emily Oken
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA
| | - Eila Suvanto
- Department of Obstetrics and Gynecology and Medical Research Center Oulu, University of Oulu, Oulu, Finland
| | - Andrew Hattersley
- Department of Molecular Medicine, University of Exeter Medical School, Royal Devon and Exeter Hospital, Exeter, Devon, United Kingdom
| | - Marisa Rebagliato
- Epidemiology and Environmental Health Joint Research Unit, FISABIO-Universitat Jaume I-Universitat de València, Valencia, Spain
- Predepartamental Unit of Medicine, Jaume I University, Castelló, Spain
- Spanish Consortium for Research on Epidemiology and Public Health, Instituto de Salud Carlos III, Madrid, Spain
| | - Isolina Riaño-Galán
- Spanish Consortium for Research on Epidemiology and Public Health, Instituto de Salud Carlos III, Madrid, Spain
- Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Asturias, Spain
- IUOPA-Department of Medicine, University of Oviedo, Oviedo, Asturias, Spain
- Servicio de Pediatría, Endocrinología Pediátrica, HUCA, Oviedo, Asturias, Spain
| | - Amaia Irizar
- Spanish Consortium for Research on Epidemiology and Public Health, Instituto de Salud Carlos III, Madrid, Spain
- Biodonostia Health Research Institute, Group of Environmental Epidemiology and Child Development, San Sebastian, Spain
- Department of Preventive Medicine and Public Health, University of the Basque Country (UPV/EHU), Leioa, Bizkaia, Spain
| | - Martine Vrijheid
- Spanish Consortium for Research on Epidemiology and Public Health, Instituto de Salud Carlos III, Madrid, Spain
- ISGlobal, Barcelona, Spain
- Universitat Pompeu Fabra, Barcelona, Spain
| | - Juana Maria Delgado-Saborit
- Epidemiology and Environmental Health Joint Research Unit, FISABIO-Universitat Jaume I-Universitat de València, Valencia, Spain
- Department of Medicine, Faculty of Health Sciences, Universitat Jaume I, Castellón de la Plana, Spain
| | - Ana Fernández-Somoano
- Spanish Consortium for Research on Epidemiology and Public Health, Instituto de Salud Carlos III, Madrid, Spain
- Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Asturias, Spain
- IUOPA-Department of Medicine, University of Oviedo, Oviedo, Asturias, Spain
| | - Loreto Santa-Marina
- Spanish Consortium for Research on Epidemiology and Public Health, Instituto de Salud Carlos III, Madrid, Spain
- Biodonostia Health Research Institute, Group of Environmental Epidemiology and Child Development, San Sebastian, Spain
- Department of Health of the Basque Government, Subdirectorate of Public Health of Gipuzkoa, San Sebastian, Spain
| | - Kristien Boelaert
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - Gabriela Brenta
- Department of Internal Medicine, Unidad Asistencial Dr. César Milstein, Buenos Aires, Argentina
| | - Rima Dhillon-Smith
- Tommys National Centre for Miscarriage Research, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, United Kingdom
| | - Chrysoula Dosiou
- Division of Endocrinology, Stanford University School of Medicine, Stanford, California, USA
| | - Jennifer L Eaton
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, and Women and Infants Hospital and Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Haixia Guan
- The First Hospital of China Medical University, Shenyang, China
| | - Sun Y Lee
- Section of Endocrinology, Diabetes, and Nutrition, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Spyridoula Maraka
- Division of Endocrinology and Metabolism, Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
- Knowledge and Evaluation Research Unit, Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
- Endocrine Section, Medicine Service, Central Arkansas Veterans Healthcare System, Little Rock, Arkansas, USA
| | - Lilah F Morris-Wiseman
- Division of Endocrine Surgery, Johns Hopkins Department of Surgery, Baltimore, Maryland, USA
| | - Caroline T Nguyen
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Zhongyan Shan
- Department of Endocrinology and Metabolism, NHC Key Laboratory of Diagnosis and Treatment of Thyroid Diseases, The First Hospital of China Medical University, Shenyang, China
| | - Mònica Guxens
- Spanish Consortium for Research on Epidemiology and Public Health, Instituto de Salud Carlos III, Madrid, Spain
- ISGlobal, Barcelona, Spain
- Universitat Pompeu Fabra, Barcelona, Spain
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Victor J M Pop
- Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
| | - John P Walsh
- Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
- Medical School, University of Western Australia, Crawley, Western Australia, Australia
| | - Kypros H Nicolaides
- Department of Women and Children's Health, Faculty of Life Sciences and Medicine King's College London, London, United Kingdom
| | - Mary E D'Alton
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, New York, USA
| | - W Edward Visser
- Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
- Academic Center for Thyroid Diseases, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - David M Carty
- Department of Diabetes, Endocrinology and Clinical Pharmacology, Glasgow Royal Infirmary, Glasgow, United Kingdom
- School of Cardiovascular and Metabolic Health, Dentistry and Nursing, University of Glasgow, Glasgow, United Kingdom
| | - Christian Delles
- School of Cardiovascular and Metabolic Health, Dentistry and Nursing, University of Glasgow, Glasgow, United Kingdom
| | - Scott M Nelson
- School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, United Kingdom
| | - Erik K Alexander
- Division of Endocrinology, Hypertension and Diabetes, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Layal Chaker
- Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
- Academic Center for Thyroid Diseases, Erasmus University Medical Center, Rotterdam, The Netherlands
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Glenn E Palomaki
- Department of Pathology and Laboratory Medicine, Women and Infants Hospital and Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Robin P Peeters
- Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
- Academic Center for Thyroid Diseases, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Sofie Bliddal
- Department of Medical Endocrinology and Metabolism, Copenhagen University Hospital, Rigshospitalet, and Department of Clinical Medicine, Faculty of Health and Clinical Sciences, Copenhagen University, Copenhagen, Denmark
| | - Kun Huang
- Department of Maternal, Child and Adolescent Health, Scientific Research Center in Preventive Medicine; School of Public Health; Anhui Medical University, Hefei, Anhui, China
| | - Kris G Poppe
- Endocrine Unit, Centre Hospitalier Universitaire Saint-Pierre, Université Libre de Bruxelles, Brussels, Belgium
| | - Elizabeth N Pearce
- Section of Endocrinology, Diabetes, and Nutrition, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Arash Derakhshan
- Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
- Academic Center for Thyroid Diseases, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Tim I M Korevaar
- Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
- Academic Center for Thyroid Diseases, Erasmus University Medical Center, Rotterdam, The Netherlands
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Lopez A, Wen T, Patel N, Booker WA, D'Alton ME, Friedman AM. Trends in and outcomes of delivery hospitalizations with lupus and antiphospholipid syndrome. Int J Gynaecol Obstet 2024; 164:1001-1009. [PMID: 37789684 DOI: 10.1002/ijgo.15171] [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: 02/03/2023] [Revised: 09/14/2023] [Accepted: 09/18/2023] [Indexed: 10/05/2023]
Abstract
OBJECTIVE To assess trends and outcomes associated with systemic lupus erythematosus (SLE) and antiphospholipid syndrome (APS) during US delivery hospitalizations. STUDY DESIGN The National Inpatient Sample from 2000 to 2019 was used for this repeated cross-sectional analysis. We identified delivery hospitalizations with and without SLE. Temporal trends in SLE during delivery hospitalizations were determined using joinpoint regression. Adjusted logistic regression models accounting for demographic, clinical, and hospital factors were used to determine adjusted odds ratios (aORs) for adverse outcomes based on the presence or absence of SLE. RESULTS Of an estimated 76 698 775 delivery hospitalizations identified in the NIS, 79386 (0.10%) had an associated diagnosis of SLE. Over the study period, SLE increased from 6.7 to 14.6 cases per 10 000 delivery hospitalizations (average annual percent change 4.5%, 95% CI 4.0-5.1). Deliveries with SLE had greater odds of non-transfusion severe morbidity (aOR 2.21, 95% CI 2.00, 2.44) and underwent a larger absolute increase in morbidity risk over the study period. SLE was associated with a range of other adverse outcomes including preterm delivery, eclampsia, cesarean delivery, and blood transfusion. CONCLUSION The proportion of deliveries to women with SLE has increased over time in the US, and SLE and APS are associated with a broad range of adverse outcomes.
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Affiliation(s)
- Ashley Lopez
- Department of Obstetrics and Gynecology, Columbia University, New York, New York, USA
| | - Timothy Wen
- Department of Obstetrics and Gynecology, University of California-San Francisco, San Francisco, California, USA
| | - Naomi Patel
- Division of Rheumatology, Allergy and Immunology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Whitney A Booker
- Department of Obstetrics and Gynecology, Columbia University, New York, New York, USA
| | - Mary E D'Alton
- Department of Obstetrics and Gynecology, Columbia University, New York, New York, USA
| | - Alexander M Friedman
- Department of Obstetrics and Gynecology, Columbia University, New York, New York, USA
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Liu LY, Wen T, Reddy UM, Mourad M, Goffman D, Nathan L, Sheen JJ, D'Alton ME, Friedman AM. Risk Factors, Trends, and Outcomes Associated With Postpartum Sepsis Readmissions. Obstet Gynecol 2024; 143:346-354. [PMID: 37944152 DOI: 10.1097/aog.0000000000005437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 09/14/2023] [Indexed: 11/12/2023]
Abstract
OBJECTIVE To evaluate the prevalence, timing, clinical risk factors, and adverse outcomes associated with postpartum readmissions for maternal sepsis. METHODS We conducted a retrospective cohort study of delivery hospitalizations and 60-day postpartum readmissions for females aged 15-54 years with and without sepsis using the 2016-2020 Nationwide Readmissions Database. Temporal trends in sepsis diagnoses during delivery hospitalizations and 60-day postpartum readmissions were analyzed with the National Cancer Institute's Joinpoint Regression Program to estimate the average annual percent change with 95% CIs. Logistic regression models were fit to determine whether delivery hospitalization characteristics were associated with postpartum sepsis readmissions, and unadjusted and adjusted odds ratios with 95% CIs were reported. Adverse outcomes associated with sepsis during delivery hospitalization and readmission were described, including death, severe morbidity, a critical care composite, and renal failure. RESULTS Overall, 15,268,190 delivery hospitalizations and 256,216 associated 60-day readmissions were included after population weighting, of which 16,399 (1.1/1,000 delivery hospitalizations) had an associated diagnosis of sepsis at delivery, and 20,130 (1.3/1,000 delivery hospitalizations) had an associated diagnosis of sepsis with postpartum readmission. A sepsis diagnosis was present in 7.9% of all postpartum readmissions. Characteristics associated with postpartum sepsis readmission included younger age at delivery, Medicaid insurance, lowest median ZIP code income quartile, and chronic medical conditions such as obesity, pregestational diabetes, and chronic hypertension. Postpartum sepsis readmissions were associated with infection during the delivery hospitalization, including intra-amniotic infection or endometritis, wound infection, and delivery sepsis. Sepsis diagnoses were associated with 24.4% of maternal deaths at delivery and 38.4% postpartum, 2.2% cases of nontransfusion severe morbidity excluding sepsis at delivery and 13.6% postpartum, 15.6% of critical care composite diagnoses at delivery and 30.1% postpartum, and 11.1% of acute renal failure diagnoses at delivery and 36.4% postpartum. CONCLUSION Sepsis accounts for a significant proportion of postpartum readmissions and is a major contributor to adverse outcomes during delivery hospitalizations and postpartum readmissions.
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Affiliation(s)
- Lilly Y Liu
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, New York; and the Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, San Francisco, California
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Liu LY, Friedman AM, Goffman D, Nathan L, Sheen JJ, Reddy UM, D'Alton ME, Wen T. Infection and Sepsis Trends during United States' Delivery Hospitalizations from 2000 to 2020. Am J Perinatol 2024. [PMID: 38408480 DOI: 10.1055/s-0044-1780538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/28/2024]
Abstract
OBJECTIVE This study aimed to evaluate trends, risk factors, and outcomes associated with infections and sepsis during delivery hospitalizations in the United States. STUDY DESIGN The 2000-2020 National Inpatient Sample was used for this repeated cross-sectional analysis. Delivery hospitalizations of patients aged 15 to 54 with and without infection and sepsis were identified. Common infection diagnoses during delivery hospitalizations analyzed included (i) pyelonephritis, (ii) pneumonia/influenza, (iii) endometritis, (iv) cholecystitis, (v) chorioamnionitis, and (vi) wound infection. Temporal trends in sepsis and infection during delivery hospitalizations were analyzed. The associations between sepsis and infection and common chronic health conditions including asthma, chronic hypertension, pregestational diabetes, and obesity were analyzed. The associations between clinical, demographic, and hospital characteristics, and infection and sepsis were determined with unadjusted and adjusted logistic regression models with unadjusted odds ratio (OR) and adjusted odds ratios with 95% confidence intervals as measures of association. RESULTS An estimated 80,158,622 delivery hospitalizations were identified and included in the analysis, of which 2,766,947 (3.5%) had an infection diagnosis and 32,614 had a sepsis diagnosis (4.1 per 10,000). The most common infection diagnosis was chorioamnionitis (2.7% of deliveries) followed by endometritis (0.4%), and wound infections (0.3%). Infection and sepsis were more common in the setting of chronic health conditions. Evaluating trends in individual infection diagnoses, endometritis and wound infection decreased over the study period both for patients with and without chronic conditions, while risk for pyelonephritis and pneumonia/influenza increased. Sepsis increased over the study period for deliveries with and without chronic condition diagnoses. Risks for adverse outcomes including mortality, severe maternal morbidity, the critical care composite, and acute renal failure were all significantly increased in the presence of sepsis and infection. CONCLUSION Endometritis and wound infections decreased over the study period while risk for sepsis increased. Infection and sepsis were associated with chronic health conditions and accounted for a significant proportion of adverse obstetric outcomes including severe maternal morbidity. KEY POINTS · Sepsis increased over the study period for deliveries with and without chronic condition diagnoses.. · Endometritis and wound infection decreased over the study period.. · Infection and sepsis accounted for a significant proportion of adverse obstetric outcomes..
