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Whelan AR, Recabo O, Ayala NK, Clark MA, Lewkowitz AK. Unplanned Operative Delivery is Associated with Decreased Perception of Control over Labor. R I Med J (2013) 2024; 107:29-30. [PMID: 38536137] [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] [Subscribe] [Scholar Register] [Indexed: 04/09/2024]
Affiliation(s)
- Anna R Whelan
- Division of Maternal-Fetal Medicine, Women & Infants Hospital of Rhode Island, Alpert Medical School of Brown University, Providence, RI
| | - Olivia Recabo
- Department of Obstetrics and Gynecology, New York Medical College, Valhalla, NY
| | - Nina K Ayala
- Division of Maternal-Fetal Medicine, Women & Infants Hospital of Rhode Island, Alpert Medical School of Brown University, Providence, RI
| | - Melissa A Clark
- Division of Maternal-Fetal Medicine, Women & Infants Hospital of Rhode Island, Alpert Medical School of Brown University; Department of Health Services, Policy and Practice, Brown University School of Public Health, Providence, RI
| | - Adam K Lewkowitz
- Division of Maternal-Fetal Medicine, Women & Infants Hospital of Rhode Island, Alpert Medical School of Brown University, Providence, RI
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Ayala NK, Rouse DJ. Failed induction of labor. Am J Obstet Gynecol 2024; 230:S769-S774. [PMID: 36848041 DOI: 10.1016/j.ajog.2021.06.103] [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: 01/15/2021] [Revised: 05/27/2021] [Accepted: 06/01/2021] [Indexed: 11/30/2022]
Abstract
Induction of labor is a widely used practice. From 2016 to 2019, >1 in 3 women giving birth in the United States did so after undergoing labor induction. The obvious goal of labor induction is vaginal birth with minimal maternal or neonatal morbidity. To achieve this goal, criteria for failed labor induction are needed. Herein, we provide an evidence-based approach to safely prevent unnecessary cesarean deliveries for failed induction. Although there are no randomized trials comparing failed labor induction criteria, the observational data have been consistent: if the status of the mother and the fetus permits, at least 12 to 18 hours of oxytocin should be administered after membrane rupture before deeming an induction of labor to have failed because of nonprogression to the active phase of labor.
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Affiliation(s)
- Nina K Ayala
- Division of Maternal-Fetal Medicine, Women & Infants Hospital of Rhode Island, Alpert Medical School of Brown University, Providence, RI.
| | - Dwight J Rouse
- Division of Maternal-Fetal Medicine, Women & Infants Hospital of Rhode Island, Alpert Medical School of Brown University, Providence, RI
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3
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Lewkowitz AK, Ayala NK, Miller ES. Perinatal Digital Mental Health Interventions: Further analysis of risk factors for high loss-to-follow-up rates. Am J Obstet Gynecol 2024:S0002-9378(24)00367-3. [PMID: 38408625 DOI: 10.1016/j.ajog.2024.02.287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 02/15/2024] [Indexed: 02/28/2024]
Affiliation(s)
- Adam K Lewkowitz
- Department of Obstetrics and Gynecology, Warren Alpert Medical School at Brown University, Providence, Rhode Island, USA; Center for Digital Health, Brown School of Public Health, Providence, Rhode Island, USA.
| | - Nina K Ayala
- Department of Obstetrics and Gynecology, Warren Alpert Medical School at Brown University, Providence, Rhode Island, USA
| | - Emily S Miller
- Department of Obstetrics and Gynecology, Warren Alpert Medical School at Brown University, Providence, Rhode Island, USA
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Ayala NK, Fain AC, Smith MM, Schlichting LE, Hamel MS, Werner EF. Implementation of In-Hospital Postpartum Glucose Tolerance Testing for People with Gestational Diabetes. Am J Perinatol 2024. [PMID: 38290557 DOI: 10.1055/a-2257-3341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2024]
Abstract
OBJECTIVE We aimed to evaluate uptake of the glucose tolerance test performed during delivery hospitalization as part of routine clinical care. STUDY DESIGN This is a retrospective cohort study of people with GDM at a tertiary center. We collected 9 months of postimplementation data after the in-hospital ("early") glucose tolerance test was adopted as a routine screening option. Adherence was compared between those who elected early glucose tolerance testing versus those who deferred testing to the standard postpartum period. Bivariable statistics including demographics, care team, and postpartum testing/visit attendance were compared between those who received early testing and those who did not using chi-square, Fisher's exact, and t-tests. RESULTS A total of 681 patients with GDM delivered during the study period. Of those who had an early glucose tolerance test ordered (n = 408), 340 (83.3%) completed the test. Among those who did not complete an early glucose tolerance test (ordered and not completed or never ordered), only 104/341 (30.5%) completed any postpartum glucose testing in the first 12 months of postpartum. There were significant differences in characteristics in terms of race/ethnicity, insurance, type of gestational diabetes (A1GDM vs. A2GDM), diabetes medications, obstetric care provider, and delivery mode. Among those who completed early testing, 43.7% of participants had impaired glucose metabolism and 6.5% had values concerning for overt diabetes mellitus. Among those who deferred testing to the standard 6- to 12-week period, 24.0% had impaired glucose metabolism and none had overt diabetes. Those who completed an early glucose tolerance test had a lower rate of postpartum visit attendance compared with those who deferred (75.6 vs. 91.5%, p < 0.01). CONCLUSION In this cohort, when the early glucose tolerance test is offered in clinical practice, adherence rates are higher than when the test is deferred until the postpartum visit. KEY POINTS · Adherence rates with the early glucose tolerance test (GTT) are higher than if the testing is deferred.. · Those who completed an early GTT had a lower rate of postpartum visit attendance compared with those who deferred.. · Offering an in-hospital postpartum GTT can help address low rates of glucose testing postpartum..
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Affiliation(s)
- Nina K Ayala
- Division of Maternal Fetal Medicine, Women and Infants Hospital of Rhode Island, Alpert Medical School of Brown University, Providence, Rhode Island
- Department of Obstetrics and Gynecology, David Geffen School of Medicine UCLA, Los Angeles, California
| | - Audra C Fain
- Department of Obstetrics and Gynecology, David Geffen School of Medicine UCLA, Los Angeles, California
| | - Megan M Smith
- Division of Maternal Fetal Medicine, Women and Infants Hospital of Rhode Island, Alpert Medical School of Brown University, Providence, Rhode Island
| | - Lauren E Schlichting
- Hassenfeld Childe Health and Innovation Institute of Brown University, Providence, Rhode Island
| | - Maureen S Hamel
- Division of Maternal Fetal Medicine, Women and Infants Hospital of Rhode Island, Alpert Medical School of Brown University, Providence, Rhode Island
- Department of Obstetrics and Gynecology, David Geffen School of Medicine UCLA, Los Angeles, California
| | - Erika F Werner
- Department of Obstetrics and Gynecology, Tufts University School of Medicine, Boston, Massachusetts
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5
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Ayala NK, Fain AC, Cersonsky TEK, Werner EF, Miller ES, Clark MA, Lewkowitz AK. Early-Pregnancy Resilience Characteristics Before Versus During the COVID-19 Pandemic. Am J Perinatol 2024. [PMID: 38290556 DOI: 10.1055/a-2257-3992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2024]
Abstract
OBJECTIVE Resilience is associated with mental and somatic health benefits. Given the social, physical, and mental health toll of the coronavirus disease 2019 (COVID-19) pandemic, we examined whether the COVID-19 pandemic was associated with population-level changes in resilience among pregnant people. STUDY DESIGN Secondary analysis of a prospective cohort of nulliparous pregnant people <20 weeks' gestation from a single hospital. Participants completed baseline assessments of resilience characteristics, including dispositional optimism (DO), mindfulness, and proactive coping. For this analysis, participants recruited before the COVID-19 pandemic were compared with those recruited during the pandemic. The primary outcome was DO, assessed as a continuous score on the validated Revised Life Orientation Test. Secondary outcomes included continuous scores on mindfulness and proactive coping assessments. Bivariable analyses were completed using chi-squared and Mann-Whitney U tests. Multivariable linear regression compared resilience scores by recruitment time frame, controlling for confounders selected a priori: maternal age, education, and marital status. RESULTS Of the 300 participants, 152 (50.7%) were recruited prior to the pandemic. Demographic and pregnancy characteristics differed between groups: the during-pandemic group was older, had higher levels of education, and were more likely to be married/partnered. There were no significant differences in any of the resilience characteristics before versus during the pandemic in bivariable or multivariable analyses. CONCLUSION In this cohort, there were no differences in early pregnancy resilience characteristics before versus during the COVID-19 pandemic. This affirms that on a population level, resilience is a stable metric, even in the setting of a global pandemic. KEY POINTS · Resilience is associated with mental and somatic health benefits.. · No difference in early-pregnancy resilience in those recruited before versus during the pandemic.. · Consistent with conceptualization of resilience as an innate characteristic..
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Affiliation(s)
- Nina K Ayala
- Department of Obstetrics and Gynecology, Alpert Medical School of Brown University, Providence, Rhode Island
| | - Audra C Fain
- Department of Obstetrics and Gynecology, David Geffen School of Medicine UCLA, Los Angeles, California
| | - Tess E K Cersonsky
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Icahn School of Medicine at Mount Sinai Hospital, New York, New York
| | - Erika F Werner
- Department of Obstetrics and Gynecology, Tufts University School of Medicine, Boston, Massachusetts
| | - Emily S Miller
- Department of Obstetrics and Gynecology, Alpert Medical School of Brown University, Providence, Rhode Island
| | - Melissa A Clark
- Department of Obstetrics and Gynecology, Alpert Medical School of Brown University, Providence, Rhode Island
- Department of Health Services, Policy and Practice, Brown School of Public Health, Providence, Rhode Island
| | - Adam K Lewkowitz
- Department of Obstetrics and Gynecology, Alpert Medical School of Brown University, Providence, Rhode Island
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Polnaszek BE, Whelan AR, Recabo O, Rossen J, Lewkowitz AK, Ayala NK. Internal Versus External Intrapartum Monitoring and Birthing Persons Perception of Control During Childbirth. R I Med J (2013) 2024; 107:34-36. [PMID: 38166076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/04/2024]
Affiliation(s)
- Brock E Polnaszek
- Warren Alpert Medical School of Brown University, Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Women & Infants Hospital, Providence, Rhode Island
| | - Anna R Whelan
- Warren Alpert Medical School of Brown University, Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Women & Infants Hospital, Providence, Rhode Island
| | | | - Julia Rossen
- Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Adam K Lewkowitz
- Warren Alpert Medical School of Brown University, Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Women & Infants Hospital, Providence, Rhode Island
| | - Nina K Ayala
- Warren Alpert Medical School of Brown University, Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Women & Infants Hospital, Providence, Rhode Island
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Gimovsky AC, Rasiah SS, Vergara-Lopez C, Has P, Ayala NK, Stroud LR. Psyche: The 5th 'P' and its Associated Impact on the Second Stage of Labor. R I Med J (2013) 2024; 107:37-44. [PMID: 38166077 PMCID: PMC10836059] [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] [Subscribe] [Scholar Register] [Indexed: 01/04/2024]
Abstract
OBJECTIVE Patients with depression during labor display dysregulated patterns of oxytocin release and this may impact second stage of labor. The objective of this study was to evaluate the association between maternal preconception and antenatal depressive disorders on the duration of second stage of labor and perinatal outcomes. STUDY DESIGN Secondary analysis of patients enrolled in the Behavioral and Mood in Mothers, Behavior in Infants study who reached the second stage of labor. Participants were assigned to: pre-conception only major depressive disorder (MDD), prenatal major depressive disorder, and non-depressed controls. Primary outcome was prolonged second stage of labor. Secondary outcomes included perinatal morbidities. RESULTS 172 patients were included. 24.4% (42/172) participants had preconception-only MDD, 42.4% (73/172) patients had prenatal MDD, and 33.1% (57/172) patients had as non-depressed controls. The adjusted pair-wise analysis between groups showed no significant difference in the duration of second stage. No statistically significant differences were noted between groups for adverse neonatal outcomes. CONCLUSION Maternal depressive disorders did not impact length of second stage of labor or immediate perinatal outcomes.
