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Objective: To evaluate whether the increased risk of breast cancer is dependent on the formulation of menopausal hormone therapy (HT) used.Methods: We performed a population-based case-control study of women aged 50 years or older using data from the U.K. Clinical Practice Research Datalink. Women with incident cases of breast cancer were age-matched (1:10) with a control group of women with comparable follow-up time with no history of breast cancer. Exposures were classified as ever or never for the following menopausal HT formulations: bioidentical estrogens, animal-derived estrogens, micronized progesterone, and synthetic progestin. Logistic regression analyses were performed to estimate the adjusted effect of menopausal HT formulation on breast cancer risk.Results: Between 1995 and 2014, 43,183 cases of breast cancer were identified and matched to 431,830 women in a control group. In adjusted analyses, compared with women who never used menopausal HT, its use was associated with an increased risk of breast cancer (odds ratio [OR] 1.12, 95% CI 1.09-1.15). Compared with never users, estrogens were not associated with breast cancer (bioidentical estrogens: OR 1.04, 95% CI 1.00-1.09; animal-derived estrogens: OR 1.01, 95% CI 0.96-1.06; both: OR 0.96, 95% CI 0.89-1.03). Progestogens appeared to be differentially associated with breast cancer (micronized progesterone: OR 0.99, 95% CI 0.55-1.79; synthetic progestin: OR 1.28, 95% CI 1.22-1.35; both OR 1.31, 0.30-5.73).Conclusion: Although menopausal HT use appears to be associated with an overall increased risk of breast cancer, this risk appears predominantly mediated through formulations containing synthetic progestins. When prescribing menopausal HT, micronized progesterone may be the safer progestogen to be used. [ABSTRACT FROM AUTHOR]

Objectives: Public health interventions to reduce maternal mortality have largely focused on obstetric causes of death. However, previous studies have noted that non-obstetrics factors, such as motor vehicle accidents, substance overdoses, homicides, and suicides, may account for a large proportion of maternal deaths. The study objective was to examine trends in maternal deaths from non-obstetric causes across races in the United States (US). Methods: A population-based cross-sectional study was conducted on 80,710,348 live births using data from the "Birth Data" and "Mortality Multiple Cause" files compiled by the Centers for Disease Control and Prevention from 2000 to 2019. The annual incidence of maternal deaths attributed to non-obstetric causes (/100,000 live-births) during pregnancy and up to 42 days postpartum were calculated across racial groups. Then the effects of race on the risk of non-obstetric maternal mortality and temporal changes over the study period were examined using logistic regression models. Results: From 2000 to 2019, a total 7,334 women died during pregnancy, childbirth, and within 42 days postpartum from non-obstetric causes, representing 34.5% (7,334/21,241) of all maternal mortality. Of non-obstetric deaths, 31.3% were caused by transport accidents and 27.3% by accidental poisoning. American Indian women were found to have the highest risk of non-obstetric maternal mortality (OR 2.20,95% CI 1.90–2.56), and 46.1% (176/382) of all deaths among pregnant American Indian women were caused by non-obstetric complications. Risk of non-obstetric maternal mortality increased overall during the 20-year study period, with a greater increase among Black (1.15, 1.13–1.17) and American Indian women (1.17, 1.13–1.21). Conclusion: Non-obstetric causes of death have become increasingly prevalent in the US, especially in American Indian women. Novel interventions to address these non-obstetric factors should especially target American Indian women to improve maternal outcomes. Significance: What is Already Known on this Subject?: Black women and American Indian women have the highest maternal mortality rates in the United States. Few studies have considered non-obstetric causes of maternal death. What this Study adds?: Non-obstetric causes of maternal mortality have become increasingly prevalent in the US within the past two decades, with more than one-third of all deaths in pregnant women being non-obstetric in nature. American Indian women and Black women were found to be at the highest risk of non-obstetric mortality, with an upward trend over time. Maternal deaths due to non-obstetric causes was also elevated among Black women compared to white women. [ABSTRACT FROM AUTHOR]

Purpose: In the United States (US), deaths during pregnancy and childbirth have increased over the past 2 decades compared to other high-income countries, and there have been reports that racial disparities in maternal mortality have widened. The study objective was to examine recent trends in maternal mortality in the US by race. Methods: Our population-based cross-sectional study used data from the Centers for Disease Control and Prevention's 2000–2019 "Birth Data" and "Mortality Multiple Cause" data files from the US to calculate maternal mortality during pregnancy, childbirth, and puerperium across race. Logistic regression models estimated the effects of race on the risk of maternal mortality and examined temporal changes in risk across race. Results: A total of 21,241 women died during pregnancy and childbirth, with 65.5% caused by obstetrical complications and 34.5% by non-obstetrical causes. Black women, compared with White women, had greater risk of maternal mortality (OR 2.13, 95% CI 2.06–2.20), as did American Indian women (2.02, 1.83–2.24). Overall maternal mortality risk increased during the 20-year study period, with an annual increase of 2.4 and 4.7/100,000 among Black and American Indian women, respectively. Conclusions: Between 2000 and 2019, maternal mortality in the US increased, overall and especially in American Indian and Black women. Targeted public health interventions to improve maternal health outcomes should become a priority. [ABSTRACT FROM AUTHOR]

• Incidence of amniotic fluid embolisms remained stable between 2000 and 2019 in the USA. • The case-fatality rate due to amniotic fluid embolisms declined over this period. • Highest incidence and fatality rates were in women ≥ 35 years and African-Americans. To estimate incidence and case-fatality rates of amniotic fluid embolism (AFE) and to examine their temporal trends. Population-based retrospective cohort study using the 2000–2019 Health Care Cost and Utilization Project, Nationwide Inpatient Sample (HCUP-NIS). Annual population rates were estimated using HCUP-NIS specific weighting. Descriptive analyses and logistic regression described trends within the cohort. Over the study period, AFE incidence rate remained stable (mean 4.9 cases/100,000 deliveries) and the case-fatality rate declined (mean 17.7 %,95 % CI 16.40–10.09). Highest AFE incidence rates and fatality rates were in women ≥ 35 years, African-Americans, and in urban-teaching hospitals. AFE mortality rates decreased among Hispanics. AFE rates remained stable and fatality rates declined over time. Highest rates of AFE occurrence and death were in women who typically have greater risk of experiencing adverse obstetrical outcomes. Continued research into early diagnostic methods and effective treatments are needed to further improve AFE incidence and mortality rates. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Adenomyosis is a common gynecologic disease involving the uterus with effect on pregnancy being poorly understood. This study aimed to evaluate the associations between adenomyosis and obstetrical and newborn outcomes. METHODS: Using the Healthcare Cost and Utilization Project–National Inpatient Sample from the United States, we conducted a retrospective cohort study of all birth-related admissions from 2016 to 2019. Pregnancies with adenomyosis were identified using the ICD-10 code N80.0, with the remaining pregnancies being the reference group. Multivariate logistic regression models, adjusting for baseline maternal demographics, were used to determine the effect of adenomyosis on pregnancy outcomes. In light of the diagnosis bias inherent in births by cesarean delivery, adjustment for mode of delivery was performed on all outcome analyses. RESULTS: Among the 2,943,532 women who delivered between 2016 and 2019, 1,084 had adenomyosis, for an overall prevalence of 36 cases per 100,000 births, which was stable throughout the study period. Adenomyosis in pregnancy was associated with increased frequency of placenta abruptio (odds ratio 1.67, 95% CI 1.17–2.39), preterm delivery (1.36, 1.16–1.59), preterm premature rupture of membranes (1.31, 1.07–1.61), postpartum hemorrhage (2.65, 2.14–3.27), postpartum transfusion (2.20, 1.62–2.99), disseminated intravascular coagulation (9.31, 4.15–20.92), sepsis (2.67, 1.60–4.45), congenital anomalies (1.95, 1.34–2.84), and intrauterine fetal demise (1.98, 1.02–3.84). CONCLUSION: Adenomyosis in pregnancy is associated with adverse obstetric and fetal outcomes. Pregnancies in patients with adenomyosis should be considered at higher risk and may benefit from delivering in centers capable of managing postpartum hemorrhage. [ABSTRACT FROM AUTHOR]

