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The purpose of this study is to clarify which pre-wash total motile count are associated with improved clinical pregnancy rate (CPR) and live birth rate (LBR) based on maternal age, AMH level, stimulation regimen, and infertility diagnosis.This was a retrospective cohort study of first completed IUI cycles at two academic fertility centers from 5/2015 to 9/2019. Cycles were stratified by pre-wash TMC, maternal age, AMH level, stimulation regimen, and infertility diagnosis. The primary outcome was CPR and secondary outcomes were live birth and miscarriage.One thousand one hundred fifty-four cycles were analyzed. Of the 162 cycles that resulted in a CPR (14.0%), most had an insemination TMC 20 million. Compared to TMC 20 million, there was no difference in CPR or LBR for lower TMC categories, excluding the TMC 2 million group, in which there were no pregnancies. When TMC was stratified by deciles, there was also no difference in CPR and LBR, including within the lowest decile (TMC 0.09-8.6 million). Younger age and higher ovarian reserve parameters were associated with higher pregnancy and LBR when stratified by TMC. There was no difference in pregnancy and LBR when considering different stimulation protocols.Our data suggest that pregnancy and LBR are equivalent above a TMC of 2 million. Data stratified by TMC and patient parameters can be used to counsel patients pursuing ART.

OBJECTIVE To evaluate changes in insulin physiology in euglycemic pregnancy and gestational diabetes mellitus (GDM). RESEARCH DESIGN AND METHODS Participants underwent oral glucose tolerance tests at ≤15 weeks’ gestation (early pregnancy), 24–32 weeks’ gestation (mid-late pregnancy), and 6–24 weeks postpartum. We evaluated longitudinal changes in insulin secretory response (log Stumvoll first-phase estimate) and insulin sensitivity (log Matsuda index) using linear mixed models. We then evaluated participants who met GDM criteria in early pregnancy (early GDM) and mid-late pregnancy (classic GDM) separately from those without GDM. We derived the pregnancy insulin physiology (PIP) index to quantify β-cell compensation for insulin resistance. RESULTS Among 166 participants, 21 had early GDM and 24 developed classic GDM. Insulin sensitivity was reduced slightly in early pregnancy (β = −0.20, P < 0.001) and substantially in mid-late pregnancy (β = −0.47, P < 0.001) compared with postpartum. Insulin secretory response (adjusted for insulin sensitivity) was augmented in early pregnancy (β = 0.16, P < 0.001) and mid-late pregnancy (β = 0.16, P = 0.001) compared with postpartum. Compared with postpartum, the PIP index was augmented in early pregnancy (β = 215, P = 0.04) but not mid-late pregnancy (β = 55, P = 0.64). Early GDM was distinguished by a substantial reduction in early pregnancy insulin sensitivity (β = −0.59, P < 0.001) compared with postpartum. Both early and classic GDM lacked evidence of early pregnancy augmentation of insulin secretory response (adjusted for insulin sensitivity) and the PIP index (P > 0.1 vs. postpartum). Early pregnancy PIP index predicted GDM independent of participant characteristics (area under the curve without PIP index 0.70 [95% CI 0.61–0.79], area under the curve with PIP index 0.87 [95% CI 0.80–0.93]). CONCLUSIONS β-Cell function is enhanced in early pregnancy. Deficient first-trimester β-cell function predicts GDM.

Placental pathology can identify characteristic features of specific infectious pathogens. The histopathology of acute SARS-CoV-2 placental infection and exposure without infection has been well described. However, whether the characteristic placental pathology persists after the acute phase of the infection is less clear. We retrospectively identified 67 COVID-19-recovered pregnant patients who had placental pathology available. After reviewing the gross and histopathology, we categorized the findings and studied the placentas for evidence of chronic infection by immunohistochemistry for the spike protein of the virus. We found these placentas showed significantly increased prevalence of maternal and a trend towards significance of fetal vascular malperfusion when compared to a control group of placentas examined for the sole indication of maternal group B streptococcal colonization. None of the COVID-19-recovered placentas showed expression of the viral spike protein; therefore, we found no evidence of persistent infection of the placenta in women with a history of COVID-19 during their pregnancy. We conclude that recovery from a SARS-CoV-2 infection during pregnancy puts the pregnancy at risk for specific pathology.