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Affiliation(s)
- Alexis C Gimovsky
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Alpert Medical School of Brown University, Providence, RI
| | - Stephen S Rasiah
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Alpert Medical School of Brown University, Providence, RI
| | - Chrystal Vergara-Lopez
- Center for Behavioral and Preventive Medicine, The Miriam Hospital; Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University, Providence, RI
| | - Phinnara Has
- Lifespan Biostatistics, Epidemiology and Research Design, Rhode Island Hospital, Alpert Medical School of Brown University, Providence, RI
| | - Nina K Ayala
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Alpert Medical School of Brown University, Providence, RI
| | - Laura R Stroud
- Center for Behavioral and Preventive Medicine, The Miriam Hospital; Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University, Providence, RI
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Lewkowitz AK, Whelan AR, Ayala NK, Hardi A, Stoll C, Battle CL, Tuuli MG, Ranney ML, Miller ES. The effect of digital health interventions on postpartum depression or anxiety: a systematic review and meta-analysis of randomized controlled trials. Am J Obstet Gynecol 2024; 230:12-43. [PMID: 37330123 PMCID: PMC10721728 DOI: 10.1016/j.ajog.2023.06.028] [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: 03/13/2023] [Revised: 06/07/2023] [Accepted: 06/08/2023] [Indexed: 06/19/2023]
Abstract
OBJECTIVE This study aimed to examine the effect of digital health interventions compared with treatment as usual on preventing and treating postpartum depression and postpartum anxiety. DATA SOURCES Searches were conducted in Ovid MEDLINE, Embase, Scopus, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov. STUDY ELIGIBILITY REQUIREMENTS The systematic review included full-text randomized controlled trials comparing digital health interventions with treatment as usual for preventing or treating postpartum depression and postpartum anxiety. STUDY APPRAISAL AND SYNTHESIS METHODS Two authors independently screened all abstracts for eligibility and independently reviewed all potentially eligible full-text articles for inclusion. A third author screened abstracts and full-text articles as needed to determine eligibility in cases of discrepancy. The primary outcome was the score on the first ascertainment of postpartum depression or postpartum anxiety symptoms after the intervention. Secondary outcomes included screening positive for postpartum depression or postpartum anxiety --as defined in the primary study --and loss to follow-up, defined as the proportion of participants who completed the final study assessment compared with the number of initially randomized participants. For continuous outcomes, the Hedges method was used to obtain standardized mean differences when the studies used different psychometric scales, and weighted mean differences were calculated when studies used the same psychometric scales. For categorical outcomes, pooled relative risks were estimated. RESULTS Of 921 studies originally identified, 31 randomized controlled trials-corresponding to 5532 participants randomized to digital health intervention and 5492 participants randomized to treatment as usual-were included. Compared with treatment as usual, digital health interventions significantly reduced mean scores ascertaining postpartum depression symptoms (29 studies: standardized mean difference, -0.64 [95% confidence interval, -0.88 to -0.40]; I2=94.4%) and postpartum anxiety symptoms (17 studies: standardized mean difference, -0.49 [95% confidence interval, -0.72 to -0.25]; I2=84.6%). In the few studies that assessed screen-positive rates for postpartum depression (n=4) or postpartum anxiety (n=1), there were no significant differences between those randomized to digital health intervention and treatment as usual. Overall, those randomized to digital health intervention had 38% increased risk of not completing the final study assessment compared with those randomized to treatment as usual (pooled relative risk, 1.38 [95% confidence interval, 1.18-1.62]), but those randomized to app-based digital health intervention had similar loss-to-follow-up rates as those randomized to treatment as usual (relative risk, 1.04 [95% confidence interval, 0.91-1.19]). CONCLUSION Digital health interventions modestly, but significantly, reduced scores assessing postpartum depression and postpartum anxiety symptoms. More research is needed to identify digital health interventions that effectively prevent or treat postpartum depression and postpartum anxiety but encourage ongoing engagement throughout the study period.
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Affiliation(s)
- Adam K Lewkowitz
- Department of Obstetrics and Gynecology, Warren Alpert Medical School, Brown University, Providence, RI; Center for Digital Health, Brown University School of Public Health, Providence, RI.
| | - Anna R Whelan
- Department of Obstetrics and Gynecology, Warren Alpert Medical School, Brown University, Providence, RI
| | - Nina K Ayala
- Department of Obstetrics and Gynecology, Warren Alpert Medical School, Brown University, Providence, RI
| | - Angela Hardi
- Becker Medical Library, Washington University School of Medicine in St. Louis, St. Louis, MO
| | - Carrie Stoll
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine in St. Louis, St. Louis, MO
| | - Cynthia L Battle
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University, Providence, RI
| | - Methodius G Tuuli
- Department of Obstetrics and Gynecology, Warren Alpert Medical School, Brown University, Providence, RI
| | - Megan L Ranney
- Center for Digital Health, Brown University School of Public Health, Providence, RI; Department of Emergency Medicine, Warren Alpert Medical School, Brown University, Providence, RI
| | - Emily S Miller
- Department of Obstetrics and Gynecology, Warren Alpert Medical School, Brown University, Providence, RI
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Smith MM, Cersonsky TEK, Ayala NK, Reddy U, Saade GR, Dudley DJ, Silver RM, Pinar H, Goldenberg RL, Lewkowitz AK, Polnaszek BE. Social vulnerability index and stillbirth: a secondary analysis of the Stillbirth Collaborative Research Network. Am J Obstet Gynecol 2023:S0002-9378(23)02131-2. [PMID: 38097031 DOI: 10.1016/j.ajog.2023.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 12/08/2023] [Indexed: 01/28/2024]
Affiliation(s)
- Megan M Smith
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Warren Alpert Medical School of Brown University, Women and Infants Hospital of Rhode Island, 101 Dudley St., Providence, RI 02885.
| | - Tess E K Cersonsky
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Warren Alpert Medical School of Brown University, Women and Infants Hospital of Rhode Island, 101 Dudley St., Providence, RI 02885
| | - Nina K Ayala
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Warren Alpert Medical School of Brown University, Women and Infants Hospital of Rhode Island, 101 Dudley St., Providence, RI 02885
| | - Uma Reddy
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Columbia University, New York, NY
| | - George R Saade
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, VA
| | - Donald J Dudley
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Virginia, Charlottesville, VA
| | - Robert M Silver
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Utah Health, Salt Lake City, UT
| | - Halit Pinar
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Warren Alpert Medical School of Brown University, Women and Infants Hospital of Rhode Island, Providence, RI
| | - Robert L Goldenberg
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Columbia University, New York, NY
| | - Adam K Lewkowitz
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Warren Alpert Medical School of Brown University, Women and Infants Hospital of Rhode Island, Providence, RI
| | - Brock E Polnaszek
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Warren Alpert Medical School of Brown University, Women and Infants Hospital of Rhode Island, Providence, RI
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Ayala NK, Fain AC, Cersonsky TEK, Werner EF, Miller ES, Clark MA, Lewkowitz AK. Early pregnancy dispositional optimism and pregnancy outcomes among nulliparous people. Am J Obstet Gynecol MFM 2023; 5:101155. [PMID: 37734660 PMCID: PMC10841240 DOI: 10.1016/j.ajogmf.2023.101155] [Citation(s) in RCA: 1] [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: 06/29/2023] [Revised: 09/07/2023] [Accepted: 09/07/2023] [Indexed: 09/23/2023]
Abstract
BACKGROUND Dispositional optimism, the expectation of positive outcomes after personal challenges, is a resilience factor associated with widespread health benefits. However, the data on pregnancy-related outcomes are more limited. OBJECTIVE This study aimed to assess the association of early pregnancy dispositional optimism with adverse perinatal outcomes. STUDY DESIGN This was a prospective cohort study completed between May 2019 and February 2022 at a single, large tertiary medical center. Nulliparous pregnant people were recruited from outpatient obstetrical care sites. Participants completed a validated assessment of dispositional optimism at <20 weeks of gestation and were followed up until delivery. The primary outcome was an adverse maternal outcome composite that included gestational diabetes mellitus, hypertensive disorders of pregnancy, and/or cesarean delivery. The secondary outcomes included individual composite components and a neonatal morbidity composite. Bivariate analyses compared characteristics and primary and secondary outcomes by dispositional optimism score quartile. Multivariable logistic regression compared outcomes by dispositional optimism score quartile with the highest quartile serving as the referent, controlling for confounders determined a priori. RESULTS Overall, 491 pregnant people were approached for participation, and 135 pregnant people (27.5%) declined participation. Among the 284 individuals who enrolled and had complete outcome data, the median dispositional optimism score was 16.0 (interquartile range, 14-18), and 47.9% of individuals experienced at least 1 adverse maternal outcome 135 (47.9%). After adjusting for confounders, the odds of adverse maternal outcomes were significantly higher in the lowest 2 optimism quartiles: quartile 1 (adjusted odds ratio, 3.33; 95% confidence interval, 1.57-7.36) and quartile 2 (adjusted odds ratio, 2.22; 95% confidence interval, 1.05-4.79) than the highest quartile. This was driven by significantly higher rates of hypertension (quartile 1: adjusted odds ratio, 2.62; 95% confidence interval, 1.12-6.29) and cesarean delivery (quartile 1: adjusted odds ratio, 2.75; 95% confidence interval, 1.20-6.55). There was no difference noted when quartile 3 was compared with quartile 4. CONCLUSION Lower early pregnancy dispositional optimism was associated with significantly higher odds of adverse maternal outcomes. Interventions targeting improvements in optimism may be a novel mechanism for reducing perinatal morbidity.
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Affiliation(s)
- Nina K Ayala
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Women and Infants Hospital of Rhode Island, Providence, RI (Drs Ayala, Miller, and Lewkowitz); Department of Obstetrics and Gynecology, Alpert Medical School of Brown University, Providence, RI (Drs Ayala, Miller, Clark, and Lewkowitz).