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Affiliation(s)
- Lilly Y Liu
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, New York
| | - Alexander M Friedman
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, New York
| | - Dena Goffman
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, New York
| | - Lisa Nathan
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, New York
| | - Jean-Ju Sheen
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, New York
| | - Uma M Reddy
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, New York
| | - Mary E D'Alton
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, New York
| | - Timothy Wen
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Francisco, San Francisco, California
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Bogardus MH, Friedman AM, Arora C, D'Alton ME, Wen T. Mode of Delivery and Obstetric Complications in the Setting of Prior Uterine Surgery. Am J Perinatol 2023. [PMID: 37967872 DOI: 10.1055/a-2211-1928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2023]
Abstract
OBJECTIVE This study aimed to evaluate cesarean rates and risk for obstetric complications among deliveries with a history of prior uterine surgery. STUDY DESIGN This serial cross-sectional study analyzed deliveries with and without prior uterine surgery in the 2016-2019 Nationwide Inpatient Sample. Unadjusted and adjusted logistic regression models were performed to assess risk of nontransfusion severe maternal morbidity (SMM) and other obstetric complications based on the presence or absence of prior uterine surgery with unadjusted and adjusted odds ratios (aORs) with 95% confidence intervals (CIs) as measures of association. Adjusted models accounted for demographic, hospital, and delivery factors. Demographics and clinical factors among deliveries with and without a prior history of uterine surgery diagnosis were compared with the chi-square test with p < 0.05 considered statistically significant. RESULTS Of 14.7 million delivery hospitalization identified, 6,910 (4.7 per 10,000) had a history of uterine surgery and 111,710 (0.76%) experienced SMM. Women with prior uterine surgery were more likely to be older, to be of unknown race or ethnicity, and to have private insurance (p < 0.01 for all). Eighty-five percent of deliveries with prior uterine surgery were performed by cesarean compared with 32% of deliveries without prior uterine surgery (p < 0.01). In adjusted analysis, compared with patients without prior uterine surgery, patients with prior uterine surgery were not at increased risk for SMM (aOR 1.23, 95% CI 0.73-2.07). Evaluating obstetric complications, patients with prior uterine surgery had a decreased risk of postpartum hemorrhage (aOR 0.64, 95% CI 0.43-0.96) and an increased risk of peripartum hysterectomy (aOR 4.12, 95% CI 1.75-9.67), and no difference in other obstetric complications assessed. CONCLUSION These findings suggest that current clinical practice results in similar delivery risks among patients with compared with without prior uterine surgery. KEY POINTS · Risk for most adverse outcomes is similar among patients with prior uterine surgery.. · Risk for peripartum hysterectomy was higher with prior uterine surgery.. · Risk for SMM was not higher with prior uterine surgery..
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Affiliation(s)
- Margaret H Bogardus
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York
| | - Alexander M Friedman
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York
| | - Chetna Arora
- Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York
| | - Mary E D'Alton
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York
| | - Timothy Wen
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of California San Francisco, San Francisco, California
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Azad H, Wen T, Bello NA, Booker WA, Purisch S, D'Alton ME, Friedman AM. Peripartum cardiomyopathy delivery hospitalization and postpartum readmission trends, risk factors, and outcomes. Pregnancy Hypertens 2023; 34:116-123. [PMID: 37948872 DOI: 10.1016/j.preghy.2023.11.004] [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: 08/11/2023] [Revised: 11/01/2023] [Accepted: 11/02/2023] [Indexed: 11/12/2023]
Abstract
OBJECTIVE To evaluate risk for peripartum cardiomyopathy during delivery and postpartum hospitalizations, and analyze associated trends, risk factors, and clinical outcomes. METHODS The 2010-2020 Nationwide Readmissions Database was used for this retrospective cohort study. Delivery hospitalizations along with postpartum readmissions occurring within five months of delivery discharge were analyzed. Risk factors associated with peripartum cardiomyopathy were analyzed with unadjusted and adjusted logistic regression models with odds ratios as measures of effect. Risk for severe adverse outcomes associated with peripartum cardiomyopathy was analyzed. Trends were analyzed with joinpoint regression. RESULTS Of 39,790,772 delivery hospitalizations identified, 9,210 were complicated by a diagnosis of peripartum cardiomyopathy (2.3 per 10,000). Risk for a 5-month readmission with a peripartum cardiomyopathy diagnosis was 4.8 per 10,000. Factors associated with peripartum cardiomyopathy during deliveries included preeclampsia with severe features (OR 18.9, 95 % CI 17.2, 20.7), preeclampsia without severe features (OR 6.9, 95 % CI 6.1, 7.8), multiple gestation (OR 4.7, 95 % CI 4.1, 5.3), chronic hypertension (OR 10.1, 95 % CI 8.9, 11.3), and older maternal age. Associations were attenuated but retained significance in adjusted models. Similar estimates were found when evaluating associations with postpartum readmissions. Peripartum cardiomyopathy readmissions were associated with 10 % of overall postpartum deaths, 21 % of cardiac arrest/ventricular fibrillation diagnoses, 18 % of extracorporeal membrane oxygenation cases, and 40 % of cardiogenic shock. In joinpoint analysis, peripartum cardiomyopathy increased significantly during delivery hospitalizations (average annual percent change [AAPC] 2.2 %, 95 % CI 1.0 %, 3.4 %) but not postpartum readmissions (AAPC 0.0 %, 95 % CI -1.6 %, 1.6 %). CONCLUSION Risk for peripartum cardiomyopathy increased during delivery hospitalizations over the study period. Obstetric conditions such as preeclampsia and chronic medical conditions that are increasing in prevalence in the obstetric population were associated with the highest odds of peripartum cardiomyopathy.
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Affiliation(s)
- Hooman Azad
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, NY 10032, USA
| | - Timothy Wen
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California-San Francisco, San Francisco, CA, USA
| | - Natalie A Bello
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Whitney A Booker
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, NY 10032, USA
| | - Stephanie Purisch
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, NY 10032, USA
| | - Mary E D'Alton
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, NY 10032, USA
| | - Alexander M Friedman
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, NY 10032, USA.
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Logue TC, Wen T, Huang Y, Wright JD, D'Alton ME, Friedman AM. Continuation of psychiatric medications during pregnancy. J Matern Fetal Neonatal Med 2023; 36:2171288. [PMID: 36710395 DOI: 10.1080/14767058.2023.2171288] [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: 01/31/2023]
Abstract
Background: While medications for anxiety and depression are commonly used in the United States, it is unclear to what degree they are continued during pregnancy.Methods: We used a large administrative database to determine whether psychiatric medications are continued during pregnancy and predictors of continued medication treatment.Results: Of 2,672,656 women included in our analysis, 86,454 (3.1%) filled a pre-pregnancy prescription for an anxiolytic or antidepressant medication within 3 months of estimated conception. Of women who filled a pre-pregnancy prescription, 49.4%, 26.1%, and 20.1% filled subsequent prescriptions in the 1st, 2nd, and 3rd trimesters. Discontinuation rates ranged by pharmaceutical agent, from 16% for fluoxetine to 71% for alprazolam. White women and women over 25 were more likely to continue anxiolytic and antidepressant treatment during pregnancy.Conclusion: Because untreated and under-treated mental health conditions are linked to adverse maternal outcomes, high discontinuation rates may have important implications for maternal health.
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Affiliation(s)
- Teresa C Logue
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, NY, USA
| | - Timothy Wen
- Division of Maternal Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, CA, USA
| | - Yongmei Huang
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, NY, USA
| | - Jason D Wright
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, NY, USA
| | - Mary E D'Alton
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, NY, USA
| | - Alexander M Friedman
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, NY, USA
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Wright GL, Wen T, Engel DJ, Guglielminotti J, Andrikopoulou M, Booker WA, D'Alton ME, Friedman AM. Delivery Outcomes and Postpartum Readmissions Associated with Ehlers-Danlos Syndrome. Am J Perinatol 2023. [PMID: 37793432 DOI: 10.1055/a-2185-4149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/06/2023]
Abstract
OBJECTIVE Given that updated estimates of Ehlers-Danlos syndrome and risks for obstetric complications including postpartum readmission may be of public health significance, we sought to analyze associated obstetric trends and outcomes in a nationally representative population. STUDY DESIGN The 2016 to 2020 Nationwide Readmissions Database was used for this retrospective cohort study. Delivery hospitalizations to women aged 15 to 54 with and without Ehlers-Danlos syndrome were identified. Temporal trends in Ehlers-Danlos syndrome diagnoses during delivery hospitalizations were analyzed using joinpoint regression to estimate the average annual percent change with 95% confidence intervals (CIs). To determine whether adverse obstetric outcomes during the delivery were associated with Ehlers-Danlos syndrome, unadjusted and adjusted logistic regression models were fit with unadjusted (odds ratio [OR]) and adjusted ORs with 95% CIs as measures of association. In addition to analyzing adverse delivery outcomes, risk for 60-day postpartum readmission was analyzed. RESULTS An estimated 18,214,542 delivery hospitalizations were included of which 7,378 (4.1 per 10,000) had an associated diagnosis of Ehlers-Danlos syndrome. Ehlers-Danlos syndrome diagnosis increased from 2.7 to 5.2 per 10,000 delivery hospitalization from 2016 to 2020 (average annual percent change increase of 16.1%, 95% CI: 9.4%, 23.1%). Ehlers-Danlos syndrome was associated with increased odds of nontransfusion severe maternal morbidity (OR: 1.84, 95% CI: 1.38, 2.45), cervical insufficiency (OR: 2.14, 95% CI: 1.46, 3.13), postpartum hemorrhage (OR: 1.41, 95% CI: 1.17, 1.68), cesarean delivery (OR: 1.26, 95% CI: 1.17, 1.36), and preterm delivery (OR: 1.35, 95% CI: 1.16, 1.56). Estimates for transfusion, placental abruption, and placenta previa did not differ significantly. Risk for 60-day postpartum readmission was 3.0% among deliveries with Ehlers-Danlos (OR: 1.76, 95% CI: 1.37, 2.25). CONCLUSION Ehlers-Danlos syndrome diagnoses approximately doubled over the 5-year study period and was associated with a range of adverse obstetric outcomes and complications during delivery hospitalizations as well as risk for postpartum readmission. KEY POINTS · Ehlers-Danlos syndrome diagnoses approximately doubled over the 5-year study period.. · Ehlers-Danlos was associated with a range of adverse obstetric outcomes.. · Ehlers-Danlos was associated with increased readmission risk..
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Affiliation(s)
- Gillian L Wright
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, New York
| | - Timothy Wen
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California-San Francisco, San Francisco, California
| | - David J Engel
- Division of Cardiology, Columbia University Irving Medical Center, New York, New York
| | - Jean Guglielminotti
- Department of Anesthesiology, Columbia University Vagelos College of Physicians and Surgeons, New York, New York
| | - Maria Andrikopoulou
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, New York
| | - Whitney A Booker
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, New York
| | - Mary E D'Alton
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, New York
| | - Alexander M Friedman
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, New York
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Arditi B, Emont J, Friedman AM, D'Alton ME, Wen T. Deliveries Among Patients With Maternal Hepatitis C Virus Infection in the United States, 2000-2019. Obstet Gynecol 2023; 141:828-836. [PMID: 36897136 DOI: 10.1097/aog.0000000000005119] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 01/12/2023] [Indexed: 03/11/2023]
Abstract
OBJECTIVE To assess clinical characteristics, trends, and outcomes associated with the diagnosis of hepatitis C virus (HCV) infection during pregnancy. METHODS This cross-sectional study analyzed delivery hospitalizations using the National Inpatient Sample. Temporal trends in both diagnosis of HCV infection and clinical characteristics associated with HCV infection were analyzed using joinpoint regression to estimate the average annual percent change (AAPC) with 95% CIs. Survey-adjusted logistic regression models were fit to assess the association among HCV infection and preterm delivery, cesarean delivery, and severe maternal morbidity (SMM), adjusting for clinical, medical, and hospital factors with adjusted odds ratios (aORs) as the measure of association. RESULTS An estimated 76.7 million delivery hospitalizations were included, in which 182,904 (0.24%) delivering individuals had a diagnosis of HCV infection. The prevalence of HCV infection diagnosed in pregnancy increased nearly 10-fold over the study period, from 0.05% in 2000 to 0.49% in 2019, representing an AAPC of 12.5% (95% CI 10.4-14.8%). The prevalence of clinical characteristics associated with HCV infection also increased over the study period, including opioid use disorder (from 10 cases/10,000 birth hospitalizations to 71 cases/10,000 birth hospitalizations), nonopioid substance use disorder (from 71 cases/10,000 birth hospitalizations to 217 cases/10,000 birth hospitalizations), mental health conditions (from 219 cases/10,000 birth hospitalizations to 1,117 cases/10,000), and tobacco use (from 61 cases/10,000 birth hospitalizations to 842 cases/10,000). The rate of deliveries among patients with two or more clinical characteristics associated with HCV infection increased from 26 cases per 10,000 birth hospitalizations to 377 cases per 10,000 delivery hospitalizations (AAPC 13.4%, 95% CI 12.1-14.8%). In adjusted analyses, HCV infection was associated with increased risk for SMM (aOR 1.78, 95% CI 1.61-1.96), preterm birth (aOR 1.88, 95% CI 1.8-1.95), and cesarean delivery (aOR 1.27, 95% CI 1.23-1.31). CONCLUSION Diagnosis of HCV infection is increasingly common in the obstetric population, which may reflect an increase in screening or a true increase in prevalence. The increase in HCV infection diagnoses occurred in the setting of many baseline clinical characteristics that are associated with HCV infection becoming more common.