Context The American Diabetes Association (ADA) recommends a 3-day preparatory diet prior to a diagnostic oral glucose tolerance test (OGTT), a test often recommended in postpartum individuals with a history of gestational diabetes (GDM). Objective Evaluate the relationship between carbohydrate intake and OGTT glucose in 2 cohorts of postpartum individuals. Methods We performed analyses of postpartum individuals from 2 prospective studies with recent GDM (Balance after Baby Intervention, BABI, n = 177) or risk factors for GDM (Study of Pregnancy Regulation of INsulin and Glucose, SPRING, n = 104) .We measured carbohydrate intake using 24-hour dietary recalls (SPRING) or Food Frequency Questionnaire (BABI) and performed 2-hour 75-g OGTTs. The main outcome measure was 120-minute post-OGTT glucose. Results There was no relationship between carbohydrate intake and 120-minute post-OGTT glucose level in either study population (SPRING: β = 0.03, [−5.5, 5.5] mg/dL, P = .99; BABI: β = −3.1, [−9.5, 3.4] mg/dL, P = .35). Adding breastfeeding status to the model did not change results (SPRING β = −0.14, [−5.7, 5.5] mg/dL, P = .95; BABI β = −3.9, [−10.4, 2.7] mg/dL, P = .25). There was, however, an inverse relationship between glycemic index and 120-minute post OGTT glucose (BABI: β = −1.1, [−2.2, −0.03] mg/dL, P = .04). Conclusion Carbohydrate intake is not associated with post-OGTT glucose levels among postpartum individuals. Dietary preparation prior to the OGTT may not be necessary in this population.

Supplementary Table S1: p-values of RT-PCR analysis of PROM1 (CD133), KIT (CD117), SOX2 and POU5F1 (OCT4) genes (Supplementary Figure SC).

Supplementary figures: SA, SB, SC, SD, SE, SF, SG and SH

Supplemental methods and supplementary figure legends

Introduction: Hypertensive disorders of pregnancy (HDP) are associated with higher future cardiovascular risk. Treatment of gestational diabetes (GDM) has been shown to reduce the risk of HDP. It is unknown if women with gestational glucose intolerance (GGI), defined as abnormal GDM screening but without a GDM diagnosis, are at higher risk of HDP. Currently, GGI is not treated. Hypothesis: We tested the hypothesis that GGI pregnancies have increased odds of HDP. Methods: This is a retrospective cohort study of 41,706 singleton pregnancies delivered at an academic center. Based on the results of GDM screening and diagnostic tests, pregnancies were categorized as normal glucose tolerance (NGT, glucose loading test < 140 mg/dl), GGI (glucose loading test ≥140 mg/dl with 0 or 1 abnormal value on oral glucose tolerance testing [OGTT] thus without GDM), or GDM (≥ 2 abnormal values on OGTT). GGI was further classified into groups with zero (GGI-0) or 1 (GGI-1) abnormal OGTT values. We used laboratory, blood pressure, and delivery reports to capture HDP and exclude chronic hypertension. Generalized estimating equations for logistic regression were used to measure the risk of HDP after adjustment for age, 1st trimester BMI, parity, insurance, race/ethnicity, and marital status. A similar approach was used to test for associations between GGI and pre-eclampsia (PE). Results: A total of 84.5% of pregnancies were classified as NGT, 8.9% as GGI-0, 3.0% as GGI-1 and 3.6% as GDM. The unadjusted frequencies of HDP and PE were higher in GGI-1 (140 [11.2%] and 64 [5.1%] of 1,251) and GDM (165 [11.1%] and 94 [6.3%] of 1,485) compared to NGT (2,275 [6.5%] and 1,100 [3.1%] of 35,238) and GGI-0 (283 [7.6%] and 136 [3.6%] of 3,732). We observed greater odds of HDP in all 3 groups compared to NGT in adjusted models, and similar trends for PE (Figure 1). Conclusions: The risks of HDP and PE in GGI-1 are greater than for NGT pregnancies and similar to the risks in GDM. Our results suggest that women with GGI-1 should be considered for intervention, similar to GDM.

