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Doshi U, Chaiken S, Hersh A, Gibbins KJ, Caughey AB. Treating Mild Chronic Hypertension During Pregnancy: A Cost-Effectiveness Analysis. Obstet Gynecol 2024; 143:562-569. [PMID: 38387029 DOI: 10.1097/aog.0000000000005531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 12/07/2023] [Indexed: 02/24/2024]
Abstract
OBJECTIVE To assess the cost effectiveness of targeting a blood pressure of less than 140/90 mm Hg compared with 160/105 mm Hg. METHODS A decision-analytic model was constructed to compare the treatment of chronic hypertension in pregnancy at mild-range blood pressures (140/90 mm Hg) with the treatment of chronic hypertension before 20 weeks of gestation at severe-range blood pressures (160/105 mm Hg) in a theoretical cohort of 180,000 patients with mild chronic hypertension. Probabilities, costs, and utilities were derived from literature and varied in sensitivity analyses. Primary outcomes included incremental cost per quality-adjusted life-year (QALY), cases of preeclampsia, preeclampsia with severe features, severe maternal morbidity (SMM), preterm birth, maternal death, neonatal death, and neurodevelopmental delay. The cost-effectiveness threshold was $100,000 per QALY. RESULTS Treating chronic hypertension in a population of 180,000 pregnant persons at mild-range blood pressures, compared with severe-range blood pressures, resulted in 14,177 fewer cases of preeclampsia (43,953 vs 58,130), 11,835 of which were cases of preeclampsia with severe features (40,530 vs 52,365). This led to 817 fewer cases of SMM (4,375 vs 5,192), and 18 fewer cases of maternal death (102 vs 120). Treating at a lower threshold also resulted in 8,078 fewer cases of preterm birth (22,000 vs 30,078), which led to 26 fewer neonatal deaths (276 vs 302) and 157 fewer cases of neurodevelopmental delay (661 vs 818). Overall, treating chronic hypertension at a lower threshold was a dominant strategy that resulted in decreased costs of $600 million and increased effectiveness of 12,852 QALYs. CONCLUSION Treating chronic hypertension at a threshold of mild-range blood pressures is a dominant (lower costs, better outcomes) and cost-effective strategy that results in fewer neonatal and maternal deaths compared with the standard treatment of treating at severe range blood pressures.
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Affiliation(s)
- Uma Doshi
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, Oregon
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Mandelbaum A, Dzubay S, Chaiken SR, Doshi U, Katlaps I, Caughey AB. Preventing eviction during pregnancy: a cost-effectiveness analysis of a theoretical safety-net program. Am J Obstet Gynecol 2023; 229:331.e1-331.e9. [PMID: 37330122 DOI: 10.1016/j.ajog.2023.06.029] [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: 03/06/2023] [Revised: 06/09/2023] [Accepted: 06/12/2023] [Indexed: 06/19/2023]
Abstract
BACKGROUND Eviction during pregnancy has been shown to be associated with adverse birth outcomes. A safety net program focused on covering the costs of rent during pregnancy may aid in preventing adverse complications. OBJECTIVE This study aimed to evaluate the cost-effectiveness of a program covering the cost of rent to prevent eviction during pregnancy. STUDY DESIGN A cost-effectiveness model using TreeAge software was designed to evaluate the cost, effectiveness, and incremental cost-effectiveness ratio associated with eviction compared to no eviction during pregnancy. The cost of eviction from a societal perspective was compared to the annual cost of housing in the no eviction group, which was estimated by the median contract rent in the United States from 2021 national census data. Birth outcomes included preterm birth, neonatal death, and major neurodevelopmental delay. Probabilities and costs were derived from the literature. The cost-effectiveness threshold was set at $100,000/QALY. We performed univariable and multivariable sensitivity analyses to assess the robustness of the results. RESULTS In our theoretical cohort of 30,000 pregnant individuals aged 15 to 44 years facing eviction annually, the no eviction during pregnancy strategy was associated with 1427 fewer preterm births, 47 fewer neonatal deaths, and 44 fewer cases of neurodevelopmental delay compared to eviction. At the median cost of rent in the United States, the no eviction strategy was associated with increased quality-adjusted life-years and decreased costs. Therefore, the no eviction strategy was the dominant strategy. In univariate sensitivity analysis varying the cost of housing, no eviction remained the cost-effective strategy and was cost-saving when rent was below $1016 per month. CONCLUSION The no eviction strategy is cost-effective and reduces cases of preterm birth, neonatal death, and neurodevelopmental delay. When rent is below the median of $1016 per month, no eviction is the cost-saving strategy. These findings suggest that policies supporting social programmatic implementation for rent coverage for pregnant people at risk of eviction have the potential to be highly beneficial in reducing costs and disparities in perinatal outcomes.