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Affiliation(s)
- Brittany Arditi
- Department of Obstetrics and Gynecology, Columbia University, New York, New York; and the Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, San Francisco, California
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Sobhani NC, Corbetta-Rastelli CM, Agarwal A, D'Alton ME, Friedman AM, Wen T. Delivery trends and obstetric outcomes in patients with Fontan circulation. Am J Obstet Gynecol MFM 2023; 5:100921. [PMID: 36882127 DOI: 10.1016/j.ajogmf.2023.100921] [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: 01/22/2023] [Revised: 02/22/2023] [Accepted: 03/01/2023] [Indexed: 03/07/2023]
Abstract
BACKGROUND With improved therapies, an increasing number of patients with Fontan circulation reach reproductive age. Pregnant patients with Fontan circulation are at high risk for obstetric complications. Most data for Fontan pregnancies and associated complications stem from single center studies, with limited national epidemiologic data available. OBJECTIVE To evaluate temporal trends in deliveries to pregnant individuals with Fontan palliation using nationwide data and to estimate associated obstetric complications among these deliveries. STUDY DESIGN Delivery hospitalizations were abstracted from the 2000-2018 Nationwide Inpatient Sample. Fontan deliveries were identified using diagnosis codes and trends in the rates of these deliveries were assessed using joinpoint regression. Baseline demographics and obstetric outcomes (including severe maternal morbidity (SMM), a composite of serious obstetric and cardiac complications) were assessed. Univariable log linear regression models were fit comparing risks of outcomes among deliveries with and without Fontan circulation. RESULTS 509 pregnancies complicated by Fontan circulation were identified at a rate of 7 per 1 million delivery hospitalizations, with a temporal increase from 2.4 to 30.3 cases per 1 million from 2000 to 2018 (p<0.01). Compared to non-Fontan deliveries, Fontan deliveries were at higher risk of hypertensive disorders (RR 1.79, 95% CI 1.42-2.27), preterm delivery (RR 2.37, 95% CI 1.90-2.96), postpartum hemorrhage (RR 4.28, 95% CI 3.35-5.45), and SMM (RR 6.09, 95% CI 4.54-8.17). CONCLUSIONS The rates of deliveries to patients with Fontan palliation are increasing on a national level. These deliveries have higher risks of obstetric complications and SMM. Additional national clinical data are necessary to better understand Fontan pregnancy complications, to improve patient counseling, and to reduce maternal morbidity.
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Affiliation(s)
- Nasim C Sobhani
- Division of Maternal Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Francisco.
| | - Chiara M Corbetta-Rastelli
- Division of Maternal Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Francisco
| | - Anushree Agarwal
- Division of Cardiology, Department of Medicine, University of California San Francisco
| | - Mary E D'Alton
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Columbia University Irving Medical Center
| | - Alexander M Friedman
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Columbia University Irving Medical Center
| | - Timothy Wen
- Division of Maternal Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Francisco
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Frappaolo AM, Logue TC, Goffman D, Nathan LM, Sheen JJ, Andrikopoulou M, Wen T, D'Alton ME, Friedman AM. Cesarean Delivery Trends Among Patients at Low Risk for Cesarean Delivery in the US, 2000-2019. JAMA Netw Open 2023; 6:e235428. [PMID: 36988955 PMCID: PMC10061237 DOI: 10.1001/jamanetworkopen.2023.5428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/30/2023] Open
Abstract
Importance Reducing rates of unnecessary cesarean deliveries is both a national and a global health objective. However, there are limited national US data on trends in indications for low-risk cesarean delivery. Objective To determine temporal trends in and indications for cesarean delivery among patients at low risk for the procedure over a 20-year period. Design, Setting, and Participants This cross-sectional study analyzed 2000 to 2019 delivery hospitalizations using the National Inpatient Sample. Births at low risk for cesarean delivery were identified using a definition from the Society for Maternal-Fetal Medicine and additional criteria. Temporal trends in cesarean birth were analyzed using joinpoint regression to estimate the average annual percentage change (AAPC) with 95% CIs. Data analysis was performed from August 2022 to January 2023. Exposure This analysis evaluated cesarean birth trends in a population at low risk for this procedure over a 20-year period. Main Outcomes and Measures In addition to overall cesarean birth risk, cesarean deliveries for nonreassuring fetal status and labor arrest were individually analyzed. Results Of an estimated 76.7 million delivery hospitalizations, 21.5 million were excluded according to the Society for Maternal-Fetal Medicine definition, and 14.7 million were excluded according to additional criteria. Of the estimated 40 517 867 deliveries included, 12.1% (4 885 716 deliveries) were by cesarean delivery. Cesarean deliveries among patients at low risk for the procedure increased from 9.7% to 13.9% between 2000 and 2009, plateaued, and then decreased from 13.0% to 11.1% between 2012 and 2019. The AAPC for cesarean delivery was 6.4% (95% CI, 5.2% to 7.6%) from 2000 to 2005, 1.2% from 2005 to 2009 (95% CI, -1.2% to 3.7%), and -2.2% from 2009 to 2019 (95% CI, -2.7% to -1.8%). Cesarean delivery for nonreassuring fetal status increased from 3.4% of all deliveries in 2000 to 5.1% in 2019 (AAPC, 2.1%; 95% CI, 1.7% to 2.5%). Cesarean delivery for labor arrest increased from 3.6% in 2000 to a peak of 4.8% in 2009 before decreasing to 2.7% in 2019. Cesarean deliveries for labor arrest increased during the first half of the study (2000-2009) for the active phase (from 1.5% to 2.1%), latent phase (from 1.1% to 1.5%), and second stage (from 0.9% to 1.3%) and then decreased from 2010 to 2019, from 2.1% to 1.7% for the active phase, from 1.5% to 1.2% for the latent phase, and from 1.2% to 0.9% for the second stage. Conclusions and Relevance Cesarean deliveries among patients at low risk for cesarean birth appeared to decrease over the latter years of the study period, with cesarean deliveries for labor arrest becoming less common.
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Affiliation(s)
- Anna M Frappaolo
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, New York, New York
| | - Teresa C Logue
- Department of Obstetrics and Gynecology, Christiana Care Health System, Newark, Delaware
| | - Dena Goffman
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, New York, New York
| | - Lisa M Nathan
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, New York, New York
| | - Jean-Ju Sheen
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, New York, New York
| | - Maria Andrikopoulou
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, New York, New York
| | - Timothy Wen
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco
| | - Mary E D'Alton
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, New York, New York
| | - Alexander M Friedman
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, New York, New York
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Pipes GM, Logue TC, Wen T, Booker WA, D'Alton ME, Friedman AM. Postpartum stroke trends, risk factors, and associated adverse outcomes. Am J Obstet Gynecol MFM 2023; 5:100864. [PMID: 36791844 DOI: 10.1016/j.ajogmf.2023.100864] [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: 10/31/2022] [Revised: 01/05/2023] [Accepted: 01/10/2023] [Indexed: 02/17/2023]
Abstract
BACKGROUND Management of postpartum stroke has been the focus of several quality improvement efforts in the past decade. However, there is little recent national trends data for postpartum stroke readmissions. OBJECTIVE This study aimed to determine trends, risk factors, and complications associated with postpartum stroke readmission. STUDY DESIGN The 2013 to 2019 Nationwide Readmissions Database was used to perform a retrospective cohort study that evaluated the risk for readmission for stroke within 60 days of delivery hospitalization discharge. Temporal trends in readmissions were analyzed using the National Cancer Institute's Joinpoint Regression Program to estimate the average annual percent change with 95% confidence intervals. Stratified trends were analyzed for hemorrhage stroke, ischemic stroke, and stroke readmissions at 1 to 10, 11 to 30, and 31 to 60 days after delivery discharge. Risk factors for stroke were analyzed using unadjusted and adjusted logistic regression models with odds ratios and 95% confidence intervals as measures of association. The risk for stroke complications, including mechanical ventilation, seizures, death, and a prolonged stay ≥14 days, was analyzed. RESULTS Of an estimated 21,754,603 delivery hospitalizations, 5006 were complicated by a 60-day postpartum readmission with a diagnosis of stroke. The average annual percent change for all stroke readmissions over the study period was not significant (average annual percent change, 0.1%; 95% confidence interval, -2.2% to 2.4%). When the trends in readmission for ischemic and hemorrhagic stroke were analyzed, the results were similar, as were the stratified analyses by readmission timing. Risk factors associated with increased odds included superimposed preeclampsia (odds ratio, 4.8; 95% confidence interval, 3.9-5.9), preeclampsia with severe features (odds ratio, 3.7; 95% confidence interval, 3.0-4.4), maternal cardiac disease (odds ratio, 3.0; 95% confidence interval, 2.5-3.7), chronic kidney disease (odds ratio, 5.0; 95% confidence interval, 3.4-7.5), and lupus (odds ratio, 7.0; 95% confidence interval, 4.9-10.2). Risk was retained in adjusted analyses. Common stroke-related complications included a prolonged hospital stay ≥14 days (12.1 per 1000 stroke-related readmissions), seizures (9.9 per 1000 stroke-related readmissions), and mechanical ventilation (6.6 per 1000 stroke-related readmissions). CONCLUSION This analysis of nationally representative data demonstrated no change in the rate of 60-day postpartum hospitalizations for stroke from 2013 to 2019. Further clinical research is indicated to optimize risk reduction for stroke after delivery hospitalization discharge.
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Affiliation(s)
- Grace M Pipes
- Department of Obstetrics and Gynecology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY (Ms Pipes and Drs Logue, Booker, D'Alton, and Friedman)
| | - Teresa C Logue
- Department of Obstetrics and Gynecology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY (Ms Pipes and Drs Logue, Booker, D'Alton, and Friedman)
| | - Timothy Wen
- and Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California-San Francisco, San Francisco, CA (Dr Wen)
| | - Whitney A Booker
- Department of Obstetrics and Gynecology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY (Ms Pipes and Drs Logue, Booker, D'Alton, and Friedman)
| | - Mary E D'Alton
- Department of Obstetrics and Gynecology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY (Ms Pipes and Drs Logue, Booker, D'Alton, and Friedman)
| | - Alexander M Friedman
- Department of Obstetrics and Gynecology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY (Ms Pipes and Drs Logue, Booker, D'Alton, and Friedman).
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Albers SM, Wen T, Monk C, Logue TC, D'Alton ME, Booker WA, Friedman AM. Postpartum psychosis during delivery hospitalizations and postpartum readmissions, 2016-2019. Am J Obstet Gynecol MFM 2023; 5:100905. [PMID: 36775196 DOI: 10.1016/j.ajogmf.2023.100905] [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: 12/15/2022] [Revised: 02/06/2023] [Accepted: 02/07/2023] [Indexed: 02/12/2023]
Abstract
BACKGROUND Up-to-date data on population-level risk factors for postpartum psychosis is limited, although increasing substance use disorders, psychiatric disorders, autoimmune disorders, and other medical comorbidities in the obstetrical population may be contributing to the increased baseline risk of postpartum psychosis. OBJECTIVE This study aimed to determine trends in and risk factors for postpartum psychosis during delivery hospitalizations and postpartum readmissions. STUDY DESIGN Analyzing the 2016-2019 Nationwide Readmission Database, this repeated cross-sectional study identified diagnoses of postpartum psychosis during delivery hospitalizations and postpartum readmissions within 60 days of discharge. The relationship among demographic, clinical, and hospital-level factors present at delivery and postpartum psychosis was analyzed with logistic regression models with adjusted odds ratios with 95% confidence intervals as measures of association. Separate models were created for postpartum psychosis diagnoses at delivery and during postpartum readmission. Temporal trends in diagnoses were analyzed with Joinpoint regression to determine the average annual percent change with 95% confidence intervals. RESULTS Of 12,334,506 deliveries in the analysis, 13,894 (1.1 per 1000) had a diagnosis of postpartum psychosis during the delivery hospitalization, and 7128 (0.6 per 1000) had a 60-day postpartum readmission with postpartum psychosis. Readmissions with postpartum psychosis increased significantly during the study period (P=.046). Most readmissions with a postpartum psychosis diagnosis occurred in 0 to 10 days (43% of readmissions) or 11 to 20 days (18% of readmissions) after discharge. Clinical factors with the highest adjusted odds for postpartum psychosis readmission included delivery postpartum psychosis (adjusted odds ratio, 5.8; 95% confidence interval, 4.2-8.0), depression disorder (adjusted odds ratio, 3.7; 95% confidence interval, 3.3-4.2), bipolar spectrum disorder (odds ratio, 2.9; 95% confidence interval, 2.3-3.5), and schizophrenia spectrum disorder (adjusted odds ratio, 2.9; 95% confidence interval, 2.1-4.0). In models analyzing postpartum psychosis diagnoses at delivery, risk factors associated with the highest odds included anxiety disorder (adjusted odds ratio, 3.9; 95% confidence interval, 3.5-4.2), schizophrenia spectrum disorder (adjusted odds ratio, 2.5; 95% confidence interval, 1.9-3.4), bipolar disorder (adjusted odds ratio, 1.8; 95% confidence interval, 1.6-2.1), stillbirth (odds ratio, 3.6; 95% confidence interval, 3.1-4.2), and substance use disorder (odds ratio, 1.7; 95% confidence interval, 1.6-1.9). In addition, chronic conditions, such as pregestational diabetes mellitus, obesity, and substance use, were associated with delivery and readmission postpartum psychosis. CONCLUSION This study determined that postpartum psychosis is increasing during postpartum readmissions and is associated with a wide range of obstetrical and medical comorbidities. Close follow-up care after delivery for other medical and obstetrical diagnoses may represent an opportunity to identify postpartum psychiatric conditions, including postpartum psychosis.