| | - Audra C Fain
- Warren Alpert Medical School of Brown University, Providence, RI (Drs Fain and Cersonsky)
| | - Tess E K Cersonsky
- Warren Alpert Medical School of Brown University, Providence, RI (Drs Fain and Cersonsky)
| | - Erika F Werner
- Department of Obstetrics and Gynecology, Tufts University School of Medicine, Boston, MA (Dr Werner)
| | - Emily S Miller
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Women and Infants Hospital of Rhode Island, Providence, RI (Drs Ayala, Miller, and Lewkowitz); Department of Obstetrics and Gynecology, Alpert Medical School of Brown University, Providence, RI (Drs Ayala, Miller, Clark, and Lewkowitz)
| | - Melissa A Clark
- Department of Obstetrics and Gynecology, Alpert Medical School of Brown University, Providence, RI (Drs Ayala, Miller, Clark, and Lewkowitz); Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI (Dr Clark)
| | - Adam K Lewkowitz
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Women and Infants Hospital of Rhode Island, Providence, RI (Drs Ayala, Miller, and Lewkowitz); Department of Obstetrics and Gynecology, Alpert Medical School of Brown University, Providence, RI (Drs Ayala, Miller, Clark, and Lewkowitz)
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11
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Lewkowitz AK, Guille C, Rubin-Miller L, Jahnke HR, Ayala NK, Miller ES, Henrich N. Association between nonbirthing parent's perinatal education and mental health support desires and perinatal anxiety among either parent. Am J Obstet Gynecol MFM 2023; 5:101177. [PMID: 37806649 PMCID: PMC10842621 DOI: 10.1016/j.ajogmf.2023.101177] [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: 07/05/2023] [Revised: 09/19/2023] [Accepted: 10/03/2023] [Indexed: 10/10/2023]
Abstract
BACKGROUND Although perinatal anxiety is common in birthing and nonbirthing parents, little is known about the mental health or educational needs of nonbirthing parents during the perinatal period and whether perinatal anxiety in the birthing parent is associated with nonbirthing parent educational preferences. OBJECTIVE This study aimed to examine the desired digital perinatal educational preferences of nonbirthing parents and whether these preferences differed by (1) endorsement of high parenthood-related anxiety in the nonbirthing partner and (2) mental health of the birthing parent (including both identified mental health conditions and presence of pregnancy-related anxiety). STUDY DESIGN In this cross-sectional study, nonbirthing and birthing parents using Maven, a digital perinatal health platform, selected the areas in which they wanted education or support from a list of options. In addition, the participants reported their experience of parenthood or pregnancy-related anxiety through a 5-item Likert scale in response to the prompt, "On a scale of 1 (not at all) to 5 (extremely), how anxious are you feeling about parenthood or pregnancy?" High parenthood or pregnancy-related anxiety was defined as being very (scale: 4) or extremely (scale: 5) anxious. Furthermore, birthing parents reported whether they had a current or previous mood disorder, but this information was not reported by nonbirthing parents. Survey responses for birthing and nonbirthing parents were linked through the digital platform. Descriptive analyses were used to assess nonbirthing parent demographics and perinatal support interests, stratified by high parenthood-related anxiety, high pregnancy-related anxiety in their partner, and perinatal mood disorders or high pregnancy-related anxiety in their partner. RESULTS Among 382 nonbirthing parents, most (85.6%) desired to receive digital support during their partner's pregnancy: the most commonly endorsed support interests were infant care (327 [85.6%]) and understanding their partner's emotional (313 [81.9%]) or physical (294 [77.0%]) experience during pregnancy. Overall, 355 nonbirthing parents (93.9%) endorsed any parenthood-related anxiety, and 63 nonbirthing parents (16.5%) were categorized as having high parenthood-related anxiety. Those with high parenthood-related anxiety were more likely to desire digital support for each topic. Among birthing parents, 124 (32.4%) had a mental health condition, and 45 (11.8%) had high pregnancy-related anxiety. When nonbirthing parents were stratified by the presence of their partner having a mental health condition or high pregnancy-related anxiety alone, no difference in desired perinatal education was identified. Although nonbirthing parents had higher rates of high parenthood-related anxiety if the birthing parent reported high pregnancy anxiety (17 [27.0%] vs 28 [8.8%]; P<.001), no difference was found with other conditions within the mental health composite. CONCLUSION In this cross-sectional study, many nonbirthing parents who engaged with a perinatal digital platform desired education on their or their partner's emotional health during the perinatal period, and most endorsed parenthood-related anxiety. Our findings suggest that perinatal mental health support is needed for nearly all parents and that nonbirthing parents who use digital health platforms are amenable to receiving comprehensive perinatal education via these platforms.
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Affiliation(s)
- Adam K Lewkowitz
- Department of Obstetrics and Gynecology, Warren Alpert Medical School of Brown University, Providence, RI (Drs Lewkowitz, Ayala, and Miller); Center for Digital Health, Brown University School of Public Health, Providence, RI (Dr Lewkowitz).
| | - Constance Guille
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC (Dr Guille); Maven Clinic, New York, NY (Dr Guille, Ms Rubin-Miller, and Drs Jahnke and Henrich)
| | - Lily Rubin-Miller
- Maven Clinic, New York, NY (Dr Guille, Ms Rubin-Miller, and Drs Jahnke and Henrich)
| | - Hannah R Jahnke
- Maven Clinic, New York, NY (Dr Guille, Ms Rubin-Miller, and Drs Jahnke and Henrich)
| | - Nina K Ayala
- Department of Obstetrics and Gynecology, Warren Alpert Medical School of Brown University, Providence, RI (Drs Lewkowitz, Ayala, and Miller)
| | - Emily S Miller
- Department of Obstetrics and Gynecology, Warren Alpert Medical School of Brown University, Providence, RI (Drs Lewkowitz, Ayala, and Miller)
| | - Natalie Henrich
- Maven Clinic, New York, NY (Dr Guille, Ms Rubin-Miller, and Drs Jahnke and Henrich)
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Brakewood ES, Stoever K, Has P, Ayala NK, Danilack-Fekete VA, Savitz D, Lewkowitz AK. Neonatal and Maternal Outcomes of Pregnancies following Stillbirth. Am J Perinatol 2023. [PMID: 37907199 DOI: 10.1055/s-0043-1776349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2023]
Abstract
OBJECTIVE Prior stillbirth increases risk of subsequent stillbirth but has unclear effect on subsequent liveborn pregnancies. We examined associations between prior stillbirth, adverse neonatal outcomes, and maternal morbidity in subsequent liveborn pregnancies. STUDY DESIGN This is a secondary analysis of a large, National Institutes of Health-funded retrospective cohort study of parturients who delivered a singleton infant at a tertiary-care hospital from January 2002 to March 2013 and had a past medical/obstetric history of diabetic, and/or hypertensive disorders, and/or pregnancy with fetal growth restriction. Our analysis included all multiparous patients from the parent study. The primary outcome was a neonatal morbidity composite (neonatal resuscitation, neonatal birth injury, respiratory distress syndrome, transient tachypnea of the newborn, hypoglycemia, sepsis). Secondary outcomes included a maternal morbidity composite (venous thromboembolism, intensive care unit admission, disseminated intravascular coagulation, sepsis, hysterectomy, pulmonary edema, renal failure, blood transfusion), other maternal/delivery complications, and neonatal intensive care unit (NICU) admission. Outcomes were compared between those with versus without prior stillbirth. Negative binomial regression controlled for maternal comorbidities and delivery year. RESULTS Among 171 and 5,245 multiparous parturients with versus without prior stillbirth, respectively, those with prior stillbirth had higher rates of pregestational diabetes, autoimmune disease, and clotting disorders. After controlling for these differences and delivery year, infants of parturients with prior stillbirth had similar risk of composite neonatal morbidity (adjusted relative ratio [aRR] 1.19; 95% confidence interval [CI] 0.99-1.45) but higher risk of NICU admission (aRR 1.42; 95% CI 1.06-1.91) compared with infants of parturients without prior stillbirth, despite delivering at similar gestational ages. Multiparous patients with prior stillbirth had equal maternal morbidity risk but higher risk of developing preeclampsia with severe features (aRR 2.11; 95% CI 1.19-3.72). CONCLUSION Compared with high-risk multiparous patients without prior stillbirth, those with prior stillbirth have higher risk of NICU admission and preeclampsia with severe features. KEY POINTS · Prior stillbirth increases risk in subsequent livebirth for NICU admission and neonatal morbidity.. · Prior stillbirth increased the risk of severe preeclampsia for mothers in subsequent livebirth.. · Additional monitoring of pregnancies of patients with prior history of demise may be warranted..
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Affiliation(s)
- Eleanor S Brakewood
- Department of Medical Education, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Kara Stoever
- Department of OB/GYN, Boston Medical Center, Boston, Massachusetts
| | - Phinnara Has
- Division of Research, Lifespan Health System, Providence, Rhode Island
| | - Nina K Ayala
- Division of Maternal Fetal Medicine, Department of OB/GYN, Women and Infants Hospital of Rhode Island, Rhode Island
| | | | - David Savitz
- Department of OB/GYN, Women and Infants Hospital of Rhode Island, Rhode Island
| | - Adam K Lewkowitz
- Division of Maternal Fetal Medicine, Department of OB/GYN, Women and Infants Hospital of Rhode Island, Rhode Island
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13
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Whelan AR, Polnaszek BE, Recabo O, Clark MA, Lewkowitz AK, Ayala NK. The relationship between body mass index and perceived control over labor. BMC Pregnancy Childbirth 2023; 23:752. [PMID: 37880671 PMCID: PMC10598931 DOI: 10.1186/s12884-023-06063-w] [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: 07/05/2023] [Accepted: 10/12/2023] [Indexed: 10/27/2023] Open
Abstract
BACKGROUND Individuals with an increased body mass index (BMI) (≥ 30 kg/m2) experience higher rates of perinatal mental health disorders than individuals with BMI < 30. Personal experience of decreased control over labor has been associated with the development postpartum mood and anxiety disorders. However, no studies have investigated the association between BMI and experience of control over labor. This study aimed to assess perceived control over labor and compare patients with BMI ≥ 30 to those with BMI < 30. METHODS We performed a secondary analysis of a cross-sectional study of postpartum patients who delivered at term (37-41 weeks gestation). Postpartum, participants completed the Labour Agentry Scale (LAS), a validated tool to assess perceived control over labor/birth. Demographic, maternal health history and obstetric/neonatal outcomes were abstracted from the patient chart. Bivariate analyses were performed between those with BMI < 30 and those with BMI ≥ 30 using Fisher's exact test. Continuous LAS scores were compared between patients with BMI < 30 and BMI ≥ 30 using Wilcoxon rank-sum tests. Higher LAS scores indicate higher perceived control over labor. Multivariable linear regression was then performed to account for confounding factors identified a priori. RESULTS There was no difference in LAS between those with BMI ≥ 30 and BMI < 30. When stratified by World Health Organization (WHO) class of BMI, those with BMI ≥ 40 had a significantly lower LAS scores than those with BMI < 30 (147 vs. 163, p = 0.02), however, this finding was no longer significant after controlling for length of labor and cesarean birth. CONCLUSION Only participants with the highest BMI experienced decreased control over labor, and this finding was no longer significant after controlling for mode of delivery and length of labor. Further research into the experience of birthing people with BMI ≥ 30 is critical to understand the increased risk of perinatal mood disorders among this population.
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Affiliation(s)
- Anna R Whelan
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Women &, Infants Hospital of Rhode Island, Alpert Medical School of Brown University, 101 Dudley St, Providence, RI, 02905, USA.
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, University of Massachusetts Chan Medical School, Worcester, MA, USA.
| | - Brock E Polnaszek
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Women &, Infants Hospital of Rhode Island, Alpert Medical School of Brown University, 101 Dudley St, Providence, RI, 02905, USA
| | - Olivia Recabo
- Department of Obstetrics and Gynecology, New York Medical College, Valhalla, NY, USA
| | - Melissa A Clark
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Women &, Infants Hospital of Rhode Island, Alpert Medical School of Brown University, 101 Dudley St, Providence, RI, 02905, USA
| | - Adam K Lewkowitz
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Women &, Infants Hospital of Rhode Island, Alpert Medical School of Brown University, 101 Dudley St, Providence, RI, 02905, USA
| | - Nina K Ayala
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Women &, Infants Hospital of Rhode Island, Alpert Medical School of Brown University, 101 Dudley St, Providence, RI, 02905, USA
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14
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Cersonsky TEK, Ayala NK, Pinar H, Dudley DJ, Saade GR, Silver RM, Lewkowitz AK. Identifying risk of stillbirth using machine learning. Am J Obstet Gynecol 2023; 229:327.e1-327.e16. [PMID: 37315754 PMCID: PMC10527568 DOI: 10.1016/j.ajog.2023.06.017] [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: 03/06/2023] [Revised: 06/08/2023] [Accepted: 06/09/2023] [Indexed: 06/16/2023]
Abstract
BACKGROUND Previous predictive models using logistic regression for stillbirth do not leverage the advanced and nuanced techniques involved in sophisticated machine learning methods, such as modeling nonlinear relationships between outcomes. OBJECTIVE This study aimed to create and refine machine learning models for predicting stillbirth using data available before viability (22-24 weeks) and throughout pregnancy, as well as demographic, medical, and prenatal visit data, including ultrasound and fetal genetics. STUDY DESIGN This is a secondary analysis of the Stillbirth Collaborative Research Network, which included data from pregnancies resulting in stillborn and live-born infants delivered at 59 hospitals in 5 diverse regions across the United States from 2006 to 2009. The primary aim was the creation of a model for predicting stillbirth using data available before viability. Secondary aims included refining models with variables available throughout pregnancy and determining variable importance. RESULTS Among 3000 live births and 982 stillbirths, 101 variables of interest were identified. Of the models incorporating data available before viability, the random forests model had 85.1% accuracy (area under the curve) and high sensitivity (88.6%), specificity (85.3%), positive predictive value (85.3%), and negative predictive value (84.8%). A random forests model using data collected throughout pregnancy resulted in accuracy of 85.0%; this model had 92.2% sensitivity, 77.9% specificity, 84.7% positive predictive value, and 88.3% negative predictive value. Important variables in the previability model included previous stillbirth, minority race, gestational age at the earliest prenatal visit and ultrasound, and second-trimester serum screening. CONCLUSION Applying advanced machine learning techniques to a comprehensive database of stillbirths and live births with unique and clinically relevant variables resulted in an algorithm that could accurately identify 85% of pregnancies that would result in stillbirth, before they reached viability. Once validated in representative databases reflective of the US birthing population and then prospectively, these models may provide effective risk stratification and clinical decision-making support to better identify and monitor those at risk of stillbirth.