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Affiliation(s)
- Ava Mandelbaum
- Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland, OR.
| | - Sarah Dzubay
- Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland, OR
| | - Sarina R Chaiken
- Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland, OR
| | - Uma Doshi
- Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland, OR
| | - Isabel Katlaps
- Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland, OR
| | - Aaron B Caughey
- Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland, OR
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Katlaps I, Ghafari-Saravi A, Mandelbaum A, Packer CH, Doshi U, Garg B, Caughey AB, Valent A. Adverse Perinatal and Neonatal Outcomes Among Adolescent Pregnancies in the United States. Am J Perinatol 2023. [PMID: 37399846 DOI: 10.1055/a-2121-7698] [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: 07/05/2023]
Abstract
BACKGROUND Despite a downward trend in recent years, adolescent pregnancies in the United States remain higher than any other Western country. Adolescent pregnancies have been inconsistently associated with adverse perinatal outcomes. OBJECTIVE To investigate the association between adolescent pregnancies and adverse perinatal and neonatal outcomes in the United States. METHODS This is a retrospective cohort study of singleton births in the US from 2014 to 2020 using national vital statistics data. Perinatal outcomes included gestational diabetes (GDM), gestational hypertension (gHTN), preterm delivery <37 weeks (PTB), cesarean delivery (CD), chorioamnionitis, small for gestational age (SGA), large for gestational age (LGA), and neonatal composite outcome. Chi-square tests were used to compare outcomes among adolescent (13-19 years) vs. adult (20-29 years) pregnancies. Multivariable logistic regression models were used to examine association of adolescent pregnancies with perinatal outcomes. For each outcome, we utilized three models: unadjusted logistic regression, adjusted for demographics, and adjusted for demographics and medical comorbidities. Similar analyses were used to compare younger (13-17 years) and older (18-19 years) adolescent pregnancies to adults. RESULTS In a cohort of 14,014,078 pregnancies, we found that adolescents were at an increased risk of PTB (adjusted odds ratio (aOR) 1.12, 99% confidence interval (CI)1.12-1.13) and SGA (aOR 1.02, 99% CI 1.01-1.03) compared to adult pregnancies. We also found that multiparous adolescents with a prior history of CD were at an increased risk of CD, compared to adults. For all other outcomes, adult pregnancies were at higher risk for adverse outcomes in the adjusted models. When comparing birth outcomes among adolescents, we found that older adolescents are at an increased risk of PTB, while younger adolescents are at an increased risk of both PTB and SGA. CONCLUSION After adjusting for confounders, our study demonstrates adolescents have an increased risk of preterm birth and SGA, compared to adults.
