Implementation of universal screening for substance use in pregnancy in a public healthcare system.

Objective: Screening questionnaires are one option for identification of at-risk substance use and substance use disorder (SUD) during pregnancy. We report the experience of a single institution following universal implementation of a brief screening tool for self-reported substance use at the first prenatal encounter.

Study Design: This is a prospective implementation study evaluating screening for substance use in pregnancy in a large safety net healthcare system.

A prospective study of antepartum anxiety screening in patients with and without a history of spontaneous preterm birth.

Background: Maternal stress has been identified as one of the most common clinical phenotypes associated with preterm birth. The American College of Obstetricians and Gynecologists recommends anxiety screening at least once in the perinatal period. The prevalence of perinatal anxiety is challenged by the absence of formalized screening protocols and underreporting in high-risk populations, such as those with a history of adverse pregnancy outcomes.

A Randomized Trial of the Effects of Ambient Operating Room Temperature on Neonatal Morbidity.

Objective: Newborn hypothermia has been implicated in neonatal morbidity without randomized evidence that it compromises the infant. Our objective was to determine if a difference in operating room temperature at cesarean birth impacts neonatal morbidity.

Study Design: Women undergoing cesarean delivery of a liveborn infant without major malformations were included.

Perinatal outcomes of young adolescent pregnancies in an urban inner city.

Background: Although substantial efforts have been made to reduce the rates of adolescent pregnancy, the United States continues to have higher rates than other industrialized countries. Research and reporting usually focus on adolescents aged 15 to 19 years. Although less common, there are pregnant young adolescents that are ≤15 years of age, with developmental and social differences from older, high school-aged adolescents.

Fetal heart rate tracings associated with eclamptic seizures.

Background: Although there is a well-known association between fetal bradycardia and maternal eclampsia, the characteristics of fetal heart rate tracings after an eclamptic seizure have not previously been thoroughly described. Fetal heart rate changes are thought to be related to maternal lactic acidemia caused by vasospasm and uterine hyperactivity leading to placental hypoperfusion and fetal hypoxia. The decision to intervene in the case of an abnormal fetal heart rate tracing after an eclamptic seizure is often difficult; however, maternal resuscitation should be the primary focus.

Congenital Malformation Risk According to Hemoglobin A1c Values in a Contemporary Cohort with Pregestational Diabetes.

Objective: The study aimed to evaluate the association between hemoglobin A1c values and likelihood of fetal anomalies in women with pregestational diabetes.

Study Design: Women with pregestational diabetes who delivered at a single institution that serves a nonreferred population from May 1, 2009 to December 31, 2018 were ascertained. Hemoglobin A1c values were obtained at the first prenatal visit.

Comparison Between In-Person and Audio-Only Virtual Prenatal Visits and Perinatal Outcomes.

Importance: Ensuring access to prenatal care services in the US is challenging, and implementation of telehealth options was limited before the COVID-19 pandemic, especially in vulnerable populations, given the regulatory requirements for video visit technology.

Objective: To explore the association of audio-only virtual prenatal care with perinatal outcomes.

Design, Setting, And Participants: This cohort study compared perinatal outcomes of women who delivered between May 1 and October 31, 2019 (n = 6559), and received in-person prenatal visits only with those who delivered between May 1 and October 31, 2020 (n = 6048), when audio-only virtual visits were integrated into prenatal care during the COVID-19 pandemic, as feasible based on pregnancy complications.

The impact of baseline proteinuria in pregnant women with pregestational diabetes mellitus.

Background: The incidence of diabetes in pregnancy has increased dramatically with the rising rates of obesity. Because there are a number of recognized adverse maternal and fetal outcomes associated with diabetes, there have been several attempts to classify this disorder for perinatal risk stratification. One of the first classification systems for pregnancy was developed by White nearly 70 years ago.

The effect of normal saline on renal function and electrolytes in women with preeclampsia.

Introduction: Due to a nationwide shortage of Ringer's lactate, normal saline became the intravenous fluid of choice at our institution in May 2018. Recent studies have shown that the administration of normal saline in critically ill patients may have adverse renal effects.

Objective: Our objective was to evaluate the renal function effects; if any, of normal saline administered to women with preeclampsia receiving magnesium sulfate.

Perinatal outcomes associated with abnormal cardiac remodeling in women with treated chronic hypertension.

Background: Adverse maternal outcomes associated with chronic hypertension include accelerated hypertension and resultant target organ damage. One example is long-standing hypertension leading to maternal cardiac dysfunction. Our group has previously identified that features of such injury manifest as cardiac remodeling with left ventricular hypertrophy.

Frequency and consequences of ventricular hypertrophy in pregnant women with treated chronic hypertension.

Background: Ventricular hypertrophy is a known sequela of long-standing chronic hypertension with associated morbidity and mortality.

Objective: We sought to assess the frequency and importance of left ventricular hypertrophy in gravidas treated for chronic hypertension during pregnancy.

Study Design: This was a retrospective study of pregnant women with chronic hypertension who were delivered at our hospital from January 2009 through February 2015.