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The objective of this work is to compare the rate of spontaneous preterm birth and associated neonatal morbidity among low-risk pregnancies conceived spontaneously versus pregnancies conceived using infertility medications/intrauterine insemination (IFM/IUI). This population-based retrospective cohort study utilized the US Vital Statistics data set from 2015 to 2019. Low-risk pregnancies, resulting in a live birth, of individuals who conceived either spontaneously or with the assistance of IFM/IUI were examined. The primary measured outcome was the rate of spontaneous preterm delivery, defined as delivery before 37 weeks' gestation without induction of labor. Of the 19,382,574 deliveries during the study period, 7,876,515 (40.6%) met the inclusion criteria. While 7,843,328 (99.6%) conceived spontaneously, 33,187 (0.4%) conceived using IFM/IUI. The rate of spontaneous preterm delivery was significantly higher for patients who conceived using IFM/IUI (71.0 per 1,000 live births) compared to patients who conceived spontaneously (60.3 per 1,000 live births; adjusted relative risk, 1.40; 95% confidence interval, 1.35–1.46). While the rate of spontaneous preterm births and associated composite of neonatal adverse outcomes are significantly higher in pregnancies conceived using IFM/IUI than spontaneous conception, the mortality is similar. [ABSTRACT FROM AUTHOR]

Background: Better understanding of the factors associated with formula feeding during the hospital stay can help in identifying potential lactation problems and promote early intervention. Our aim was to ascertain factors associated with exclusive formula feeding in newborns of low‐risk pregnancies. Methods: A population‐based, retrospective study using the United States vital statistics datasets (2014‐2018) evaluating low‐risk pregnancies with a nonanomalous singleton delivery from 37 to 41 weeks. People with hypertensive disorders, or diabetes, were excluded. Primary outcome was newborn feeding (breast vs exclusive formula feeding) during hospital stay. Adjusted relative risks (aRRs) with 95% confidence intervals (CI) were calculated. Results: Of the 19 623 195 live births during the study period, 11 605 242 (59.1%) met inclusion criteria and among them, 1 929 526 (16.6%) were formula fed. Factors associated with formula feeding included: age < 20 years (aRR 1.31 [95% CI 1.31‐1.32]), non‐Hispanic Black (1.42, 1.41‐1.42), high school education (1.69, 1.69‐1.70) or less than high school education (1.94, 1.93, 1.95), Medicaid insurance (1.52, 1.51, 1.52), body mass index (BMI) < 18.5 (1.10, 1.09‐1.10), BMI 25‐29.9 (1.09, 1.09‐1.09), BMI 30‐34.9 (1.19, 1.19‐1.20), BMI 35‐39.9 (1.31, 1.30‐1.31), BMI ≥ 40 (1.43, 1.42‐1.44), multiparity (1.29, 1.29‐1.30), lack of prenatal care (1.49, 1.48‐1.50), smoking (1.75, 1.74‐1.75), and gestational age (ranged from 37 weeks [1.44, 1.43‐1.45] to 40 weeks [1.11, 1.11‐1.12]). Conclusions: Using a large cohort of low‐risk pregnancies, we identified several modifiable factors associated with newborn feeding (eg, prepregnancy BMI, access to prenatal care, and smoking cessation). Improving the breast feeding initiation rate should be a priority in our current practice to ensure equitable care for all neonates. [ABSTRACT FROM AUTHOR]

Objective In an effort to reduce the primary cesarean delivery (CD) rate, the American College of Obstetricians and Gynecologists (ACOG) recommended new labor guidelines in 2014 that allow longer duration of labor times. There are little data on the impact of these guidelines on CD rates and pregnancy outcomes in a predominantly Hispanic population. This study aimed to compare the primary CD rates and maternal and neonatal outcomes in patients undergoing primary CD for arrest of labor before and after implementation of the 2014 guidelines. Study Design This was a retrospective cohort study of term patients who underwent a CD for an arrest disorder between January 2011 and April 2017 at a county teaching hospital. Our primary outcome was the composite maternal and neonatal morbidities (CMM and CNM, respectively). Differences in the demographic and clinical characteristics, CMM, and CNM stratified by time period (pre- vs. postimplementation) were examined. Results There were 4,976 deliveries in the study period: 525 (11%) underwent primary CD for arrest disorder; 298 (6%) prior to 2014, and 227 (5%) after 2014 (p = 0.62). There was no significant difference in the rate of CD between the two periods (13.4 vs. 13.3%, p = 0.81). In patients undergoing CD for arrest of dilation (n = 389), the CMM and CNM did not significantly change between both groups (63.3 vs. 56%, p = 0.15). In patients who had a CD for arrest of descent (n = 136), the rate of CMM significantly increased from 50 to 75% (p = 0.02) with no significant change in the CNM (13.2 vs. 20%, p = 0.3). Conclusion Despite significant changes in labor management after the publication of the 2014 guidelines, our primary CD rate was not reduced, and we noticed an increase in CMM in patients who had CD for arrest of descent. A randomized controlled trial is needed to further evaluate the effect of these guidelines nationally. Key Points The Obstetric Care Consensus statement aims to decrease the rate of cesarean delivery (CD). We observed an increase in morbidity in CD if done for arrest of descent (pre/post the consensus). A randomized controlled trial is needed to further assess the impact of the guidelines on morbidity. [ABSTRACT FROM AUTHOR]