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Affiliation(s)
- Isabel Katlaps
- Oregon Health & Science University School of Medicine, Portland, United States
| | | | - Ava Mandelbaum
- Oregon Health & Science University School of Medicine, Portland, United States
| | - Claire H Packer
- Brigham and Women's Hospital Department of Obstetrics and Gynecology, Boston, United States
| | - Uma Doshi
- Oregon Health & Science University School of Medicine, Portland, United States
| | - Bharti Garg
- Obstetrics and Gynecology, Oregon Health & Science University, Portland, United States
| | - Aaron B Caughey
- Obstetrics and Gynecology, Oregon Health & Science University, Portland, United States
| | - Amy Valent
- Obstetrics and Gynecology, OHSU, Portland, United States
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Egan RC, Chaiken SR, Derrah K, Doshi U, Hersh A, Packer CH, Caughey AB. Universal Tetanus-Diphtheria-Pertussis Vaccination During Pregnancy: A Cost-Effectiveness Analysis. Obstet Gynecol 2023; 141:837-844. [PMID: 36897561 DOI: 10.1097/aog.0000000000005103] [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] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 12/15/2022] [Indexed: 03/11/2023]
Abstract
OBJECTIVE To assess the cost effectiveness of tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccination in pregnant patients in the United States. METHODS A decision-analytic model in TreeAge was developed to compare universal Tdap vaccination in pregnancy with no Tdap vaccination in pregnancy using a theoretical cohort of 3.66 million pregnant individuals, the approximate number of deliveries per year in the United States. Outcomes included infant pertussis infections, infant hospitalizations, infant encephalopathy cases, infant deaths, and maternal pertussis infections. All probabilities and costs were derived from the literature. Utilities were applied to discounted life expectancies at a rate of 3% to generate quality-adjusted life-years (QALYs). A strategy was considered cost effective if it had an incremental cost-effectiveness ratio of less than $100,000 per QALY. Univariable and multivariable sensitivity analyses were performed to assess the robustness of the model to changes in the baseline assumptions. RESULTS With a baseline assumption of vaccine cost at $47.75, Tdap vaccination was cost effective at $7,601 per QALY. The vaccination strategy was associated with a decrease of 22 infant deaths, 11 infant encephalopathy cases, 2,018 infant hospitalizations, 6,164 infant pertussis infections, and 8,585 maternal pertussis infections, with an increase of 19,489 QALYs. In sensitivity analyses, the strategy was cost effective until the incidence of maternal pertussis became lower than 1.6 cases per 10,000 individuals, the cost of the Tdap vaccine was greater than $540, or previous pertussis immunity was present in more than 92.1% of pregnant individuals. CONCLUSION In a theoretical U.S. cohort of 3.66 million pregnant individuals, Tdap vaccination during pregnancy is cost effective and reduces infant morbidity and mortality compared with no vaccination during pregnancy. These findings are especially relevant given that approximately half of individuals are not vaccinated during pregnancy and recent data have shown that postpartum maternal vaccination and cocooning strategies are ineffective. Public health strategies to encourage greater uptake of Tdap vaccination should be used to reduce the morbidity and mortality of pertussis infection.
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Affiliation(s)
- Rachel C Egan
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, Oregon
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Chaiken SR, Mandelbaum AD, Garg B, Doshi U, Packer CH, Caughey AB. Association Between Rates of Down Syndrome Diagnosis in States With vs Without 20-Week Abortion Bans From 2011 to 2018. JAMA Netw Open 2023; 6:e233684. [PMID: 36943268 PMCID: PMC10031387 DOI: 10.1001/jamanetworkopen.2023.3684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/23/2023] Open
Abstract
IMPORTANCE Many states enacted 20-week abortion bans from 2011 to 2018. Such bans affect individuals who receive diagnoses of fetal anomalies and aneuploidy in the second trimester, preventing pregnant individuals from having the choice of whether or not to continue the pregnancy. OBJECTIVES To examine the trends of neonatal Down syndrome rates and assess the association between enactment of 20-week abortion bans and rates of Down syndrome diagnosis. DESIGN, SETTING, AND PARTICIPANTS This population-based, historical cohort study used National Vital Statistics System data on 31 157 506 births in the US from 2011 to 2018. Statistical analysis was performed from May 2021 to February 2023. EXPOSURE States were categorized as those with or without a 20-week abortion ban enacted during the study period. MAIN OUTCOMES AND MEASURES Demographic characteristics between the ban and no-ban states were compared using χ2 tests and 2-sample t tests. Multivariable logistic regression evaluated the adjusted odds of Down syndrome among births in states that enacted 20-week abortion bans after the abortion ban enactment, adjusting for state, year of birth, maternal race and ethnicity, age, educational level, insurance, and number of prenatal visits. RESULTS The cohort consisted of 31 157 506 births (mean [SD] maternal age, 28.4 [5.9] years) in the United States, of whom 15 951 neonates (0.05%) received a diagnosis of Down syndrome at birth. A total of 17 states enacted 20-week abortion bans during the study period, and 33 states did not enact bans. In both states with and states without bans, the birth prevalence of neonatal Down syndrome increased over time; in states with bans, rates increased from 48.0 to 58.4 per 100 000 births; in states without bans, rates increased from 47.4 to 53.3 per 100 000 births. In multivariable logistic regression assessing the interaction of time and presence of a 20-week abortion ban, the odds of Down syndrome were higher in states that enacted 20-week abortion bans after enactment of the law compared with the years prior to enactment of the ban (adjusted odds ratio, 1.22; 95% CI, 1.11-1.35). CONCLUSIONS AND RELEVANCE In the US from 2011 to 2018, neonatal Down syndrome diagnoses increased more in states that enacted 20-week abortion bans compared with states that did not enact bans. Because these abortion bans were enacted throughout the study period and are known to inhibit choice in patient decision-making, it is possible that the difference in the rates of diagnosis is associated with these policies.
