Publications by authors named "Adam K Lewkowitz"

Background: Low-income pregnant patients are at high risk of postpartum depression (PPD). Mothers and Babies (MB) is a cognitive behavioral therapy-based program that prevents up to 50% of de novo PPD when provided in person to low-income Spanish- and English-speaking people who are pregnant without depression. MB is limited by the need for trained personnel to support it.

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Prenatal substance use (PSU) is a serious perinatal health issue in the United States with consequential health effects. To address this issue and protect children from the detrimental effects of substance exposure during pregnancy, the US government amended the Child Abuse Prevention and Treatment Act to provide funding to states with protocol to notify child protective services of PSU cases and develop treatment plans for affected families. Although well-intentioned, this statute resulted in diverse inter- and intrastate interpretations and implementation of PSU regulations nationwide, ultimately leading to mass confusion about who the policy applies to and when it should be applied.

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Article Synopsis
  • The study evaluated the link between not following prenatal care guidelines and the causes of stillbirths.
  • It analyzed data from the Stillbirth Collaborative Research Network, focusing on adherence to ACOG/AAP and MiPATH recommendations for prenatal visits.
  • Results indicated that a significant portion of stillbirth cases were from mothers who weren't following these guidelines, with a particular increase in stillbirths associated with hypertensive disorders.
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  • The study investigates the long-term effects of opioid maintenance treatment (OMT) during pregnancy, specifically focusing on the impact of methadone and buprenorphine on childhood neurodevelopmental disorders (NDDs).
  • Using Rhode Island Medicaid data from 2008-2018, the research looks at pregnancies with opioid use disorder (OUD) and evaluates the timing of drug exposure during gestation.
  • Results indicated that children exposed to methadone in early pregnancy had a significantly higher incidence of NDDs (36%) compared to those exposed to buprenorphine (17%), highlighting a potential risk associated with the timing and type of OMT used.
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Article Synopsis
  • - The maternal mortality rate (MMR) in the U.S. remains significantly higher than in other high-income countries, with substantial racial disparities, especially among Black and American Indian/Alaska Native women.
  • - Existing surveillance systems, particularly Maternal Mortality Review Committees (MMRCs), provide valuable data that can help identify solutions to reduce these alarming trends.
  • - To improve maternal health outcomes, a coordinated national effort targeting all stages of pregnancy and postpartum care is essential, along with strategic recommendations to ensure equitable maternal care across the country.
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Objective: To determine maternal and neonatal outcomes in individuals with iron deficiency receiving antepartum intravenous (IV) iron supplementation, stratified by the degree of anemia.

Study Design: Retrospective cohort study of iron-deficient pregnant patients who received at least one IV infusion of iron (iron sucrose, low molecular weight iron dextran [LMWID], or ferric carboxymaltose) during their pregnancy from January 1, 2011 through June 16, 2022. Our primary outcomes included both neonatal composite morbidity and maternal composite morbidity in the context of maternal anemia.

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Perinatal mortality and severe maternal morbidity among individuals with hypertensive disorders of pregnancy (HDP) are often driven by persistent, uncontrolled hypertension. Whereas traditional perinatal blood pressure (BP) ascertainment occurs through in-person clinic appointments, self-measured blood pressure (SMBP) programs allow individuals to measure their BP remotely and receive remote management by a medical team. Though data remain limited on clinically important outcomes such as maternal morbidity, these programs have shown promise in improving BP ascertainment rates in the immediate postpartum period and enhancing racial and ethnic equity in BP ascertainment after hospital discharge.

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Individuals who have a potentially traumatic birth experience are not at increased risk of worsening postpartum depression or anxiety when enrolled in a perinatal collaborative care model

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Objective: Outside of pregnancy, proactive coping has been associated with both mental and physical well-being and with improved quality of life in chronic disease, but its effects in pregnancy are understudied. Our objective was to evaluate whether early pregnancy proactive coping was associated with adverse perinatal outcomes.

Study Design: This was a planned secondary analysis of nulliparous pregnant people recruited from a tertiary care center.

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Objective: Remote self-measured blood pressure (SMBP) programs improve racial health equity among postpartum people with hypertensive disorders of pregnancy (HDP) who receive recommended blood pressure ascertainment after hospital discharge.1-3 However, as prior studies have been conducted within racially diverse but ethnically homogeneous populations,1-3 the effect of SMBP programs on ethnicity-based inequities is less understood.4 We examined whether SMBP rates differed among Hispanic versus non-Hispanic participants in remote SMBP programs.

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Objective: Oligohydramnios (defined as amniotic fluid volume < 5 cm or deepest vertical pocket < 2 cm) is regarded as an ominous finding on prenatal ultrasound. Amniotic fluid, however, is not static, and to date, there have been no studies comparing perinatal outcomes in patients who are diagnosed with oligohydramnios that resolves and those who have persistent oligohydramnios.

Study Design: This is a secondary analysis of a National Institutes of Health-funded retrospective cohort study of singleton gestations delivered at a tertiary care hospital between 2002 and 2013 with mild hypertensive disorders and/or fetal growth restriction (FGR).

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Objective:  Resilience is associated with mental and somatic health benefits. Given the social, physical, and mental health toll of the coronavirus disease 2019 (COVID-19) pandemic, we examined whether the COVID-19 pandemic was associated with population-level changes in resilience among pregnant people.

Study Design:  Secondary analysis of a prospective cohort of nulliparous pregnant people <20 weeks' gestation from a single hospital.

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