Objective  Women with placenta accreta spectrum (PAS) having an unplanned delivery may have worse outcome compared with women with a planned delivery. The primary objective of this study was to compare severe maternal morbidity among women with PAS who had a planned scheduled delivery versus an unplanned delivery. Secondary objective was to compare neonatal outcomes. Study Design  Retrospective cohort study at two tertiary centers (January 2009 to June 2019) of all women who underwent a hysterectomy with a histologic proven PAS. Primary outcome was severe maternal morbidity which defined as any of the following: transfusion of ≥4 RBC units or ureter/bowel injury. Neonatal outcome was a composite neonatal morbidity defined as any of the following: Apgar score's < 5 at 5 minutes, mechanical ventilation, or respiratory distress syndrome. Maternal demographic, clinical, and sonographic characteristics were compared between the two groups (planned vs. unplanned). Descriptive statistics were used as appropriate, and a statistical significance was established if p -value was < 0.05. Results  Of 109 women who underwent cesarean hysterectomy for PAS, 41 (37.6%) had an unplanned delivery. There was no significant difference in the number of previous cesarean deliveries or ultrasound findings between the two groups. Women with an unplanned delivery were more likely to bleed during pregnancy than those that had a planned delivery (p  = 0.04). Women with unplanned delivery had lower gestational age at delivery (30.3 vs. 33.8 weeks, p  = 0.001) had a 75% higher rate of the primary outcome (63 vs. 36%, p  = 0.007) and had a higher rate of intensive care unit admissions (39 vs. 17.7%, p  = 0.01) compared with women with a planned delivery. The neonatal morbidity did not differ between the two groups. Conclusion  Since unplanned cesarean hysterectomy among women with PAS occurs in 40% and is associated with significantly higher morbidity, interventions are needed to mitigate the rate of adverse outcomes. Key Points Only 60% of women with PAS reached planned delivery at 34 weeks. PAS unplanned delivery is associated with high morbidity. Some women with PAS may need a scheduled earlier delivery. [ABSTRACT FROM AUTHOR]

Objective: To compare composite maternal and neonatal adverse outcomes among women with at least a bachelor's degree by racial and ethnic groups.Methods: This was a retrospective cohort study using the U.S. vital statistics data sets. We included women with at least a bachelor's degree who delivered a nonanomalous live singleton neonate at 24-40 weeks. The primary outcome, composite maternal adverse outcome, included admission to intensive care unit, maternal transfusion, ruptured uterus, unplanned hysterectomy, or unplanned operating room procedure after delivery. The secondary outcome, composite neonatal adverse outcome, included 5-minute Apgar score less than 5, assisted ventilation for more than 6 hours, neonatal seizure, birth injury, or neonatal death. Multivariable regression models were used to estimate the association between maternal race and adverse outcomes.Results: Of 11.8 million live births, 2.2 million (19%) met the inclusion criteria; 81.5% were to non-Hispanic white women, 8.5% to non-Hispanic black women, and 10% Hispanic women. The overall rate of composite maternal adverse outcome was 5.3 per 1,000 live births. Compared with non-Hispanic white women, the risk of the composite maternal adverse outcome was significantly higher among non-Hispanic black women (adjusted relative risk [aRR] 1.20; 95% CI 1.13-1.27), but lower among Hispanic women (aRR 0.69; 95% CI 0.64-0.74), a pattern which varied among different gestational age groups. The overall rate of composite neonatal adverse outcome was 11.6 per 1,000 live births. The risk of composite neonatal adverse outcome was significantly higher among neonates with non-Hispanic black mothers (aRR 1.25; 95% CI 1.20-1.30), but lower among neonates with Hispanic mothers (aRR 0.71; 95% CI 0.68-0.75), compared with neonates delivered by non-Hispanic white mothers and varied across gestational age.Conclusion: Among women with at least a bachelor's degree, small but measurable racial and ethnic disparities in composite maternal and neonatal adverse outcomes. [ABSTRACT FROM AUTHOR]

