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Aim: To estimate the incidence of abruption in first births and recurrence in the subsequent birth in patients of a large US‐based integrated health care system. Methods: Retrospective population‐based cohort study of patients with first two consecutive singleton births using data from the Kaiser‐Permanente South California health care system who delivered over a period of 30 years (1991–2021), using longitudinally linked electronic health records. ICD‐9/ICD‐10 codes "641.20" and "O45.x" identified placental abruption. We calculated the incidence and rates of abruption in first and second pregnancies. We used logistic regression to estimate the adjusted odds ratios (aOR) for abruption in second pregnancies in patients with and without abruptions in their first pregnancies. Results: Of the 126 264 patients with first two consecutive singleton births over the period, 805 had abruptions in their first births, and 861 in their second births. Rates of abruption in first and second births were 0.63% and 0.68%, respectively. Twenty‐seven patients had abruptions in both first and second births. Rates of abruption in the second birth among individuals with and without previous placental abruption were 3.35% and 0.66%, respectively, giving an approximately five‐fold increased odds of abruption in a second pregnancy in individuals who had abruption in their first birth when compared with those who did not have placental abruption in their first birth (aOR: 4.95, 95% confidence interval: 3.35–7.31, p < 0.00001). Interpregnancy interval had no statistically significant association with recurrence. Conclusion: Abruption in a first birth is associated with an approximately five‐fold increased odds of abruption in a second birth. [ABSTRACT FROM AUTHOR]

Background: Pregnancy complications are risk factors for cardiovascular disease (CVD). Little is known about the role of renal biomarkers measured shortly after delivery, individually or in combination with pregnancy complications, in predicting subsequent severe maternal CVD., Methods and Results: This study included 566 mothers of diverse races and ethnicities from the Boston Birth cohort, enrolled at delivery and followed prospectively. Plasma creatinine and CysC (cystatin C) were measured 1 to 3 days after delivery. CVD during follow-up was defined by physician diagnoses in electronic medical records. Associations of renal biomarkers and pregnancy complications with time-to-CVD events were assessed using Cox proportional hazards models. During an average of 10.3±3.2 years of follow-up, 30 mothers developed 1 or more CVDs. Only a modest association was observed between creatinine and risk of CVD. In comparison, we found that per 0.1 mg/L increase of CysC was associated with a hazard ratio (HR) of 1.2 (95% CI, 1.1-1.4) for CVD after adjusting for covariates. Compared with those without preeclampsia and with normal CysC level (≤75th percentile), mothers with preeclampsia and elevated CysC (>75th percentile) had the highest risk of CVD (HR, 4.6 [95% CI, 1.7-17.7]), whereas mothers with preeclampsia only or with elevated CysC only did not have significantly increased CVD risk. Similar synergistic effects for CVD were observed between CysC and preterm delivery., Conclusions: In this sample of US, traditionally underrepresented multiracial and multiethnic high-risk mothers, elevated maternal plasma CysC, independently and jointly with pregnancy complications, increased risk of CVD later in life. These findings warrant further investigation., Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT03228875.