INTRODUCTION: The incidence of Lyme disease (LD) infections has risen in recent decades. Gestational LD has been associated with adverse pregnancy outcomes; however, the results have been contradictory. The objective of this study was to examine the effects of gestational LD on obstetrical and neonatal outcomes. METHODS: Using the Healthcare Cost and Utilization Project–National Inpatient Sample database from the United States, we conducted a retrospective cohort study of pregnant women who were admitted to hospital between 2016 and 2019. The exposed group consisted of pregnant women with gestational LD infection (ICD-10 code of A692x), whereas the comparison group consisted of pregnant women without gestational LD. Descriptive statistics and multivariate logistic regression models, adjusted for baseline maternal characteristics, were used to determine the associations between gestational LD and obstetrical and neonatal outcomes. RESULTS: Our cohort included 2,943,575 women, 226 of whom were diagnosed with LD during pregnancy. The overall incidence of gestational LD was 7.67 per 100,000 pregnancy admissions. The incidence of gestational LD was stable during the study period. Women with gestational LD were more likely to be Caucasian, older, have private health insurance, and earn higher incomes than the comparison group. Gestational LD was associated with an increased risk of placental abruption (adjusted odds ratio [aOR] 3.45, 95% CI 1.53–7.80) and preterm birth (aOR 1.58, 95% CI 1.03–2.42). CONCLUSION: Gestational LD is associated with a higher risk of placental abruption and preterm birth. Pregnancies complicated by LD may benefit from being closely monitored in tertiary care settings. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Over the past two decades, there has been a trend toward increasing maternal age in the United States. The study objective was to examine the association of maternal age with maternal mortality in the United States and examine temporal trends in mortality by maternal age. METHODS: A nationwide population-based cross-sectional study in the United States between 2000 and 2019 was conducted using data from the Centers for Disease Control and Prevention's "Birth Data" and "Mortality Multiple Cause" data files. Annual incidence and period trends in maternal deaths were calculated using the annual maternal deaths over annual live births across age groups. Multivariate logistic regression models were used to estimate the association between maternal age and risk of maternal mortality and calculate temporal changes in risk of mortality over the study period. RESULTS: Between 2000 and 2019, 21,241 deaths were observed in women during pregnancy and childbirth for an average incidence of 26.3 maternal deaths/100,000 births (95% CI 21.8–31.2). Of all deaths, 6,870 (32.3%) were in women 35 years or older, while only 15.1% of live births were attributed to women 35 years or older. Compared with women 25–29 years of age, there was a significantly greater risk of maternal mortality among women 35–39 (odds ratio 1.60, 95% CI 1.53–1.67), 40–44 (3.78, 3.60–3.99), 45–49 (28.49, 26.49–30.65), and 50–54 (343.50, 319.44–369.37). Risk of mortality increased over time, with the greatest rise in women 35 years or older. CONCLUSION: In the United States, maternal mortality increased during the past two decades, especially in women 35 years or older. Given these findings, targeted strategies to reduce the increasing maternal mortality should become a priority. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Public health interventions to reduce maternal mortality have focused on direct and indirect obstetric causes, while neglecting nonobstetric causes of death. The study objective was to examine recent trends in maternal deaths from nonobstetric causes in the United States. METHODS: A population-based cross-sectional study was conducted in the United States using data from the "Birth Data" and "Mortality Multiple Cause" files compiled by the Centers for Disease Control and Prevention from 2000 to 2019. The annual incidence of maternal deaths attributed to nonobstetric causes per 100,00 live births were calculated across racial groups using official death certificates, while the effects of race on the risk of nonobstetric maternal mortality and temporal changes over the study period were examined using logistic regression models. RESULTS: From 2000 to 2019, a total of 7,334 women died during pregnancy and childbirth from nonobstetric causes, where 31.3% of these deaths were caused by transport accidents and 27.3% by accidental poisoning. American Indian women were found to be at the highest risk of nonobstetric maternal mortality (odds ratio 2.20, 95% CI 1.90–2.56), and 46.1% of all deaths among pregnant American Indian women were caused by nonobstetric complications. The risk of nonobstetric maternal mortality increased overall during the study period, with a greater increase among Black (1.15, 1.13–1.17) and American Indian women (1.17, 1.13–1.21). CONCLUSION: Nonobstetric causes of death have become increasingly prevalent in the United States, overall and especially in American Indian women. Novel interventions to address these nonobstetric factors should especially target American Indian women to improve maternal outcomes. [ABSTRACT FROM AUTHOR]

Purpose: Vulvodynia and vaginismus are common chronic vulvar pain disorders for which there is a paucity of literature on pregnancy outcomes of affected women. The study objective was to evaluate the associations between vulvodynia and vaginismus and obstetric outcomes. Methods: We performed a retrospective cohort study including all birth-related admissions from 1999 to October 2015 extracted from the Healthcare Cost and Utilization Project-National Inpatient Sample from the United States. Women with vulvodynia or vaginismus were identified using the appropriate ICD-9 codes. Multivariate logistic regression models, adjusted for baseline maternal characteristics, were performed to evaluate the effect of vulvodynia and vaginismus on obstetrical and neonatal outcomes. Results: A total of 879 obstetrical patients with vulvodynia or vaginismus were identified in our cohort of 13,792,544 patients admitted for delivery in US hospitals between 1999 and 2015, leading to an overall prevalence of 6 cases per 100,000 births. Between 1999 and 2015, the annual prevalence of vulvodynia or vaginismus rose from 2 to 16 cases per 100,000. Vulvodynia and vaginismus were associated with increased risks of eclampsia, chorioamnionitis, post-term pregnancy, cesarean delivery, instrumental vaginal delivery, blood transfusions, prolonged hospital stays, congenital anomalies and intrauterine growth restriction. Conclusion: Vulvodynia and vaginismus in pregnancy appears underreported in pregnancy compared to reported population rates. Prevalence of reporting seems to have increased in the last decades and is associated with increased risks of maternal and newborn morbidities. Obstetrical caregivers should be aware of the underreporting of these conditions and the associated adverse effects when counseling obstetrical patients. [ABSTRACT FROM AUTHOR]