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Affiliation(s)
- Sarina R Chaiken
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland
| | - Ava D Mandelbaum
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland
| | - Bharti Garg
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland
| | - Uma Doshi
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland
| | - Claire H Packer
- Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Aaron B Caughey
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland
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Samuel H, Chaiken SR, Doshi U, Arora M, Caughey AB. Immediate kangaroo mother care for low birth weight babies reduces neonatal mortality: A cost-effectiveness analysis. Am J Obstet Gynecol 2023. [DOI: 10.1016/j.ajog.2022.11.279] [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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Arora M, Doshi U, Chaiken SR, Samuel H, Caughey AB. Allergy evaluation in syphilis positive pregnant individuals with penicillin allergy: A cost effectiveness analysis. Am J Obstet Gynecol 2023. [DOI: 10.1016/j.ajog.2022.11.365] [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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Egan R, Doshi U, Chaiken SR, Garg B, Caughey AB. CDH and CCHD trends among states with vs without 20-week abortion bans from 2012-2018. Am J Obstet Gynecol 2023. [DOI: 10.1016/j.ajog.2022.11.1201] [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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Chaiken SR, Garg B, Doshi U, Arora M, Samuel H, Caughey AB. ECV attempts by year and race/ethnicity in the United States from 2011-2018. Am J Obstet Gynecol 2023. [DOI: 10.1016/j.ajog.2022.11.1227] [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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Chaiken SR, Doshi U, Arora M, Caughey AB. Fetal Scalp pH Sampling with EFM vs. EFM Alone: A two-delivery cost-effectiveness analysis. Am J Obstet Gynecol 2023. [DOI: 10.1016/j.ajog.2022.11.419] [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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Mandelbaum A, Dzubay SK, Chaiken SR, Doshi U, Katlaps I, Caughey AB. Impact of eviction during pregnancy: a cost-effectiveness analysis. Am J Obstet Gynecol 2023. [DOI: 10.1016/j.ajog.2022.11.483] [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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Doshi U, Hersh AR, Garg B, Chaiken SR, Caughey AB. Rates of preeclampsia in subsequent pregnancies by race/ethnicity. Am J Obstet Gynecol 2023. [DOI: 10.1016/j.ajog.2022.11.706] [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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Wallace JD, Doshi U, Chaiken SR, Caughey AB. Financial incentives for smoking cessation during pregnancy and postpartum: a cost-effectiveness analysis. Am J Obstet Gynecol 2023. [DOI: 10.1016/j.ajog.2022.11.850] [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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Bridges A, Doshi U, Caughey AB. Bakri balloon vs. jada device for treatment of postpartum hemorrhage: a cost-effective analysis. Am J Obstet Gynecol 2023. [DOI: 10.1016/j.ajog.2022.11.1018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Doshi U, Leonetti AR, Garg B, Curl OJ, Chaiken SR, Caughey AB. Risk factors for extended ICU stays in the setting of postpartum hemorrhage. Am J Obstet Gynecol 2023. [DOI: 10.1016/j.ajog.2022.11.708] [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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Doshi U, Hersh AR, Garg B, Chaiken SR, Caughey AB. Rates of preeclampsia in subsequent pregnancies by BMI. Am J Obstet Gynecol 2023. [DOI: 10.1016/j.ajog.2022.11.709] [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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Egan