Publications by authors named "Arthur J Vaught"

Article Synopsis
  • Maternal cardiovascular changes during pregnancy are crucial for adequate placental blood flow, but hypertensive disorders of pregnancy (HDP) affect around 10% of pregnancies, leading to serious heart issues.
  • Women with HDP face long-term cardiovascular risks, including hypertension and heart disease, shortly after delivery and in the following decades.
  • There is a pressing need for standardized early cardiovascular screening for these women, but current protocols are lacking due to insufficient evidence and variations in risk related to race and health determinants.
View Article and Find Full Text PDF
Article Synopsis
  • Prepregnancy diabetes and obesity are significant risk factors for hypertensive disorders of pregnancy (HDPs), with 7% of birthing individuals in a study experiencing HDP.
  • Among different racial and ethnic groups, HDP was most prevalent in American Indian and Alaska Native individuals, while diabetes and obesity showed the strongest associations with HDPs in Native Hawaiian and Other Pacific Islander and Asian individuals, respectively.
  • The study found that diabetes and obesity account for notable population attributable fractions of HDPs, emphasizing the need for targeted interventions, especially among vulnerable populations such as Native Hawaiian and Other Pacific Islander individuals.
View Article and Find Full Text PDF

Pelvic adhesions are nonanatomic connections between organs and normal peritoneal surfaces that develop secondary to a maladaptive inflammatory response to tissue insults. Comprised of fibrous tissue, adhesions can result in the distortion of operative dissection planes, which can complicate the establishment of abdominal access in patients undergoing surgery, prolong the length of surgery, and increase the risk of injury to bowel and other structures if involved by extensive adhesive disease. This can adversely impact patient outcomes by increasing the risk of surgical complications including bleeding, infection, and prolonging postoperative length of stay.

View Article and Find Full Text PDF

Background: Gestational diabetes mellitus (GDM) is associated with increased long-term risk of cardiovascular disease but the cardiovascular structural and functional changes that contribute to risk are not well understood.

Objectives: The purpose of this study was to determine whether GDM is associated with adverse cardiac remodeling and endothelial dysfunction a decade after delivery, independent of type 2 diabetes.

Methods: Women with deliveries between 2008 and 2009 were initially selected from a prospective clinical cohort.

View Article and Find Full Text PDF
Article Synopsis
  • - The study analyzes preeclampsia outcomes in different US regions, focusing on complications and management of the condition based on data from The Preeclampsia Registry which includes mostly White women (92%) across various regions (Northeast, Midwest, South, and West).
  • - Results reveal that women in the South and Midwest had the highest maximum systolic blood pressure during pregnancy, with Southern women receiving more pre-pregnancy antihypertensives and antenatal steroids, and delivering earlier than their counterparts in other regions.
  • - Regional differences also showed that women in the South experienced higher rates of complications like elevated liver enzymes, and more severe conditions like renal complications and hemolysis were noted in women from the
View Article and Find Full Text PDF

Objectives: To identify classes of psychosocial stressors among women who developed preeclampsia and to evaluate the associations between these classes and correlates of psychosocial wellbeing.

Study Design: We performed a secondary analysis of women who developed preeclampsia (n = 727) from the Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-be (nuMoM2b) cohort (2010-2013). Latent class analysis was used to identify classes of social stressors based on seven psychological and sociocultural indicators.

View Article and Find Full Text PDF

A 27-year-old pregnant woman at 24 weeks of gestation was admitted with cardiogenic shock due to mechanical mitral valve thrombosis. Following discussion with the heart team, thrombolysis was achieved with tissue plasminogen activator therapy followed by heparin infusion. Ultimately, the patient required mitral valve replacement for persistently elevated gradients.

View Article and Find Full Text PDF

Placenta accreta spectrum disorder (PASD) encompasses various types of abnormal placentation in which chorionic villi directly adhere to or invade the myometrium. The incidence of PASD has dramatically risen in the US over the past 3 decades owing to the increased rates of patients undergoing cesarean sections. While PASD remains a significant cause of maternal morbidity and mortality, accurate prenatal identification and characterization of PASD is associated with improved outcomes.

View Article and Find Full Text PDF

Background: Severe maternal morbidity and mortality are increasing in the United States with continued healthcare disparities among Non-Hispanic Black women. However, there is sparse data on the disparities of severe maternal morbidity and mortality by race/ethnicity as it relates to community type.

Objective: To determine whether residing in rural communities increases the racial/ethnic disparities in severe maternal morbidity and mortality.

View Article and Find Full Text PDF

Maternal psychosocial stress may be a risk factor for poor cardiovascular health (CVH) during pregnancy. We aimed to identify classes of psychosocial stressors in pregnant women and to evaluate their cross-sectional association with CVH. We performed a secondary analysis of women from the Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-be (nuMoM2b) cohort (2010 to 2013).

View Article and Find Full Text PDF

Background: Postpartum hemorrhage is a leading cause of maternal morbidity and mortality in the United States and disproportionately affects pregnant persons of color.

Objective: This study aimed to identify the demographic and obstetrical characteristics of those who received different levels of antihemorrhagic intervention in the setting of severe postpartum hemorrhage requiring blood transfusion.

Study Design: This was a retrospective cohort study of patients with documented postpartum hemorrhage (estimated blood loss of ≥1000 mL) and blood product transfusion.