INTRODUCTION: First-trimester bleeding is associated with miscarriage and preterm birth, for which progesterone has been suggested to improve outcomes. Our study objective was to evaluate the effect of progesterone treatment throughout pregnancy on preventing miscarriage and preterm birth in pregnancies with first trimester bleeding. METHODS: This was a multicenter, double-blind, placebo-controlled, randomized trial comparing 200 mg micronized progesterone, vaginally administered nightly from presentation to 34 weeks of gestation, with an identically appearing placebo. Subjects with vaginal bleeding and live intrauterine pregnancy <14 weeks of gestation were eligible. Multifetal gestations, cervical insufficiency, recurrent pregnancy loss, or bleeding unrelated to placentation were excluded. Primary outcome was occurrence of live term pregnancy. Secondary outcomes included adverse maternal/newborn events and time to miscarriage or birth. Chi-square analyses compared proportions and Mann-Whitney tests compared time-to-event outcomes. RESULTS: A total of 549 patients were randomized, of whom 16 withdrew or were lost to follow-up, leaving 264 patients in the progesterone group and 269 patients in the placebo group. Baseline characteristics were comparable in both groups. The number of patients having a live term birth among those in the progesterone group was 197 (74.6%), compared with 190 (70.6%) in the placebo group (P =.30). Compared to the placebo group, those in the progesterone group had comparable risks of abortion <20 weeks (38 (14.4%) versus 43 (16.0%), P =.94), preterm birth (27 [10.2%] versus 33 [12.3%], P =.46), and stillbirth (2 [0.9%] versus 3 [1.3%], P =.65). There were no differences in adverse maternal or newborn outcomes, or in time-to-event for miscarriage or birth between the groups. CONCLUSION: Progesterone prescribed throughout pregnancy is not effective in preventing miscarriage or prematurity in subjects presenting with first-trimester vaginal bleeding in context of a live intrauterine pregnancy. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Induction of labor (IOL) at 39 weeks has been associated with decreased risk of cesarean delivery. The study objective was to evaluate the effect of IOL at 39 weeks on perinatal death in low-risk pregnancies. METHODS: We used the National Center for Health Statistics Linked Birth/Infant Deaths data from 2013 to 2017 to carry out a propensity score matched cohort study to test the influence of IOL at 39 weeks on risk of stillbirth and infant death. Low-risk singleton pregnancies with a live fetus at 39 weeks with no known congenital malformations who underwent an IOL were matched with comparable pregnancies that were not induced at 39 weeks and that delivered no later than 42 weeks. RESULTS: From >20 million births, 825,323 (4%) low-risk pregnancies that were induced at 39 weeks were propensity score matched (5:1 ratio) to a comparable group of pregnancies that were not induced at 39 weeks. Compared to pregnancies that were not induced at 39 weeks, IOL at 39 weeks was associated with increased risk of perinatal death (10.8 versus 5.8/10,000; OR, 3.83.5–4.2; P <.0001), which consisted of a decreased risk of stillbirth (0 versus 0.7/10,000) and an increased risk of infant death (10.8 versus 5.1/10,000; OR, 4.2; 95% CI, 3.8–4.6; P <.0001). Among live-born infants, the risk of sudden infant death syndrome was more common among pregnancies induced at 39 weeks (OR, 4.3; 95% CI, 3.6–5.2; P <.0001). CONCLUSION: IOL at 39 weeks in low-risk singleton pregnancies is associated with an increased risk of perinatal death. While this may not have a material effect on risk to an individual patient, adoption of widespread practices of inducing low-risk pregnancies at 39 weeks may lead to increases in perinatal deaths on a population level. [ABSTRACT FROM AUTHOR]

Purpose: With improvement in cancer care and fertility preservation, increasing numbers of cancer survivors are requiring obstetrical care. The objective of our study was to evaluate the effect of history of chemotherapy exposure on maternal and neonatal outcomes. Methods: A retrospective population-based cohort study was conducted using the Healthcare Cost and Utilization Project-Nationwide Inpatient Sample (HCUP-NIS) to obtain data on maternal and newborn outcomes in a cohort of births occurring between the years 2006 and 2015. The annual and overall prevalence of chemotherapy exposure was calculated among pregnant women, and multivariate logistic regression models were used to estimate the effect of history of exposure to chemotherapy on the risk of adverse maternal and newborn outcomes. Results: Of 7,907,139 birth admissions, 613 had a history of chemotherapy exposure for an overall incidence of 7.75 per 100,000 admissions. The prevalence of chemotherapy exposure in pregnancy increased during the study period (P < 0.001). Women with a history of chemotherapy were more likely to suffer from obstetric and medical complications including pre-eclampsia, chorioamnionitis, postpartum hemorrhage, and venous thromboembolism as well as an increased risk in overall mortality (OR 9.39, 95% CI 1.31–67.32). No differences were observed in the incidence of adverse neonatal outcomes, including stillbirth, intra-uterine growth restriction, or preterm birth. Conclusion: Women with history of chemotherapy have higher incidence of pregnancy complications and maternal death, with no differences in fetal or newborn outcomes. [ABSTRACT FROM AUTHOR]

Purpose: Increased body mass index (BMI) is an independent risk factor for stillbirth. The purpose of this study was to determine an optimal time of delivery at term in obese women in order to decrease the risk of stillbirth in this population. Methods: We conducted a retrospective population-based cohort study using the CDC’s Period Linked Birth-Infant Death and Fetal Death data. The study population included all singleton, term births with a recorded pre-pregnancy BMI that occurred between 2014 and 2017. Unconditional logistic regression analyses were used to estimate the risk of stillbirth in each BMI class at each gestational week from 37 weeks and onwards comparing with births to normal-weight women at 41 weeks. Results: Of 12,742,980 births in our cohort, 46.8% were to women with a normal BMI, 26.9% were to women who were classified as overweight, 14.5% were to women in obesity class I, 7.3% in obesity class II, and 4.8% in obesity class III. Within each BMI class, the risk of stillbirth increased with gestational age, with the most pronounced rises in risk occurring at later gestational ages. In a dose-response relationship, the risk of stillbirth exceeded that of a normal BMI pregnancy at 41 weeks at the following gestational age and BMI category: obese class 1 at 39 weeks (OR 1.15 95% CI 1.00–1.31), obese class II at 38 weeks (OR 1.21 95% CI 1.04–1.41) and obese class III at 37 weeks (OR 1.30 95% CI 1.11–1.52). Conclusion: Compared to women with a normal BMI at 41 weeks, there was a higher risk of stillbirth at term in women with each increase in BMI class. Consideration should be given to early induction among these women to reduce the risk of stillbirth. [ABSTRACT FROM AUTHOR]

Objective: The incidence of Lyme disease (LD) infections has risen in recent decades. Gestational LD has been associated with adverse pregnancy outcomes; however, the results have been contradictory. The study objective was to examine the effects of gestational LD on obstetrical and neonatal outcomes. Methods: Using the Healthcare Cost & Utilization Project National (Nationwide) Inpatient Sample from the United States, we conducted a retrospective cohort study of pregnant patients admitted to the hospital between 2016 and 2019. The exposed group consisted of pregnant patients with gestational LD infection (International Classification of Diseases, Tenth Revision [ICD‐10] code A692x), while the comparison group consisted of pregnant patients without gestational LD. Descriptive statistics and multivariate logistic regression models, adjusted for baseline maternal characteristics, were used to determine the associations between gestational LD and obstetrical and neonatal outcomes. Results: The cohort included 2 943 575 women, 226 of whom were diagnosed with LD during pregnancy. The incidence of LD was 7.67 per 100 000 pregnancy admissions. The incidence of gestational LD was stable over the study period. Pregnant patients with LD were more likely white, older, to have private health insurance, and to belong to a higher income quartile. Gestational LD was associated with an increased risk of placental abruption (adjusted odds ratio [aOR], 3.45 [95% confidence interval (CI), 1.53–7.80]) and preterm birth (aOR, 1.58 [95% CI, 1.03–2.42]). Conclusion: Gestational LD is associated with a higher risk of placental abruption and preterm birth. Pregnancies complicated by LD, while associated with a higher risk of certain adverse outcomes, can be followed in most healthcare settings. Synopsis: Lyme disease in pregnancy is associated with an increased risk of placental abruption and preterm birth. [ABSTRACT FROM AUTHOR]

Pregnancy outcomes in women with inflammatory myopathies (IM) are not well studied. The purpose of this study is to evaluate the effects of IM on maternal and neonatal outcomes. We conducted a retrospective cohort study using data from the Healthcare Cost and Utilization Project – Nationwide Inpatient Sample (HCUP-NIS) from 1999 to 2015. Among all pregnant women who delivered during this period, those with a diagnosis of IM were identified using the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) coding, which included all patients with dermatomyositis and polymyositis. Maternal and neonatal outcomes were compared in pregnant women with and without IM. Multivariate logistic regression analysis was used to estimate the adjusted effects of IM on these outcomes. A total of 13,792,544 pregnant women delivered between 1999 and 2015, of which 308 had a diagnosis of IM, for an overall prevalence of 2 per 100,000 pregnant women, with rates increasing over the study period. Pregnant women with IM were more likely to be older, African American and suffer from other autoimmune connective tissue diseases. IM in pregnancy was associated with greater risk of preeclampsia, caesarean delivery, major postpartum infections, urinary tract infections and longer hospital stay. Neonates born to mothers with IM had greater risk of prematurity, small for gestational age and intrauterine fetal demise. Pregnant women with IM are at higher risk of adverse maternal and neonatal outcomes and should be closely followed in specialized centers with collaboration between maternal-fetal medicine and rheumatology. [ABSTRACT FROM AUTHOR]