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Affiliation(s)
- Tess E K Cersonsky
- Department of Obstetrics & Gynecology, Women & Infants Hospital of Rhode Island, Warren Alpert Medical School of Brown University, Providence, RI.
| | - Nina K Ayala
- Department of Obstetrics & Gynecology, Women & Infants Hospital of Rhode Island, Warren Alpert Medical School of Brown University, Providence, RI
| | - Halit Pinar
- Department of Pathology, Women & Infants Hospital of Rhode Island, Warren Alpert Medical School of Brown University, Providence, RI
| | - Donald J Dudley
- Department of Obstetrics & Gynecology, University of Virginia, Charlottesville, VA
| | - George R Saade
- Department of Obstetrics & Gynecology, Eastern Virginia Medical School, Norfolk, VA
| | - Robert M Silver
- Department of Obstetrics & Gynecology, University of Utah Health, Salt Lake City, UT
| | - Adam K Lewkowitz
- Department of Obstetrics & Gynecology, Women & Infants Hospital of Rhode Island, Warren Alpert Medical School of Brown University, Providence, RI
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15
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Whelan AR, Polnaszek BE, Recabo O, Clark MA, Lewkowtiz AK, Ayala NK. Body Mass Index and Perceived Labor Control: Could weight stigma explain differences in birth experience? Res Sq 2023:rs.3.rs-3142767. [PMID: 37502868 PMCID: PMC10371127 DOI: 10.21203/rs.3.rs-3142767/v1] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Abstract
Background Individuals with a body mass index (BMI) of ≥ 30 kg/m2 experience weight stigma when interacting with the healthcare system. There is limited data on how weight stigma impacts patient's experience of obstetric care. This study aims to assess perceived control over the birth process and compare patients with BMI ≥ 30 to those with BMI < 30. Methods We performed a secondary analysis of a cross-sectional study of term patients. Postpartum, participants completed the Labour Agentry Scale (LAS), a validated tool to assess perceived control over labor/birth. Continuous LAS scores were compared between patients with BMI < 30 and BMI ≥ 30. Results There was no difference in LAS between those with BMI ≥ 30 and BMI < 30. When stratified by World Health Organization (WHO) class of BMI, those with BMI ≥ 40 had a significantly lower LAS scores than those with BMI < 30 (147 vs. 163, p = 0.02), however, this finding was no longer significant after controlling for length of labor and cesarean birth. Conclusion Only participants with the highest BMI experienced decreased control over labor, and this finding was no longer significant after controlling for mode of delivery and length of labor. Further research is necessary into how weight stigma influences birthing people's experience.
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Affiliation(s)
- Anna R Whelan
- Women & Infants Hospital of Rhode Island, Alpert Medical School of Brown University
| | - Brock E Polnaszek
- Women & Infants Hospital of Rhode Island, Alpert Medical School of Brown University
| | | | - Melissa A Clark
- Women & Infants Hospital of Rhode Island, Alpert Medical School of Brown University
| | - Adam K Lewkowtiz
- Women & Infants Hospital of Rhode Island, Alpert Medical School of Brown University
| | - Nina K Ayala
- Women & Infants Hospital of Rhode Island, Alpert Medical School of Brown University
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16
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Abstract
OBJECTIVE Pregnancies complicated by perinatal mood disorders or a history of mental health disorder are at increased risk for complications including postpartum depression/anxiety. Patients' perceived control over childbirth is known to be an important factor for development of postpartum depression/anxiety. It is unclear whether women with preexisting and/or current depression and/or anxiety have different perceptions of control during childbirth compared with those without these comorbidities. This study aimed to evaluate the association between a current and/or prior diagnosis of depression and/or anxiety and scores on the Labour Agentry Scale (LAS), a validated tool evaluating patient's experience of control over their labor and delivery. STUDY DESIGN This is a cross-sectional study of nulliparous patients admitted at term to a single center. Participants completed the LAS after delivery. A trained researcher performed detailed chart reviews for all participants. Participants were identified as having a current or historical diagnosis of depression/anxiety by self-report confirmed by chart review. Scores on the LAS were compared between those with versus without a diagnosis of depression/anxiety prior to admission for delivery. RESULTS A total of 73 (44.8%) of the 149 participants held a current and/or prior diagnosis of depression and/or anxiety. Baseline demographics were similar between those with and without depression/anxiety. Mean scores on the LAS (range: 91-201) were significantly lower for those with depression/anxiety than those without a prior diagnosis (150.0 vs. 160.5, p < 0.01). Even after controlling for mode of delivery, admission indication, anesthesia, and Foley balloon usage, participants with anxiety and depression had scores that were on average 10.4 points lower on the LAS (95% confidence interval: -19.25, -1.62). CONCLUSION Participants with a current and/or prior diagnosis of depression and/or anxiety scored lower on the LAS as compared with those without psychiatric diagnoses. Patients with psychiatric diagnoses may benefit from increased education and support during childbirth. KEY POINTS · Control over childbirth is an important factor in the development of postpartum depression/anxiety.. · Patients with a prior or current diagnosis of anxiety and depression have lower labor agentry scores.. · These differences remained significant even when controlling for confounders such as delivery mode..
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Affiliation(s)
- Anna R. Whelan
- Division of Maternal-Fetal Medicine, Women and Infants Hospital of Rhode Island, Alpert Medical School of Brown University, Providence, Rhode Island
| | - Olivia Recabo
- Department of Obstetrics and Gynecology, New York Medical College, Valhalla, New York
| | - Nina K. Ayala
- Division of Maternal-Fetal Medicine, Women and Infants Hospital of Rhode Island, Alpert Medical School of Brown University, Providence, Rhode Island
| | - Melissa A. Clark
- Division of Maternal-Fetal Medicine, Women and Infants Hospital of Rhode Island, Alpert Medical School of Brown University, Providence, Rhode Island
| | - Adam K. Lewkowitz
- Division of Maternal-Fetal Medicine, Women and Infants Hospital of Rhode Island, Alpert Medical School of Brown University, Providence, Rhode Island
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Kelly JC, Ayala NK, Holroyd L, Raghuraman N, Carter EB, Williams SA, Mills MM, Friedman H, Zhang F, Townsel C. Number of buprenorphine induction attempts impacts maternal and neonatal outcomes: a multicenter cohort study. Am J Obstet Gynecol MFM 2023; 5:100998. [PMID: 38236700 DOI: 10.1016/j.ajogmf.2023.100998] [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: 02/06/2023] [Revised: 04/14/2023] [Accepted: 04/27/2023] [Indexed: 01/23/2024]
Abstract
BACKGROUND Buprenorphine can be used to treat maternal opioid use disorder effectively and decrease obstetrical risks. Compared with the use of other medications to treat opioid use disorder, the use of buprenorphine results in improved neonatal outcomes; however, its use is associated with higher rates of treatment attrition. Initiation of buprenorphine, termed "induction," is a high-risk time for treatment dropout and can require repeated attempts. OBJECTIVE This study aimed to evaluate the effect of multiple buprenorphine induction attempts on maternal and neonatal outcomes. STUDY DESIGN This was a retrospective cohort study of all pregnant patients who underwent sublingual buprenorphine induction for the treatment of opioid use disorder from June 18, 2018, to January 1, 2021, at 3 tertiary care centers. Patients who required only 1 attempt for successful buprenorphine induction were compared with those who required multiple attempts but ultimately were successful in the treatment initiation during pregnancy, confirmed by urine drug screening. The primary outcome was nonprescribed opioid use at the time of delivery. The secondary outcomes included obstetrical and neonatal outcomes associated with opioid use disorder. Background characteristics were compared using Fisher exact, chi-square, Mann-Whitney U, and Student t tests. The outcomes were compared using multivariable logistic regression, and time to delivery after initiation of prenatal care was compared between groups using Kaplan-Meier curves and a Cox proportional-hazards model. RESULTS Overall, 63 patients undergoing buprenorphine induction during pregnancy were included, with 38 (60.3%) patients with 1 attempt and 25 patients (39.7%) with multiple attempts. There was no statistical difference between the 2 groups in terms of background characteristics. Compared with a single successful attempt, multiple attempts at buprenorphine induction were associated with a significantly increased odds of nonprescribed opioid use at the time of delivery (76.0% vs 15.8%; adjusted odds ratio, 30.00; 95% confidence interval, 5.50-163.90), increased risk of preterm birth (48.0% vs 15.8%; adjusted hazard ratio, 3.24; 95% confidence interval, 1.17-8.95), and decreased rate of breastfeeding at both maternal discharge (24.0% vs 78.9%; adjusted odds ratio, 0.06; 95% confidence interval, 0.00-0.30) and infant discharge (24.0% vs 55.3%; adjusted odds ratio, 0.23; 95% confidence interval, 0.10-0.80). CONCLUSION Requiring multiple attempts for buprenorphine induction significantly increases the odds of nonprescribed opioid use at the time of delivery and preterm birth and decreases the odds of breastfeeding. As the buprenorphine induction process may affect obstetrical outcomes for patients induced during pregnancy, investigating the techniques that increase the likelihood of successful induction is crucially needed to improve outcomes in patients with maternal opioid use disorder.