R, Doshi U, Chaiken SR, Garg B, Caughey AB. Omphalocele and gastroschisis trends among states with vs without 20-week abortion bans from 2012-2018. Am J Obstet Gynecol 2023. [DOI: 10.1016/j.ajog.2022.11.1200] [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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Hersh AR, Doshi U, Garg B, Caughey AB. Association of body mass index and recurrence of gestational diabetes mellitus. Am J Obstet Gynecol 2023. [DOI: 10.1016/j.ajog.2022.11.189] [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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Chaiken SR, Garg B, Arora M, Dzubay SK, Doshi U, Caughey AB. Comparing perinatal outcomes between hospitals with and without midwife birth attendants. Am J Obstet Gynecol 2023. [DOI: 10.1016/j.ajog.2022.11.1228] [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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Arora M, Chaiken SR, Doshi U, Garg B, Caughey AB. Impact of WIC benefits on perinatal outcomes among pregnant patients with low prenatal care utilization. Am J Obstet Gynecol 2023. [DOI: 10.1016/j.ajog.2022.11.364] [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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Hawkinson L, Chaiken SR, Doshi U, Caughey AB. Cost-Effectiveness of Universal Repeat Screening for HIV in the Third Trimester of Pregnancy. Am J Obstet Gynecol 2023. [DOI: 10.1016/j.ajog.2022.11.331] [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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Esposito L, Garg B, Chaiken SR, Doshi U, Caughey AB. Obstetric outcomes of gestational weight gain outside of IOM guidelines. Am J Obstet Gynecol 2023. [DOI: 10.1016/j.ajog.2022.11.615] [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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Zhang J, Doshi U, Wolz RL, Kosachevsky P, Oldham MJ, Gillman IG, Lee KM. Fit-for-purpose characterization of air-liquid-interface (ALI) in vitro exposure systems for e-vapor aerosol. Toxicol In Vitro 2022; 82:105352. [PMID: 35341918 DOI: 10.1016/j.tiv.2022.105352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 03/03/2022] [Accepted: 03/18/2022] [Indexed: 11/28/2022]
Abstract
Air-liquid-interface (ALI) exposure systems deliver aerosol to the apical surface of cells which mimics the in vivo inhalation exposure conditions. It is necessary, however, to quantify the delivered amount of aerosol for ALI-based in vitro toxicity assessment. In this study, we evaluated two commercially available ALI exposure systems, a Vitrocell® Ames 48 (Ames 48) and a Vitrocell® 24/48 (VC 24/48), and the Vitrocell® VC1/7 smoking machine using a cig-a-like cartridge-based e-vapor device with a prototype formulation (containing 4% nicotine by weight). We characterized aerosol particle-size distribution, aerosol mass, and major chemical components (nicotine, propylene glycol, and glycerol) at the generation source and verified the repeatability of the aerosol generation. We determined aerosol delivery at the ALI by gravimetric analysis of mass collected on Cambridge filter pads and analytical quantitation of the buffer medium which showed that both aerosol mass and nicotine to an exposure insert linearly increased up to 400 puffs. The delivered aerosol mass covered a wide range of 0.8-3.4 mg per insert in the Ames 48 with variability (relative standard deviation, RSD) up to 12% and 1.1-6.4 mg per insert in the VC 24/48 with variability up to 15%. The delivered nicotine ranged approximately up to 200 μg per insert in both exposure systems. These results provided operation and aerosol delivery information of these ALI exposure systems for subsequent in vitro testing of e-vapor aerosols.
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Affiliation(s)
- J Zhang
- Altria Client Services LLC, Richmond, VA, United States of America.