Acute pancreatitis is a rare condition that can be associated with significant complications. The objective of this study is to evaluate the maternal and newborn outcomes associated with acute pancreatitis in pregnancy. A retrospective cohort study using the Healthcare Cost and Utilization Project-Nationwide Inpatient Sample from the United States was performed. All pregnant patients with acute pancreatitis were identified using International Classification of Disease-9 coding from 1999 to 2015. The effect of acute pancreatitis on maternal and neonatal outcomes in pregnancy was evaluated using multivariate logistic regression, while adjusting for baseline maternal characteristics. From 1999 to 2015, there were a total of 13,815,919 women who gave birth. There were a total of 14,258 admissions of women diagnosed with acute pancreatitis, including 1,756 who delivered during their admission and 12,502 women who were admitted in the antepartum period and did not deliver during the same admission. Acute pancreatitis was associated with increased risk of prematurity, OR 3.78 (95% CI 3.38–4.22), preeclampsia, 3.81(3.33–4.36), postpartum hemorrhage, 1.90(1.55–2.33), maternal death, 9.15(6.05–13.85), and fetal demise, 2.60(1.86–3.62) among women diagnosed with acute pancreatitis. Among women with acute pancreatitis, delivery was associated with increased risk of requiring transfusions, 6.06(4.87–7.54), developing venous thromboembolisms, 2.77(1.83–4.18), acute respiratory failure, 3.66(2.73–4.91), and disseminated intravascular coagulation, 8.12(4.12–16.03). Acute pancreatitis in pregnancy is associated with severe complications, such as maternal and fetal death. Understanding the risk factors that may lead to these complications can help prevent or minimize them through close fetal and maternal monitoring. [ABSTRACT FROM AUTHOR]

Obsessive–compulsive disorder (OCD) is a mental disorder linked to functional impairments and adverse health outcomes. We sought to examine the association between pregnant women with OCD and obstetrical and neonatal outcomes in the USA. A retrospective population-based cohort study was conducted using data provided by pregnant women from the Nationwide Inpatient Sample, a nationally representative database of hospitalizations in the USA, from 1999 to 2015. Using diagnostic and procedure codes from the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM), we identified births and classified women by OCD status. Demographic and clinical characteristics were compared for women with and without OCD and multivariate logistic regressions were used to obtain odds ratios (OR) to compare obstetrical and neonatal outcomes between the two groups, adjusting for relevant demographic and clinical variables. Between 1999 and 2015, there were 3365 births to women with OCD, corresponding to an overall prevalence of 24.40 per 100,000 births. Women with OCD were more likely to be older than 25, Caucasian, of higher socioeconomic status, smokers or used drugs and alcohol, and have other comorbid psychiatric conditions. In adjusted models, OCD was associated with a higher risk of gestational hypertension, preeclampsia, premature rupture of membranes, caesarean and instrumental deliveries, venous thromboembolisms and preterm birth. Pregnancies in women with OCD are at high risk of adverse obstetrical and neonatal outcomes. A multidisciplinary approach should be used to identify high risk behaviours and ensure adequate prenatal follow-up and care be available for those with high risk pregnancies. [ABSTRACT FROM AUTHOR]

Obstructive sleep apnea (OSA) is linked to many health comorbidities. We aimed to ascertain if OSA correlates with a rise in poor obstetrical outcomes. Employing the United States' Healthcare Cost and Utilization Project – National Inpatient Sample, we performed our retrospective cohort study including all women who delivered between 2006 and 2015. ICD-9 codes were used to characterize women as having a diagnosis of OSA. Temporal trends in pregnancies with OSA were studied, baseline features were evaluated among gravidities in the presence and absence of OSA, and multivariate logistic regression analysis was utilized in assessing consequences of OSA on patient and newborn outcomes. Of a total 7,907,139 deliveries, 3,115 belonged to patients suffering from OSA, resulting in a prevalence of 39 per 100,000 deliveries. Rates rose from 10.14 to 78.12 per 100,000 deliveries during the study interval (p<0.0001). Patients diagnosed with OSA were at higher risk of having pregnancies with preeclampsia, OR 2.2 (95% CI 2.0–2.4), eclampsia, 4.1 (2.4–7.0), chorioamnionitis, 1.4 (1.2–1.8), postpartum hemorrhage, 1.4 (1.2–1.7), venous thromboembolisms, 2.7 (2.1–3.4), and to deliver by caesarean section, 2.1 (1.9–2.3). Cardiovascular and respiratory complications were also more common among these women, as was maternal death, 4.2 (2.2–8.0). Newborns of OSA patients were at elevated risk of being premature, 1.3 (1.2–1.5) and having congenital abnormalities, 2.3 (1.7–3.0). Pregnancies with OSA were linked to an elevated risk of poor maternal and neonatal outcomes. During pregnancy, OSA patients should receive attentive follow-up care in a tertiary hospital. [ABSTRACT FROM AUTHOR]

Concerns have been raised about the potential association between selective serotonin reuptake inhibitors (SSRIs)/serotonin-norepinephrine reuptake inhibitors (SNRIs) and the risk of abnormal uterine bleeding (AUB), which may be influenced by the affinity of SSRIs/SNRIs for serotonin transporter. Thus, we assessed whether SSRIs/SNRIs with high-affinity for serotonin transporter are associated with AUB compared to SSRIs/SNRIs with low-affinity in non-pregnant women. Using the UK Clinical Practice Research Datalink, we identified a cohort of women aged 15–24 years, newly prescribed a high- or low-affinity SSRI/SNRI between 1990 and 2019. Confounding was addressed using standardized morbidity ratio weighting. We used weighted Cox proportional hazards models to estimate the hazard ratio (HR) and 95 % confidence interval (CI) of AUB associated with high-affinity compared with low-affinity SSRIs/SNRIs. We assessed the risk of anemia as a secondary outcome. The cohort included 156,307 users of high-affinity SSRIs/SNRIs and 102,631 users of low-affinity SSRIs/SNRIs. High-affinity SSRIs/SNRIs were not associated with an increased risk of AUB compared with low-affinity SSRIs/SNRIs (incidence rates: 46.3 versus 42.4 per 1000 person-years, respectively; HR 1.01, 95 % CI 0.93–1.09). Duration of use, age, and comorbidities did not modify the risk. However, high-affinity SSRIs/SNRIs were associated with an increased risk of anemia (HR 1.29, 95 % CI 1.04–1.61) compared with low-affinity SSRIs/SNRIs. Residual confounding may still be present. The risk of AUB did not differ between high- and low-affinity SSRIs/SNRIs. However, the potential risk of anemia suggests the need for monitoring and further investigation of the risk of AUB with these medications. • SSRIs/SNRIs affinity to receptors may influence risk of abnormal uterine bleeding. • Strong-affinity SSRIs/SNRIs were not associated with risk of abnormal uterine bleeding. • Strong-affinity SSRIs/SNRIs were associated with a higher risk of anemia. • Monitoring of these potential side effects may be considered when prescribing SSRIs/SNRIs. [ABSTRACT FROM AUTHOR]