Introduction: A potential manner to lower the morbidity with the hypertensive disoreders of pregancy is to explore the time of day of delivery.Objective: To compare composite neonatal adverse outcomes among term women with hypertensive disorders.Methods: This population-based cohort study used the U.S. vital statistics dataset from 2013 to 2017. Time of delivery was categorized into three shifts. The primary outcome was composite neonatal adverse outcome..Results: Compared to neonates delivered at the first shift, the risk of composite neonatal adverse outcome was higher at the third shift (aRR = 1.19, 95% CI = 1.13-1.25).Conclusion: the risk of composite neonatal adverse outcome is higher if the delivery occurs at the third (23:00-7:00) shift. [ABSTRACT FROM AUTHOR]

Objective: To use a large national database to compare composite maternal or neonatal morbidity among low-risk, full-term women.Methods: This cohort study, using the U.S. vital statistics datasets (2011-2015), evaluated low-risk nulliparous women with nonanomalous singleton gestations who labored at 39, 40, or 41 weeks of gestation (as reported in completed weeks of gestation; eg, 39 weeks include 39 0/7 to 39 6/7 weeks). The primary outcome, composite neonatal morbidity, included any of the following: Apgar score below 5 at 5 minutes, assisted ventilation longer than 6 hours, seizure, or mortality. The secondary outcome, composite maternal morbidity, included any of the following: intensive care unit admission, blood transfusion, uterine rupture, or unplanned hysterectomy. Multivariable Poisson regression was used to estimate the association between gestational age and morbidity (using adjusted relative risk [aRR] and 95% CI).Results: Of 19.8 million live births during the study interval, 3.3 million met inclusion criteria: 43.5% were delivered at 39 weeks of gestation, 41.4% at 40 weeks, and 15.1% at 41 weeks. The overall rates of composite neonatal and maternal morbidity were 8.8 and 2.8 per 1,000 live births, respectively. Composite neonatal morbidity was higher for those delivered at 40 (aRR 1.22; 95% CI 1.19-1.25) and 41 (aRR 1.53; 95% CI 1.49-1.58) weeks of gestation when compared with 39 weeks. Composite maternal morbidity was also significantly higher with delivery at 40 (aRR 1.19; 95% CI 1.14-1.25) and 41 weeks of gestation (aRR 1.56; 95% CI 1.47-1.65).Conclusion: Among low-risk nulliparous women, the rate of composite neonatal and maternal morbidity increases, albeit modestly, from 39 through 41 weeks of gestation. [ABSTRACT FROM AUTHOR]

Objective  This study aimed to compare the maternal and neonatal adverse outcomes among singletons delivered at 36 weeks or later with cerclage during index pregnancy versus those without cerclage. Study Design  This retrospective cohort study utilized the U.S. vital statistics datasets from 2011 to 2013. Inclusion criteria were women with nonanomalous singletons, with and without cerclage placement, without diabetes or hypertensive disorders, and delivered at 36 to 41 weeks. The coprimary outcomes were composite maternal and neonatal adverse outcomes. Composite maternal adverse outcome included admission to intensive care unit, maternal transfusion, ruptured uterus, unplanned hysterectomy, or unplanned operating room procedure. Composite neonatal adverse outcome included Apgar score less than 5 at 5 minutes, assisted ventilation for more than 6 hours, neonatal seizure, birth injury, or neonatal death. Secondary outcomes were chorioamnionitis and cesarean delivery. Multivariable Poisson's regression models with error variance were used while adjusting for confounders. Adjusted relative risk (aRR) with 95% confidence intervals (CIs) were calculated. Results  Of the 8,508,228 women who met inclusion criteria, 0.2% had a cerclage and reached 36 weeks. Composite maternal (aRR: 2.04; 95% CI: 1.76–2.36) and neonatal (aRR: 1.28; 95% CI: 1.11–1.47) adverse outcomes were significantly higher among those with cerclage than those without cerclage. Chorioamnionitis (aRR: 1.47; 95% CI: 1.30–1.67) and cesarean delivery (aRR: 1.10; 95% CI: 1.08–1.12) were also significantly higher in women with cerclage than those without cerclage. Conclusion  There is an association between increased composite maternal and neonatal adverse outcomes among women with cerclage who delivered at 36 to 41 weeks as compared with those without cerclage. Key Points Cerclage is associated with increased composite maternal adverse outcome in women at 36–41 weeks. Cerclage is associated with increased composite neonatal adverse outcome in women at 36–41 weeks. Increased chorioamnionitis and cesarean delivery rates are associated with cerclage in women at 36–41 weeks. [ABSTRACT FROM AUTHOR]