| | - U Doshi
- Altria Client Services LLC, Richmond, VA, United States of America
| | - R L Wolz
- Enthalpy Analytical, Richmond, VA, United States of America
| | - P Kosachevsky
- Enthalpy Analytical, Richmond, VA, United States of America
| | - M J Oldham
- Altria Client Services LLC, Richmond, VA, United States of America
| | - I G Gillman
- Enthalpy Analytical, Richmond, VA, United States of America; Enthalpy Analytical, Richmond, VA, United States of America
| | - K M Lee
- Altria Client Services LLC, Richmond, VA, United States of America
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Packer CH, Doshi U, Garg B, Valent AM. Adverse Perinatal Outcomes Among Teen Pregnancies in the US. Am J Obstet Gynecol 2022. [DOI: 10.1016/j.ajog.2021.11.293] [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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Doshi U, Curl O, Mester NS, Garg B, Caughey AB. Maternal and neonatal outcomes by gestational week in individuals with BMI>50. Am J Obstet Gynecol 2022. [DOI: 10.1016/j.ajog.2021.11.280] [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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Chaiken SR, Doshi U, Caughey AB. Lower Uterine Segment Ultrasound Among Individuals with Prior Cesarean: A Cost-Effectiveness Analysis. Am J Obstet Gynecol 2022. [DOI: 10.1016/j.ajog.2021.11.428] [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: 11/16/2022]
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Beardsworth KM, Doshi U, Raymond E, Baldwin MK. Miles and days until medical abortion via TelAbortion versus clinic in Oregon and Washington, USA. BMJ Sex Reprod Health 2022; 48:e38-e43. [PMID: 33789954 DOI: 10.1136/bmjsrh-2020-200972] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 03/01/2021] [Accepted: 03/15/2021] [Indexed: 05/06/2023]
Abstract
BACKGROUND Medical abortion provided via telemedicine is becoming more widely available, potentially decreasing travel time for in-person abortion evaluation. METHODS We conducted a retrospective chart review of all outpatient medical abortions from October 2016 through December 2019 at our academic medical centre in Portland, Oregon, USA. Using mifepristone administration logs, we identified patients who underwent abortion via direct-to-patient telemedicine or in clinic. Both groups had pre-abortion ultrasound examination. We extracted patient characteristics and geographic data to compare travel distance to clinic, ultrasound facility, and nearest advertised abortion clinic. We compared time from first contact until mifepristone ingestion and gestational age at mifepristone ingestion. RESULTS Median distance from mailing address to clinic for 80 telemedicine and 124 clinic medical abortions was 95 (range 4-377) and 12 (range 0-184) miles (p<0.01). Distance travelled to ultrasound facility was shorter for telemedicine patients (median 7 miles, range 0-150 vs 12 miles, range 0-184; p<0.01) excluding outliers >200 miles. Distance to nearest advertised abortion clinic was equal between groups (median 7 miles, p=0.4). Time to mifepristone administration (ingestion) was longer (11 vs 6 days; p<0.01) and median gestational age was higher (49 vs 44 days; p=0.01) for telemedicine. CONCLUSIONS Telemedicine increases the reach of abortion providers and provides care to more geographically distant patients. Patients chose telemedicine abortion even when they had an equidistant option, suggesting that patients value telemedicine for reasons other than geographic convenience. This telemedicine delivery model that included ultrasound testing prior to abortion resulted in up to a 5-day delay in abortion initiation, which was not clinically significant.
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Affiliation(s)
| | - Uma Doshi
- Department of Obstetrics & Gynecology, Oregon Health & Science University, Portland, Oregon, USA
| | | | - Maureen K Baldwin
- Department of Obstetrics & Gynecology, Oregon Health & Science University, Portland, Oregon, USA
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Doshi U, Mester NS, Packer CH, Garg B, Caughey AB. Influence of BMI on adverse perinatal outcomes in women undergoing ToLAC in preterm delivery. Am J Obstet Gynecol 2022. [DOI: 10.1016/j.ajog.2021.11.279] [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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Doshi U, Avram CM, Packer CH, Caughey AB. Cell-free DNA as a second screen after positive quad screen for Trisomy 18:A cost-effectiveness analysis. Am J Obstet Gynecol 2022. [DOI: 10.1016/j.ajog.2021.11.1257] [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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Doshi U, Avram CM, Packer CH, Caughey AB. Cell-free DNA as a second screen after positive quad screen for Trisomy 21: a Cost-Effective Analysis. Am J Obstet Gynecol 2022. [DOI: 10.1016/j.ajog.2021.11.1258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
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Mester NS, Packer CH, Doshi U, Caughey AB, Marshall NE, Gibbins KJ. Optimal Timing of Delivery in Women with History of Stillbirth: A Decision Analysis. Am J Obstet Gynecol 2022. [DOI: 10.1016/j.ajog.2021.11.811] [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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Doshi U, Mester NS, Packer CH, Garg B, Caughey AB. How does preterm VBAC success vary by hospital size? Am J Obstet Gynecol 2022. [DOI: 10.1016/j.ajog.2021.11.281] [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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Curl O, Doshi U, Mester NS, Garg B, Caughey AB. Maternal and Neonatal Outcomes in the Setting of Pre-Existing Diabetes by Gestational Age. Am J Obstet Gynecol 2022. [DOI: 10.1016/j.ajog.2021.11.786] [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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Chaiken SR, Doshi U, Packer CH, Garg B, Caughey AB. Down Syndrome Trends Among States With vs. Without 20-Week Abortion Bans from 2012-2018. Am J Obstet Gynecol 2022. [DOI: 10.1016/j.ajog.2021.11.1244] [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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Abstract