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Affiliation(s)
- Saundra M Albers
- Department of Obstetrics and Gynecology, Columbia University, New York, NY (Ms Albers and Drs Monk, Logue, D'Alton, Booker, and Friedman)
| | - Timothy Wen
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, San Francisco, CA (Dr Wen)
| | - Catherine Monk
- Department of Obstetrics and Gynecology, Columbia University, New York, NY (Ms Albers and Drs Monk, Logue, D'Alton, Booker, and Friedman); New York State Psychiatric Institute, New York, NY (Dr Monk)
| | - Teresa C Logue
- Department of Obstetrics and Gynecology, Columbia University, New York, NY (Ms Albers and Drs Monk, Logue, D'Alton, Booker, and Friedman)
| | - Mary E D'Alton
- Department of Obstetrics and Gynecology, Columbia University, New York, NY (Ms Albers and Drs Monk, Logue, D'Alton, Booker, and Friedman)
| | - Whitney A Booker
- Department of Obstetrics and Gynecology, Columbia University, New York, NY (Ms Albers and Drs Monk, Logue, D'Alton, Booker, and Friedman)
| | - Alexander M Friedman
- Department of Obstetrics and Gynecology, Columbia University, New York, NY (Ms Albers and Drs Monk, Logue, D'Alton, Booker, and Friedman).
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Yang L, Friedman AM, Krenitsky NM, Wen T, D'Alton ME, Wright JD, Booker W, Huang Y. Risk for adverse maternal outcomes among women with chronic hypertension. BJOG 2023; 130:621-635. [PMID: 36655368 DOI: 10.1111/1471-0528.17382] [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: 04/19/2022] [Revised: 10/28/2022] [Accepted: 11/08/2022] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To determine whether longitudinal health data accounts for end-organ injury or death in the setting of chronic hypertension. DESIGN Cohort of 64 799 deliveries to 61 854 women. SETTING US claims data for the preiod 2008-2019. POPULATION Women with a delivery hospitalisation and chronic hypertension. METHODS Risk for a composite of acute end-organ injury or death during the delivery hospitalisation and 30 days postpartum was analysed. Adjusted logistic regression models were derived with discrimination for each model estimated by the C-statistic. Poisson regression was used to estimate adjusted risk ratios. Starting with models using data from pregnancy, further adjustment was performed accounting for healthcare use in the year prior to pregnancy, including hospitalisations, emergency department encounters, prescription medications and pre-pregnancy diagnoses. MAIN OUTCOME MEASURES Acute end-organ injury or death. RESULTS The composite outcome occurred among 5.7% of 64 799 deliveries. For patients with commercial insurance, filling non-hypertensive medications from ≥11 different classes, compared with none (adjusted risk ratio, aRR 4.07, 95% CI 2.86-5.79), three or more hospitalisations before pregnancy, compared with none (aRR 4.75, 95% CI 3.46-6.52), and chronic kidney disease diagnosed in the year before pregnancy (aRR 2.35, 95% CI 1.88, 2.94) were associated with increased risk. For pregnancies covered by commercial insurance, the C-statistic increased from 0.615 (95% CI 0.599-0.630) in the model with pregnancy data only to 0.796 (95% CI 0.783-0.808) for the model additionally including healthcare use in the year before pregnancy. Findings with Medicaid were similar. CONCLUSIONS Prepregnancy care use predicted adverse maternal outcomes. These data may be important in risk stratification.
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Affiliation(s)
- Lanbo Yang
- Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA
| | - Alexander M Friedman
- Department of Obstetrics and Gynecology, College of Physicians and Surgeons, Columbia University, New York, New York, USA
| | - Nicole M Krenitsky
- Department of Obstetrics and Gynecology, College of Physicians and Surgeons, Columbia University, New York, New York, USA
| | - Timothy Wen
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California - San Francisco, San Francisco, California, USA
| | - Mary E D'Alton
- Department of Obstetrics and Gynecology, College of Physicians and Surgeons, Columbia University, New York, New York, USA
| | - Jason D Wright
- Department of Obstetrics and Gynecology, College of Physicians and Surgeons, Columbia University, New York, New York, USA
| | - Whitney Booker
- Department of Obstetrics and Gynecology, College of Physicians and Surgeons, Columbia University, New York, New York, USA
| | - Yongmei Huang
- Department of Obstetrics and Gynecology, College of Physicians and Surgeons, Columbia University, New York, New York, USA
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Lopez A, Wen T, D'Alton ME, Friedman AM. Trends in and outcomes associated with systemic lupus erythematosus and anti-phospholipid syndrome during U.S. deliveries. Am J Obstet Gynecol 2023. [DOI: 10.1016/j.ajog.2022.11.482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Sheen JJ, Arditi B, Friedman AM, D'Alton ME, Wen T. Chronic conditions and risk for severe maternal morbidity stratified by maternal age ≥40. Am J Obstet Gynecol 2023. [DOI: 10.1016/j.ajog.2022.11.574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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18
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Albers S, Wen T, D'Alton ME, Friedman AM. Risk factors for postpartum psychosis readmissions after delivery hospitalizations. Am J Obstet Gynecol 2023. [DOI: 10.1016/j.ajog.2022.11.733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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19
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Emeruwa UN, Azad H, Ona S, Bejerano S, Alnafisee S, Emont J, Mathew S, Batlle M, Arnold D, Ukoha EP, Janice aubey, D'Alton ME, Miller RS, Gyamfi-Bannerman C. Furosemide for the prevention of de novo postpartum hypertension: A randomized placebo-controlled trial. Am J Obstet Gynecol 2023. [DOI: 10.1016/j.ajog.2022.11.1258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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20
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O'Shaugnessy F, Govindappagari S, Huang Y, Syeda SK, D'Alton ME, Wright JD, Friedman AM. Postthrombotic Syndrome and Chronic Pulmonary Embolism after Obstetric Venous Thromboembolism. Am J Perinatol 2023; 40:22-24. [PMID: 34808685 DOI: 10.1055/s-0041-1739471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE While the majority of venous thromboembolism (VTE) during pregnancy events resolve with anticoagulation, long-term complications may occur including (1) postthrombotic syndrome and (2) chronic pulmonary embolism. The objective of this study was to determine risk of these two complications. STUDY DESIGN A retrospective cohort study using the MarketScan databases was performed on deliveries from 2008 to 2014. We identified women aged 15 to 54 years diagnosed with acute VTE during pregnancy, the delivery hospitalization, or ≤60 days postpartum who received at least one prescription postpartum for anticoagulants. Risks of (1) chronic PE and (2) postthrombotic syndrome were evaluated for women at 6, 12, 24, and 60 months after delivery hospitalization through 2017 via the International Classification of Diseases, 9th/10th Revision, Clinical Modification codes. RESULTS Of 4,267 of 4,128,900 pregnancies complicated by VTE, the majority had DVT alone (61.8%, n = 2,637), while 25.8% had PE alone (n = 1,103) and 12.4% (n = 527) had both DVT and PE. Of the entire cohort, 3,328 retained insurance coverage at 6 months, 2,823 at 12 months, 2,161 at 24 months, and 831 at 60 months. Restricted to DVT, risk of postthrombotic syndrome was 0.7% at 6 months (n = 17), 1.1% at 12 months (n = 22), 1.7% at 24 months (n = 26), and 2.7% at 60 months (n = 16). Among women with PE diagnoses, the risk of chronic PE was 2.4% at 6 months (n = 30), 3.3% at 12 months (n = 36), 4.2% at 24 months (n = 36), and 7.2% at 60 months (n = 24). CONCLUSION In comparison to the general population, the risk of postthrombotic syndrome was lower. In comparison, the risk of chronic PE was similar to the estimates in the general population at comparable time points after PE events. For women with obstetric PE, it may be appropriate to be vigilant for findings and symptoms associated with chronic PE. KEY POINTS · Risk of postthrombotic syndrome after obstetric deep vein thrombosis is low.. · Risk of chronic pulmonary embolism may approximate that in the general population.. · Overall risk of chronic complications after obstetric VTE was relatively low..
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Affiliation(s)
- Fergal O'Shaugnessy
- Pharmacy Department, Rotunda Hospital, Dublin, Ireland.,Division of Population Health Sciences, Royal College of Surgeons, Dublin, Ireland
| | | | - Yongmei Huang
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, New York
| | - Sbaa K Syeda
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, New York
| | - Mary E D'Alton
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, New York
| | - Jason D Wright
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, New York
| | - Alexander M Friedman
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, New York
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Chen C, Yang K, Nan H, Unverzagt F, McClure LA, Irvin MR, Judd S, Cushman M, Kamin Mukaz D, Klaunig JE, D'Alton ME, Kahe K. Associations of Telomere Length and Change With Cognitive Decline Were Modified by Sex and Race: The REGARDS Study. Am J Alzheimers Dis Other Demen 2023; 38:15333175231175797. [PMID: 37340856 PMCID: PMC10624094 DOI: 10.1177/15333175231175797] [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] [Subscribe] [Scholar Register] [Indexed: 06/22/2023]
Abstract
INTRODUCTION We examined the associations of baseline telomere length (TL) and TL change with cognitive function over time in older US adults, as well as differences by sex and race. METHODS A total of 1820 cognitively healthy individuals (median baseline age: 63 years) were included. Telomere length was measured using qPCR-based method at baseline and among 614 participants in the follow-up examination 10 years later. Cognitive function was assessed by a four-test battery every 2 years. RESULTS In multivariable-adjusted linear mixed models, longer baseline TL and smaller attrition/lengthening of TL over time were associated with better Animal Fluency Test score. Longer baseline TL was also linearly associated with better Letter Fluency Test score. The observed associations were consistently more pronounced in women than men and in Black compared to White participants. DISCUSSION Telomere length may be a biomarker that predicts long-term verbal fluency and executive function, particularly in women and Black Americans.