Background: Intrapartum decision-making for women with a previous caesarean section (CS) is complex due to competing risks of trial of labour after cesarean (TOLAC) and elective repeat CS (ERCS). Objective: Determine rates of TOLAC and vaginal birth after cesarean (VBAC) in sub-Saharan Africa (SSA) and estimate rates of adverse events associated with TOLAC versus ERCS. Search Strategy: We searched PubMed, MEDLINE, CAB, EMBASE, and African-specific databases. Selection Criteria: We included studies with at least one previous CS conducted in SSA. Data Collection and Analysis: We extracted data on study design, planned and actual delivery mode, and maternal and perinatal outcomes. We calculated median TOLAC and VBAC rates pooled mean uterine rupture rate and compared uterine rupture rates and mortality between TOLAC and ERCS. Main Results: From 51 included studies, the median TOLAC and VBAC rates, weighted for sample size, were 75% (IQR: 40-100%) and 34% (IQR: 24-44%) , respectively; and the weighted mean uterine rupture rate was 1.3% (SD: 1.6%). The uterine rupture rate [1.2% vs 0.2%, OR 1.54 (95% CI 0.63-3.75)] and maternal mortality [0.3% vs

OBJECTIVE Pregnant individuals are universally screened for gestational diabetes mellitus (GDM). Gestational glucose intolerance (GGI) (an abnormal initial GDM screening test without a GDM diagnosis) is not a recognized diabetes risk factor. We tested for an association between GGI and diabetes after pregnancy. RESEARCH DESIGN AND METHODS We conducted a retrospective cohort study of individuals followed for prenatal and primary care. We defined GGI as an abnormal screening glucose-loading test result at ≥24 weeks’ gestation with an oral glucose tolerance test (OGTT) that did not meet GDM criteria. The primary outcome was incident diabetes. We used Cox proportional hazards models with time-varying exposures and covariates to compare incident diabetes risk in individuals with GGI and normal glucose tolerance. RESULTS Among 16,836 individuals, there were 20,359 pregnancies with normal glucose tolerance, 2,943 with GGI, and 909 with GDM. Over a median of 8.4 years of follow-up, 428 individuals developed diabetes. Individuals with GGI had increased diabetes risk compared to those with normal glucose tolerance in pregnancy (adjusted hazard ratio [aHR] 2.01 [95% CI 1.54–2.62], P < 0.001). Diabetes risk increased with the number of abnormal OGTT values (zero, aHR 1.54 [1.09–2.16], P = 0.01; one, aHR 2.97 [2.07–4.27], P < 0.001; GDM, aHR 8.26 [6.49–10.51], P < 0.001 for each compared with normal glucose tolerance). The fraction of cases of diabetes 10 years after delivery attributable to GGI and GDM was 8.5% and 28.1%, respectively. CONCLUSIONS GGI confers an increased risk of future diabetes. Routinely available clinical data identify an unrecognized group who may benefit from enhanced diabetes screening and prevention.

Data on the association of maternal gestational weight gain (GWG) and gestational diabetes mellitus (GDM) with childhood asthma are limited and inconsistent. We aimed to investigate these associations in a U.S. pre-birth cohort. Analyses included 16,351 mother–child pairs enrolled in the Massachusetts General Hospital Maternal-Child Cohort (1998–2010). Data were obtained by linking electronic health records for prenatal visits/delivery to determine BMI, GWG, and GDM (National Diabetes Data Group criteria) and to determine asthma incidence and allergies (atopic dermatitis or allergic rhinitis) for children. The associations of prenatal exposures with asthma were evaluated using logistic regression adjusted for maternal characteristics. A total of 2306 children (14%) developed asthma by age 5 years. Overall, no association was found between GWG and asthma. GDM was positively associated with offspring asthma (OR 1.46, 95% CI 1.14–1.88). Associations between GDM and asthma were observed only among mothers with early pregnancy BMI between 20 and 24.9 kg/m2 (OR 2.31, CI 1.46–3.65, p-interaction 0.02). We report novel findings on the impact of prenatal exposures on asthma, including increased risk among mothers with GDM, particularly those with a normal BMI. These findings support the strengthening of interventions targeted toward a healthier pregnancy, which may also be helpful for childhood asthma prevention.