Purpose: Leukemia is the most common cancer among children and young adults and an increasing number of affected patients can expect a full recovery and long-term survival. The study objective was to determine the prevalence of leukemia survivors among pregnant women and to examine the maternal and fetal outcomes of this population.Materials and Methods: We conducted a retrospective population-based cohort study on all births recorded in the Health - Care Cost and Utilization Project - Nationwide Inpatient Sample between 1999 and 2014. We measured the prevalence of leukemia survivors in pregnancy and performed multivariate logistic regression to calculate adjusted odds ratios for maternal and fetal outcomes among this group compared to a nonaffected one.Results: Our cohort consisted of 14,513,587 births, of which 1,269 were to women with a history of leukemia or leukemia in remission, corresponding to a prevalence of 8.74 per 100,000 births. The prevalence rose steadily over the 16-year study period. Pregnant women who were leukemia survivors were more likely to experience gestational diabetes (OR 1.36, 95% CI 1.08-1.70), threatened preterm labor (1.50, 1.09-2.08), venous thromboembolism (4.40, 2.86-6.78), and to require blood transfusions (1.89, 1.24-2.88). Preterm deliveries (1.25, 1.02-1.54) and congenital anomalies (2.32, 1.39-3.86) among their newborns were also more common.Conclusion: The prevalence of leukemia survivors among pregnant women has been steadily rising. While the disease may no longer be active during their pregnancy, leukemia survivors appeared to have increased risks of several adverse outcomes and as such, should be monitored closely in centers with access to specialized care. [ABSTRACT FROM AUTHOR]

Women with a previous caesarean delivery face a difficult choice in their next pregnancy: planning another caesarean or attempting vaginal delivery, both of which are associated with potential maternal and perinatal complications. This trial aimed to assess whether a multifaceted intervention, which promoted person-centred decision making and best practices, would reduce the risk of major perinatal morbidity among women with one previous caesarean delivery. We conducted an open, multicentre, cluster-randomised, controlled trial of a multifaceted 2-year intervention in 40 hospitals in Quebec among women with one previous caesarean delivery, in which hospitals were the units of randomisation and women the units of analysis. Randomisation was stratified according to level of care, using blocked randomisation. Hospitals were randomly assigned (1:1) to the intervention group (implementation of best practices and provision of tools that aimed to support decision making about mode of delivery, including an estimation of the probability of vaginal delivery and an ultrasound estimation of the risk of uterine rupture), or the control group (no intervention). The primary outcome was a composite risk of major perinatal morbidity. This trial was registered with ISRCTN, ISRCTN15346559. 21 281 eligible women delivered during the study period, from April 1, 2016 to Dec 13, 2019 (10 514 in the intervention group and 10 767 in the control group). None were lost to follow-up. There was a significant reduction in the rate of major perinatal morbidity from the baseline period to the intervention period in the intervention group as compared with the control group (adjusted odds ratio [OR] for incremental change over time, 0·72 [95% CI 0·52–0·99]; p=0·042; adjusted risk difference –1·2% [95% CI –2·0 to –0·1]). Major maternal morbidity was significantly reduced in the intervention group as compared with the control group (adjusted OR 0·54 [95% CI 0·33–0·89]; p=0·016). Minor perinatal and maternal morbidity, caesarean delivery, and uterine rupture rates did not differ significantly between groups. A multifaceted intervention supporting women in their choice of mode of delivery and promoting best practices resulted in a significant reduction in rates of major perinatal and maternal morbidity, without an increase in the rate of caesarean or uterine rupture. Canadian Institutes of Health Research (CIHR, MOP-142448). [ABSTRACT FROM AUTHOR]

Purpose: To identify risk factors associated with bladder injury during cesarean delivery, and to determine the frequency of associated morbidities. Methods: Data obtained from the United States' Health Care Cost and Utilization Project-Nationwide Inpatient Sample were used to conduct a retrospective population-wide cohort study. ICD-9 codes were used to identify women who underwent a cesarean delivery between 1999 and 2015. Subsequently, women were classified based on whether or not they experienced a bladder injury during delivery. Multivariate logistic regression was used to determine predictors of bladder injury in cesarean deliveries and to examine the associated morbidities while adjusting for baseline maternal demographics and clinical characteristics. Results: Of 4,169,681 cesarean deliveries identified, there were 7,627 (0.2%) bladder injuries for an overall incidence of 18 per 10,000. Women ≥ 35 years were at greater risk of bladder injury 1.5 (1.4–1.6), as were women with endometriosis 2.0 (1.5–2.7) and Crohn's disease 2.7 (1.7–4.2). Risk of bladder injury increased if the cesarean delivery was associated with placenta previa 2.2 (1.9–2.4), previous cesarean delivery 4.3 (4.1–4.6), failed instrumental delivery 4.1 (3.5–4.8), fetal distress 1.7 (1.6–1.8), failed trial of labor after cesarean delivery 1.3 (1.2–1.4), and labor dystocia 1.7 (1.6–1.8). Cesarean hysterectomies presented the greatest risk for bladder injury 37.0 (33.7–40.6). Bladder injury was associated with an increased frequency of sepsis, venous thromboembolism, peritonitis, blood transfusions and longer hospital stays. Conclusion: Bladder injury during cesarean deliveries is a rare outcome but it is more common among women with certain demographic and clinical characteristics. Among these cases, strategies to prevent sepsis and venous thromboembolism should be considered. [ABSTRACT FROM AUTHOR]

Background: Individuals with hypertensive disorders of pregnancy (HDP) have an elevated lifetime risk of chronic hypertension, metabolic syndrome, and premature cardiovascular disease. Because breastfeeding duration and exclusivity have been associated in observational studies with improved cardiovascular health, optimizing breastfeeding in those with HDP might be an unrealized cardio-prevention approach, in particular because individuals with HDP have more breastfeeding challenges. Breastfeeding supportive interventions targeting one's breastfeeding self-efficacy have been shown to improve breastfeeding rates. Methods: We designed an open-label, multi-center 1:1 randomized behavioral trial to test whether a previously validated self-efficacy enhancing breastfeeding intervention can improve breastfeeding duration and/or exclusivity, and lower postpartum blood pressure at 12 months. Randomization is computer-generated and stratified by site (four hospitals in Montreal, Quebec and one hospital in Kingston, Ontario; all in Canada). Included are breastfeeding participants with HDP (chronic/gestational hypertension or preeclampsia) who delivered a live singleton infant at > 34 weeks, speak English or French, and have no contraindications to breastfeeding. Informed and written consent is obtained at hospitalization for delivery or a re-admission with hypertension within 1 week of discharge. Participants assigned to the intervention group receive a breastfeeding self-efficacy-based intervention delivered by a trained lactation consultant in hospital, with continued reactive/proactive support by phone or text message for up to 6 months postpartum. Regardless of group assignment, participants are followed for self-reported outcomes, automated office blood pressure, and home blood pressure at several time points with end of follow-up at 12 months. Discussion: This study will assess whether an intensive nurse-led behavioral intervention can improve breastfeeding rates and, in turn, postpartum blood pressure – an early marker for atherosclerotic cardiovascular disease. If effective, this form of enhanced breastfeeding support, along with closer BP and metabolic surveillance, can be implemented broadly in individuals lactating after HDP. Trial registration: ClinicalTrials.gov, # NCT04580927, registered on Oct 9, 2020. [ABSTRACT FROM AUTHOR]

Severe hypercalcemia resulting from hyperparathyroidism may result in adverse perinatal outcomes. The objective of this study was to evaluate maternal and neonatal outcomes among pregnant women with hyperparathyroidism using a population database. A retrospective cohort study was conducted using data from the Healthcare Cost and Utilization Project-Nationwide Inpatient Sample from 1999–2015. ICD-9 codes were used to identify women diagnosed with hyperparathyroidism during pregnancy. Perinatal outcomes between pregnant women with and without hyperparathyroidism were compared. Multivariate logistic regression, controlling for age, race, income, insurance type, hospital location, and comorbidities, evaluated the effect of hyperparathyroidism on perinatal outcomes. Of 13,792,544 deliveries included over the study period, 368 were to women with hyperparathyroidism. The overall incidence of hyperparathyroidism was 2.7/100,000 births, increasing from 1.6 to 5.2/100,000 births over the study period (p < 0.0001). Women with hyperparathyroidism were older and had more comorbidities, such as obesity, and pre-gestational hypertension and diabetes. Relative to the comparison group, women with hyperparathyroidism were more likely to deliver preterm, OR 1.69 (95% CI 1.24–2.29), to develop preeclampsia, 3.14 (2.30–4.28), and to deliver by cesarean, 1.69 (1.36–2.09). Infants born to mothers with hyperparathyroidism were more likely to be growth restricted, 1.83 (1.08–3.07), and to be diagnosed with a congenital anomaly, 4.21 (2.09–8.48). Hyperparathyroidism during pregnancy is associated with a significant increase in adverse perinatal outcomes, including preeclampsia, preterm delivery, fetal growth restriction, and congenital anomalies. As such, pregnancies among women with hyperparathyroidism should be considered high-risk, and specialized care is recommended in order to minimize maternal and neonatal morbidity. [ABSTRACT FROM AUTHOR]