View Article and Find Full Text PDF

Hypertensive disorders of pregnancy continue to be significant contributors to adverse perinatal outcome and maternal mortality, as well as inducing life-long cardiovascular health impacts that are proportional to the severity and frequency of pregnancy complications. The placenta is the interface between the mother and fetus and its failure to undergo vascular maturation in tandem with maternal cardiovascular adaptation by the end of the first trimester predisposes to hypertensive disorders and fetal growth restriction. While primary failure of trophoblastic invasion with incomplete maternal spiral artery remodeling has been considered central to the pathogenesis of preeclampsia, cardiovascular risk factors associated with abnormal first trimester maternal blood pressure and cardiovascular adaptation produce identical placental pathology leading to hypertensive pregnancy disorders.

View Article and Find Full Text PDF

Background: Hypertension is a key contributor to the global epidemic of cardiovascular disease and is responsible for more deaths worldwide than any other cardiovascular risk factor. Hypertensive disorders of pregnancy, of which preeclampsia and eclampsia are the most common forms, have been shown to be a female-specific risk factor for chronic hypertension.

Objective: This study aimed to determine the proportion and risk factors for persistent hypertension at 3 months after delivery among women with hypertensive disorders of pregnancy in Southwestern Uganda.

View Article and Find Full Text PDF

The pregnancy-related mortality rate in the United States is excessively high. The American Heart Association is dedicated to fighting heart disease and recognizes that cardiovascular disease, preexisting or acquired during pregnancy, is the leading cause of maternal mortality in the United States. Comprehensive scientific statements from cardiology and obstetrics experts guide the treatment of cardio-obstetric patients before, during, and after pregnancy.

View Article and Find Full Text PDF

Objective: To determine if maternal cardiac disease affects delivery mode and to investigate maternal morbidity.

Study Design: Retrospective cohort study performed using electronic medical record data. Primary outcome was mode of delivery; secondary outcomes included indication for cesarean delivery, and rates of severe maternal morbidity.

View Article and Find Full Text PDF
Article Synopsis
  • ECMO therapy has become more common among adults, and studies indicate better outcomes for pregnant women compared to non-pregnant individuals during the H1N1 pandemic.
  • This study analyzed data from the National Readmissions Database to compare outcomes, costs, and complications for pregnant and non-pregnant women receiving ECMO between 2013 and 2019.
  • Results showed that pregnancy-associated ECMO resulted in lower in-hospital mortality rates and fewer bleeding complications, as well as shorter hospital stays and lower overall costs.
View Article and Find Full Text PDF

Introduction: Preeclampsia is associated with decreased maternal low-density lipoprotein cholesterol (LDL-c), which is essential for fetal growth. The underlying mechanisms for decreased LDL-c in preeclampsia remain unknown. Proprotein convertase subtillisin/kexin type 9 (PCSK9) regulates serum LDL-c via LDL receptor (LDL-R) degradation.

View Article and Find Full Text PDF

Background: Cardiac arrhythmias are associated with increased maternal morbidity. There are limited data on trends of arrhythmias among women hospitalized for delivery.

Materials And Methods: We used the National Inpatient Sample (NIS) database to identify delivery hospitalizations for individuals aged 18-49 years between 2009 to 2019 and utilized coding data from the 9th and 10th editions of the to identify supraventricular tachycardias (SVT), atrial fibrillation (AF), atrial flutter, ventricular tachycardia (VT), and ventricular fibrillation (VF).

View Article and Find Full Text PDF

Objective: Peripartum hysterectomy is associated with increased morbidity and mortality relative to elective gynecologic hysterectomy and its incidence has grown with the rising cesarean delivery rate. We sought to understand indications and perioperative outcomes for peripartum hysterectomy at our academic institution and to evaluate differences among racial/ethnic groups.

Study Design: We performed a retrospective chart review of women at a tertiary care center who underwent delivery of a newborn and had a peripartum hysterectomy during the same admission between 2008 and 2018.

View Article and Find Full Text PDF

Objective: To report a case of severe ovarian hyperstimulation syndrome (OHSS) persisting into the late second trimester of a singleton pregnancy.

Design: Case report.

Setting: Academic tertiary care center.

View Article and Find Full Text PDF

Purpose Of Review: The "fourth trimester" concept, defined as the first 12 weeks after delivery (and beyond), is a critical window of time for clinicians to intervene to optimize women's cardiovascular health after pregnancy. A timely and comprehensive postpartum cardiovascular assessment should be performed in all women following delivery in order to (1) follow up medical conditions present prior to conception, (2) evaluate symptoms and signs of common postpartum complications, and (3) identify risk factors and prevent future adverse cardiovascular outcomes. In this review, we aim to discuss major maternal cardiovascular risk factors such as hypertensive disorders of pregnancy, gestational diabetes mellitus, postpartum weight retention, and postpartum depression, as well as lactation as a potential protective risk modifying factor.

View Article and Find Full Text PDF

Pulmonary arterial hypertension (PAH) is a vasoconstrictive disease of the distal pulmonary vasculature resulting in adverse right heart remodeling. Pregnancy in PAH patients is associated with high maternal morbidity and mortality as well as neonatal and fetal complications. Pregnancy-associated changes in the cardiovascular, pulmonary, hormonal, and thrombotic systems challenge the complex PAH physiology.

View Article and Find Full Text PDF
Article Synopsis
  • * The field of cardio-obstetrics focuses on managing women with or at high risk for heart disease related to pregnancy, highlighting the need for more specialists with this expertise.
  • * Proposed specialized training pathways for cardiovascular fellows are aimed at filling knowledge gaps and preparing healthcare providers to better care for women with cardiovascular issues throughout the pregnancy journey.
View Article and Find Full Text PDF

Background Women with polycystic ovary syndrome (PCOS) have an increased risk of pregnancy-associated complications. However, data on peripartum cardiovascular complications remain limited. Hence, we investigated trends, outcomes, and predictors of cardiovascular complications associated with PCOS diagnosis during delivery hospitalizations in the United States.

View Article and Find Full Text PDF