Objective This article aims to compare the composite maternal and neonatal morbidities (CMM and CNM, respectively) between macrosomic (≥4,000 g) and nonmacrosomic (<4,000 g) newborns among women with diabetes mellitus (DM). Methods Maternal demographic and peripartum outcome data (N = 1,260) were collected from a retrospective cohort. CMM included chorioamnionitis/endometritis, wound infection, shoulder dystocia, eclampsia, pulmonary edema, admission for hypoglycemia, 3rd/4th degree perineal laceration, and death.CNMincluded 5-minute Appearance, Pulse, Grimace, Activity and Respiration (APGAR) score of <4, neonatal intensive care unit (NICU) admission, respiratory distress syndrome, mechanical ventilation, intraventricular hemorrhage grade III/IV, necrotizing enterocolitis stage II/III, hypoglycemia, hypocalcemia, bronchopulmonary dysplasia, sepsis, seizures, hyperbilirubinemia, and death.Multivariable Poisson regression models with robust error variance were used to calculate adjusted relative risk (aRR) and 95% confidence interval (CI). Results The study population consisted of 967 subjects, including 854 (88.3%) nonmacrosomic and 113 (11.7%) macrosomic infants. After adjustment, the risk of CMMwas higher amongmacrosomic deliveries (aRR = 4.08, 95% CI = 2.45-6.80). The risk of CNM was also higher among macrosomic deliveries (aRR = 1.77, 95% CI = 1.39-2.24). Macrosomia was associated with an increased risk in NICU admission, hypoglycemia, and hyperbilirubinemia. Conclusion Among DM deliveries, macrosomia was associated with a fourfold higher risk of CMM and almost twofold higher risk of CNM. [ABSTRACT FROM AUTHOR]

Objective: To assess whether racial and ethnic disparities in adverse infant and maternal outcomes exist among low-risk term pregnancies.Methods: This population-based retrospective cohort study used U.S. vital statistics data from 2014 to 2017. Women with low-risk, nonanomalous singleton pregnancies who labored and delivered at 37-41 weeks of gestation were included and categorized by maternal race and ethnicity: non-Hispanic white (white), non-Hispanic black (black), Hispanic, and non-Hispanic Asian (Asian). Multivariable Poisson regression models were used to estimate the associations of composite neonatal adverse outcome (Apgar score less than 5 at 5 minutes, assisted ventilation for more than 6 hours, neonatal seizure, or neonatal death), infant mortality, and composite maternal adverse outcome (blood transfusion, admission to the intensive care unit, uterine rupture, or unplanned hysterectomy) with maternal race and ethnicity.Results: Of 9,205,873 women included, 55.5% were white, 13.7% were black, 24.3% were Hispanic, and 6.5% were Asian. Risk for the composite neonatal adverse outcome was higher among neonates of black women (unadjusted relative risk [uRR] 1.16, 95% CI 1.13-1.18; adjusted relative risk [aRR] 1.07, 95% CI 1.05-1.10), and lower for neonates of Hispanic and Asian women compared with neonates of white women. A similar pattern of disparity was observed for infant mortality; the risk for infants of black women was significantly increased (uRR 1.89, 95% CI 1.81-1.98; aRR 1.33, 95% CI 1.26-1.39). For the composite maternal adverse outcome, the risk was highest for Asian mothers (uRR 1.09, 95% CI 1.03-1.14; aRR 1.12, 95% CI 1.06-1.18), lowest for Hispanic mothers, and similar for black mothers when compared with white mothers after adjustment for confounders.Conclusion: Among low-risk term pregnancies, the risk for adverse outcomes varied by maternal race and ethnicity. Infants of black women were at the highest risk for neonatal morbidity and infant mortality, and Asian mothers were most likely to experience maternal adverse outcomes. [ABSTRACT FROM AUTHOR]

There are limited contemporary data available describing the characteristics of patients who neither died nor were readmitted to the hospital during the first year after hospital discharge for an acute myocardial infarction (AMI) in comparison with those who died and/or were readmitted to the hospital during this high-risk period. Residents of the Worcester, Massachusetts, metropolitan area discharged after an AMI from 3 central Massachusetts hospitals on a biennial basis from 2001 to 2011 comprised the study population. The average age of this population (n = 4,268) was 69 years, 62% were men, and 92% were white. From 2001 to 2011, 43.5% of patients were classified as low-risk survivors of an AMI, 12.3% died, and 44.2% did not die but had at least 1 rehospitalization during the subsequent year. The proportion of low-risk survivors increased from 42.6% to 46.4%, whereas the proportion of those who died within a year after hospital discharge decreased from 14.3% to 10.5%, respectively, during the years under study. After adjusting for several patient characteristics, younger (≤65 years) persons, men, those who were married, those who did not present with multimorbidities, and patients who did not develop in-hospital clinical complications were more likely to be classified as a low-risk AMI survivor. Identifying low-risk survivors of an AMI may help health care providers to focus more intensive efforts and interventions on those at higher risk for dying and/or being readmitted to the hospital during the postdischarge transition period after an AMI. [ABSTRACT FROM AUTHOR]