BACKGROUND By allowing users to track their menstrual periods and the associated signs and symptoms, Menstrual Cycle Tracking Apps (MCTAs) may have potential in epidemiological studies of women’s health. However, there is limited information on the characteristics of MCTA users compared to both those who track their cycles in other ways and those who do not track their cycles. OBJECTIVE We sought to examine differences between individuals tracking their cycles through MCTAs (app-users), individuals tracking through means other than MCTAs (other-trackers), and non-trackers in the Ovulation and Menstruation Health Pilot Study survey METHODS Our study collected survey responses from 263 participants recruited from a gynecology clinic (n=36), a community fair (n=61), and the internet (n=166). We then compared differences in demographic/socioeconomic/lifestyle factors, health conditions, and menstrual cycle characteristics between MCTA users and non-app users and between women who tracked their cycles (with any forms of tracking) and those who did not. RESULTS Overall, participants were mostly white, had attained 4-years of college education or higher, and had a median annual household income between $50,000-$74,999. Among all participants, 103 were MCTA users (app-users), 62 used other forms of cycle tracking (i.e., paper, digital calendar, software, birth control, and memory) (other-trackers), and 95 did not engage in any form of tracking (non-trackers). No meaningful differences in race/ethnicity, household income, and education level between app-users and other-trackers and between other-trackers and non-trackers were found. Menstrual cycle characteristics, such as cycle length, frequencies of normal and abnormal cycles, time to cycle regularity, and age at menarche were also comparable between app-users and other-trackers and between other-trackers and non-trackers. For self-reported factors, other trackers compared to app-users were more likely to smoke (18% vs 6%), use hormonal birth control (89% vs 72%), and had a higher prevalence of endometriosis (5% vs 1%) but a lower prevalence of heartburn (17% vs 26 %). Other trackers had a higher proportion of cholesterol (14%v 7 %), diabetes (5% v 0 %), and anxiety disorder (41% v 27%) compared to non-trackers in this study. CONCLUSIONS Our results suggest that app-users and other-trackers and other-trackers and non-trackers are largely comparable in demographic factors, socioeconomic factors, and menstrual cycle characteristics. Non-trackers, however, may potentially have a slightly differing disease burden compared to MCTA users. Our findings strengthen the generalizability of epidemiological results drawn from studies utilizing MCTAs. Within studies using MCTA sourced data, the addition of survey questions or health data may further facilitate whether differences exist between MCTA sourced data and comparison populations

A positive urine fentanyl toxicology test may have significant consequences for peripartum individuals, yet the extent to which fentanyl in a labor epidural may lead to such a positive test is poorly characterized.To quantify the extent to which neuraxial fentanyl in labor neuraxial analgesia can lead to a positive peripartum maternal or neonatal urine toxicology test.We performed a prospective cohort study of pregnant participants planning a vaginal delivery with neuraxial analgesia. Participants with a history of substance use disorder, hypertension, renal or liver disease were excluded. A urine sample was collected prior to initiation of neuraxial analgesia, each time the bladder was emptied in labor, and up to four times postpartum. Neonatal urine was collected once. Urine fentanyl testing was performed with two common toxicology testing methods: immunoassay and Liquid-Chromatography with Tandem Mass Spectrometric detection (LC-MS/MS).33 maternal-infant dyads yielded a total of 178 urine specimens. All maternal specimens were negative for fentanyl on LC-MS/MS and immunoassay prior to initiation of neuraxial analgesia. Intrapartum, 26/30 (76.7%) of participants had positive LC-MS/MS for fentanyl or its metabolites, and 12/30 (40%) participants had positive immunoassays. Postpartum, 19/21 (90.5%) participants had positive LC-MS/MS, and 13/21 (61.9%) had a positive immunoassay. Of the 13 neonatal specimens collected, 10 (76.9%) were positive on LC-MS/MS, the last of which remained positive 29 hours and 50 minutes after delivery.Neuraxial fentanyl for labor analgesia may lead to positive maternal and neonatal toxicology tests at various times after epidural initiation and cessation and at different rates depending on the testing method used. Caution should be used in interpreting toxicology test results in individuals who receive neuraxial analgesia to avoid false assumptions of non-prescribed use.

Objective This study aimed to characterize attitudes toward novel coronavirus disease 2019 (COVID-19) vaccination and to evaluate factors associated with vaccine uptake among pregnant individuals. Study Design An anonymous survey was distributed to a convenience sample of pregnant individuals receiving prenatal care at two large urban academic hospitals in a single health care network in Massachusetts. Individual demographic variables were included in the survey along with questions assessing attitudes toward COVID-19 and vaccination in pregnancy. Data were analyzed using parametric or nonparametric tests when appropriate, and associated odds ratios (OR) were calculated via univariable logistic regression. Results There were 684 surveys distributed, and 477 pregnant and postpartum individuals completed the survey, for a response rate of 69.7%. Overall, 233 (49.3%) had received or were scheduled to receive a COVID-19 vaccine. Age, White race, non-Hispanic or Latinx ethnicity, working from home, and typical receipt of the influenza vaccine were associated with COVID-19 vaccination. Further, 276 respondents (58.4%) reported that their provider recommended the COVID-19 vaccine in pregnancy; these participants were more likely to have received a vaccine (OR = 5.82, 95% confidence interval [CI]: 3.68–9.26, p Conclusion Strategies are needed to improve patient education regarding vaccine side effects and safety in pregnancy. Policy changes should focus on making it feasible for patients to schedule a vaccine and miss work without loss of pay to get vaccinated. Key Points

