Improving Care Beyond Birth: A Qualitative Study of Postpartum Care After High-Risk Pregnancy.

The postpartum period is a window to engage birthing people in their long-term health and facilitate connections to comprehensive care. However, postpartum systems often fail to transition high-risk patients from obstetric to primary care. Exploring patient experiences can be helpful for optimizing systems of postpartum care.

Oxaliplatin desensitization for ovarian in pregnancy: A case report.

•Incidence of cancer in pregnancy is rising and successful treatment of these patients requires expert multidisciplinary care.•Platinum hypersensitivity reactions in ovarian cancer are commonly treated with desensitization protocols.•To our knowledge, chemotherapy desensitization in pregnant patients has not been previously reported.

Decline in Prenatal Buprenorphine/Naloxone Fills during the COVID-19 Pandemic in the United States.

Objectives: Pregnancy provides a critical opportunity to engage individuals with opioid use disorder in care. However, before the COVID-19 pandemic, there were multiple barriers to accessing buprenorphine/naloxone during pregnancy. Care disruptions during the pandemic may have further exacerbated these existing barriers.

Society for Maternal-Fetal Medicine Special Statement: Utilizing telemedicine to address disparities in maternal-fetal medicine: a call to policy action.

The combination of deserts in maternal-fetal medicine coverage across the United States and the COVID-19 pandemic accelerated the implementation of telemedicine programs for maternal-fetal medicine care delivery. Although telemedicine-based care has the potential to facilitate timely access to maternal-fetal medicine services, which can improve maternal and neonatal outcomes, telemedicine is a relatively novel healthcare modality that needs to be implemented strategically. As with any medical service, telemedicine care requires rigorous evaluation to assess outcomes and ensure quality.

Mobilizing the fourth trimester to improve population health: interventions for postpartum transitions of care.

Birthing people in the United States, particularly those from marginalized communities, experience an unexpectedly high rate of morbidity and mortality. Optimal postpartum care is an opportunity to address immediate maternal health concerns while providing a connection to further high-value primary care. However, postpartum care in the United States is fragmented and incomplete.

Self-monitoring of blood pressure among women with hypertensive disorders of pregnancy: a systematic review.

Background: The World Health Organization (WHO) recommends self-monitoring of blood pressure (SMBP) for hypertension management. In addition, during the COVID-19 response, WHO guidance also recommends SMBP supported by health workers although more evidence is needed on whether SMBP of pregnant individuals with hypertension (gestational hypertension, chronic hypertension, or pre-eclampsia) may assist in early detection of pre-eclampsia, increase end-user autonomy and empowerment, and reduce health system burden. To expand the evidence base for WHO guideline on self-care interventions, we conducted a systematic review of SMBP during pregnancy on maternal and neonatal outcomes.

Controversies in Gestational Diabetes.

Gestational diabetes mellitus (GDM) complicates approximately 7% of pregnancies in the USA. Despite recognition of the benefits of diagnosing and treating GDM, there are several areas of controversy that remain unresolved. There is debate as to whether to screen for GDM with the one-step versus the two-step approach.

Bridging the postpartum gap: best practices for training of obstetrical patient navigators.

The postpartum period represents a critical window of opportunity to improve maternal short- and long-term health, including optimizing postpartum recovery, providing effective contraception, caring for mood disorders, managing weight, supporting lactation, initiating preventive care, and promoting cardiometabolic health. However, inadequate postpartum care, especially for individuals facing social and structural barriers, is common in the United States and contributes to suboptimal health outcomes with lasting consequences. Patient navigation is a patient-centered intervention that uses trained personnel to identify financial, cultural, logistical, and educational obstacles to effective healthcare and to mitigate these barriers to facilitate comprehensive and timely access to needed health services.

A multidisciplinary telemedicine model for management of coronavirus disease 2019 (COVID-19) in obstetrical patients.

Background: The COVID-19 pandemic caused by the SARS-CoV-2 has increased the demand for inpatient healthcare resources; however, approximately 80% of patients with COVID-19 have a mild clinical presentation and can be managed at home.

Objective: This study aimed to describe the feasibility and clinical and process outcomes associated with a multidisciplinary telemedicine surveillance model to triage and manage obstetrical patients with known exposures and symptoms of COVID-19.

Study Design: We implemented a multidisciplinary telemedicine surveillance model with obstetrical physicians and nurses to standardize ambulatory care for obstetrical patients with confirmed or suspected COVID-19 based on the symptoms or exposures at an urban academic tertiary care center with multiple hospital-affiliated and community-based practices.

Changes in Delivery Timing for High-Risk Pregnancies in the United States.

Objective: This study was aimed to assess whether the "39-week" rule is being extended to high-risk pregnancies and if so whether this has led to changes in neonatal morbidity or stillbirth.

Study Design: Birth certificate data between 2010 and 2014 from 23 states (55% of births in the United States) were used. Pregnancies were classified as high risk if they had any one of the following: maternal age greater than or equal to 40 years, prepregnancy body mass index (BMI) greater than or equal to 40 kg/m, chronic (prepregnancy) hypertension, or diabetes (pregestational or gestational).

The combined impact of maternal age and body mass index on cumulative live birth following in vitro fertilization.

Background: It is critical to evaluate the combined impact of age and body mass index on the cumulative likelihood of live birth following in vitro fertilization, as achieving a lower body mass index before infertility treatment often is recommended for women with overweight and obesity. It is important to consider whether achieving a particular body mass index, thus resulting in an older age at in vitro fertilization cycle start, is beneficial or harmful to the likelihood of live birth.