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Affiliation(s)
- Jeannie C Kelly
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, MO (Drs Kelly, Holroyd, Raghuraman, and Carter); Division of Clinical Research, Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, MO (Drs Kelly, Raghuraman, and Carter, Mses Williams and Mills, and Dr Zhang); Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI (Dr Townsel).
| | - Nina K Ayala
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Warren Alpert Medical School of Brown University, Providence, RI (Dr Ayala)
| | - Lauren Holroyd
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, MO (Drs Kelly, Holroyd, Raghuraman, and Carter)
| | - Nandini Raghuraman
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, MO (Drs Kelly, Holroyd, Raghuraman, and Carter); Division of Clinical Research, Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, MO (Drs Kelly, Raghuraman, and Carter, Mses Williams and Mills, and Dr Zhang)
| | - Ebony B Carter
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, MO (Drs Kelly, Holroyd, Raghuraman, and Carter); Division of Clinical Research, Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, MO (Drs Kelly, Raghuraman, and Carter, Mses Williams and Mills, and Dr Zhang)
| | - Samantha A Williams
- Division of Clinical Research, Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, MO (Drs Kelly, Raghuraman, and Carter, Mses Williams and Mills, and Dr Zhang)
| | - Melissa M Mills
- Division of Clinical Research, Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, MO (Drs Kelly, Raghuraman, and Carter, Mses Williams and Mills, and Dr Zhang)
| | - Hayley Friedman
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Warren Alpert Medical School of Brown University, Providence, RI (Dr Ayala)
| | - Fan Zhang
- Division of Clinical Research, Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, MO (Drs Kelly, Raghuraman, and Carter, Mses Williams and Mills, and Dr Zhang)
| | - Courtney Townsel
- Division of Newborn Medicine, Department of Pediatrics, Washington University School of Medicine, St. Louis, MO (Dr Friedman)
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18
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Whelan AR, Recabo O, Ayala NK, Clark MA, Lewkowitz AK. Unplanned Operative Delivery is Associated with Decreased Perception of Control over Labor. Res Sq 2023:rs.3.rs-2849715. [PMID: 37214857 PMCID: PMC10197791 DOI: 10.21203/rs.3.rs-2849715/v1] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Background Unplanned operative delivery is associated with postpartum depression (PPD), but the mechanism is unknown. We aimed to assess the sense of control over labor for those who had unplanned delivery (unplanned cesarean or operative vaginal delivery: uCD/OVD) versus spontaneous vaginal delivery (SVD). Methods Secondary analysis of a cross-sectional survey study of term patients admitted for delivery at a tertiary center. After delivery, patients completed the Labour Agentry Scale (LAS), a validated tool to assess perceived control over labor and birth. Demographics, obstetric and neonatal outcomes and LAS scores were compared between patients who underwent uCD/OVD versus SVD. Multivariable logistic regression to assess the relationship between uCD/OVD and LAS score controlling for confounders that differed in the bivariate analysis. Results Of the 149 patients, 50 (33.6%) underwent uCD/OVD. There were no differences in maternal age, race/ethnicity, insurance status or education level between those who had uCD/OVD versus SVD. Patients who had uCD/OVD had higher median body mass index (BMI) than those who had SVD (33.2 vs 30.1 kg/m2, p = 0.03). There were no differences in rate of medical or psychiatric morbidity between groups. Additionally, there were no differences in reason for admission, however those who had uCD/OVD had significantly longer times to delivery than those who underwent SVD (22 vs 14 hrs, p < 0.01). Gestational age at delivery was also significantly higher for those who underwent uCD/OVD compared to SVD (40.2 vs 39.6 wks, p = 0.02). For the primary outcome, LAS scores were lower for those who underwent uCD/OVD compared to SVD (146 vs. 164, p < 0.01). This remained significant even after controlling for length of labor, BMI and gestational age at delivery (p < 0.01). Conclusions Even after accounting for length of labor, uCD/OVD is associated with a reduction in perceived control over labor, which may mediate the known increased risk of PPD. Further qualitative research is needed to examine how to better support patients' wellbeing after uCD/OVD.
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Affiliation(s)
- Anna R Whelan
- Women & Infants Hospital of Rhode Island, Alpert Medical School of Brown University
| | | | - Nina K Ayala
- Women & Infants Hospital of Rhode Island, Alpert Medical School of Brown University
| | - Melissa A Clark
- Women & Infants Hospital of Rhode Island, Alpert Medical School of Brown University
| | - Adam K Lewkowitz
- Women & Infants Hospital of Rhode Island, Alpert Medical School of Brown University
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19
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Niehaus SC, Brown TM, Kempner ME, Skarha JE, Ayala NK. Maternal and Neonatal Outcomes Before and During the COVID-19 Pandemic. R I Med J (2013) 2023; 106:58-62. [PMID: 36989101] [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] [Subscribe] [Scholar Register] [Indexed: 03/30/2023]
Abstract
OBJECTIVE The COVID-19 pandemic brought about many social, psychological, and economic changes. We sought to compare pregnancy and birth outcomes immediately preceding the COVID-19 lockdown to those 12 months later. STUDY DESIGN This was a retrospective cohort study of people giving birth at a large-volume tertiary medical center in Rhode Island. We compared those who gave birth in February 2020 to those in February 2021. Results: Fewer people delivered in 2021 than 2020 (562 vs. 655). There was a non-significant decrease in the number of primary cesarean deliveries from 2020 to 2021. Insurance status modified this effect as there was a significant decrease in the number of patients with private insurance undergoing primary cesarean (63.6 vs 36.4%, p=0.004). Neonatal complications significantly decreased (55.4% vs 47.4%, p=0.006). CONCLUSION There were differences in sociodemographic characteristics and outcomes of birthing people between 2020 and 2021. The socioeconomic and healthcare landscape caused by COVID-19 altered statewide birthing patterns.
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Affiliation(s)
| | - Teresa M Brown
- Alpert Medical School of Brown University, Providence, RI
| | | | | | - Nina K Ayala
- Division of Maternal Fetal Medicine, Women & Infants Hospital of Rhode Island; Alpert Medical School of Brown University, Providence, RI
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20
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Ayala NK, Schlichting L, Lewkowitz AK, Kole-White MB, Gjelsvik A, Monteiro K, Amanullah S. The Association of Antenatal Depression and Cesarean Delivery among First-Time Parturients: A Population-Based Study. Am J Perinatol 2023; 40:356-362. [PMID: 36228650 PMCID: PMC9970759 DOI: 10.1055/a-1960-2919] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
OBJECTIVE Antenatal depression (AD) has been considered a risk factor for cesarean delivery (CD); however, the supporting data are inconsistent. We used a large, nationally representative dataset to evaluate whether there is an association between AD and CD among women delivering for the first time. STUDY DESIGN We utilized the 2016 to 2019 Multistate Pregnancy Risk Assessment Monitoring System (PRAMS) from the Centers for Disease Control. First-time parturients who reported depression in the 3 months prior to or at any point during their recent pregnancy were compared with those who did not. The mode of delivery was obtained through the birth certificate. Maternal demographics, pregnancy characteristics, and delivery characteristics were compared by the report of AD using bivariable analyses. Population-weighted multivariable regression was performed, adjusting for maternal age, race/ethnicity, insurance, pregnancy complications, preterm birth, and body mass index (BMI). RESULTS Of the 61,605 people who met the inclusion criteria, 18.3% (n = 11,896) reported AD and 29.8% (n = 19,892) underwent CD. Parturients with AD were younger, more likely to be non-Hispanic white, publicly insured, use tobacco in pregnancy, deliver earlier, have lower levels of education, higher BMIs, and more medical comorbidities (hypertension and diabetes). After adjustment for these differences, there was no difference in risk of CD between those with AD compared with those without (adjusted odds ratio: 1.04; 95% confidence interval: 0.97-1.13). CONCLUSION In a large, population-weighted, nationally representative sample of first-time parturients, there was no association between AD and CD. KEY POINTS · Antenatal depression is increasingly common and has multiple known morbidities.. · Prior data on antenatal depression and cesarean delivery are mixed.. · We found no association between depression and cesarean delivery..
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Affiliation(s)
- Nina K. Ayala
- Division of Maternal Fetal Medicine, Women and Infants Hospital of Rhode Island, Providence, Rhode Island
- Address for correspondence Nina K. Ayala, MD Division of Maternal Fetal Medicine, Women and Infants Hospital of Rhode Island101 Dudley Street, Providence, RI 02905
| | - Lauren Schlichting
- Hassenfeld Child Health Innovation Institute, Brown University School of Public Health, Providence, Rhode Island
| | - Adam K. Lewkowitz
- Division of Maternal Fetal Medicine, Women and Infants Hospital of Rhode Island, Providence, Rhode Island
| | - Martha B. Kole-White
- Division of Maternal Fetal Medicine, Women and Infants Hospital of Rhode Island, Providence, Rhode Island
| | - Annie Gjelsvik
- Hassenfeld Child Health Innovation Institute, Brown University School of Public Health, Providence, Rhode Island
- Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island
- Department of Pediatrics, Alpert Medical School of Brown University, Providence, Rhode Island
| | | | - Siraj Amanullah
- Hassenfeld Child Health Innovation Institute, Brown University School of Public Health, Providence, Rhode Island
- Department of Pediatrics, Alpert Medical School of Brown University, Providence, Rhode Island
- Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, Rhode Island
- Department of Health Services, Policy and Practice, Brown School of Public Health, Providence, Rhode Island
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Ayala NK, Whelan AR, Recabo O, Cersonsky TE, Bublitz MH, Sharp MC, Lewkowitz AK. Dispositional Optimism, Mode of Delivery, and Perceived Labor Control among Recently Delivered Parturients. Am J Perinatol 2023; 40:122-127. [PMID: 35738357 PMCID: PMC9805476 DOI: 10.1055/a-1882-9940] [Citation(s) in RCA: 1] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVE Dispositional optimism (DO) is an understudied transdiagnostic resilience factor among peripartum individuals. Low DO is associated with increased fear and pain in labor and increased rates of emergent cesarean delivery, but it is unknown whether DO is associated with perceived control over the labor process. STUDY DESIGN This a planned secondary analysis of a prospective observational cohort of term parturients (n = 164) who were recruited in July and August 2021 during their delivery hospitalization at a single, tertiary medical center. Participants completed a baseline demographic survey prior to delivery and then completed evaluations of DO (Revised Life-Orientation Test [LOT-R]) and control over the labor process (Labor Agentry Scale [LAS]) during their postpartum hospitalization. DO was dichotomized into low and high by score of ≤14 or >14 on LOT-R, respectively, and labor agentry scores were compared between groups. Maternal demographics, pregnancy, and delivery characteristics were compared by DO status. Multivariable regression was performed, adjusting for known confounders (induction, labor analgesia, and mode of delivery). RESULTS Demographic, pregnancy, and neonatal characteristics were similar between those with low compared with high DO. People with low DO had significantly higher rates of cesarean section (44 vs. 24%, p = 0.02) and overall had lower LAS scores (139.4 vs. 159.4, p < 0.001), indicating that they felt less control over their labor process than those with high DO. In the multivariable regression, those with low DO had higher odds of a low LAS score after controlling for induction, labor analgesia, and mode of delivery (adjusted odds ratio = 1.29, 95% confidence interval: 1.20-1.39). CONCLUSION People with low DO had significantly lower perceived control over their labor, even after controlling for differences in mode of delivery. Interventions to alter DO may be an innovative way to improve birth experience and its associated perinatal mental health morbidities. KEY POINTS · It is unknown if there is an association between DO and perceived labor control.. · People with low DO had higher rates of cesarean delivery and lower perceived labor control.. · Altering DO may be a novel mechanism for improving birth experience..
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Affiliation(s)
- Nina K. Ayala
- Division of Maternal Fetal Medicine, Women and Infants Hospital of Rhode Island
- Department of Obstetrics and Gynecology, Alpert Medical School of Brown University
| | - Anna R. Whelan
- Division of Maternal Fetal Medicine, Women and Infants Hospital of Rhode Island
- Department of Obstetrics and Gynecology, Alpert Medical School of Brown University
| | | | | | - Margaret H. Bublitz
- Women’s Medicine Collaborative at Lifespan Hospital System
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University
| | - Meghan C. Sharp
- Women’s Medicine Collaborative at Lifespan Hospital System
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University
| | - Adam K. Lewkowitz
- Division of Maternal Fetal Medicine, Women and Infants Hospital of Rhode Island
- Department of Obstetrics and Gynecology, Alpert Medical School of Brown University
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22
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Whelan A, Recabo O, Clark MA, Lewkowitz AK, Ayala NK. Understanding patient experience following unplanned operative delivery. Am J Obstet Gynecol 2023. [DOI: 10.1016/j.ajog.2022.11.751] [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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Ayala NK, Fain A, Cersonsky TE, Werner EF, Miller ES, Lewkowitz AK. Dispositional optimism is associated with adverse pregnancy outcomes. Am J Obstet Gynecol 2023. [DOI: 10.1016/j.ajog.2022.11.940] [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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24
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Cersonsky TE, Ayala NK, Pinar H, Dudley DJ, Saade GR, Silver RM, Lewkowitz AK. Using machine learning to identify stillbirth risk utilizing data from the stillbirth collaborative research network. Am J Obstet Gynecol 2023. [DOI: 10.1016/j.ajog.2022.11.986] [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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Smith MM, Cersonsky TE, Ayala NK, Reddy UM, Saade GR, Dudley DJ, Silver RM, Lewkowitz AK, Polnaszek B. Social vulnerability index and stillbirth: A secondary analysis of the Stillbirth Collaborate Research Network. Am J Obstet Gynecol 2023. [DOI: 10.1016/j.ajog.2022.11.363] [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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Ayala NK, Lewkowitz AK, Whelan AR, Miller ES. Perinatal Mental Health Disorders: A Review of Lessons Learned from Obstetric Care Settings. Neuropsychiatr Dis Treat 2023; 19:427-432. [PMID: 36865680 PMCID: PMC9971615 DOI: 10.2147/ndt.s292734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 02/17/2023] [Indexed: 02/25/2023] Open
Abstract
Perinatal mental health has garnered significant attention within obstetrics over the last couple of decades as the long- and short-term morbidities of untreated perinatal mental health disorders on both the mother and fetus/neonate have become increasingly apparent. There have been major strides in increasing screening for perinatal mental health disorders, clinician comfort with prescribing common psychiatric medications, and integrating mental health professionals into prenatal care via health services approaches such as the collaborative care model. Despite these advances, however, gaps still remain in the tools used for screening and diagnosis, obstetric clinician training in diagnosis and management of perinatal mood and anxiety disorders, as well as patient access to mental health care during pregnancy and especially postpartum. Herein we review the state of perinatal mental health from the perspective of the obstetric provider and identify areas of ongoing innovation.