Background: Gestational glucose intolerance (GGI, abnormal initial gestational diabetes [GDM] screen) conveys an increased risk of future diabetes (DM) , even when GDM criteria is not met. We previously defined subtypes of GGI/GDM according to the underlying mechanism leading to hyperglycemia (insulin resistance vs. deficiency) . We aimed to determine if GGI subtypes are at differential risk for future prediabetes/DM; we hypothesized increased risk with insulin deficient subtypes. Methods: We defined GGI as glucose loading test 1-hr glucose ≥ 140 mg/dL at > 22 weeks’ gestation. We applied homeostasis model assessment (HOMA) to fasting glucose and insulin at 16-20 weeks’ gestation and classified pregnancies with GGI without GDM into subtypes according to the presence of insulin resistance and/or deficiency. We used Cox proportional-hazards models with time-varying exposures to assess risk of preDM/DM (HbA1c ≥ 5.7% at ≥ 3 months after delivery) in each GGI subtype compared to pregnancies with normal glucose tolerance after adjustment for age, race/ethnicity, health insurance, and first trimester BMI. Women were censored at the time of last HbA1c or GDM diagnosis. Results: Of 671 women with a median 9.9 years of follow-up, 29% (n=196) developed preDM/DM. Among pregnancies in 113 women with GGI, 54% had the insulin resistant subtype (IR) , 25% had the insulin deficient subtype (ID) , and 16% had the mixed pathophysiology subtype (MP) . Subtypes with insulin deficiency (ID + MP) and insulin resistance (IR) were both associated with increased risk of preDM/DM (ID + MP hazard ratio [HR]=1.8 [1.1-2.9], p=0.02 and IR HR=1.7 [1.1-2.6], p=0.01) . Each insulin deficient subtype also appeared to carry increased risk: ID HR=1.7 (0.9-3.1, p=0.12) and MP HR=2.1 (1.0-4.2, p=0.048) . Conclusions: GGI confers an increased risk of future prediabetes/DM, regardless of the mechanism leading to glucose intolerance. A combination of insulin resistance and deficiency may convey the highest risk of future prediabetes/DM. Disclosure D.J. Selen: None. T. Thaweethai: None. K. James: None. J.L. Ecker: None. J.B. Meigs: Consultant; Quest Diagnostics. C.E. Powe: None. Funding National Institutes of Health (T32DK007028) , Massachusetts General Hospital (Physician Scientist Development Award and Claflin Distinguished Scholar’s Award)

Background: Dietary modification in gestational diabetes (GDM) has focused on restricting carbohydrates. Some research suggests that increased dietary fat intake, which often occurs with carbohydrate restriction, may worsen insulin resistance in women with GDM. We tested for a relationship between dietary fat intake and insulin sensitivity in pregnant women. Methods: Pregnant women in the late 2nd trimester, (median [IQR] =26 [25-27] weeks’ gestation) completed a 75 g oral glucose tolerance test (OGTT) and a validated self-administered 24-hr dietary recall. We tested for an association between fat intake the day before the OGTT and insulin sensitivity (inverse of insulin resistance, measured using Matsuda index) using linear regression, adjusting for age, race, education, parity, BMI, gestational age, carbohydrate intake, and caloric intake. We also tested for associations with insulin secretion (measured using Stumvoll 1st phase estimate, with adjustment for insulin sensitivity) , and fasting, 1-hr and 2-hr OGTT glucose (mg/dl) . Results: Pregnant women (N=120, age 34 [31-36]) consumed 82 g of fat [62-101], 235 g of carbohydrate [195-298] and 78 g of protein [61-100] during a 24-hr period. Carbohydrate and fat intake were inversely related after adjusting for total caloric intake (0.3 fewer g of carbohydrate per additional g of fat, P Conclusion: Our results suggest that dietary fat intake does not increase insulin resistance in pregnant women. This may have implications for dietary recommendations in women with GDM. Disclosure E.A.Rosenberg: None. E.W.Seely: None. T.Thaweethai: None. K.James: None. C.Yu: None. M.J.Callahan: None. S.Nelson: None. C.E.Powe: None. Funding National Institutes of Health (1F32DK126343-01A1) ,Nation Institutes of Health (K23DK113218) , and the Robert Wood Johnson Foundation’s Harold Amos Medical Faculty Development Program