Study Question: Is there an increased risk of unplanned peripartum hysterectomy in pregnancies with assissted reproductive technology compared to those without ART?Summary Answer: Although the absolute risks are low, there is an almost five-fold increased risk of unplanned peripartum hysterectomy and 1.7 more unplanned peripartum hysterectomies occur per 1000 deliveries in pregnancies with ART compared to those without ART.What Is Known Already: It has been reported that pregnancies with ART was associated with increased risk of peripartum hysterectomy in one case-control study and in one cohort study.Study Design, Size, Duration: A retrospective cohort study was conducted using a birth cohort from 2014 and 2015 in the United States, which includes more than 7 million births. Propensity score (PS) matching was used to control for confounding.Participants/materials, Setting, Methods: Subjects were divided into two groups: pregnancies with and without ART. We calculated PSs with demographic, clinical and socioeconomic variables, and subjects were matched using the PS with a 1:1 ratio. Subjects comprised 43868 ART pregnancies and 43868 non-ART pregnancies after PS matching. The primary outcome of interest was the risk of unplanned peripartum hysterectomy which was compared by evaluating the relative risk and the risk difference between the two groups after PS matching.Main Results and the Role Of Chance: Baseline characteristics were similar between groups after PS matching. The risk of peripartum hysterectomy in women with ART was 4.947 times that of those without ART (0.0021 [94/43868] vs 0.0004 [19/43868]; 95% confidence interval [CI] 3.022-8.098). The risk difference between two groups was 0.0017 (95% CI 0.0012-0.0022).Limitations, Reasons For Caution: There is a possibility of bias due to unmeasured confounding such as fibroids, previous history of uterine surgery and intrauterine procedures. Misclassification of the exposure and/or the outcome could also influence the results.Wider Implications Of the Findings: Although we found a five-fold increased risk of unplanned peripartum hysterectomy in pregnancies with ART compared to those without ART, the results should be interpreted with caution in a clinical context as the overall number and the absolute risk of unplanned peripartum hysterectomy are very low in either group (1/2325 in the non-ART group, and 1/468 in the ART group). However, it would be appropriate as future research agenda to explore mechanisms and/or etiology underlying this finding.Study Funding/competing Interest(s): No external funding was used and there are no competing interests.Trial Registration Number: Not applicable. [ABSTRACT FROM AUTHOR]

Preeclampsia, one of four hypertensive disorders of pregnancy, has traditionally been characterized as new-onset hypertension and proteinuria developing after 20 weeks' gestation. It is, however, now understood to be a complex, progressive, multisystem disorder with a highly variable presentation and a number of potentially life-threatening complications. The American College of Obstetricians and Gynecologists Task Force on Hypertension in Pregnancy has refined preeclampsia diagnostic criteria accordingly, and as the disorder's pathogenesis has been more clearly defined, new targets for screening, diagnosis, prevention, and treatment have emerged. This clinical update provides a review of current practice related to preeclampsia risk assessment, prediction, and management. It discusses preeclampsia pathophysiology and points readers to valuable health care resources on the topic. [ABSTRACT FROM AUTHOR]

Study Question: Does the risk of adverse outcomes at the time of ectopic pregnancy vary by race/ethnicity among women receiving Medicaid, the public health insurance program for low-income people in the USA?Summary Answer: Among Medicaid beneficiaries with ectopic pregnancy, 11% experienced at least one complication, and women from all racial/ethnic minority groups were significantly more likely than whites to experience complications.What Is Known Already: In this population of Medicaid recipients, African American women are significantly more likely than whites to experience ectopic pregnancy, but the risk of adverse outcomes has not previously been assessed.Study Design, Size, and Duration: We conducted a cross-sectional observational study of all women (n = 19 135 106) ages 15-44 enrolled in Medicaid for any amount of time during 2004-2008 who lived in one of the following 14 US states: Arizona; California; Colorado; Florida; Illinois; Indiana; Iowa; Louisiana; Massachusetts; Michigan; Minnesota; Mississippi; New York; and Texas.Participants/materials, Settings, Methods: We analyzed Medicaid claims records for inpatient and outpatient encounters and identified ectopic pregnancies with a principal diagnosis code for ectopic pregnancy from 2004-2008. We calculated the ectopic pregnancy complication rate as the number of ectopic pregnancies with at least one complication (blood transfusion, hysterectomy, any sterilization, or length-of-stay (LOS) > 2 days) divided by the total number of ectopic pregnancies. We used Poisson regression to assess the risk of ectopic pregnancy complication by race/ethnicity. Secondary outcomes were each individual complication, and ectopic pregnancy-related death. We calculated the ectopic pregnancy mortality ratio as the number of deaths divided by live births.Main Results and the Role Of Chance: Ectopic pregnancy-associated complications occurred in 11% of cases. Controlling for age and state, the risk of any complication was significantly higher among women who were black (incidence risk ratio [IRR] 1.47, 95% CI 1.43-1.53, P < 0.0001), Hispanic (IRR 1.16, 95% CI 1.12-1.21, P < 0.0001), Asian (IRR 1.34, 95% CI 1.24-1.45, P < 0.0001), American Indian/Alaskan Native (IRR 1.34 95% CI 1.16-1.55, P < 0.0001), and Native Hawaiian/Pacific Islander (IRR 1.61, 95% CI 1.39-1.87, P < 0.0001) compared with white women. The ectopic pregnancy mortality ratio was 0.48 per 100 000 live births, similar to that reported in previous US surveillance.Limitations, Reasons For Caution: This is a secondary analysis of insurance claims.Wider Implications Of the Findings: Among women at higher baseline risk of pregnancy complications due to their economic status, women from racial/ethnic minority groups face an additional risk of ectopic pregnancy adverse outcomes compared with whites. Systematic changes to reduce racial disparities are an essential part of improving maternal health in the USA.Study Funding/competing Interests: The Eunice Kennedy Shriver National Institute of Child Health and Human Development (1 K08 HD060663 to D.B.S.). The authors report no conflict of interest.Trial Registration Number: Not applicable. [ABSTRACT FROM AUTHOR]