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Affiliation(s)
- Cheng Chen
- Department of Obstetrics and Gynecology, Vagelos College of Physician and Surgeons, Columbia University, New York, NY, USA
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Keming Yang
- Clinical and Translational Epidemiology Unit, Department of Medicine, Massachusetts General Hospital & Department of Nutrition, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Hongmei Nan
- Department of Global Health, Richard M. Fairbanks School of Public Health, Indiana University–Purdue University Indianapolis, Indianapolis, IN, USA
| | - Frederick Unverzagt
- Department of Psychiatry, School of Medicine, Indiana University, Indianapolis, IN, USA
| | - Leslie A. McClure
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Marguerite R. Irvin
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Suzanne Judd
- Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Mary Cushman
- Department of Medicine, Larner College of Medicine at the University of Vermont, Burlington, VT, USA
| | - Debora Kamin Mukaz
- Department of Medicine, Larner College of Medicine at the University of Vermont, Burlington, VT, USA
| | - James E. Klaunig
- Department of Environmental and Occupational Health, School of Public Health, Indiana University–Bloomington, Bloomington, IN, USA
| | - Mary E. D'Alton
- Department of Obstetrics and Gynecology, Vagelos College of Physician and Surgeons, Columbia University, New York, NY, USA
| | - Ka Kahe
- Department of Obstetrics and Gynecology, Vagelos College of Physician and Surgeons, Columbia University, New York, NY, USA
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
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Syeda S, Arditi B, Parra N, Krenitsky N, D'Alton ME, Andrikopoulou M, Friedman AM, Wen T. Recent US labor induction trends and outcomes stratified by pre-pregnancy maternal body mass index. Am J Obstet Gynecol 2023. [DOI: 10.1016/j.ajog.2022.11.1229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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23
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Pipes G, Friedman AM, Logue T, Wen T, Miller EC, D'Alton ME. Trends in postpartum stroke and risk for associated adverse outcomes. Am J Obstet Gynecol 2023. [DOI: 10.1016/j.ajog.2022.11.830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Arditi B, Syeda S, Azad H, Sheen JJ, D'Alton ME, Friedman AM, Wen T. Trends in chronic conditions and associated risk for severe maternal morbidity, 2000-2019. Am J Obstet Gynecol 2023. [DOI: 10.1016/j.ajog.2022.11.496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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25
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Frappaolo A, Linder AH, Wen T, D'Alton ME, Friedman AM. Trends in and outcomes associated with obstructive sleep apnea during deliveries in the U.S. Am J Obstet Gynecol 2023. [DOI: 10.1016/j.ajog.2022.11.749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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26
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Andrikopoulou M, Wen T, D'Alton ME, Friedman AM. Trends in newborn hospitalization transfers for hypoplastic left heart and transposition of the great arteries. Am J Obstet Gynecol 2023. [DOI: 10.1016/j.ajog.2022.11.625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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27
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Bogardus M, Friedman AM, D'Alton ME, Wen T. Maternal morbidity and obstetric complications during deliveries with prior uterine surgery. Am J Obstet Gynecol 2023. [DOI: 10.1016/j.ajog.2022.11.346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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28
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Liu L, Friedman AM, Mourad M, Reddy UM, D'Alton ME, Wen T. Postpartum maternal sepsis and septic shock readmissions: trends and associated risk factors. Am J Obstet Gynecol 2023. [DOI: 10.1016/j.ajog.2022.11.619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Gorsch LP, Wen T, Lonier JY, Zork N, Mourad M, D'Alton ME, Friedman AM. Trends in delivery hospitalizations with pregestational and gestational diabetes mellitus and associated outcomes: 2000-2019. Am J Obstet Gynecol 2022:S0002-9378(22)02266-9. [PMID: 36509174 DOI: 10.1016/j.ajog.2022.12.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 08/12/2022] [Revised: 12/06/2022] [Accepted: 12/06/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND Pregestational diabetes mellitus and its associated risks may be increasing in the obstetrical population. OBJECTIVE This study aimed to characterize the trends in delivery hospitalizations with pregestational diabetes mellitus, the prevalence of chronic diabetes complications, and the risk for adverse outcomes. STUDY DESIGN This repeated, cross-sectional study used the United States National Inpatient Sample to identify delivery hospitalizations with pregestational diabetes mellitus between 2000 and 2019. Trends in delivery hospitalizations with pregestational diabetes mellitus were assessed using joinpoint regression to determine the average annual percent change. Trends in chronic diabetes complications, including chronic kidney disease, neuropathy, peripheral vascular disease, and diabetic retinopathy, were also analyzed. The risk for adverse obstetrical outcomes was compared between patients with and those without pregestational diabetes mellitus using adjusted logistic regression models that were adjusted for demographic, clinical, and hospital characteristics with adjusted odds ratios with 95% confidence intervals as measures of association. RESULTS Of 76.7 million delivery hospitalizations, 179,885 (0.23%) had type 1 diabetes mellitus, 430,544 (0.56%) had type 2 diabetes mellitus, and 99,327 (0.13%) had unspecified diabetes mellitus. From 2000 to 2019, the prevalence of diabetes mellitus increased from 1.8 to 7.3 per 1000 deliveries for type 2 diabetes mellitus (average annual percent change, 8.0%; 95% confidence interval, 6.9%-9.2%), from 1.5 to 3.2 per 1000 deliveries for unspecified diabetes mellitus (average annual percent change, 3.9%; 95% confidence interval, 1.4%-6.3%), and from 2.7 in 2000 to 2.8 per 1000 deliveries (average annual percent change, 0.2%; 95% confidence interval, -0.8% to 1.3%) for type 1 diabetes mellitus. The prevalence of chronic diabetes mellitus complications increased from 2.7% to 5.6% over the study period (average annual percent change, 5.9%; 95% confidence interval, 3.7%-8.0%). Pregestational diabetes mellitus was associated with severe maternal morbidity, cesarean delivery, hypertensive disorders of pregnancy, preterm birth, and shoulder dystocia. CONCLUSION Pregestational diabetes mellitus increased over the study period, driven by a quadrupling in the prevalence of type 2 diabetes mellitus. Notably, the prevalence of chronic diabetes mellitus complications doubled concomitantly. Pregestational diabetes mellitus was associated with a range of adverse outcomes. These findings are further evidence that pregestational diabetes mellitus is an important contributor to maternal risk and that optimizing diabetes care in women of childbearing age will continue to be of major public health importance.
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Affiliation(s)
- Lindsey P Gorsch
- Columbia University Vagelos College of Physicians and Surgeons, New York, NY
| | - Timothy Wen
- Department of Obstetrics and Gynecology, University of California San Francisco, San Francisco, CA
| | - Jacqueline Y Lonier
- Division of Endocrinology, Department of Internal Medicine, Columbia University Irving Medical Center, New York, NY
| | - Noelia Zork
- Department of Obstetrics and Gynecology, Columbia University, New York, NY
| | - Mirella Mourad
- Department of Obstetrics and Gynecology, Columbia University, New York, NY
| | - Mary E D'Alton
- Department of Obstetrics and Gynecology, Columbia University, New York, NY
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Staniczenko AP, Wen T, Gonzalez A, D'Alton ME, Logue TC, Friedman AM. Trends and outcomes of delivery hospitalizations with unstable housing, 2000-2018. J Matern Fetal Neonatal Med 2022; 35:10455-10457. [PMID: 36539262 DOI: 10.1080/14767058.2022.2128664] [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: 12/24/2022]
Abstract
Purpose: Data on trends in and implications of unstable housing during pregnancy are limited. The purpose of this study was to address these knowledge gaps.Methods: This repeat cross-sectional study using the National Inpatient Sample analyzed unstable housing diagnoses among 2000-2018 delivery hospitalizations. Joinpoint regression was used to estimate trends in unstable housing by calculating the average annual percent change.Results: From 2000 to 2018, 27,984 delivery hospitalizations had associated diagnoses of unstable housing (0.03%). There was a significant increase in the unstable housing rates, from 0.72 per 10,000 deliveries in 2000 to 12.8 per 10,000 deliveries in 2018. Delivery hospitalizations with unstable housing were at significantly higher risk of antepartum hemorrhage, preterm delivery, hypertensive disorders of pregnancy, postpartum hemorrhage, and severe maternal morbidity than those without.Conclusions: This serial cross-sectional analysis of delivery hospitalizations found that the reported prevalence of unstable housing is low but increasing and associated with adverse outcomes.
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Affiliation(s)
- Anna P Staniczenko
- Department of Obstetrics and Gynecology, Columbia University, New York, NY, USA
| | - Timothy Wen
- Department of Obstetrics and Gynecology, University of California-San Francisco, San Francisco, CA, USA
| | - Amalia Gonzalez
- Department of Obstetrics and Gynecology, Columbia University, New York, NY, USA
| | - Mary E D'Alton
- Department of Obstetrics and Gynecology, Columbia University, New York, NY, USA
| | - Teresa C Logue
- Department of Obstetrics and Gynecology, Columbia University, New York, NY, USA
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31
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Linder AH, Wen T, Guglielminotti JR, Levine LD, Kim YY, Purisch SE, D'Alton ME, Friedman AM. Delivery outcomes associated with maternal congenital heart disease, 2000-2018. J Matern Fetal Neonatal Med 2022; 35:9991-10000. [PMID: 35658780 PMCID: PMC9691578 DOI: 10.1080/14767058.2022.2081803] [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] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 05/05/2022] [Accepted: 05/20/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE To characterize temporal trends and outcomes of delivery hospitalization with maternal congenital heart disease (CHD). MATERIALS AND METHODS For this repeated cross-sectional analysis, deliveries to women aged 15-54 years with maternal CHD were identified in the 2000-2018 National Inpatient Sample. Temporal trends in maternal CHD were analyzed using joinpoint regression to estimate the average annual percentage change (AAPC) with 95% CIs. The relationship between maternal CHD and several adverse maternal outcomes was analyzed with log-linear regression models. Risk for adverse outcomes in the setting of maternal CHD was further characterized based on additional diagnoses of cardiac comorbidity including congestive heart failure, arrhythmia, valvular disease, pulmonary disorders, and history of thromboembolism. RESULTS Of 73,109,790 delivery hospitalizations, 51,841 had a diagnosis of maternal CHD (7.1 per 10,000). Maternal CHD rose from 4.2 to 10.9 per 10,000 deliveries (AAPC 4.8%, 95% CI 4.2%, 5.4%). Maternal CHD deliveries with a cardiac comorbidity diagnosis also increased from 0.6 to 2.6 per 10,000 from 2000 to 2018 (AAPC 8.4%, 95% CI 6.3%, 10.6%). Maternal CHD was associated with severe maternal morbidity (adjusted risk ratios [aRR] 4.97, 95% CI 4.75, 5.20), cardiac severe maternal morbidity (aRR 7.65, 95% CI 7.14, 8.19), placental abruption (aRR 1.30, 95% 1.21, 1.38), preterm delivery (aRR 1.47, 95% CI 1.43, 1.51), and transfusion (aRR 2.28, 95% CI 2.14, 2.42). Risk for severe morbidity (AAPC 4.7%, 95% CI 2.5%, 6.9%) and cardiac severe morbidity (AAPC 4.7%, 95% CI 2.5%, 6.9%) increased significantly among women with maternal CHD over the study period. The presence of cardiac comorbidity diagnoses was associated with further increased risk. CONCLUSION Maternal CHD is becoming more common among US deliveries. Among deliveries with maternal CHD, risk for severe morbidity is increasing. These findings support that an increasing burden of risk from maternal CHD in the obstetric population.
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Affiliation(s)
- Alice H Linder
- Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Timothy Wen
- Department of Obstetrics and Gynecology, University of California-San Francisco, San Francisco, CA, USA
| | | | - Lisa D Levine
- Obstetrics & Gynecology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Yuli Y Kim
- Philadelphia Maternal Congenital Heart Center, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Stephanie E Purisch
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, NY, USA
| | - Mary E D'Alton
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, NY, USA
| | - Alexander M Friedman
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, NY, USA
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Grantz KL, Grewal J, Kim S, Grobman WA, Newman RB, Owen J, Sciscione A, Skupski D, Chien EK, Wing DA, Wapner RJ, Ranzini AC, Nageotte MP, Craigo S, Hinkle SN, D'Alton ME, He D, Tekola-Ayele F, Hediger ML, Buck Louis GM, Zhang C, Albert PS. Unified standard for fetal growth velocity: the Eunice Kennedy Shriver National Institute of Child Health and Human Development Fetal Growth Studies. Am J Obstet Gynecol 2022; 227:916-922.e1. [PMID: 35926648 PMCID: PMC9729377 DOI: 10.1016/j.ajog.2022.07.045] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 07/26/2022] [Indexed: 01/27/2023]
Affiliation(s)
- Katherine L Grantz
- Division of Population Health Research, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD.
| | - Jagteshwar Grewal
- Division of Population Health Research, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD
| | - Sungduk Kim
- Biostatistics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD
| | | | - Roger B Newman
- Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston, SC
| | - John Owen
- University of Alabama at Birmingham, Birmingham, AL
| | - Anthony Sciscione
- Department of Obstetrics and Gynecology, ChristianaCare Health System, Newark, DE
| | | | - Edward K Chien
- Women and Infants Hospital of Rhode Island, Providence, RI; Cleveland Clinic, Cleveland, OH
| | - Deborah A Wing
- University of California, Irvine, Orange, CA; Fountain Valley Regional Hospital and Medical Center, Fountain Valley, CA
| | | | - Angela C Ranzini
- Saint Peter's University Hospital, New Brunswick, NJ; The MetroHealth System, Cleveland, OH
| | - Michael P Nageotte
- Miller Children's and Women's Hospital Long Beach/Long Beach Memorial Medical Center, Long Beach, CA
| | - Sabrina Craigo
- Department of Obstetrics and Gynecology, Tufts Medical Center, Boston, MA
| | - Stefanie N Hinkle
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | | | - Dian He
- Division of Population Health Research, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD; The Prospective Group, Inc, Fairfax, VA
| | - Fasil Tekola-Ayele
- Division of Population Health Research, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD
| | - Mary L Hediger
- Division of Population Health Research, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD
| | | | - Cuilin Zhang
- Division of Population Health Research, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD; Bia-Echo Asia Centre for Reproductive Longevity & Equality, Yong Loo Lin School of Medicine, National University of Singapore, Queenstown, Singapore; Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Queenstown, Singapore
| | - Paul S Albert
- Biostatistics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD
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Frappaolo AM, Linder AH, Wen T, Andrikopoulou M, Booker WA, D'Alton ME, Friedman AM. Trends in and outcomes associated with obstructive sleep apnea during deliveries in the United States, 2000-2019. Am J Obstet Gynecol MFM 2022; 5:100775. [PMID: 36781348 DOI: 10.1016/j.ajogmf.2022.100775] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 07/29/2022] [Revised: 10/04/2022] [Accepted: 10/06/2022] [Indexed: 02/13/2023]
Abstract
BACKGROUND Population-level data on obstructive sleep apnea among pregnant women in the United States and associated risk for adverse outcomes during delivery may be of clinical importance and public health significance. OBJECTIVE This study aimed to assess trends in and outcomes associated with obstructive sleep apnea during delivery hospitalizations. STUDY DESIGN This repeated cross-sectional study analyzed delivery hospitalizations using the National Inpatient Sample. Temporal trends in obstructive sleep apnea were analyzed using joinpoint regression to estimate the average annual percentage change with 95% confidence intervals. Survey-adjusted logistic regression models were fit to assess the association between obstructive sleep apnea and mechanical ventilation or tracheostomy, acute respiratory distress syndrome, hypertensive disorders of pregnancy, peripartum hysterectomy, pulmonary edema/heart failure, stillbirth, and preterm birth. RESULTS From 2000 to 2019, an estimated 76,753,013 delivery hospitalizations were identified, of which 54,238 (0.07%) had a diagnosis of obstructive sleep apnea. During the study period, the presence of obstructive sleep apnea during delivery hospitalizations increased from 0.4 to 20.5 cases per 10,000 delivery hospitalizations (average annual percentage change, 20.6%; 95% confidence interval, 19.1-22.2). Clinical factors associated with obstructive sleep apnea included obesity (4.3% of women without and 57.7% with obstructive sleep apnea), asthma (3.2% of women without and 25.3% with obstructive sleep apnea), chronic hypertension (2.0% of women without and 24.5% with obstructive sleep apnea), and pregestational diabetes mellitus (0.9% of women without and 10.9% with obstructive sleep apnea). In adjusted analyses accounting for obesity, other clinical factors, demographics, and hospital characteristics, obstructive sleep apnea was associated with increased odds of mechanical ventilation or tracheostomy (adjusted odds ratio, 21.9; 95% confidence interval, 18.0-26.7), acute respiratory distress syndrome (adjusted odds ratio, 5.9; 95% confidence interval, 5.4-6.5), hypertensive disorders of pregnancy (adjusted odds ratio, 1.6; 95% confidence interval, 1.6-1.7), stillbirth (adjusted odds ratio, 1.2; 95% confidence interval, 1.0-1.4), pulmonary edema/heart failure (adjusted odds ratio, 3.7; 95% confidence interval, 2.9-4.7), peripartum hysterectomy (adjusted odds ratio, 1.66; 95% confidence interval, 1.23-2.23), and preterm birth (adjusted odds ratio, 1.2; 95% confidence interval, 1.1-1.2). CONCLUSION Obstructive sleep apnea diagnoses are increasingly common in the obstetrical population and are associated with a range of adverse obstetrical outcomes during delivery hospitalizations.