Purpose: Psoriasis is a common auto-immune disease affecting the skin and joints for which the current literature remains limited and contradictory in the context of pregnancy. The purpose of our study was to evaluate the association between psoriasis in pregnancy and maternal and newborn outcomes. Methods: A population based retrospective cohort study was conducted using the 1999–2015 United States’ Healthcare Cost and Utilization Project Nationwide Inpatient Sample. ICD-9 codes were used to identify delivery admissions to women with or without psoriasis, as well as maternal and fetal outcomes. Adjusting for baseline characteristics, multivariate logistic regression models were performed to estimate the effects of psoriasis on maternal and newborn outcomes. Results: The cohort consisted of 3737 women with psoriasis, among a total of 13,792,544 pregnancy admissions in US hospitals between the years 1999 and 2015, for a period prevalence of 27.1 cases per 100,000 pregnant women. Psoriasis was associated with preeclampsia, OR 1.4 (95% CI 1.2–1.6), gestational diabetes, 1.27 (1.13–1.42), myocardial infarction, 13.4 (3.3–54.6), chorioamnionitis, 1.3 (1.0–1.6), delivery by cesarean section, 1.2 (1.1–1.3), anemia, 1.74 (1.18–2.57), and requiring blood transfusions, 1.4 (1.0–1.8). Their newborns were at higher risk of being born preterm, 1.2 (1.1–1.4), congenital anomalies, 1.7 (1.2–2.4), and intra-uterine growth restriction, 1.5 (1.2–1.7). Conclusion: Women with psoriasis and their newborns appear more prone to adverse outcomes of pregnancy. It would be prudent for these women to be followed closely during pregnancy by their obstetrical caregiver and dermatologist. Further investigation is warranted regarding the management of psoriasis during pregnancy. [ABSTRACT FROM AUTHOR]

Purpose Hidradenitis suppurativa (HS) is a debilitating chronic inflammatory skin disease with an often-unsatisfactory response to treatment. The objective was to evaluate the association between HS and pregnancy, delivery and neonatal outcomes. Methods The United States’ Healthcare Cost and Utilization Project-Nationwide Inpatient Sample database was used to conduct a retrospective cohort study among all women who delivered between 1999 and 2015. ICD-9 code 705.83 identified those with HS, with the remaining deliveries composing the comparison group. Multivariate logistic regression compared maternal and neonatal outcomes between these two groups, while adjusting for baseline maternal variables. Results The study included 13,792,544 deliveries, of which 1021 were associated with an HS diagnosis (7.4/100,000 deliveries). During the observation period, there was an upward trend in the prevalence of HS among pregnant women (<0.0001). Pregnant women with HS were more likely to be African-American, to belong to a lower income quartile, and to be insured by Medicaid. They were also more likely to smoke, to be morbidly obese, and to be hypertensive. Compared with women without HS, those with HS had a greater likelihood of developing preeclampsia (OR 1.36, 95% CI 1.08–1.71), delivering by cesarean section (OR 1.78, 95% CI 1.56–2.02), and having a baby with congenital anomalies (OR 2.00, 95% CI 1.10–3.62). Conclusions Although HS is a complex skin disorder, pregnancies complicated by HS had comparable outcomes to non-HS pregnancies, with the exception of a greater risk of preeclampsia, cesarean sections, and congenital anomalies. Health-care providers and women should be aware of these HS associated risks. [ABSTRACT FROM AUTHOR]

Purpose To evaluate the effect of pregnancy on the clinical presentation, inpatient procedure rates, and length of hospital stay, on women with urolithiasis. Materials and methods We carried out a matched cohort study using the United States’ Healthcare Cost and Utilization Project-Nationwide Inpatient Sample database from 1999 to 2015. Pregnant women with urolithiasis were compared to age-matched non-pregnant women (1:1) with urolithiasis. Baseline clinical characteristics were compared between the two cohorts and the effect of pregnancy on select inpatient procedural and clinical outcomes was evaluated using conditional logistic regression models. Results There were 42,113 pregnant patients diagnosed with urolithiasis during the study period. It was observed that pregnant patients were less likely to present with classic clinical symptoms of urinary tract stones, such as flank pain, OR 0.63, 95% CI 0.56–0.70, and fever, 0.22 (0.16–0.30), but tended to have longer hospital stays. The pregnant patients were less commonly affected by infectious conditions, namely urinary tract infections, 0.56 (0.53–0.59), sepsis, 0.17 (0.14–0.20), and pyelonephritis, 0.34 (0.36–0.44). Invasive and surgical procedures were less commonly performed in pregnant women. Conclusions Pregnant women admitted with urolithiasis appear to be less symptomatic with fewer interventions and complications than non-pregnant women with urolithiasis. [ABSTRACT FROM AUTHOR]

Purpose Pregnancy among women with end-stage renal disease (ESRD) has risen in frequency, which may be attributed to improvements in hemodialysis care. Our objective was to describe baseline characteristics and pregnancy outcomes among women with ESRD on hemodialysis. Methods Using the United States’ Healthcare Cost and Utilization Project-Nationwide Inpatient Sample, we created a cohort of women with ESRD on hemodialysis who gave birth between 2005 and 2015. We determined the proportion of adverse maternal and neonatal outcomes among this cohort. Then, we created a composite measure of vascular-mediated adverse pregnancy outcomes. Women who experienced at least one of either preeclampsia, intrauterine growth restriction, or intrauterine fetal death were categorized as having the composite measure. Then, multivariate regression models were used to estimate the associations between maternal baseline demographic and clinical characteristics and the composite measure. Results Among 8,765,973 deliveries between 2005 and 2015, 307 were to women with ESRD on hemodialysis. Over the study period, the incidence of pregnancies to women with ESRD increased from 0.47 to 5.76/100,000 births. An estimated 28% of pregnancies were complicated by preeclampsia, 8% by placental abruption, 58% delivered by cesarean, and in the postpartum, 28% required blood transfusions and 6% experienced sepsis. About 45% of babies were born preterm and 14% had IUGR. The composite measure of adverse events was not found to be associated with any baseline maternal characteristics. Conclusions The frequency of pregnant women with ESRD on hemodialysis has risen, with adverse pregnancy complications for both mother and fetus. Transfer to high-risk centers is suggested for women with ESRD. [ABSTRACT FROM AUTHOR]