Rationale & Objectives: Preeclampsia, which disproportionately affects Black women, is a leading cause of preterm delivery and risk for future hypertension and chronic kidney disease (CKD). Apolipoprotein L1 (APOL1) kidney risk alleles, common among Black individuals, contribute substantially to CKD disparities. Given the strong link between preeclampsia and CKD, we investigated whether maternal and fetal APOL1 risk alleles can jointly influence preeclampsia risk, and explored potential modifiers of the association between APOL1 and preeclampsia., Study Design: Nested case-control study., Setting & Participants: 426 Black mother-infant pairs (275 African Americans and 151 Haitians) from the Boston Birth Cohort., Exposure: Maternal and fetal APOL1 risk alleles., Outcomes: Preeclampsia., Analytical Approach: Logistic regression models with adjustment for demographic characteristics were applied to analyze associations between fetal and maternal APOL1 risk alleles and risk of preeclampsia and to investigate the effects of modification by maternal country of origin., Results: Fetal APOL1 risk alleles tended to be associated with an increased risk of preeclampsia, which was not statistically significant in the total genotyped population. However, this association was modified by maternal country of origin (P<0.05 for interaction tests): fetal APOL1 risk alleles were significantly associated with an increased risk of preeclampsia among African Americans under recessive (odds ratio [OR], 3.6 [95% CI, 1.3-9.7]; P=0.01) and additive (OR, 1.7 [95% CI, 1.1-2.6]; P=0.01) genetic models but not in Haitian Americans. Also, maternal-fetal genotype discordance at the APOL1 locus was associated with a 2.6-fold higher risk of preeclampsia (P<0.001) in African Americans., Limitations: Limited sample size in stratified analyses; self-reported maternal country of origin; pre-pregnancy estimated glomerular filtration rate (eGFR) and proteinuria data in mothers were not collected; unmeasured confounding social and/or environmental factors; no replication study., Conclusions: This study supports the hypothesis that fetal APOL1 kidney risk alleles are associated with increased risk for preeclampsia in a recessive mode of inheritance in African Americans and suggests that maternal-fetal genotype discordance is also associated with this risk. These conclusions underscore the need to better understand maternal-fetal interaction and their genetic and environmental factors as contributors to ethnic disparities in preeclampsia., (Copyright © 2020 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.)