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Affiliation(s)
- Anna M Frappaolo
- From the Department of Obstetrics and Gynecology, Columbia University, New York, NY (Mses Frappaolo and Linder, Drs Andrikopoulou, Booker, D'Alton and Friedman)
| | - Alice H Linder
- From the Department of Obstetrics and Gynecology, Columbia University, New York, NY (Mses Frappaolo and Linder, Drs Andrikopoulou, Booker, D'Alton and Friedman)
| | - Timothy Wen
- and Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California-San Francisco, San Francisco, CA (Dr Wen)
| | - Maria Andrikopoulou
- From the Department of Obstetrics and Gynecology, Columbia University, New York, NY (Mses Frappaolo and Linder, Drs Andrikopoulou, Booker, D'Alton and Friedman)
| | - Whitney A Booker
- From the Department of Obstetrics and Gynecology, Columbia University, New York, NY (Mses Frappaolo and Linder, Drs Andrikopoulou, Booker, D'Alton and Friedman)
| | - Mary E D'Alton
- From the Department of Obstetrics and Gynecology, Columbia University, New York, NY (Mses Frappaolo and Linder, Drs Andrikopoulou, Booker, D'Alton and Friedman)
| | - Alexander M Friedman
- From the Department of Obstetrics and Gynecology, Columbia University, New York, NY (Mses Frappaolo and Linder, Drs Andrikopoulou, Booker, D'Alton and Friedman).
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Monk C, Dimidjian S, Galinsky E, Gregory KD, Hoffman MC, Howell EA, Miller ES, Osborne C, Rogers CE, Saxbe DE, D'Alton ME. The Transition to Parenthood in Obstetrics: Enhancing Prenatal Care for Two Generation Impact. Am J Obstet Gynecol MFM 2022; 4:100678. [PMID: 35728782 DOI: 10.1016/j.ajogmf.2022.100678] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 06/13/2022] [Accepted: 06/15/2022] [Indexed: 11/25/2022]
Abstract
Obstetrics, the specialty overseeing infant and parent health before birth, could be expanded to address the inter-related areas of parents' prenatal impact on children's brain development and their own psychosocial needs during a time of immense change and neuroplasticity. Obstetrics is primed for the shift that is happening in pediatrics, which is moving from its traditional focus on physical health to a coordinated, whole child, two or multi-generation approach. Pediatric care now includes developmental screening, parenting education, parent coaching, access to developmental specialists, brain-building caregiving skills, linkages to community resources, and tiered interventions with psychologists. Drawing on decades of Developmental Origins of Health and Disease research highlighting the prenatal beginnings of future health and new studies on the transition to parenthood describing adult development from pregnancy to early postpartum, we propose that, similar to pediatrics, the integration of education and intervention strategies into the prenatal care ecosystem should be tested for its potential to improve child cognitive and social-emotional development and parental mental health. Pediatric care programs can serve as models of change for the systematic development, testing and, incorporation of new content into prenatal care as universal, first-tier treatment as well as evidenced-based, triaged interventions according to level of need. To promote optimal beginnings for the whole family, we propose an augmented prenatal care ecosystem that aligns with, and could build on, current major efforts to enhance perinatal care individualization through consideration of medical, social, and structural determinants of health.
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Affiliation(s)
- Catherine Monk
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, NY; Department of Psychiatry, Columbia University Irving Medical Center, New York, NY.
| | - Sona Dimidjian
- Department of Psychology and Neuroscience, University Colorado, Boulder
| | | | | | - M Camille Hoffman
- Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Aurora; Department of Psychiatry, University of Colorado School of Medicine, Aurora
| | - Elizabeth A Howell
- Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Emily S Miller
- Department of Obstetrics and Gynecology, Northwestern University, Chicago, IL; Department of Psychiatry and Behavioral Health Sciences, Northwestern University, Chicago, IL
| | - Cynthia Osborne
- Department of Leadership, Policy, and Organizations, Peabody College, Vanderbilt University, Nashville, TN
| | - Cynthia E Rogers
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO
| | - Darby E Saxbe
- Department of Psychology, University of Southern California, Los Angeles
| | - Mary E D'Alton
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, NY
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van Biema F, Friedman AM, Cepin AG, Wen T, Staniczenko AP, D'Alton ME, Logue TC. Trends in Use of Long-Acting Reversible Contraception during Delivery Hospitalizations, 2000-2019. Am J Obstet Gynecol 2022; 227:659-661.e2. [PMID: 35667418 DOI: 10.1016/j.ajog.2022.05.061] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 05/31/2022] [Indexed: 11/17/2022]
Affiliation(s)
| | - Alexander M Friedman
- Division of Maternal-Fetal Fetal Medicine Department of Obstetrics and Gynecology Vagelos College of Physicians and Surgeons Columbia University 622 West 168th St. New York, NY 10032.
| | - Ana G Cepin
- Department of Obstetrics and Gynecology, Columbia University, 622 West 168th St., New York, NY 10032
| | - Timothy Wen
- Department of Obstetrics and Gynecology, University of California San Francisco, San Francisco, CA
| | - Anna P Staniczenko
- Department of Obstetrics and Gynecology, Columbia University, New York, NY
| | - Mary E D'Alton
- Department of Obstetrics and Gynecology, Columbia University, New York, NY
| | - Teresa C Logue
- Department of Obstetrics and Gynecology, Columbia University, New York, NY
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Wen T, Schmidt CN, Sobhani NC, Guglielminotti J, Miller EC, Sutton D, Lahtermaher Y, D'Alton ME, Friedman AM. Trends and outcomes for deliveries with hypertensive disorders of pregnancy from 2000 to 2018: A repeated cross-sectional study. BJOG 2022; 129:1050-1060. [PMID: 34865302 PMCID: PMC10028501 DOI: 10.1111/1471-0528.17038] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Revised: 11/10/2021] [Accepted: 11/24/2021] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To analyse trends, risk factors, and outcomes related to hypertensive disorders of pregnancy (HDP). DESIGN Repeated cross-sectional. SETTING US delivery hospitalisations. POPULATION Delivery hospitalisations in the 2000-2018 National Inpatient Sample. METHODS US hospital delivery hospitalisations with HDP were analysed. Several trends were analysed: (i) the proportion of deliveries by year with HDP, (ii) the proportion of deliveries with HDP risk factors and (iii) adverse outcomes associated with HDP including maternal stroke, acute renal failure and acute liver injury. Risk ratios were determined using regression models with HDP as the exposure of interest. MAIN OUTCOME MEASURES Prevalence of HDP, risk factors for HDP and associated adverse outcomes. RESULTS Of 73.1 million delivery hospitalisations, 7.7% had an associated diagnosis of HDP. Over the study period, HDP doubled from 6.0% of deliveries in 2000 to 12.0% in 2018. The proportion of deliveries with risk factors for HDP increased from 9.6% in 2000 to 24.6% in 2018. In adjusted models, HDP were associated with increased stroke (aRR [adjusted risk ratio] 15.9, 95% CI 14.8-17.1), acute renal failure (aRR 13.8, 95% CI 13.5-14.2) and acute liver injury (aRR 1.2, 95% CI 1.2-1.3). Among deliveries with HDP, acute renal failure and acute liver injury increased; in comparison, stroke decreased. CONCLUSION Hypertensive disorders of pregnancy increased in the setting of risk factors for HDP becoming more common, whereas stroke decreased. TWEETABLE ABSTRACT While hypertensive disorders of pregnancy increased from 2000 to 2018, stroke appears to be decreasing.
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Affiliation(s)
- Timothy Wen
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, San Francisco, California, USA
| | - Christina N Schmidt
- University of California San Francisco School of Medicine, San Francisco, California, USA
| | - Nasim C Sobhani
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, San Francisco, California, USA
| | - Jean Guglielminotti
- Department of Anesthesiology, Columbia University Irving Medical Center, New York, New York, USA
| | - Eliza C Miller
- Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, New York, USA
| | - Desmond Sutton
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, New York, USA
| | - Yael Lahtermaher
- Escola de Medicina Souza Marques (EMSM), Fundação Tecnico Educação Souza Marques, Rio De Janeiro, Brazil
| | - Mary E D'Alton
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, New York, USA
| | - Alexander M Friedman
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, New York, USA
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Yu K, Faye AS, Wen T, Guglielminotti JR, Huang Y, Wright JD, D'Alton ME, Friedman AM. Outcomes during delivery hospitalisations with inflammatory bowel disease. BJOG 2022; 129:1073-1083. [PMID: 35152548 DOI: 10.1111/1471-0528.17039] [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: 08/06/2021] [Revised: 10/22/2021] [Accepted: 11/05/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To characterise inflammatory bowel disease (IBD) trends and associated risk during delivery hospitalisations. DESIGN Cross-sectional. SETTING US delivery hospitalisations. POPULATION Delivery hospitalisations in the 2000-2018 National Inpatient Sample. METHODS This study analysed a nationally representative hospital discharge database based on the presence of IBD. Temporal trends in IBD were analysed using joinpoint regression to estimate the average annual percent change (AAPC). IBD severity was characterised by the presence of diagnoses such as penetrating and stricturing disease and history of bowel resection. Risks for adverse outcomes were analysed based on presence of IBD. Poisson regression models were performed with unadjusted and adjusted risk ratios (aRR) as measures of effect. MAIN OUTCOME MEASURE Prevalence of IBD and associated adverse outcomes. RESULTS Of 73 109 790 delivery hospitalisations, 89 965 had a diagnosis of IBD. IBD rose from 0.06% in 2000 to 0.21% in 2018 (AAPC 7.3%, 95% CI 6.7-7.9%). Among deliveries with IBD, IBD severity diagnoses increased from 4.1% to 8.1% from 2000 to 2018. In adjusted analysis, IBD was associated with increased risk for preterm delivery (aRR 1.50, 95% CI 1.47-1.53), severe maternal morbidity (aRR 1.93, 95% CI 1.83-2.04), venous thrombo-embolism (aRR 2.76, 95% CI 2.39-3.18) and surgical injury during caesarean delivery hospitalisation (aRR 5.03, 95% CI 4.76-5.31). In the presence of a severe IBD diagnosis, risk was further increased for all adverse outcomes. CONCLUSION IBD is increasing in the obstetric population and is associated with adverse outcomes. Risk is increased in the presence of a severe IBD diagnosis. TWEETABLE ABSTRACT Deliveries among women with inflammatory bowel disease are increasing. Disease severity is associated with adverse outcomes.
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Affiliation(s)
- K Yu
- Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - A S Faye
- Department of Medicine, Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Division of Gastroenterology, Department of Medicine, NYU Grossman School of Medicine, Inflammatory Bowel Disease Center, NYU Langone Health, New York, NY, USA
| | - T Wen
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California-San Francisco, San Francisco, CA, USA
| | | | - Y Huang
- Department of Obstetrics and Gynecology, Columbia University, New York, NY, USA
| | - J D Wright
- Department of Obstetrics and Gynecology, Columbia University, New York, NY, USA
| | - M E D'Alton
- Department of Obstetrics and Gynecology, Columbia University, New York, NY, USA
| | - A M Friedman
- Department of Obstetrics and Gynecology, Columbia University, New York, NY, USA
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Zhang Y, Angley M, Qi X, Lu L, D'Alton ME, Kahe K. Maternal electronic cigarette exposure in relation to offspring development: a comprehensive review. Am J Obstet Gynecol MFM 2022; 4:100659. [PMID: 35568317 DOI: 10.1016/j.ajogmf.2022.100659] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 04/09/2022] [Accepted: 04/27/2022] [Indexed: 01/04/2023]
Abstract
Electronic cigarettes (e-cigarettes) have become increasingly popular in young generations in the United States. Because the adverse pregnancy outcomes associated with combustible cigarette smoking are well-recognized, many pregnant women switch to e-cigarettes believing that this alternative is low in toxic chemicals. However, most e-cigarettes contain nicotine, which can easily pass through the placenta and accumulate to a high concentration in fetal blood circulation. Studies have also detected toxic metals (eg, lead, cadmium, and nickel) in e-cigarettes, and carbonyl compounds and flavorings, which are suggested to be irritative and even carcinogenic. There are questions that need to be answered about the risks of e-cigarette exposure during pregnancy. Unfortunately, research evaluating the association between maternal e-cigarette exposure and offspring health is scarce, especially with regard to human studies. Some evidence from laboratory and animal studies, although inconsistent, showed that maternal exposure to e-cigarette vapor may lead to restricted growth of offspring. E-cigarette exposure may also have an impact on the metabolic health of offspring, manifested as distorted glucose homeostasis and energy metabolism. In addition, in utero exposure may lead to defects in respiratory, vascular, and neurologic system development. For humans, investigations mostly focused on immediate birth outcomes such as small-for-gestational-age neonates, low birthweight, and preterm birth; however, the results were inconclusive. Research also suggests that maternal e-cigarette exposure may result in compromised neurodevelopment in newborns. In summary, current evidence is insufficient to rigorously evaluate the health impacts of maternal e-cigarette use on offspring development. Future investigations are warranted.