Information on the use of extracorporeal membrane oxygenation (ECMO) in obstetric patients is scarce. The objective was to conduct a systematic review examining ECMO use in pregnant and postpartum patients in order to identify indications leading to ECMO use and to assess mortality rates. PubMed, EMBASE, Cochrane Library, and SCOPUS were searched using the terms "extracorporeal membrane oxygenation" and "pregnancy" up to 1 November 2020. Case reports and case series reporting the use of ECMO in pregnancy were eligible. Data about maternal age, gestational age, diagnosis, type of ECMO, time on ECMO, pregnancy outcomes, and maternal survival were extracted from studies. The search yielded 1696 citations, of which 125 were included. There were 213 obstetric patients treated with ECMO over a 30-year period. The frequency of reports increased considerably over the last decade. The majority of patients were treated in their third trimester (28.2%) or postpartum (32.9%). Most common etiologies included influenza-induced ARDS (27.7%), pulmonary embolism (13.6%), peripartum cardiomyopathy (11.7%), and infection (11.7%). Pregnancy outcomes ended with live births, either on ECMO (15.5%, 95% CI 10.6–20.4) or not on ECMO (58.3%, 95% CI 51.7–64.9), in fetal demise (8.9%, 95% CI 5.1–12.7), or in spontaneous or induced abortion on ECMO (4.2%, 95% CI 1.5–6.9) or not on ECMO (4.2%, 95% CI 1.5–6.9). Maternal survival was 79.3%. Although women placed on ECMO had a high mortality rate, this is likely an indication of the severity of illness. Overall, ECMO appears to be a valid therapy for the temporary support of vital organs in severely ill pregnant women. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Thrombotic thrombocytopenic purpura (TTP) is a rare microangiopathy. Little is known of its impact on pregnancy. The aim was to evaluate the association between maternal TTP and pregnancy and neonatal outcomes. METHODS: A retrospective cohort study was conducted using the U.S. Healthcare Cost and Utilization Project–Nationwide Inpatient Sample. A cohort of women who delivered between 1999 and 2015 was created. Then ICD-9 code 446.6 was used to identify women with a diagnosis of TTP, with the remaining women without a TTP diagnosis being the comparison group. Multivariate logistic regression estimated the effect of TTP on maternal and neonatal outcomes, while adjusting for maternal baseline variables. RESULTS: A total of 13,792,544 women delivered between 1999 and 2015, of whom 280 had a TTP diagnosis (2/100,000). Women with a TTP diagnosis, compared to those without, had more preexisting health conditions (diabetes, hypertension, and obesity). TTP was associated with several adverse outcomes: maternal death (odds ratio [OR], 215.50; 95% CI, 121.19–383.22), preeclampsia (OR, 18.63, 14.57–23.82), eclampsia (OR, 27.80; 95% CI, 13.08–59.11), placental abruption (OR, 5.20; 95% CI, 3.18–8.50), disseminated intravascular coagulation (OR, 139.11; 95% CI, 81.97–236.09), venous thromboembolism (OR, 10.69; 95% CI, 5.25–21.73), sepsis (OR, 118.42; 95% CI, 63.62–220.42), myocardial infarction (OR, 268.60; 95% CI, 84.30–855.81), postpartum hemorrhage (OR, 15.00; 95% CI, 11.66–19.29), requiring a blood transfusion (OR, 59.77; 95% CI, 46.54–76.76), and cesarean delivery (OR, 3.52; 95% CI, 2.74–4.53). Neonates born to women with a TTP diagnosis were at increased risk for preterm birth (OR, 3.40; 95% CI, 2.58–4.49), intrauterine growth restriction (OR, 2.73; 95% CI, 1.68–4.41), and stillbirth (OR, 9.41; 95% CI, 5.95–14.88). CONCLUSION: TTP increases the risk of adverse maternal and neonatal outcomes, including maternal and fetal death. Women with TTP in the past or present should be followed closely by a multidisciplinary team. [ABSTRACT FROM AUTHOR]

Purpose: Ehlers-Danlos Syndrome (EDS) is an inherited connective tissue disorder caused by abnormal collagen synthesis. Little is known about its effects on pregnancy. The purpose of this study was to evaluate the pregnancy outcomes in women with EDS.Materials and Methods: We conducted a population-based retrospective cohort study using the Healthcare Cost and Utilization Project Nationwide Inpatient Sample database from the United States. The study included women who delivered between 1999 and 2014. We measured the prevalence of EDS over time, and compared the baseline, obstetrical, and neonatal outcomes among women with EDS to the general obstetrical population without EDS. Unconditional logistic regression models were used to calculate the adjusted effect of EDS on maternal and neonatal outcomes.Results: The overall prevalence of EDS in pregnancy was 7 per 100,000 births, with the trend increasing over the 16 year study period (p < .0001). Women with EDS were more likely to be Caucasian, belong to a higher income quartile, and smoke. Pregnancies in women with EDS were associated with prematurity, 1.47 (1.18-1.82), cervical incompetence, 3.11 (1.99-4.85), antepartum hemorrhage, 1.71 (1.16-2.50), placenta previa, 2.26 (1.35-3.77) and maternal death, 9.04 (1.27-64.27). Pregnant women with EDS were more likely to be delivered by cesarean section, 1.55 (1.36-1.76), have longer postpartum stays (>7 days), 2.82 (2.08-3.85), and have a neonate with intra-uterine growth restriction, 1.81 (1.29-2.54).Conclusions: EDS in pregnancy is a high-risk condition with increased maternal morbidity and mortality, as well as newborn morbidity. Consideration should be given to prematurity preventative measures and high-risk pregnancy consultation. [ABSTRACT FROM AUTHOR]

Purpose: We sought to describe temporal trends in hospital admissions for threatened preterm labor (TPTL) and to examine hospital admission duration among women delivered or discharged undelivered. Methods: We carried out a cohort study on all TPTL admissions among pregnancies with a live singleton fetus and intact membranes between 1999 and 2015 using the United States' Healthcare Cost and Utilization Project-Nationwide Inpatient Sample. ICD-9 codes were used to identify women with TPTL. Duration of antenatal admission length of stay was calculated in days following admission to hospital until delivery ("Delivery Admission") or undelivered discharge ("Observation Admission"). Analyses included evaluating trends of birth admissions over total admissions, identifying predictors of delivery using logistic regression, and measuring risk for delivery with increasing duration of antepartum hospitalization. Results: Of 15,335,288 pregnancy admissions, 1,089,987 admissions were for TPTL, with 61.8% being 'Delivery Admissions". During the 16-year study period, overall rates of TPTL admissions declined with a rising proportion of admissions being "Delivery Admissions". "Delivery Admissions" were more common among patients who were older, non-Caucasian, obese, or who had placental abruption. "Observation Admissions" were more common among admissions for antepartum hemorrhage or antepartum spotting. Among all "Delivery Admissions" for TPTL, 89% had delivered within 2 days, 7% delivered within 3–6 days, and 5% delivered beyond 6 days. Conclusion: Overall admissions for TPTL declined over the study period with increasing proportions being "Delivery Admissions". Protocols taking into consideration declining risk of preterm birth among patients undelivered after 2 days may be helpful in reducing unnecessary prolonged observation admissions. [ABSTRACT FROM AUTHOR]

Excluding pregnant people from Covid‐19 clinical trials may lead to unintended harmful consequences. For this study, an online questionnaire was sent to physicians belonging to Canadian professional medical associations in order to evaluate their perspectives on the participation of pregnant women in Covid‐19 clinical trials. The majority of respondents expressed support for including pregnant women in Covid‐19 trials (119/165; 72%), especially those investigating therapies with a prior safety record in pregnancy (139/164; 85%). The main perceived barriers to inclusion identified were unwillingness of pregnant patients to participate and of treating teams to offer participation, the burden of regulatory approval, and a general "culture of exclusion" of pregnant women from trials. We describe why some physicians may be reluctant to include pregnant individuals in trials, and we identify barriers to the appropriate participation of pregnant people in clinical research. [ABSTRACT FROM AUTHOR]

The effects of lipid metabolism disorders (LMD) on pregnancy outcomes is not well known. The purpose of this study is to evaluate the impact of LMD on maternal and fetal outcomes. Using the Healthcare Cost and Utilization Project – National Inpatient Sample from the United States, we carried out a retrospective cohort study of all births between 1999 and 2015 to determine the risks of complications in pregnant women known to have LMDs. All pregnant patients diagnosed with LMDs between 1999 and 2015 were identified using the International Classification of Disease-9 coding, which included all patients with pure hypercholesterolemia, pure hyperglyceridemia, mixed hyperlipidemia, hyperchylomicronemia, and other lipid metabolism disorders. Adjusted effects of LMDs on maternal and newborn outcomes were estimated using unconditional logistic regression analysis. A total of 13,792,544 births were included, 9,666 of which had an underlying diagnosis of LMDs for an overall prevalence of 7.0 per 10,000 births. Women with LMDs were more likely to have pregnancies complicated by diabetes, hypertension, and premature births, and to experience myocardial infarctions, venous thromboembolisms, postpartum hemorrhage, and maternal death. Their infants were at increased risk of congenital anomalies, fetal growth restriction, and fetal demise. Women with LMDs are at significantly higher risk of adverse maternal and newborn outcomes. Prenatal counselling should take into consideration these risks and antenatal care in specialized centres should be considered. [ABSTRACT FROM AUTHOR]