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Affiliation(s)
- Nina K Ayala
- Division of Maternal Fetal Medicine, Women and Infants Hospital of Rhode Island, Providence, RI, USA.,Department of Obstetrics and Gynecology, Alpert Medical School of Brown University, Providence, RI, USA
| | - Adam K Lewkowitz
- Division of Maternal Fetal Medicine, Women and Infants Hospital of Rhode Island, Providence, RI, USA.,Department of Obstetrics and Gynecology, Alpert Medical School of Brown University, Providence, RI, USA
| | - Anna R Whelan
- Division of Maternal Fetal Medicine, Women and Infants Hospital of Rhode Island, Providence, RI, USA.,Department of Obstetrics and Gynecology, Alpert Medical School of Brown University, Providence, RI, USA
| | - Emily S Miller
- Division of Maternal Fetal Medicine, Women and Infants Hospital of Rhode Island, Providence, RI, USA.,Department of Obstetrics and Gynecology, Alpert Medical School of Brown University, Providence, RI, USA
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Fain A, Cersonsky TE, Lewkowitz AK, Werner EF, Miller ES, Ayala NK. Early Pregnancy Mindfulness and Adverse Perinatal Outcomes. Am J Obstet Gynecol 2023. [DOI: 10.1016/j.ajog.2022.11.205] [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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Cersonsky TE, Ayala NK, Saade GR, Dudley DJ, Pinar H, Silver RM, Reddy UM, Lewkowitz AK. Adherence to recommended prenatal visits and stillbirth risk: a Stillbirth Collaborative Research Network secondary analysis. Am J Obstet Gynecol 2023. [DOI: 10.1016/j.ajog.2022.11.434] [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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29
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Polnaszek B, Whelan A, Recabo O, Rossen J, Lewkowitz AK, Ayala NK. Patient’s Perception of control: Does the presence of internal or external fetal monitoring matter intrapartum? Am J Obstet Gynecol 2023. [DOI: 10.1016/j.ajog.2022.11.217] [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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30
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Cersonsky TE, Fain A, Lewkowitz AK, Werner EF, Miller ES, Ayala NK. Proactive coping in early pregnancy and adverse pregnancy outcomes. Am J Obstet Gynecol 2023. [DOI: 10.1016/j.ajog.2022.11.432] [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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31
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Young A, Rasiah SS, Recabo O, Ayala NK, Lewkowitz AK, Whelan A. Patient race and experience of control over labor. Am J Obstet Gynecol 2023. [DOI: 10.1016/j.ajog.2022.11.743] [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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32
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Lewkowitz AK, Allen E, Sakowicz A, Ayala NK, Whelan A, Battle CL, Miller ES. Association between potentially traumatic birthing experience and worsening postpartum depression or anxiety trajectories. Am J Obstet Gynecol 2023. [DOI: 10.1016/j.ajog.2022.11.175] [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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33
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Lewkowitz AK, Cersonsky TEK, Reddy UM, Goldenberg RL, Dudley DJ, Silver RM, Ayala NK. Association of Perceived Lack of Paternal Support After Stillbirth With Maternal Postpartum Depression or Anxiety. JAMA Netw Open 2022; 5:e2231111. [PMID: 36094505 PMCID: PMC9468888 DOI: 10.1001/jamanetworkopen.2022.31111] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
This cross-sectional study examines the incidence of postpartum depression and anxiety in women who perceive a lack paternal support after stillbirth.
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Affiliation(s)
- Adam K. Lewkowitz
- Department of Obstetrics and Gynecology, Alpert Medical School of Brown University, Providence, Rhode Island
| | - Tess E. K. Cersonsky
- Department of Medical Education, Alpert Medical School of Brown University, Providence, Rhode Island
| | - Uma M. Reddy
- Department of Obstetrics & Gynecology, Columbia University School of Medicine, New York, New York
| | - Robert L. Goldenberg
- Department of Obstetrics & Gynecology, Columbia University School of Medicine, New York, New York
| | - Donald J. Dudley
- Department of Obstetrics & Gynecology, University of Virginia School of Medicine, Charlottesville
| | - Robert M. Silver
- Department of Obstetrics and Gynecology, University of Utah School of Medicine, Salt Lake City
| | - Nina K. Ayala
- Department of Obstetrics and Gynecology, Alpert Medical School of Brown University, Providence, Rhode Island
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34
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Ayala NK, Rouse DJ. Assessment and Interpretation of Small or Underpowered Randomized Clinical Trials. Clin Obstet Gynecol 2022; 65:252-259. [PMID: 35476618 DOI: 10.1097/grf.0000000000000696] [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] [Indexed: 11/26/2022]
Abstract
The randomized controlled trial has long been recognized as the gold standard of research designs. As small or underpowered trials have become increasingly common in obstetrics and gynecology, it is essential to appraise the trial design and results with a critical eye and understand the limitations of these trials including the potential for selection bias, inability to discriminate uncommon outcomes and the imprecision of point estimates. When small or underpowered trials are designed to be assessed in combination with other trials in high-quality meta-analysis, some of these limitations are minimized.
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Affiliation(s)
- Nina K Ayala
- Division of Maternal Fetal Medicine Alpert Medical School of Brown University, Department of Obstetrics and Gynecology, Women & Infants Hospital of Rhode Island, Providence, Rhode Island
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35
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Ayala NK, Lewkowitz AK, Gjelsvik A, Monteiro K, Amanullah S. Antenatal Depression and Cesarean Delivery Among Recently-Delivered Nulliparous Women in Rhode Island. R I Med J (2013) 2022; 105:32-36. [PMID: 35081186] [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] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
OBJECTIVE Antenatal depression (AD) is frequently cited as a risk factor for cesarean delivery (CD) with limited supporting data. STUDY DESIGN We utilized 2016-2018 data from the Pregnancy Risk Assessment Monitoring System (PRAMS) survey for the state of Rhode Island. Nulliparous women who reported AD (n=242) were compared to women who did not (n=1,081). Maternal demographics, pregnancy and delivery characteristics were compared by AD status using population-weighted bivariable analyses and multivariable logistic regression. RESULTS 17.7% reported AD, and 34% underwent CD. There was no difference in CD based on reported AD status (aOR 1.04; 95% CI 0.69, 1.56). However, there were significant differences between those reporting AD compared to those who did not: less education, more public insurance, use of Women, Infants and Children (WIC) benefits, tobacco use, and pre-gestational hypertension/diabetes. CONCLUSION In this large, population-based, state representative sample, we found no difference in CD among recently delivered nulliparous women with and without AD.
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Affiliation(s)
- Nina K Ayala
- Division of Maternal Fetal Medicine, Women & Infants Hospital of Rhode Island
| | - Adam K Lewkowitz
- Division of Maternal Fetal Medicine, Women & Infants Hospital of Rhode Island
| | - Annie Gjelsvik
- Hassenfeld Child Health Innovation Institute, Brown University; Department of Epidemiology, Brown School of Public Health
| | | | - Siraj Amanullah
- Hassenfeld Child Health Innovation Institute, Brown University;Department of Pediatrics, Department of Emergency Medicine, Alpert Medical School of Brown University; Department of Health Services, Policy and Practice, Brown School of Public Health
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36
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Dizon MLV, deRegnier RAO, Weiner SJ, Varner MW, Rouse DJ, Costantine MM, Wapner RJ, Thorp JM, Blackwell SC, Ayala NK, Saad AF, Caritis SN. Differential Gene Expression in Cord Blood of Infants Diagnosed with Cerebral Palsy: A Pilot Analysis of the Beneficial Effects of Antenatal Magnesium Cohort. Dev Neurosci 2022; 44:412-425. [PMID: 35705018 PMCID: PMC9474611 DOI: 10.1159/000525483] [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: 09/30/2021] [Accepted: 06/08/2022] [Indexed: 02/01/2023] Open
Abstract
The Beneficial Effects of Antenatal Magnesium clinical trial was conducted between 1997 and 2007, and demonstrated a significant reduction in cerebral palsy (CP) in preterm infants who were exposed to peripartum magnesium sulfate (MgSO4). However, the mechanism by which MgSO4 confers neuroprotection remains incompletely understood. Cord blood samples from this study were interrogated during an era when next-generation sequencing was not widely accessible and few gene expression differences or biomarkers were identified between treatment groups. Our goal was to use bulk RNA deep sequencing to identify differentially expressed genes comparing the following four groups: newborns who ultimately developed CP treated with MgSO4 or placebo, and controls (newborns who ultimately did not develop CP) treated with MgSO4 or placebo. Those who died after birth were excluded. We found that MgSO4 upregulated expression of SCN5A only in the control group, with no change in gene expression in cord blood of newborns who ultimately developed CP. Regardless of MgSO4 exposure, expression of NPBWR1 and FTO was upregulated in cord blood of newborns who ultimately developed CP compared with controls. These data support that MgSO4 may not exert its neuroprotective effect through changes in gene expression. Moreover, NPBWR1 and FTO may be useful as biomarkers and may suggest new mechanistic pathways to pursue in understanding the pathogenesis of CP. The small number of cases ultimately available for this secondary analysis, with male predominance and mild CP phenotype, is a limitation of the study. In addition, differentially expressed genes were not validated by qRT-PCR.