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Affiliation(s)
- Yijia Zhang
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, NY (XX Zhang, XX Angley, XX Lu, XX D'Alton, and XX Kahe); Department of Epidemiology, Columbia University Irving Medical Center, New York, NY (XX Zhang, XX Angley, XX Lu, and XX Kahe)
| | - Meghan Angley
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, NY (XX Zhang, XX Angley, XX Lu, XX D'Alton, and XX Kahe); Department of Epidemiology, Columbia University Irving Medical Center, New York, NY (XX Zhang, XX Angley, XX Lu, and XX Kahe)
| | - Xinran Qi
- School of Nursing, Capital Medical University, Beijing, China (XX Qi)
| | - Liping Lu
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, NY (XX Zhang, XX Angley, XX Lu, XX D'Alton, and XX Kahe); Department of Epidemiology, Columbia University Irving Medical Center, New York, NY (XX Zhang, XX Angley, XX Lu, and XX Kahe)
| | - Mary E D'Alton
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, NY (XX Zhang, XX Angley, XX Lu, XX D'Alton, and XX Kahe)
| | - Ka Kahe
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, NY (XX Zhang, XX Angley, XX Lu, XX D'Alton, and XX Kahe); Department of Epidemiology, Columbia University Irving Medical Center, New York, NY (XX Zhang, XX Angley, XX Lu, and XX Kahe).
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Yang K, Chen C, Yan Q, Shen X, Jiang L, Ma R, Lu L, Zhu J, Tian Y, Cai W, D'Alton ME, Zhang J, Kahe K. Combined association of early exposure to long-chain n-3 polyunsaturated fatty acids, mercury and selenium with cognitive performance in 1-year-old infants. Environ Res 2022; 207:112186. [PMID: 34627802 DOI: 10.1016/j.envres.2021.112186] [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] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 09/18/2021] [Accepted: 10/04/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Previous studies on long-chain n-3 polyunsaturated fatty acids (LCn3PUFAs) and infant neurodevelopment did not consider effect modifications of mercury (Hg) and selenium (Se). OBJECTIVES To examine the joint association of prenatal LCn3PUFAs, Hg and Se with infant cognitive performance, and to explore whether DNA methylation may explain this potential association. METHODS A total of 484 newborns were enrolled from the Shanghai Birth Cohort with available data on cord blood LCn3PUFA, nail Hg and Se during 2015-2016. Cord blood LCn3PUFA concentrations were assessed by gas chromatography, and nail Hg and Se concentrations were measured using clippings collected within 6 months of birth by inductively coupled plasma mass spectrometry. Five aspects of infant neurodevelopment (communication, gross motor, fine motor, problem-solving, and personal-social skills) were assessed using the Age and Stage Questionnaire (ASQ) at ages 6 and 12 months. Multivariable-adjusted generalized estimating equations models were performed to examine the associations between cord blood LCn3PUFA concentrations and ASQ test scores, and these associations were stratified by nail Hg and Se levels. Epigenome-wide DNA methylation in cord blood was compared in a random subgroup consisting of 19 infants from the highest and 21 from the lowest decile of LCn3PUFA concentrations. RESULTS LCn3PUFAs were not significantly associated with any ASQ test scores. However, in the subgroup with lower Hg (<median 0.13 ppm) and higher Se (≥median 0.87 ppm) levels, infants with higher LCn3PUFA concentrations had higher ASQ scores indicating better performance in gross motor skills [quartile 4 vs. 1: mean difference = 7.78; 95% confidence interval=(3.47, 12.09); Ptrend<0.01; Pinteraction = 0.03]. Additionally, twenty CpG sites were differentially methylated when comparing high to low LCn3PUFA groups. CONCLUSION The association of prenatal LCn3PUFA concentrations with infant neurodevelopment, particularly gross motor skills, may be observed among infants with high Se and low Hg levels.
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Affiliation(s)
- Kefeng Yang
- Department of Nutrition, Xin Hua Hospital Affiliated to School of Medicine, Shanghai Jiao Tong University, Shanghai, China; Shanghai Key Laboratory of Pediatric Gastroenterology and Nutrition, Shanghai, China
| | - Cheng Chen
- Department of Obstetrics and Gynecology, Vagelos College of Physicians and Surgeons, Columbia University, New York, USA; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, USA
| | - Qi Yan
- Department of Obstetrics and Gynecology, Vagelos College of Physicians and Surgeons, Columbia University, New York, USA
| | - Xiuhua Shen
- Department of Nutrition, Xin Hua Hospital Affiliated to School of Medicine, Shanghai Jiao Tong University, Shanghai, China; Shanghai Key Laboratory of Pediatric Gastroenterology and Nutrition, Shanghai, China
| | - Linlei Jiang
- Instrumental Analysis Platform, School of Agriculture and Biology, Shanghai Jiao Tong University, Shanghai, China
| | - Rui Ma
- MOE-Shanghai Key Laboratory of Children's Environmental Health, Xin Hua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Liping Lu
- Department of Obstetrics and Gynecology, Vagelos College of Physicians and Surgeons, Columbia University, New York, USA; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, USA
| | - Jie Zhu
- Nutrition and Foods Program, School of Family and Consumer Sciences, Texas State University, San Marcos, TX, USA
| | - Ying Tian
- MOE-Shanghai Key Laboratory of Children's Environmental Health, Xin Hua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Wei Cai
- Department of Nutrition, Xin Hua Hospital Affiliated to School of Medicine, Shanghai Jiao Tong University, Shanghai, China; Shanghai Key Laboratory of Pediatric Gastroenterology and Nutrition, Shanghai, China
| | - Mary E D'Alton
- Department of Obstetrics and Gynecology, Vagelos College of Physicians and Surgeons, Columbia University, New York, USA
| | - Jun Zhang
- MOE-Shanghai Key Laboratory of Children's Environmental Health, Xin Hua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Ka Kahe
- Department of Obstetrics and Gynecology, Vagelos College of Physicians and Surgeons, Columbia University, New York, USA; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, USA.
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Emeruwa UN, Gyamfi-Bannerman C, Wen T, Booker W, Wright JD, Huang Y, D'Alton ME, Friedman AM. Adverse Outcomes during Postpartum Readmissions after Deliveries Complicated by Hypertensive Disorders of Pregnancy. Am J Perinatol 2022; 39:699-706. [PMID: 34768308 DOI: 10.1055/s-0041-1739429] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE This study aimed to characterize risk for postpartum complications based on specific hypertensive diagnosis at delivery. STUDY DESIGN This retrospective cohort study used the 2010 to 2014 Nationwide Readmissions Database to identify 60-day postpartum readmissions. Delivery hospitalizations were categorized based on hypertensive diagnoses as follows: (1) preeclampsia with severe features, (2) superimposed preeclampsia, (3) chronic hypertension, (4) preeclampsia without severe features, (5) gestational hypertension, or (6) no hypertensive diagnosis. Risks for 60-day readmission was determined based on hypertensive diagnosis at delivery. The following adverse outcomes during readmissions were analyzed: (1) stroke, (2) pulmonary edema and heart failure, (3) eclampsia, and (4) severe maternal morbidity (SMM). We fit multivariable log-linear regression models to assess the magnitude of association between hypertensive diagnoses at delivery and risks for readmission and associated complications with adjusted risk ratios (aRR) as measures of effect. RESULTS From 2010 to 2014, 15.7 million estimated delivery hospitalizations were included in the analysis. Overall risk for 60-day postpartum readmission was the highest among women with superimposed preeclampsia (6.6%), followed by preeclampsia with severe features (5.2%), chronic hypertension (4.0%), preeclampsia without severe features (3.9%), gestational hypertension (2.9%), and women without a hypertensive diagnosis (1.5%). In adjusted analyses for pulmonary edema and heart failure as the outcome, risks were the highest for preeclampsia with severe features (aRR = 7.82, 95% confidence interval [CI]: 6.03, 10.14), superimposed preeclampsia (aRR = 8.21, 95% CI: 5.79, 11.63), and preeclampsia without severe features (aRR = 8.87, 95% CI: 7.06, 11.15). In the adjusted model for stroke, risks were similarly highest for these three hypertensive diagnoses. Evaluating risks for SMM during postpartum readmission, chronic hypertension and superimposed preeclampsia were associated with the highest risks. CONCLUSION Chronic hypertension was associated with increased risk for a broad range of adverse postpartum outcomes. Risk estimates associated with chronic hypertension with and without superimposed preeclampsia were similar to preeclampsia with severe features for several outcomes. KEY POINTS · Chronic hypertension was associated with increased risk for a broad range of adverse outcomes.. · Close postpartum follow-up is required if hypertension is present at delivery.. · The majority of readmissions occurred within 10 days after delivery hospitalization discharge..
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Affiliation(s)
- Ukachi N Emeruwa
- Division of Maternal-Fetal Fetal Medicine, Department of Obstetrics and Gynecology, College of Physicians and Surgeons, Columbia University, New York, New York
| | - Cynthia Gyamfi-Bannerman
- Division of Maternal-Fetal Fetal Medicine, Department of Obstetrics and Gynecology, College of Physicians and Surgeons, Columbia University, New York, New York
| | - Timothy Wen
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, San Francisco, California
| | - Whitney Booker
- Division of Maternal-Fetal Fetal Medicine, Department of Obstetrics and Gynecology, College of Physicians and Surgeons, Columbia University, New York, New York
| | - Jason D Wright
- Division of Maternal-Fetal Fetal Medicine, Department of Obstetrics and Gynecology, College of Physicians and Surgeons, Columbia University, New York, New York
| | - Yongmei Huang
- Division of Maternal-Fetal Fetal Medicine, Department of Obstetrics and Gynecology, College of Physicians and Surgeons, Columbia University, New York, New York
| | - Mary E D'Alton
- Division of Maternal-Fetal Fetal Medicine, Department of Obstetrics and Gynecology, College of Physicians and Surgeons, Columbia University, New York, New York
| | - Alexander M Friedman
- Division of Maternal-Fetal Fetal Medicine, Department of Obstetrics and Gynecology, College of Physicians and Surgeons, Columbia University, New York, New York
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Spiegelman J, Bertozzi-Villa C, D'Alton ME, Aubey JJ, Fuchs K, Goffman D, Gyamfi-Bannerman C, Miller R, Robinson KE, Sheen JJ, Simpson LL, Valderrama NE, Wen T, Zork N, Friedman AM. Obstetric Inpatient and Ultrasound Clinical Personnel Absences during the COVID-19 Pandemic in New York City. Am J Perinatol 2022; 39:714-716. [PMID: 34808686 DOI: 10.1055/s-0041-1740008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To review obstetric personnel absences at a hospital during the initial peak of coronavirus disease 2019 (COVID-19) infection risk in New York City from March 25 to April 21, 2020. STUDY DESIGN This retrospective study evaluated absences at Morgan Stanley Children's Hospital. Clinical absences for (1) Columbia University ultrasonographers, (2) inpatient nurses, (3) labor and delivery operating room (OR) technicians, (4) inpatient obstetric nurse assistants, and (5) attending physicians providing inpatient obstetric services were analyzed. Causes of absences were analyzed and classified as illness, vacation and holidays, leave, and other causes. Categorical variables were compared with the chi-square test or Fisher's exact test. RESULTS For nurses, absences accounted for 1,052 nursing workdays in 2020 (17.2% of all workdays) compared with 670 (11.1%) workdays in 2019 (p < 0.01). Significant differentials in days absent in 2020 compared with 2019 were present for (1) postpartum nurses (21.9% compared with 12.9%, p < 0.01), (2) labor and delivery nurses (14.8% compared with 10.6%, p < 0.01), and (3) antepartum nurses (10.2% compared with 7.4%, p = 0.03). Evaluating nursing assistants, 24.3% of workdays were missed in 2020 compared with 17.4% in 2019 (p < 0.01). For ultrasonographers, there were 146 absences (25.2% of workdays) in 2020 compared with 96 absences (16.0% of workdays) in 2019 (p < 0.01). The proportion of workdays missed by OR technicians was 22.6% in 2020 and 18.3% in 2019 (p = 0.25). Evaluating attending physician absences, a total of 78 workdays were missed due to documented COVID-19 infection. Evaluating the causes of absences, illness increased significantly between 2019 and 2020 for nursing assistants (42.6 vs. 57.4%, p = 0.02), OR technicians (17.1 vs. 55.9%, p < 0.01), and nurses (15.5 vs. 33.7%, p < 0.01). CONCLUSION COVID-19 outbreak surge planning represents a major operational issue for medical specialties such as critical care due to increased clinical volume. Findings from this analysis suggest it is prudent to devise backup staffing plans. KEY POINTS · 1) COVID-19 outbreak surge planning represents a major operational issue for obstetrics.. · 2) Inpatient obstetric volume cannot be reduced.. · 3) Staffing contingencies plans for nurses, sonographers, and physicians may be required..