BACKGROUND Syphilis infections affect many pregnant women worldwide every year. The increasing rates of maternal and congenital syphilis infections in recent years in the United States necessitates further investigation into the adverse effects of syphilis infection on maternal and neonatal health. OBJECTIVE We sought to examine the association of maternal syphilis infection with adverse pregnancy and perinatal outcomes. METHODS We performed a retrospective cohort study of women with singleton pregnancies who delivered between 23 and 42 weeks in California between 2007 and 2011. We compared demographic characteristics and pregnancy outcomes between pregnant women with syphilis and without syphilis. Maternal outcomes of interest included gestational hypertension, pre-eclampsia, gestational diabetes, preterm delivery, cesarean delivery, induction of labor, and severe maternal morbidity. Neonatal outcomes included neonatal intensive care unit admission, congenital anomaly, congenital syphilis, small for gestational age, stillbirth, neonatal death, infant death. Descriptive statistics were assessed using chi-square/Fisher's Exact tests. Multivariable logistic regression was used to estimate the association between syphilis and adverse pregnancy and perinatal outcomes. Statistical comparisons with a p-value of less than .05 and 95% CI that did not cross the null were considered statistically significant. RESULTS Among a cohort of 2,566,246 women, there were 991 pregnancies complicated by maternal infection with syphilis (0.04%). We found during multivariable logistic regression that syphilis infection was significantly associated with preterm delivery (aOR: 1.27, 95% CI: 1.05-1.54), NICU admission >24 h (aOR: 2.54, 95% CI: 2.13-3.04) and stillbirth (aOR: 5.01, 95% CI: 3.16-7.92) after adjusting for a number of potential confounders including maternal age, race/ethnicity, education, parity, prenatal visits, body mass index, smoking and insurance status. CONCLUSION Maternal syphilis infection in pregnancy is associated with specific adverse pregnancy outcomes, even after adjusting for potential confounders. These data can be used to counsel patients with syphilis in pregnancy, and in developing approaches to clinical care. Due to the increased risk of stillbirth, perhaps such patients should receive antenatal testing. Further research is necessary to investigate the mechanisms of morbidity.
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Affiliation(s)
- Alison Schlueter
- Department of Obstetrics & Gynecology, Oregon Health & Science University, Portland, OR, USA
| | - Uma Doshi
- Department of Obstetrics & Gynecology, Oregon Health & Science University, Portland, OR, USA
| | - Bharti Garg
- Department of Obstetrics & Gynecology, Oregon Health & Science University, Portland, OR, USA
| | - Alyssa R Hersh
- Department of Obstetrics & Gynecology, Oregon Health & Science University, Portland, OR, USA
| | - Aaron B Caughey
- Department of Obstetrics & Gynecology, Oregon Health & Science University, Portland, OR, USA
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Schlueter A, Doshi U, Garg B, Hersh AR, Caughey AB. 1083 Adverse pregnancy outcomes associated with maternal syphilis infection. Am J Obstet Gynecol 2021. [DOI: 10.1016/j.ajog.2020.12.1108] [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: 11/16/2022]
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Doshi U, Packer CH, Garg B, Caughey AB. 1153 Influence of race on adverse perinatal outcomes in women undergoing TOLAC. Am J Obstet Gynecol 2021. [DOI: 10.1016/j.ajog.2020.12.1177] [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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Gopalakrishna A, Longo TA, Fantony JJ, Doshi U, Harrison MR, Van Noord M, Inman BA. High rates of venous thromboembolic events in patients undergoing systemic therapy for urothelial carcinoma: A systematic review and meta-analysis. Urol Oncol 2016; 34:407-14. [PMID: 27267581 PMCID: PMC4996725 DOI: 10.1016/j.urolonc.2016.05.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Revised: 04/27/2016] [Accepted: 05/04/2016] [Indexed: 12/12/2022]
Abstract
BACKGROUND Patients undergoing systemic therapy for urothelial carcinoma (UC) are at increased risk for venous thromboembolic (VTE) events. The objective of the current study was to determine the rate of VTE events in patients undergoing systemic therapy for UC and assess factors affecting this rate. METHODS This study was registered with the PROSPERO database (CRD42015025774). We searched Pubmed, MEDLINE, EMBASE, The Cochrane Library, CINAHL, and Web of Science libraries through August 2014. As per PRISMA guidelines, 2 reviewers independently reviewed titles and abstracts. Disagreements were arbitrated by a third reviewer. After full text review, data were abstracted and pooled using a random effects model. Authors were contacted for clarification of data. To determine VTE risk factors, subgroup analyses and meta-regression were conducted. RESULTS We identified 3,635 publications in the initial search, of which 410 met inclusion criteria for full text review. Of these, we were able to obtain data on the outcome of interest for 62 publications. A total of 5,082 patients, of which 77% were male, underwent systemic therapy for UC, with 373 VTE events. The proportion of patients who had had prior surgery, chemotherapy, or radiation was 55%, 25%, and 9%, respectively. Fixed effects and random effects models were used to estimate the VTE rate, yielding event rates of 6.7% and 5.4%, respectively. CONCLUSIONS VTE occurs frequently in patients undergoing systemic therapy for UC. The VTE rate was affected by the country of origin, history of radiation, as well as by the systemic treatment class. The study was limited by the incomplete reporting of all variables of interest.