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Affiliation(s)
- Maria L V Dizon
- The Department of Pediatrics, Northwestern University, Chicago, Illinois, USA
| | | | - Steven J Weiner
- The George Washington University Biostatistics Center, Washington, District of Columbia, USA
| | - Michael W Varner
- The Departments of Obstetrics and Gynecology of the University of Utah, Salt Lake City, Utah, USA
| | - Dwight J Rouse
- The Department of Obstetrics and Gynecology, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Maged M Costantine
- The Department of Obstetrics and Gynecology, The Ohio State University, Columbus, Ohio, USA
| | - Ronald J Wapner
- The Department of Obstetrics and Gynecology, Thomas Jefferson University and Drexel University, Philadelphia, Pennsylvania, USA
- The Department of Obstetrics and Gynecology, Columbia University, New York, New York, USA
| | - John M Thorp
- The Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Sean C Blackwell
- University of Texas Health Science Center at Houston-Children's Memorial Hermann Hospital, Houston, Texas, USA
| | - Nina K Ayala
- The Department of Obstetrics and Gynecology, Brown University, Providence, Rhode Island, USA
| | - Antonio F Saad
- The Department of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston, Texas, USA
| | - Steve N Caritis
- The Department of Obstetrics and Gynecology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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37
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Ayala NK, Schlichting L, Lewkowitz AK, Kole-White MB, Gjelsvik A, Amanullah S. Association between antenatal depression and cesarean delivery among nulliparous parturients. Am J Obstet Gynecol 2022. [DOI: 10.1016/j.ajog.2021.11.985] [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: 11/25/2022]
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38
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Recabo O, Gould AJ, Has P, Ayala NK, Kole-White MB, Danilack VA, Savitz DA, Lewkowitz AK. Are infants born to high-risk patients with grand multiparity at increased risk of adverse outcomes? Am J Obstet Gynecol 2022. [DOI: 10.1016/j.ajog.2021.11.512] [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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39
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Whelan AR, Ayala NK, Werner EF. Postpartum Use of Weight Loss and Metformin for the Prevention of Type 2 Diabetes Mellitus: a Review of the Evidence. Curr Diab Rep 2021; 21:37. [PMID: 34495405 DOI: 10.1007/s11892-021-01410-7] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/21/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE OF REVIEW As many as 70% of patients diagnosed with gestational diabetes mellitus (GDM) will go on to develop type 2 diabetes (T2DM) within their lifetimes. Implementing strategies to mitigate this progression in the postpartum period when patients are already connected to care is essential in optimizing lifelong health for our patients. Both lifestyle modification and metformin have been investigated as options to reduce type 2 diabetes risk in patients with a history of GDM. RECENT FINDINGS The current model for postpartum testing and care of patients with GDM has been shown to have poor uptake rates. Similarly, intervening with lifestyle modification postpartum has not resulted in significant diabetes risk reduction in prospective studies. Metformin is known to decrease insulin resistance and is also associated with weight loss. Data from large prospective studies has indicated that metformin may be a useful addition to lifestyle modifications to prevent progression to diabetes, but additional studies are needed specifically in postpartum individuals. Metformin is a safe in the postpartum period and may reduce diabetes risk if started soon after delivery in individuals with GDM, but additional studies are needed to determine which individuals with GDM are most likely to benefit from this medication.
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Affiliation(s)
- Anna R Whelan
- Women & Infants Hospital of Rhode Island Division of Maternal Fetal Medicine, Alpert Medical School At Brown University, 101 Dudley St, Providence, RI, USA.
| | - Nina K Ayala
- Women & Infants Hospital of Rhode Island Division of Maternal Fetal Medicine, Alpert Medical School At Brown University, 101 Dudley St, Providence, RI, USA
| | - Erika F Werner
- Women & Infants Hospital of Rhode Island Division of Maternal Fetal Medicine, Alpert Medical School At Brown University, 101 Dudley St, Providence, RI, USA
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40
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Hunter LA, Ayala NK. Parvovirus B19 in Pregnancy: A Case Review. J Midwifery Womens Health 2021; 66:385-390. [PMID: 34101977 DOI: 10.1111/jmwh.13254] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 10/18/2020] [Revised: 04/13/2021] [Accepted: 04/21/2021] [Indexed: 12/16/2022]
Abstract
Parvovirus B19 has been identified as the cause of erythema infectiosum, a common childhood illness. Also known as fifth disease, this virus is highly contagious among school-age children, especially during the winter months when outbreaks within classrooms are widespread. The majority of adults have had the infection in childhood and are immune to recurrence. Approximately 40% of childbearing-age individuals, however, remain nonimmune and susceptible to infection. If acquired during pregnancy, parvovirus B19 infection can have devastating fetal consequences, especially if contracted in the second trimester. Vertical transmission of parvovirus B19 occurs more readily during this gestational period, and fetal loss rates of 8% to 17% have been reported as a result of severe fetal anemia and hydrops fetalis. Unfortunately, adults with parvovirus B19 infection are often asymptomatic and do not exhibit the classic slapped-cheek rash seen in childhood. More commonly, adults will exhibit atypical symptoms such as joint arthralgias. Maternal history of direct exposure to a confirmed case within the family or the presence of atypical symptoms warrants serum antibody screening. Although the presence of immunoglobulin G confirms immunity, any immunoglobulin M positivity will require ongoing fetal surveillance for evidence of fetal anemia and hydrops fetalis. Serial ultrasound imaging for 8 to 12 weeks with Doppler measurements of the peak systolic velocity in the middle cerebral artery are the mainstays of fetal monitoring. Referral to a maternal-fetal medicine specialist with experience in fetal blood sampling and intrauterine transfusion is recommended for any cases of hydrops fetalis or if a concern for severe fetal anemia exists.
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Affiliation(s)
- Linda A Hunter
- Midwifery Division, Department of Obstetrics and Gynecology, Alpert Medical School of Brown University, Providence, Rhode Island
| | - Nina K Ayala
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Alpert Medical School of Brown University, Providence, Rhode Island
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Kole-White MB, Griffin L, Ding JJ, Ayala NK, Has P, Werner EF. Breastfeeding Success Among Women with Gestational Diabetes Managed by Diet Only Compared with Those Requiring Medications. Breastfeed Med 2021; 16:419-423. [PMID: 33999695 DOI: 10.1089/bfm.2020.0321] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 11/13/2022]
Abstract
Objective: Breastfeeding is known to have a positive impact on maternal and neonatal health. Some have suggested that gestational diabetes mellitus (GDM) is associated with lower breastfeeding rates, but it is not known whether rates are further impacted by glucose control in pregnancy. Thus, we examined whether patients with GDM requiring medication (A2 GDM) were more likely to not initiate or discontinue breastfeeding compared with patients with GDM well controlled by diet (A1 GDM). Research Design and Methods: This is a secondary analysis of a prospective cohort study of 600 patients with GDM. Eligible patients were enrolled during their delivery hospitalization and followed prospectively postpartum. The primary outcome was exclusive breastfeeding at hospital discharge and secondary outcomes included breastfeeding rates at 3 months postpartum. Patients classified as A2 GDM were compared with those classified as A1 GDM. Results: Of the 600 patients enrolled, 301 had A2 GDM and 299 had A1 GDM. Patients who needed medication were observed to be older and more likely to be parous and obese. There were no significant differences in labor outcomes or neonatal complications. After adjusting for baseline differences between the two groups, adjusted odds ratios (aORs) for exclusive breastfeeding rates were similar in mothers with A2 GDM compared with those with A1 GDM at hospital discharge (aOR 0.83 [0.54-1.28]) and 3 months postpartum (aOR 0.58 [0.34-1.01]). Additionally, any breastfeeding rates were similar in mothers with A2 GDM compared with those with A1 GDM, both at hospital discharge (aOR 0.72 [0.44-1.16]) and 3 months postpartum (aOR 0.63 [0.34-1.17]). Conclusions: After adjusting for baseline differences, there was no difference in any or exclusive breastfeeding rates at hospital discharge or 3 months postpartum among patients with A2 GDM compared with those with A1 GDM.
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Affiliation(s)
- Martha B Kole-White
- Division of Maternal Fetal Medicine, Women and Infants Hospital, Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Laurie Griffin
- Division of Maternal Fetal Medicine, Women and Infants Hospital, Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Jia Jennifer Ding
- Division of Maternal Fetal Medicine, Women and Infants Hospital, Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Nina K Ayala
- Division of Maternal Fetal Medicine, Women and Infants Hospital, Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Phinnara Has
- Division of Maternal Fetal Medicine, Women and Infants Hospital, Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Erika F Werner
- Division of Maternal Fetal Medicine, Women and Infants Hospital, Alpert Medical School of Brown University, Providence, Rhode Island, USA
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Kole-White MB, Ayala NK, Danilack VA, Has P, Savitz DA, Werner EF. 607 Is race/ethnicity a risk factor for severe maternal morbidity in patients with diabetes in pregnancy? Am J Obstet Gynecol 2021. [DOI: 10.1016/j.ajog.2020.12.628] [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: 10/22/2022]
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Ding JJ, Kole-White MB, Ayala NK, Booker T, Has P, Werner EF. 736 Comparing neonatal outcomes among patients undergoing intravenous glucose tolerance testing for diagnosis of gestational diabetes. Am J Obstet Gynecol 2021. [DOI: 10.1016/j.ajog.2020.12.759] [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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Premkumar A, Ayala NK, Miller CH, Grobman WA, Miller ES. Postpartum NSAID Use and Adverse Outcomes among Women with Hypertensive Disorders of Pregnancy: A Systematic Review and Meta-analysis. Am J Perinatol 2021; 38:1-9. [PMID: 32682329 DOI: 10.1055/s-0040-1713180] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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 was aimed to perform a systematic review and meta-analysis of the association between postpartum nonsteroidal anti-inflammatory drug (NSAID) use among women with hypertensive disorders of pregnancy (HDP) and risks of adverse postpartum outcomes. STUDY DESIGN Studies were eligible if they included women who had been diagnosed with HDP and were postpartum, reported exposure to NSAIDs, were written in English, and were published between January 2000 and November 2019. Assessment of bias was performed using the Newcastle-Ottawa scale for observational studies or the Cochrane Collaborative tool for randomized trials. The primary outcome was maternal blood pressure ≥ 150 mm Hg systolic and/or 100 mm Hg diastolic. Secondary outcomes were persistent blood pressures ≥ 160 mm Hg systolic and/or 110 mm Hg diastolic, mean arterial pressure (MAP), initiation or up-titration of antihypertensive medication, length of hospital stay, rehospitalization for blood pressure control, and postpartum opioid use. A random-effect meta-analysis was performed using RevMan, with a p-value < 0.05 used to indicate statistical significance (PROSPERO CRD no.: 42019127043). RESULTS Among 7,395 abstracts identified, seven studies (four randomized and three cohort studies, n = 777 patients) met inclusion criteria. All cohort analyses exhibited low levels of bias, while two randomized controlled trials exhibited a high risk of bias in blinding and inclusion criteria. There was no association between NSAID use and blood pressures ≥ 150 mm Hg systolic and/or 100 mm Hg diastolic (risk ratio [RR]: 1.21, 95% confidence interval [CI]: 0.89-1.64). Conversely, NSAID use was associated with a statistically significant, but clinically insignificant, increase in length of postpartum stay (0.21 days, 95% CI: 0.05-0.38). No other secondary outcomes were significantly different between groups. CONCLUSION Postpartum NSAID use among women with HDP was not associated with maternal hypertension exacerbation. These findings support the recent American College of Obstetricians and Gynecologists' guideline change, wherein preeclampsia is no longer a contraindication to postpartum NSAID use. KEY POINTS · Postpartum (PP) NSAID use does not worsen hypertension in preeclampsia.. · PP NSAID use is associated with a longer, though clinically insignificant, length of stay.. · Our findings support ACOG's recommendations for PP NSAID use..