Background: Treatment of gestational diabetes (GDM) reduces the risk of large for gestational age (LGA) birthweight and associated complications in infants. Pregnant people with gestational glucose intolerance (GGI, abnormal glucose loading test (GLT) without GDM) usually remain untreated. We examined the risk of LGA among women with GGI in a large cohort. Methods: In a retrospective cohort study of 44,628 singleton pregnancies delivered at an academic center at >28 weeks' gestation, pregnancies with a GLT >140 mg/dl and either a normal 3-hour 100-gram oral glucose tolerance test (OGTT) or one abnormal OGTT value were classified as GGI, and those with 2 abnormal OGTT values as GDM. We used generalized estimating equations for logistic regression to examine the risk of LGA (birthweight >90th percentile for gestational age) in GGI versus normal glucose tolerance (NGT, GLT Results: LGA was present in 7.7% of 36,964 pregnancies with NGT, 9.6% of 4357 with GGI and normal OGTT, 14.3% of 15with GGI and one abnormal OGTT value, and 14.5% of 1800 with GDM. The odds of LGA were higher in GGI than NGT pregnancies (adjusted OR 1.4 [1.3-1.5], p Conclusion: Infants of untreated people with GGI have increased risk of LGA birthweight. The risk of LGA in GGI pregnancies with one abnormal OGTT value was similar to that in GDM in a clinical setting where only GDM was treated. Disclosure J.Maya: None. D.J.Selen: None. T.Thaweethai: None. S.Hsu: None. C.Yu: None. K.James: None. A.Kaimal: None. M.Hivert: Advisory Panel; American Heart Association, Research Support; American Diabetes Association. C.E.Powe: None. Funding MGH (Physician Scientist Development Award and Claflin Distinguished Scholar's Award)

Administrative data, including International Classification of Disease (ICD) codes and birth certificate records, are often used for retrospective gestational diabetes mellitus (GDM) research investigations, to describe associations of GDM with perinatal complications and long-term outcomes, and to determine GDM prevalence. Research investigating the validity of using ICD codes and birth certificates for GDM ascertainment shows varying degrees of reliability.To evaluate the accuracy of both ICD codes and birth certificate diagnosis for GDM ascertainment in a large hospital-based cohort of pregnant individuals, using laboratory criteria for GDM as the reference.We studied individuals who received prenatal care at an academic hospital and affiliated community health centers between 1998 and 2016. In the setting of universal two-step screening for GDM, pregnant individuals were classified as having GDM if greater than or equal to two oral glucose tolerance test values met or exceeded National Diabetes Data Group (NDDG) thresholds. We calculated the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for ICD code and birth certificate ascertainment of GDM, along with their exact binomial 95% confidence intervals (95% CI).In a cohort of 51,059 pregnancies with complete glucose screening, 1303 (2.6%) met NDDG laboratory criteria for GDM. GDM ICD codes had moderate sensitivity of 70.5% (95% CI: 67.9%, 72.9%), high specificity of 99.3% (95% CI: 99.3%, 99.4%), a PPV of 73.3% (95% CI: 70.8%, 75.8%), and a NPV of 99.2% (95% CI: 99.1%, 99.3%). In the 46,512 pregnancies linked to birth certificate data, birth certificate diagnosis had moderate sensitivity (66.3% [95% CI: 63.6%, 69.0%]), high specificity (98.9% [95% CI: 98.8%, 99.0%]), moderate PPV (62.1% [95% CI: 59.8%, 64.4%]), and high NPV (99.1% [95% CI: 99.0%, 99.2%]).Ascertainment of GDM using administrative data, including ICD codes or birth certificates, has moderate sensitivity, moderate PPV, high specificity, and high NPV. Our findings provide context for interpreting the validity of studies that depend on administrative data for ascertainment of GDM and comparing them to prospective studies that use laboratory-based GDM criteria.