Objective: To examine the associations between risk of pre‐eclampsia and pregnancy levels of maternal 25‐hydroxyvitamin D (25[OH]D) and oxidative stress biomarkers. Methods: A nested case–control study (n = 99; 34 cases; 65 controls) within a prospective pregnancy cohort. Maternal 25(OH)D and oxidative stress markers (six isomers of F2‐isoprostanes; F2‐isoPs) were measured in plasma at 12–18 and 24–26 gestational weeks. Vitamin D deficiency was defined as 25[OH]D less than 50 nmol/L. Results: Maternal vitamin D deficiency was associated with increased 8‐iso‐PGF2α (P = 0.037), 15(R)‐PGF2α (P = 0.004), (±)5‐iPF2α‐VI (P = 0.026) at 12–18 weeks. Vitamin D deficiency was inversely associated with 8‐iso‐PGF2α (P = 0.019) and (±)5‐iPF2α‐VI isomer (P = 0.010) at 24–26 weeks. Both maternal vitamin D deficiency (adjusted odds ratio [aOR], 4.79; 95% confidence interval [CI], 1.67–13.75) and increased (±)5‐iPF2α‐VI (aOR, 2.46; 95% CI, 1.16–5.22) at 24–26 weeks were associated with risk of pre‐eclampsia. However, the interaction test between 25(OH)D and (±)5‐iPF2α‐VI was not significant (P = 0.143). Conclusion: Plasma 25(OH)D below 50 nmol/L was associated with increased oxidative stress levels during pregnancy as measured by two F2‐isoP isomers, including the well‐studied marker 8‐iso‐PGF2α. Whether vitamin D‐induced oxidative stress mediates the risk of pre‐eclampsia warrants future study. Synopsis: In pregnancy, plasma 25‐hydroxyvitamin D levels lower than 50 nmol/L were associated with both increased oxidative stress measured as F2‐isoprostanes and increased risk of pre‐eclampsia. [ABSTRACT FROM AUTHOR]

Background: Optimal obstetric management for women with coronavirus disease (COVID-19) is not known. We describe the management of six pregnant women requiring in-hospital care for severe COVID-19. Methods: A retrospective chart review was conducted to identify pregnant women who tested positive for Severe Acute Respiratory Syndrome Coronavirus (SARS-CoV-2) between 15 March and 30 June 2020. A subset of women meeting criteria for severe COVID-19 was included. Results: Four women required non-invasive supplemental oxygen therapy and two required mechanical ventilation. Four women were discharged from hospital undelivered and two required preterm delivery. One woman had a pulmonary embolism, and two required re-admission for worsening symptoms. Conclusion: Management of pregnant women with severe COVID-19 is complex and should involve multidisciplinary expertise. Avoiding early delivery may be a safe option. We recommend an individualized approach to care, including careful consideration of the expected risks and benefits of expectant obstetric management versus delivery. [ABSTRACT FROM AUTHOR]

To evaluate if induction of labor (IOL) in obese women at 39 weeks of gestation decreases the risk of cesarean delivery (CD). We conducted a retrospective propensity score matched study using the Center for Disease Control's (CDC's) Period Linked Birth-Infant Death data. The study population consisted of cephalic singleton births to women with BMI greater or equal to 30.0 kg/m2 who delivered at or beyond 39 weeks between 2013 and 2017. Women with prior CD were excluded. Women who underwent IOL at 39 weeks were propensity score matched 1:5 on the basis of CD risk factors to women who did not undergo IOL at 39 weeks but may have had an IOL at a later gestational age. Conditional logistic regression compared CD rates and maternal outcomes between obese women induced at 39 weeks with those not induced at 39 weeks. Our cohort consisted of 197,343 obese women induced at 39 weeks and 986,715 obese women not induced at 39 weeks. Overall, the risk of CD among women who had an IOL at 39 weeks was lower than those without an IOL at 39 weeks, 0.59 (0.58–0.60). The decrease in CD risk was more pronounced in multiparas, 0.47 (0.46–0.49) than nulliparas, 0.81 (0.79–0.83). When stratified by BMI, the effect of IOL on lowering CD risk was similar across all obesity classes. Aside from an increased risk of instrumental deliveries, morbidities were comparable in both groups. IOL at 39 weeks among obese women appears to lower the risk of CD, without compromising maternal outcomes. [ABSTRACT FROM AUTHOR]

Purpose: Celiac disease (CD) is a permanent immune reaction to gluten that is likely related to genetic factors. Some studies have linked CD to adverse maternal and/or neonatal outcomes but the data has been contradictory. The purpose of this study was to evaluate the effect of CD on pregnancy outcomes.Materials and Methods: We used data from the Healthcare Cost and Utilization Project-Nationwide Inpatient Sample (NIS) of the USA to conduct a population-based retrospective cohort study of women who delivered between 1999 and 2014. Pregnancies were categorized as having CD if corresponding ICD-9 code was present. Unconditional logistic regression models were used to estimate the adjusted effect on maternal and fetal outcomes.Results: There were 14,513,587 births during the study period of which 2755 were to women with CD, for an overall prevalence of 1.9 cases/10,000 births and with rates increasing over the study period. Women with CD tended to be older, Caucasian and to have pre-existing comorbidities, especially other autoimmune diseases. Women with CD were at greater risk of hyperemesis gravidarum, 4.52 (3.68-5.57), Clostridium difficile colitis, 7.56 (3.14-18.20), and venous thromboembolic events, 2.93 (2.07-4.15), as well as, hospital stays >3 d, 2.06 (1.75-2.43). Infants of women with CD were more likely to be growth restricted, 1.80 (1.46-2.21) and have congenital malformations, 3.51 (2.68-4.58).Conclusions: CD in pregnancy is associated with increased adverse maternal and newborn complications. These pregnancies should be considered high risk and may benefit from increased surveillance. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Tracheal intubation (TI) is associated with hypoxia and an increase in intracranial pressure, potentially leading to brain injury. We aimed to estimate trends, risk factors, and outcomes among term neonates undergoing TI, using a large population-based database. METHODS: This is a retrospective cohort study of 2,122,245 births using the Healthcare Cost and Utilization Project/Nationwide Inpatient Sample from 2015 to 2018. Term infants having undergone TI were identified using ICD-10 codes. Infants with congenital anomalies were excluded. Multivariate logistic regression models were used to evaluate outcomes while adjusting for confounders. RESULTS: Rate of death was 4.4% among the 13,205 infants who had TI, and 0.04% among the 2,109,040 infants who did not have TI. Infants undergoing TI in urban teaching hospitals had higher odds of death compared to infants in rural hospitals (OR 1.77, 95% CI 1.17–2.69). Infants who had TI and died had higher odds of intraventricular hemorrhage (IVH; OR 5.28, 95% CI 4.08–6.83), hypoxic-ischemic encephalopathy (HIE; OR 2.34, 95% CI 1.86–2.94), and sepsis (OR 1.50, 95% CI 1.23–1.83); pulmonary hemorrhage (PH) was the greatest predictor of death (OR 7.34, 95% CI 5.17–10.42). Among infants who had TI and survived, odds of IVH (OR 76.24, 95% CI 67.33–86.32), HIE (OR 291.86, 95% CI 263.26–323.56), sepsis (OR 28.76, 95% CI 27.39–30.31), and PH (OR 542.01, 95% CI 384.73–763.58) were higher compared to controls. CONCLUSION: Term infants undergoing TI have higher mortality rates compared to controls; TI survivors have an increased risk of neurological sequelae. Non-invasive respiratory support and postnatal neuroprotective interventions should be optimized in term infants. [ABSTRACT FROM AUTHOR]