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Affiliation(s)
- Ashish Premkumar
- Department of Obstetrics and Gynecology, Northwestern University, Chicago, Illinois
| | - Nina K Ayala
- Department of Obstetrics and Gynecology, Brown University, Providence, Rhode Island
| | - Corinne H Miller
- Department of Obstetrics and Gynecology, Northwestern University, Chicago, Illinois
| | - William A Grobman
- Department of Obstetrics and Gynecology, Northwestern University, Chicago, Illinois
| | - Emily S Miller
- Department of Obstetrics and Gynecology, Northwestern University, Chicago, Illinois
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Kole MB, Ayala NK, Clark MA, Has P, Esposito M, Werner EF. Factors Associated With Hypoglycemia Among Neonates Born to Mothers With Gestational Diabetes Mellitus. Diabetes Care 2020; 43:e194-e195. [PMID: 33051333 DOI: 10.2337/dc20-1261] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 09/01/2020] [Indexed: 02/03/2023]
Affiliation(s)
- Martha B Kole
- Division of Maternal Fetal Medicine, Women and Infants Hospital, Alpert Medical School of Brown University, Providence, RI
| | - Nina K Ayala
- Division of Maternal Fetal Medicine, Women and Infants Hospital, Alpert Medical School of Brown University, Providence, RI
| | - Melissa A Clark
- Department of Health Services, Policy and Practice, Brown University School of Public Health, and Department of Obstetrics and Gynecology, Women and Infants Hospital, Alpert Medical School of Brown University, Providence, RI
| | - Phinnara Has
- Division of Maternal Fetal Medicine, Women and Infants Hospital, Alpert Medical School of Brown University, Providence, RI
| | - Mathew Esposito
- Division of Maternal Fetal Medicine, Women and Infants Hospital, Alpert Medical School of Brown University, Providence, RI
| | - Erika F Werner
- Division of Maternal Fetal Medicine, Women and Infants Hospital, Alpert Medical School of Brown University, Providence, RI
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Ayala NK, Schlichting LE, Kole MB, Clark MA, Vivier PM, Viner-Brown SI, Werner EF. Operative vaginal delivery and third grade educational outcomes. Am J Obstet Gynecol MFM 2020; 2:100221. [PMID: 33345929 DOI: 10.1016/j.ajogmf.2020.100221] [Citation(s) in RCA: 2] [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: 04/30/2020] [Revised: 08/15/2020] [Accepted: 09/01/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Operative vaginal delivery rates continue to drop nationally with many citing neonatal safety concerns as a primary driver of this decrease. Previous evidence on short-term neonatal outcomes does not support this concern. OBJECTIVE This study aimed to better understand the impact of delivery mode on childhood educational outcomes. STUDY DESIGN A statewide retrospective cohort was created in which third grade Rhode Island Department of Education data for 2014 to 2017 were linked to Rhode Island Department of Health birth certificate data. Children's third grade reading and math proficiencies were compared by the mode of delivery listed in their birth certificates. The study population was limited to children who were term, singleton births without congenital anomalies. The mode of delivery was classified as operative vaginal (forceps or vacuum), primary cesarean, or spontaneous vaginal delivery. Children born via repeat cesarean delivery were excluded. Bivariate analyses were conducted to assess differences in demographic variables between mothers and children by mode of delivery and between reading and math proficiencies and mode of delivery. Bivariable and multivariable log-binomial regression was used to examine the association between subject proficiency and predictors including mode of delivery, gestational age, sex, race/ethnicity, and lunch subsidy. RESULTS Of the 18,247 children who met the inclusion criteria, 6% were delivered by operative vaginal delivery, 19% by primary cesarean delivery, and the remaining 75% by spontaneous vaginal delivery. After adjustment for confounders including gestational age at delivery, child's race/ethnicity, sex, and socioeconomic factors, there was no difference in reading proficiency (adjusted risk ratio, 1.03; 95% confidence interval, 0.96-1.10) or math proficiency (adjusted risk ratio, 1.01; 95% confidence interval, 0.95-1.08) in those born by operative vaginal delivery compared with primary cesarean delivery, and no difference was found in either proficiency when spontaneous vaginal delivery was compared with primary cesarean delivery (reading, adjusted risk ratio, 0.97; 95% confidence interval, 0.93-1.01; math, adjusted risk ratio, 0.98; 95% confidence interval, 0.94-1.01). CONCLUSION Operative vaginal delivery was not associated with differences in later childhood educational outcomes after adjusting for baseline differences. This should assuage previous concerns about long-term safety outcomes after operative vaginal delivery and may assist in shared decision making when operative vaginal or primary cesarean delivery is being considered.
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Affiliation(s)
- Nina K Ayala
- Division of Maternal-Fetal Medicine, Women and Infants Hospital of Rhode Island, Warren Alpert Medical School, Brown University, Providence, RI; Hassenfeld Child Health Innovation Institute, Brown University, Providence, RI.
| | | | - Martha B Kole
- Division of Maternal-Fetal Medicine, Women and Infants Hospital of Rhode Island, Warren Alpert Medical School, Brown University, Providence, RI; Hassenfeld Child Health Innovation Institute, Brown University, Providence, RI
| | - Melissa A Clark
- Hassenfeld Child Health Innovation Institute, Brown University, Providence, RI; Department of Health Services, Policy, and Practice, School of Public Health, Brown University, Providence, RI; Departments of Pediatrics and Emergency Medicine, Warren Alpert Medical School, Brown University, Providence, RI
| | - Patrick M Vivier
- Hassenfeld Child Health Innovation Institute, Brown University, Providence, RI; Department of Health Services, Policy, and Practice, School of Public Health, Brown University, Providence, RI
| | - Samara I Viner-Brown
- Center for Health Data and Analysis, Rhode Island Department of Health, Providence, RI
| | - Erika F Werner
- Division of Maternal-Fetal Medicine, Women and Infants Hospital of Rhode Island, Warren Alpert Medical School, Brown University, Providence, RI; Hassenfeld Child Health Innovation Institute, Brown University, Providence, RI
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Leviter JI, Sojar S, Ayala NK, Wing R. Thyrotoxicosis in a Postpartum Adolescent: A Simulation Case for Emergency Medicine Providers. MedEdPORTAL 2020; 16:10967. [PMID: 32934982 PMCID: PMC7485909 DOI: 10.15766/mep_2374-8265.10967] [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] [Figures] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 02/29/2020] [Indexed: 06/11/2023]
Abstract
INTRODUCTION Thyroid storm is a rare but life-threatening disease process that may be difficult to recognize and mimics other disease processes. It is critical for the emergency medicine clinician to be able to recognize thyroid storm in patients in order to effectively stabilize and treat them. METHODS In this standardized patient case, learners were faced with a 17-year-old postpartum woman presenting to the emergency department with respiratory distress and altered mental status secondary to thyroid storm. The target learners were emergency department providers, including residents, medical students, and advanced practice practitioners. Providers were expected to identify signs and symptoms of thyroid storm and to initiate appropriate diagnostic workup and management of this complex patient. Debriefing followed the simulation using a debriefing guide and PowerPoint presentation. RESULTS Thirty-four learners participated in this simulation. All learners agreed or strongly agreed that the simulation case was relevant to their work, and 97% agreed or strongly agreed that it was effective in teaching thyroid storm management skills. Eighty-five percent felt that following the simulation, they would be confident in their ability to recognize thyroid storm in a postpartum patient and to recognize and manage respiratory distress and altered mental status in a postpartum patient. DISCUSSION Learners felt that this case was effective in teaching the skills necessary for caring for postpartum patients with respiratory distress and altered mental status. Future directions include conducting the simulation in situ to include multidisciplinary teams and increasing the learner pool to include OB/GYN residents.
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Affiliation(s)
- Julie I. Leviter
- Assistant Professor of Clinical Pediatrics, Department of Pediatric Emergency Medicine, Yale University School of Medicine
| | - Sakina Sojar
- Pediatric Emergency Medicine Fellow, Departments of Emergency Medicine and Pediatrics, Warren Alpert Medical School of Brown University and Hasbro Children's Hospital/Rhode Island Hospital
| | - Nina K. Ayala
- Maternal Fetal Medicine Fellow, Department of Obstetrics and Gynecology, Warren Alpert Medical School of Brown University and Women & Infants Hospital of Rhode Island
| | - Robyn Wing
- Assistant Professor, Departments of Emergency Medicine and Pediatrics, Division of Pediatric Emergency Medicine, Warren Alpert Medical School of Brown University and Rhode Island Hospital/Hasbro Children's Hospital; Director of Pediatric Simulation, Lifespan Medical Simulation Center
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Kole MB, Ayala NK, Clark MA, Has P, Werner EF. Coping with the Unexpected: Patient Trust in Physicians following Delivery. Am J Perinatol 2020; 37:666-670. [PMID: 31891959 DOI: 10.1055/s-0039-3401795] [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: 10/25/2022]
Abstract
OBJECTIVE Patient's trust in physicians is a significant predictor of continuity, adherence, and satisfaction with care. However, it is unclear what influences a woman's trust in her physician. This study sought to determine if women's trust in their clinicians was affected by unexpected outcomes at the time of delivery. STUDY DESIGN This is a secondary analysis of a prospective cohort of 300 postpartum women with gestational diabetes mellitus. Participants completed the validated Trust in Physician Scale during their postpartum hospitalization. Participants' scores were compared based on their exposure to an unexpected pregnancy outcome. RESULTS Of the 300 women consented to participate in this study, 294 completed the Trust in Physician Scale. The mean overall trust score was 80/100 with a range of 42 to 100. Unexpected pregnancy outcomes occurred in 41% (120) of women in this cohort. There was no significant difference in the trust score between women who did and did not have at least one unexpected outcome (0.79 vs. 0.79, p = 0.93). Additionally, there was no significant association between the trust score and any individual unexpected pregnancy outcome. CONCLUSION Unexpected pregnancy outcomes are not associated with changes in women's trust in their obstetric clinicians. These results emphasize the antepartum period as the essential time for patient-physician relationship building which has important implications for postpartum follow-up and long-term psychiatric sequelae from unexpected outcomes.
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Affiliation(s)
- Martha B Kole
- Division of Maternal Fetal Medicine, Women and Infants Hospital, Alpert Medical School of Brown University, Providence, Rhode Island
| | - Nina K Ayala
- Division of Maternal Fetal Medicine, Women and Infants Hospital, Alpert Medical School of Brown University, Providence, Rhode Island
| | - Melissa A Clark
- Department of Health Services, Policy and Practice, Brown University School of Public Health, Providence, Rhode Island.,Department of Obstetrics and Gynecology, Women and Infants Hospital, Alpert Medical School of Brown University, Providence, Rhode Island
| | - Phinnara Has
- Division of Maternal Fetal Medicine, Women and Infants Hospital, Alpert Medical School of Brown University, Providence, Rhode Island
| | - Erika F Werner
- Division of Maternal Fetal Medicine, Women and Infants Hospital, Alpert Medical School of Brown University, Providence, Rhode Island
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Swanson K, Ayala NK, Barnes RB, Desai N, Miller M, Yee LM. Understanding gestational surrogacy in the United States: a primer for obstetricians and gynecologists. Am J Obstet Gynecol 2020; 222:330-337. [PMID: 31982386 DOI: 10.1016/j.ajog.2020.01.037] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [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: 11/22/2019] [Revised: 01/10/2020] [Accepted: 01/16/2020] [Indexed: 11/19/2022]
Abstract
As gestational surrogacy (a process by which intended parents contract with a woman to carry a fetus that the intended parents will raise) increases across the United States, it is imperative that obstetrician/gynecologists understand the unique nuances of caring for patients who are gestational surrogates. Gestational surrogacy offers a route to parenthood for individuals and families who may otherwise have limited options. Understanding surrogacy requires multiple ethical considerations about the potential medical and psychosocial effects on gestational surrogates as well as the families built through surrogacy. There is a dearth of research on the subject, particularly in the United States and other countries that practice compensated surrogacy. Here we seek to review the process of gestational surrogacy in the United States, including the legal landscape, current trends in gestational surrogacy use, and what is known about the medical and social effects of this process on all participants. We also aim to highlight the limitations of available data and to identify topics for future research to provide optimal evidence-based and just care for these patients.
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Affiliation(s)
- Kate Swanson
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Division of Maternal-Fetal Medicine, University of California San Francisco, San Francisco, CA.
| | - Nina K Ayala
- Department of Obstetrics & Gynecology, Division of Maternal-Fetal Medicine, Brown University, Providence, RI
| | - Randall B Barnes
- Department of Obstetrics & Gynecology, Division of Reproductive Endocrinology & Infertility, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Nidhi Desai
- Desai & Miller Adoption and Reproductive Technology Law, Chicago, IL
| | - Marcy Miller
- Desai & Miller Adoption and Reproductive Technology Law, Chicago, IL
| | - Lynn M Yee
- Department of Obstetrics & Gynecology, Division of Maternal-Fetal Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
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Kole MB, Griffin L, Ding JJ, Ayala NK, Has P, Werner EF. 780: Breastfeeding continuation rates following gestational diabetes. Am J Obstet Gynecol 2020. [DOI: 10.1016/j.ajog.2019.11.796] [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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