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Affiliation(s)
- Jessica Spiegelman
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, New York
| | - Clara Bertozzi-Villa
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, New York
| | - Mary E D'Alton
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, New York
| | - Janice J Aubey
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, New York
| | - Karin Fuchs
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, New York
| | - Dena Goffman
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, New York
| | - Cynthia Gyamfi-Bannerman
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, New York
| | - Russell Miller
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, New York
| | - Kenya E Robinson
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, New York
| | - Jean-Ju Sheen
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, New York
| | - Lynn L Simpson
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, New York
| | - Natali E Valderrama
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, New York
| | - Timothy Wen
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, New York
| | - Noelia Zork
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, New York
| | - Alexander M Friedman
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, New York
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Bousleiman S, Rouse DJ, Gyamfi-Bannerman C, Huang Y, D'Alton ME, Siddiq Z, Wright JD, Friedman AM. Decision to Incision and Risk for Fetal Acidemia, Low Apgar Scores, and Hypoxic Ischemic Encephalopathy. Am J Perinatol 2022; 39:416-424. [PMID: 32957140 DOI: 10.1055/s-0040-1717068] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE This study aimed to assess risk for fetal acidemia, low Apgar scores, and hypoxic ischemic encephalopathy based on decision-to-incision time interval in the setting of emergency cesarean delivery. STUDY DESIGN This unplanned secondary analysis of the Maternal-Fetal Medicine Units prospective observational cesarean registry dataset evaluated risk for hypoxic ischemic encephalopathy, umbilical cord pH ≤7.0, and Apgar score ≤4 at 5 minutes based on decision-to-incision time for emergency cesarean deliveries. Cesarean occurring for nonreassuring fetal heart rate monitoring, bleeding previa, nonreassuring antepartum testing, placental abruption, or cord prolapse was classified as emergent. Decision-to-incision time was categorized as <10 minutes, 10 to <20 minutes, 20 to <30 minutes, 30 to <50 minutes, or ≥50 minutes. As secondary outcomes umbilical cord pH ≤7.1, umbilical artery pH ≤7.0, and Apgar score ≤5 at 5 minutes were analyzed. RESULTS Of 5,784 women included in the primary analysis, 12.4% had a decision-to-incision interval ≤10 minutes, 20.2% 11 to 20 minutes, 14.9% 21 to 30 minutes, 18.2% 31 to 50 minutes, and 16.5% >50 minutes. Risk for umbilical cord pH ≤7.0 was highest at ≤10 and 11 to 20 minutes (10.2 and 7.9%, respectively), and lowest at 21 to 30 minutes (3.9%), 31 to 50 minutes (3.9%), and >50 minutes (3.5%) (p < 0.01). Risk for Apgar scores ≤4 at 5 minutes was also higher with decision-to-incision intervals ≤10 and 11 to 20 minutes (4.3 and 4.4%, respectively) compared with intervals of 21 to 30 minutes (1.7%), 31 to 50 minutes (2.1%), and >50 minutes (2.0%) (p < 0.01). Hypoxic ischemic encephalopathy occurred in 1.5 and 1.0% of women with decision-to-incision intervals of ≤10 and 11 to 20 minutes compared with 0.3 and 0.5% for women with decision-to-incision intervals of 21 to 30 minutes and 31 to 50 minutes (p = 0.04). Risk for secondary outcomes was also higher with shorter decision-to-incision intervals. CONCLUSION Shorter decision-to-incision times were associated with increased risk for adverse outcomes in the setting of emergency cesarean. KEY POINTS · Shorter intervals likely occur with higher risk cases.. · Shorter intervals were associated with higher neonatal risk.. · Shorter intervals were associated with low cord pH..
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Affiliation(s)
- Sabine Bousleiman
- Columbia University College of Physicians and Surgeons, New York Presbyterian Hospital, New York City, New York
| | - Dwight J Rouse
- Division of Research, Department of Obstetrics and Gynecology, Women and Infants Hospital, Warren Alpert Medical School at Brown University, Providence, Rhode Island
| | - Cynthia Gyamfi-Bannerman
- Columbia University College of Physicians and Surgeons, New York Presbyterian Hospital, New York City, New York
| | - Yongmei Huang
- Columbia University College of Physicians and Surgeons, New York Presbyterian Hospital, New York City, New York
| | - Mary E D'Alton
- Columbia University College of Physicians and Surgeons, New York Presbyterian Hospital, New York City, New York
| | - Zainab Siddiq
- Columbia University College of Physicians and Surgeons, New York Presbyterian Hospital, New York City, New York
| | - Jason D Wright
- Columbia University College of Physicians and Surgeons, New York Presbyterian Hospital, New York City, New York
| | - Alexander M Friedman
- Columbia University College of Physicians and Surgeons, New York Presbyterian Hospital, New York City, New York
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Duffy CR, Huang Y, Andrikopoulou M, Stern-Ascher CN, Wright JD, D'Alton ME, Friedman AM. Vancomycin during delivery hospitalizations for women with group B streptococcus. J Matern Fetal Neonatal Med 2022; 35:898-906. [PMID: 32160789 PMCID: PMC7757725 DOI: 10.1080/14767058.2020.1733520] [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] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 02/07/2020] [Accepted: 02/19/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Vancomycin use for intrapartum GBS prophylaxis is not well characterized. The objective of this study was to describe trends in the use of vancomycin among women undergoing vaginal delivery with group B Streptococcus (GBS) colonization. METHODS An administrative inpatient database that includes medications was analyzed to evaluate antibiotic use in women undergoing vaginal delivery hospitalizations complicated by GBS colonization from January 2006 to March 2015. Patients with other obstetric or infectious indications for antibiotics were excluded. Frequency of use of individual antibiotic agents was determined. The Cochran-Armitage test was used to assess temporal trends. An adjusted log-linear regression model accounting for demographic and hospital factors with vancomycin receipt as the outcome was performed with adjusted risk ratios (aRR) and 95% confidence intervals (CI) as the measure of effect. Hospital level variation in administration of vancomycin was also evaluated. RESULTS 469,717 deliveries met inclusion criteria and were included in this analysis. Use of vancomycin increased from 0.8% of patients in 2006 to 3.8% of patients in the first quarter of 2015. Comparing 2015 to 2006 both the unadjusted (relative risk 4.89 95% CI 4.26-5.60) and adjusted (aRR 4.52 95% 3.94-5.19) models demonstrated significantly increased likelihood of vancomycin administration. In evaluating hospital level vancomycin use, variation was noted with 8.0% of centers administering vancomycin to ≥6.0% of patients. CONCLUSIONS Vancomycin is becoming increasingly commonly used for intrapartum GBS prophylaxis. Further research and quality improvements initiatives are indicated to optimize intrapartum GBS antibiotic prophylaxis.
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Affiliation(s)
- Cassandra R Duffy
- Division of Maternal-Fetal Fetal Medicine, Department of Obstetrics and Gynecology, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Yongmei Huang
- Division of Maternal-Fetal Fetal Medicine, Department of Obstetrics and Gynecology, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Maria Andrikopoulou
- Division of Maternal-Fetal Fetal Medicine, Department of Obstetrics and Gynecology, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Conrad N Stern-Ascher
- Division of Maternal-Fetal Fetal Medicine, Department of Obstetrics and Gynecology, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Jason D Wright
- Division of Maternal-Fetal Fetal Medicine, Department of Obstetrics and Gynecology, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Mary E D'Alton
- Division of Maternal-Fetal Fetal Medicine, Department of Obstetrics and Gynecology, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Alexander M Friedman
- Division of Maternal-Fetal Fetal Medicine, Department of Obstetrics and Gynecology, College of Physicians and Surgeons, Columbia University, New York, NY, USA
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Logue TC, Wen T, Monk C, Guglielminotti J, Huang Y, Wright JD, D'Alton ME, Friedman AM. Trends in and complications associated with mental health condition diagnoses during delivery hospitalizations. Am J Obstet Gynecol 2022; 226:405.e1-405.e16. [PMID: 34563500 DOI: 10.1016/j.ajog.2021.09.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 07/15/2021] [Revised: 09/14/2021] [Accepted: 09/17/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Mental health conditions during delivery hospitalizations are not well characterized. OBJECTIVE This study aimed to characterize the prevalence of maternal mental health condition diagnoses and associated risk during delivery hospitalizations in the United States. STUDY DESIGN The 2000 to 2018 National Inpatient Sample was used for this repeated cross-sectional analysis. Delivery hospitalizations of women aged 15 to 54 years with and without mental health condition diagnoses, including depressive disorder, anxiety disorder, bipolar spectrum disorder, and schizophrenia spectrum disorder, were identified. Temporal trends in mental health condition diagnoses during delivery hospitalizations were determined using the National Cancer Institute's Joinpoint Regression Program to estimate the average annual percent change with 95% confidence intervals. The trends in chronic conditions associated with mental health condition diagnoses, including asthma, pregestational diabetes mellitus, chronic hypertension, obesity, and substance use, were analyzed. The association between mental health conditions and the following adverse outcomes was determined: (1) severe maternal morbidity, (2) preeclampsia or gestational hypertension, (3) preterm delivery, (4) postpartum hemorrhage, (5) cesarean delivery, and (6) maternal mortality. Regression models for each outcome were performed with unadjusted and adjusted risk ratios as measures of effects. RESULTS Of 73,109,791 delivery hospitalizations, 2,316,963 (3.2%) had ≥1 associated mental health condition diagnosis. The proportion of delivery hospitalizations with a mental health condition increased from 0.6% in 2000 to 7.3% in 2018 (average annual percent change, 11.4%; 95% confidence interval, 10.3%-12.6%). Among deliveries in women with a mental health condition diagnosis, chronic health conditions, including asthma, pregestational diabetes mellitus, chronic hypertension, obesity, and substance use, increased from 14.9% in 2000 to 38.5% in 2018. Deliveries to women with a mental health condition diagnosis were associated with severe maternal morbidity (risk ratio, 1.88; 95% confidence interval, 1.86-1.90), preeclampsia and gestational hypertension (risk ratio, 1.59; 95% confidence interval, 1.58-1.60), preterm delivery (risk ratio, 1.35; 95% confidence interval, 1.35-1.36), postpartum hemorrhage (risk ratio, 1.37; 95% confidence interval, 1.36-1.38), cesarean delivery (risk ratio, 1.20; 95% confidence interval, 1.20-1.20), and maternal death (risk ratio, 1.31; 95% confidence interval, 1.12-1.56). The increased risk was retained in adjusted models. CONCLUSION The proportion of delivery hospitalizations with mental health condition diagnoses increased significantly throughout the study period. Mental health condition diagnoses were associated with other underlying chronic health conditions and a modestly increased risk of a range of adverse outcomes. The findings suggested that mental health conditions are an important risk factor in adverse maternal outcomes.
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Affiliation(s)
- Teresa C Logue
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, NY
| | - Timothy Wen
- Department of Obstetrics and Gynecology, University of California San Francisco, San Francisco, CA
| | - Catherine Monk
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, NY; New York State Psychiatric Institute, New York, NY
| | - Jean Guglielminotti
- Department of Anesthesiology, Columbia University Irving Medical Center, New York, NY
| | - Yongmei Huang
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, NY
| | - Jason D Wright
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, NY
| | - Mary E D'Alton
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, NY
| | - Alexander M Friedman
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, NY.
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Wen T, Corbetta-Rastelli C, Sobhani NC, Liu B, Arditi B, D'Alton ME, Friedman AM. National trends, estimated costs, and predictors of ‘never events’ following birth hospitalization. Am J Obstet Gynecol 2022. [DOI: 10.1016/j.ajog.2021.11.990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Andrikopoulou M, Wen T, Sheen JJ, D'Alton ME, Friedman AM. Obesity and nulliparous, term, singleton, vertex cesarean delivery rates on the United States county level. Am J Obstet Gynecol 2022. [DOI: 10.1016/j.ajog.2021.11.932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Linder AH, Wen T, Purisch S, D'Alton ME, Friedman AM. Delivery trends and outcomes in pregnant women with adult congenital heart disease from 2000-2018. Am J Obstet Gynecol 2022. [DOI: 10.1016/j.ajog.2021.11.605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Yu K, Faye A, Wen T, Guglielminotti J, Huang Y, Wright JD, D'Alton ME, Friedman AM. Trends in and Outcomes during Delivery Hospitalizations with Inflammatory Bowel Disease. Am J Obstet Gynecol 2022. [DOI: 10.1016/j.ajog.2021.11.610] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
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Wen T, Arditi B, Sobhani NC, Corbetta-Rastelli C, Liu B, D'Alton ME, Friedman AM. National trends in postpartum readmission risk for venous thromboembolism. Am J Obstet Gynecol 2022. [DOI: 10.1016/j.ajog.2021.11.481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Oberlin AM, Wen T, D'Alton ME, Friedman AM. Risk factors for obstetric venous thromboembolism stratified by mode of delivery. Am J Obstet Gynecol 2022. [DOI: 10.1016/j.ajog.2021.11.763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
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