A range of women's health issues are intimately related to chronic kidney disease, yet nephrologists' confidence in counseling or managing these issues has not been evaluated. The women's health working group of Cure Glomerulonephropathy (CureGN), an international prospective cohort study of glomerular disease, sought to assess adult nephrologists' training in, exposure to, and confidence in managing women's health. A 25-item electronic questionnaire was disseminated in the United States (US) and Canada via CureGN and Canadian Society of Nephrology email networks and the American Society of Nephrology Kidney News. Response frequencies were summarized using descriptive statistics. Responses were compared across provider age, gender, country of practice, and years in practice using Pearson's chi-squared test or Fisher's exact test. Among 154 respondents, 53% were women, 58% practiced in the US, 77% practiced in an academic setting, and the median age was 41–45 years. Over 65% of respondents lacked confidence in women's health issues, including menstrual disorders, preconception counseling, pregnancy management, and menopause. Most provided contraception or preconception counseling to less than one woman per month, on average. Only 12% had access to interdisciplinary pregnancy clinics. Finally, 89% felt that interdisciplinary guidelines and/or continuing education seminars would improve knowledge. Participants lacked confidence in both counseling and managing women's health. Innovative approaches are warranted to improve the care of women with kidney disease and might include the expansion of interdisciplinary clinics, the development of case-based teaching materials, and interdisciplinary treatment guidelines focused on this patient group. [ABSTRACT FROM AUTHOR]

Objectives: This study sought to identify whether pregnancy complications differ between women with and without a psychiatric disorder diagnosis prior to pregnancy., Methods: Women who gave birth between 2007 and 2009 in Pennsylvania and were enrolled in Medicaid from one year prior to their pregnancy until their delivery were included (N=9,930); those with psychiatric disorders were compared with a matched control group (N=4,965 for each). Logistic regression analysis estimated the odds of having a pregnancy complication among those with a psychiatric diagnosis prior to pregnancy, adjusting for demographic characteristics and chronic general medical conditions., Results: Compared with the control group, women with a psychiatric disorder prior to pregnancy had greater odds of having at least one pregnancy complication (odds ratio=1.48, 95% confidence interval=1.37-1.61). Compared with the control group, their odds of antepartum hemorrhage were 1.50 times higher, their odds of preterm labor were 1.45 times higher, and their odds of preterm birth were 1.61 times higher., Conclusions: Women with psychiatric disorders prior to pregnancy were more likely to experience pregnancy complications, including pregnancy hemorrhage, preterm labor, and preterm birth, after the analysis controlled for age, race-ethnicity, and chronic illness status before and during pregnancy. The finding of an association between psychiatric disorders and a higher complication risk suggests the importance of population-based preconception interventions for women with psychiatric disorders and prenatal monitoring to reduce the risk of pregnancy complications in this group.

Objective: We sought to characterize complications of pregnancy, labor, and delivery associated with maternal asthma in a contemporary US cohort. Study Design: We studied a retrospective cohort based on electronic medical record data from 223,512 singleton deliveries from 12 clinical centers across the United States from 2002 through 2008. Results: Women with asthma had higher odds of preeclampsia (adjusted odds ratio [aOR], 1.14; 95% confidence interval [CI], 1.06−1.22), superimposed preeclampsia (aOR, 1.34; 95% CI, 1.15−1.56), gestational diabetes (aOR, 1.11; 95% CI, 1.03−1.19), placental abruption (aOR, 1.22; 95% CI, 1.09−1.36), and placenta previa (aOR, 1.30; 95% CI, 1.08−1.56). Asthmatic women had a higher odds of preterm birth overall (aOR, 1.17; 95% CI, 1.12−1.23) and of medically indicated preterm delivery (aOR, 1.14; 95% CI, 1.01−1.29). Asthmatics were less likely to have spontaneous labor (aOR, 0.87; 95% CI, 0.84−0.90) and vaginal delivery (aOR, 0.84; 95% CI, 0.80−0.87). Risks were higher for breech presentation (aOR, 1.13; 95% CI, 1.05−1.22), hemorrhage (aOR, 1.09; 95% CI, 1.03−1.16), pulmonary embolism (aOR, 1.71; 95% CI, 1.05−2.79), and maternal intensive care unit admission (aOR, 1.34; 95% CI, 1.04−1.72). Conclusion: Maternal asthma increased risk for nearly all outcomes studied in a general obstetric population. [ABSTRACT FROM AUTHOR]