AIMS/HYPOTHESIS: Despite recommendations to screen women with diabetes risk factors for hyperglycaemia in the first trimester, criteria for normal glucose values in early pregnancy have not been firmly established. We aimed to compare glucose levels in early pregnancy with those later in gestation and outside of pregnancy in women with diabetes risk factors. METHODS: In pregnant women (N=123) followed longitudinally through the postpartum period, and a separate cohort of non-pregnant women (N=65), we performed 75 g oral glucose tolerance tests. All participants had one or more risk factors for diabetes. Using linear regression, we tested for differences in glucose levels between non-pregnant and pregnant women at early (7–15 weeks) and mid-late (24–32 weeks) gestation as well as postpartum, with adjustment for maternal age, parity, marital status and BMI. In a longitudinal analysis using mixed-effects models, we tested for differences in glucose levels across early and mid-late pregnancy compared with postpartum. Differences are expressed as β (95% CI). RESULTS: Fasting glucose was lower in pregnant compared with non-pregnant women by 0.34 (0.18, 0.51) mmol/l (p

IntroductionThis study aims to characterize attitudes towards COVID-19 vaccination and to evaluate factors associated with vaccine uptake amongst pregnant individuals.MethodsAn anonymous survey was distributed to a convenience sample of pregnant individuals receiving prenatal care at two large urban academic hospitals in a single healthcare network in Massachusetts. Individual demographic variables were included in the survey along with questions assessing attitudes towards COVID-19 and vaccination in pregnancy.ResultsOf 477 respondents, 233 (49.3%) had received or were scheduled to receive a COVID-19 vaccine. Age, White race, non-Hispanic/LatinX ethnicity, working from home, and typical receipt of the influenza vaccine were associated with COVID-19 vaccination. 276 respondents (58.4%) reported that their provider recommended the COVID-19 vaccine in pregnancy; these participants were more likely to have received a vaccine (OR 5.82, 95% confidence interval [CI] 3.68-9.26). Vaccinated individuals were less likely to be worried about the effects of the vaccine on themselves (OR 0.18, 95% CI 0.12-0.27) or their developing babies (OR 0.17, 95% CI 0.11-0.26). Unvaccinated individuals were less likely to report that it is easy to schedule a COVID-19 vaccine (OR 0.56, 95% CI 0.34-0.93), to travel to receive a vaccine (OR 0.19, 95% CI 0.10-0.36), and to miss work to receive a vaccine (OR 0.30, 95% CI 0.18-0.48).ConclusionsStrategies are needed to improve patient education regarding vaccine side effects and safety in pregnancy and to change policy to make it feasible for pregnant patients to schedule and miss work without loss of pay to get vaccinated.Key PointsThere were racial and ethnic disparities in COVID-19 vaccination.Unvaccinated respondents were more likely to be concerned about vaccine effects for themselves or their growing babies.Unvaccinated respondents cited work and scheduling-related barriers to vaccination, indicating areas for advocacy

To compare placental pathology from term singleton live births conceived with fresh embryo transfer vs. those conceived without assisted reproductive technology (ART).Retrospective cohort study.Academic fertility center.Women with a term singleton live birth who conceived after fresh autologous in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) cycles (ART group) and those who conceived without ART.An experienced placental pathologist categorized placental pathology as anatomic, inflammatory, or vascular. Patient characteristics were compared by chi-squared tests, Student's t-test, or nonparametric tests. Multivariate logistic regression models were used to compare placental pathology between pregnancies conceived with and without ART.Incidence of anatomic, inflammatory, and vascular placental pathology.There was a higher incidence of placental pathology in the ART group (n = 511) than in the non-ART group (n = 121), specifically anatomic (adjusted odds ratio [aOR] 2.50, 95% confidence interval [CI] 1.42-4.40) and vascular (aOR 2.00, 95% CI 1.13-3.53) pathology. These findings were driven primarily by the significantly higher odds of anatomic (aOR 2.97, 95% CI 1.55-5.66) and vascular (aOR 1.98, 95% CI 1.04-3.75) pathology observed in ICSI pregnancies. Single blastocyst transfers remained associated with increased anatomic pathology (ART: aOR 4.89, 95% CI 2.28-10.49; ICSI: aOR 3.38, 95% CI 1.49-7.71).Fresh embryo transfer is associated with increased anatomic and vascular placental pathology in term singleton live births compared with conception without ART. This finding should be investigated prospectively in a larger cohort of patients.