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Race/ethnicity is associated with intrauterine growth restriction (IUGR) and small-for-gestational age (SGA) birth. We evaluated the extent to which this association is mediated by adequacy of prenatal care (PNC). A retrospective cohort study was conducted using US National Center for Health Statistics natality files for the years 2011–2017. We performed mediation analyses using a statistical approach that allows for exposure-mediator interaction, and we estimated natural direct effects, natural indirect effects, and proportions mediated. All effects were estimated as risk ratios. Among 23,118,656 singleton live births, the excess risk of IUGR among Black women, Hispanic women, and women of other race/ethnicity as compared with White women was partly mediated by PNC adequacy: 13% of the association between non-Hispanic Black race/ethnicity and IUGR, 12% of the association in Hispanic women, and 10% in other women was attributable to PNC inadequacy. The percentage of excess risk of SGA birth that was mediated was 7% in Black women, 6% in Hispanic women, and 5% in other women. Our findings suggest that PNC adequacy may partly mediate the association between race/ethnicity and fetal growth restriction. In future research, investigators should employ causal mediation frameworks to consider additional factors and mediators that could help us better understand this association. [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]

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]