Objectives: To evaluate the combined impact of age and body mass index on the cumulative live birth rate following in vitro fertilization to inform when delaying in vitro fertilization treatment to achieve a lower body mass index may be beneficial or detrimental to the likelihood of live birth.

Timing of First Milk Expression to Maximize Breastfeeding Continuation Among Mothers of Very Low-Birth-Weight Infants.

Objective: To estimate the time of first milk expression among mothers of very low-birth-weight (VLBW, 1,500 g or less) infants that predicts the maximal duration of mother's milk provision during hospitalization in the neonatal intensive care unit (NICU).

Methods: We performed a secondary analysis and studied 1,157 mother-VLBW infant pairs in nine Massachusetts hospitals born from January 2015 until December 2017. We determined the cut-point for timing of first milk expression after delivery that was associated with the highest probability of any and exclusive provision of mother's milk for the infant at NICU discharge or transfer using recursive partitioning.

Association Between Changes in Postpartum Weight and Waist Circumference and Changes in Cardiometabolic Risk Factors Among Women With Recent Gestational Diabetes.

Introduction: Women with gestational diabetes mellitus (GDM) have a 30% to 70% risk for developing type 2 diabetes and are at increased risk for cardiovascular disease. Little is known about how anthropometric changes in the first postpartum year modify cardiometabolic risk factors.

Methods: We randomly assigned women in the Balance After Baby study to an intervention group consisting of participation in a web-based lifestyle program or to a control group in which no program was offered.

Predictors of very early postpartum weight loss in women with recent gestational diabetes mellitus.

Women with gestational diabetes (GDM) have a 7-12-fold increased risk for developing type 2 diabetes later in life. Postpartum weight retention is highly predictive for future obesity, and further increases risk for type 2 diabetes. We sought to identify predictors of losing at least 75% of gestational weight gain by very early postpartum in women with recent GDM.

Online Birth Plans and Anticipatory Guidance: A Critical Review Using Web Analytics and Crowdsourcing.

We assessed the content of online birth plans using Web analytics and crowdsourcing to identify the most commonly accessed online birth plans. We analyzed the first 14 websites of 6 different searches across time. We repeated this search using 200 individuals recruited by a commercial crowdsourcing service.

Disparities in Care for Publicly Insured Women With Pregestational Diabetes.

Objective: To investigate the association among public health insurance, preconception care, and pregnancy outcomes in pregnant women with pregestational diabetes.

Methods: This is a retrospective cohort of pregnant women with pregestational type 1 or type 2 diabetes from 2006 to 2011 in Massachusetts-a state with universal insurance coverage since 2006. Women delivering after 24 weeks of gestation and receiving endocrinology and obstetric care in a multidisciplinary clinic were included.

Preconception consultations with Maternal Fetal Medicine for obese women: a retrospective chart review.

Background: Obesity is associated with impaired fertility and pregnancy complications, and preconception weight loss may improve some of these outcomes. The purpose of this study was to evaluate the quality and effectiveness of Maternal Fetal Medicine (MFM) preconception consults for obese women.

Methods: We performed a retrospective chart review examining 162 consults at an academic medical center from 2008 to 2014.

Patterns of gestational diabetes diagnosis inside and outside of clinical guidelines.

Background: Hospital discharge codes are often used to determine the incidence of gestational diabetes mellitus (GDM) at state and national levels. Previous studies demonstrate substantial variability in the accuracy of GDM reporting, and rarely report how the GDM was diagnosed. Our aim was to identify deliveries coded as gestational diabetes, and then to determine how the diagnosis was assigned and whether the diagnosis followed established guidelines.

The association of early unexplained elevated alanine aminotransferase with large-for-gestational-age birthweight.

Background: Nonalcoholic fatty liver disease causes hepatic insulin resistance and is associated with metabolic syndrome. Elevated levels of alanine aminotransferase are associated with nonalcoholic fatty liver disease. The effect of hepatic insulin resistance is not only increased glycogen breakdown but also liberation of free fatty acids due to increased lipolysis.

The Association of Alanine Aminotransferase in Early Pregnancy with Gestational Diabetes.

Background: Elevated alanine amino transferase, attributed to nonalcoholic fatty liver, is associated with later development of type 2 diabetes mellitus. We sought to determine whether maternal ALT values are associated with subsequent development of gestational diabetes.

Methods: We performed a nested case-control study utilizing prospectively banked serum samples collected in early gestation.

A Multi-State Analysis of Early-Term Delivery Trends and the Association With Term Stillbirth.

Objective: To investigate whether reduction in early-term deliveries was associated with increasing rates of term stillbirth.

Methods: This is a retrospective descriptive analysis of variation in term delivery timing and stillbirth from 2005 to 2011 based on birth certificate and fetal death data. Early-term deliveries (37 0/7-38 6/7 weeks of gestation) as a percentage of total term delivery and term stillbirth rates were calculated for each state, both overall and for low- and high-risk women.

Employing a Multi-level Approach to Recruit a Representative Sample of Women with Recent Gestational Diabetes Mellitus into a Randomized Lifestyle Intervention Trial.

Objective: The postpartum period is a window of opportunity for diabetes prevention in women with recent gestational diabetes (GDM), but recruitment for clinical trials during this period of life is a major challenge.

Methods: We adapted a social-ecologic model to develop a multi-level recruitment strategy at the macro (high or institutional level), meso (mid or provider level), and micro (individual) levels. Our goal was to recruit 100 women with recent GDM into the Balance after Baby randomized controlled trial over a 17-month period.