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Affiliation(s)
| | - Thomas A Longo
- Division of Medical Oncology, Duke University Medical Center, Durham, NC
| | | | - Uma Doshi
- Division of Urology, Duke University Medical Center, Durham, NC
| | - Michael R Harrison
- Division of Medical Oncology, Duke University Medical Center, Durham, NC
| | - Megan Van Noord
- Research and Education Services, Duke University Medical Center, Durham, NC
| | - Brant A Inman
- Division of Urology, Duke University Medical Center, Durham, NC.
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Nabavizadeh N, Doshi U, Meng L, Elliott D, Tanyi J, Fuss M. Heterogeneous Dose Prescription for Early Stage Lung Cancer Stereotactic Body Radiation Therapy (SBRT): Implications on Dose Gradient. Int J Radiat Oncol Biol Phys 2013. [DOI: 10.1016/j.ijrobp.2013.06.1946] [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: 11/29/2022]
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Abstract
Fingerprint recognition technology is an important part of criminal investigations it is the basis of some security systems and an important tool of government operations such as the Immigration and Naturalization Services, registration procedures in the Armed Forces, and so forth. After the tragic events of September 11, 2001, the importance of reliable fingerprint recognition technology became even more obvious. In the current study, pressure-induced changes of distances between ridges of a fingerprint were measured. Using calibrated silicon pressure sensors we scanned the distribution of pressure across a finger pixel by pixel, and also generated maps of an average pressure distribution during fingerprinting. Emulating the fingerprinting procedure employed with widely used optical scanners, we found that on average the distance between ridges decreases by about 20% when a finger is positioned on a scanner. Controlled loading of a finger demonstrated that it is impossible to reproduce the same distribution of pressure across a given finger during repeated fingerprinting procedures.
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Affiliation(s)
- S Mil'shtein
- Advanced Electronic Technology Center, Electrical and Computer Engineering Department, University of Massachusetts, Lowell, MA 01854, USA.
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Abstract
To establish the value of monitoring cerebral perfusion pressure (CPP) as an index for outcome in acutely ill neonates, blood pressure and intracranial pressure (ICP) were monitored in 44 sick newborn infants. ICP was measured via the fontanel using a noninvasive technique. The results indicate that CPP was similar in preterm hyaline membrane disease infants with intracranial bleed and in those without bleed. In term asphyxiated infants, CPP correlated with outcome; 86% of those with low CPP either died or developed cerebral palsy and 75% of those with normal CPP were neurologically normal. We feel that low CPP in asphyxiated term infants must be viewed with concern.
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Abstract
Thromboembolism of abdominal aorta and its branches after umbilical artery catheterization has been previously reported. In the past, total occlusion of the abdominal aorta and its major branches was associated with high mortality. Successful aortic thrombectomy in the neonatal period has been reported only once in English literature. The successful management of 2 infants described here shows the need for early diagnosis and aggressive approach, including surgical thrombectomy when indicated. Thromboembolism of abdominal aorta and iliac arteries can be diagnosed by noninvasive methods, such as 2-dimensional echoaortography and Doppler blood flow measurement.
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