Publications by authors named "Heather Lipkind"
Purpose: To estimate the rate of ambulatory care use among postpartum persons by rurality of residence and pregnancy-related conditions.
Methods: We used Maine Health Data Organization's All Payer Claims Data for persons who delivered between 2007 and 2019 (N = 121,905). We estimated rates of ambulatory care (nonemergency department outpatient health care) utilization during the first 24 months' postpartum by level of rurality (urban, large rural, small rural, and isolated rural) and by pregnancy-related conditions (prenatal depression, hypertensive disorders of pregnancy, and gestational diabetes).
Article Synopsis
- - The study assesses the impact of the newly approved RSV vaccine on pregnancy outcomes for individuals vaccinated between 32 to 36 weeks of gestation during the RSV season from September 2023 to January 2024.
- - Researchers analyzed data from 2 NYC hospitals, focusing on outcomes like preterm birth, hypertensive disorders, and NICU admissions among vaccinated and non-vaccinated individuals who had singleton pregnancies.
- - Findings indicated that 34.5% of the 2973 participants received the vaccine, with slightly lower rates of preterm birth in vaccinated individuals (5.9%) compared to non-vaccinated (6.7%), but overall results did not show a significant association between vaccination and improved outcomes.
Importance: COVID-19 vaccination is recommended throughout pregnancy to prevent pregnancy complications and adverse birth outcomes associated with COVID-19 disease. To date, data on birth defects after first-trimester vaccination are limited.
Objective: To evaluate the associated risks for selected major structural birth defects among live-born infants after first-trimester receipt of a messenger RNA (mRNA) COVID-19 vaccine.
Article Synopsis
- The study aimed to assess how using reversible postpartum contraception impacts the likelihood of recurring pregnancy issues in subsequent pregnancies and whether this effect is connected to longer interpregnancy intervals (IPIs).
- Researchers analyzed data from Maine on women who had live births between 2007 and 2019, focusing on conditions like prenatal depression, hypertensive disorders, and gestational diabetes.
- Findings showed that while postpartum contraception use was linked to longer IPIs, it did not decrease the recurrence risk of the targeted pregnancy conditions, highlighting a gap in healthcare provision.
Article Synopsis
- The study investigated the potential link between COVID-19 vaccination during pregnancy and the risk of stillbirth, addressing concerns of vaccine hesitancy among pregnant individuals.
- A matched case-control approach was used, analyzing data from 276 confirmed stillbirths and 822 live births to assess any significant associations with vaccination status.
- Results indicated no significant association between COVID-19 vaccination and stillbirth risk, regardless of vaccine type, number of doses, or timing of vaccination, suggesting that vaccination does not increase the risk of stillbirth in pregnant individuals.
To understand obstetric provider perspectives on child protective services (CPS)-mandated reporting requirements and how they affect care for pregnant and postpartum patients with opioid use disorder (OUD). Key informant interviews were conducted virtually with obstetricians, nurse practitioners, and social workers caring for obstetric patients ( = 12). Providers were asked about their experience as mandated reporters working with patients with OUD.
View Article and Find Full Text PDFArticle Synopsis
- - This study aimed to assess whether getting vaccinated with mRNA COVID-19 vaccines during pregnancy affects the risk of adverse pregnancy outcomes like preterm birth and small-for-gestational age infants.
- - Researchers analyzed data from over 55,000 individuals with live singleton pregnancies and found that 42.3% received one or two doses of the vaccine, with the vaccination rate varying across maternal demographics.
- - The results indicated that vaccinated individuals had a lower risk of preterm birth compared to unvaccinated individuals, but the vaccination did not significantly impact the risks of small-for-gestational age infants, gestational diabetes, gestational hypertension, or preeclampsia.
Background: Cardiovascular disease is the leading cause of death among women in the United States. It is well established that gestational diabetes mellitus is associated with an overall lifetime increased risk of cardiometabolic disease, even among those without intercurrent type 2 diabetes. However, the association between gestational diabetes mellitus and short-term risk of cardiovascular disease is unclear.
View Article and Find Full Text PDFObjective: To estimate the rate of acute health care use (hospitalizations and emergency department [ED] visits) among postpartum persons by rurality of residence and pregnancy complications.
Data Sources And Study Setting: 2006-2021 data from the Maine Health Data Organization's All Payer Claims Data.
Study Design: We estimated the rates of hospitalizations and ED visits during the first 24 months postpartum, separately, overall and by four-level rurality of residence (urban, large rural, small rural, and isolated rural) and by pregnancy complications (prenatal depression, hypertensive disorders of pregnancy [HDP], and gestational diabetes mellitus [GDM]).
Article Synopsis
- Continuous hemodynamic monitoring can improve the management of severe preeclampsia by assessing cardiac output (CO) and total peripheral resistance (TPR) using different methods: NICOM, Clearsite Fingercuff (CS), and 3D-echocardiography (3DE).
- The study found that CS showed a strong correlation with 3DE for measuring both CO and TPR, indicating it could serve as an interchangeable method, while NICOM displayed poor correlation and did not meet interchangeability criteria for these measurements.
- Overall, the findings suggest that while Clearsite Fingercuff may be a useful tool for monitoring CO and TPR in severe preeclampsia,
Objective: To determine whether a community-informed, language-concordant postpartum video education campaign, developed with community input, improves patients' knowledge of warning signs for postpartum maternal mortality (infection, hemorrhage, hypertensive disorders, and postpartum depression) compared with routine discharge procedures.
Methods: A single-center, investigator-blinded, parallel-group randomized controlled trial of postpartum individuals who delivered at a large, urban, tertiary care hospital. Eligible participants were enrolled and completed a baseline knowledge questionnaire.
Article Synopsis
- The study investigates the potential link between COVID-19 booster vaccinations during pregnancy and the risk of spontaneous abortion, addressing concerns about vaccine safety among pregnant individuals.
- Conducted across eight health systems, the research analyzed data from 112,718 unique pregnancies to evaluate outcomes based on vaccination timing and other factors such as maternal age and race.
- Findings aim to clarify the safety of receiving mRNA COVID-19 booster shots during early pregnancy, which is crucial for increasing vaccination adherence within this population.
The aim of this study is to estimate the risk of a new mental health diagnosis within the first 24 months postpartum among women with common pregnancy conditions, overall and by rurality. This longitudinal population-based study used the Maine Health Data Organization's All-Payer Claims Data to estimate the cumulative risk of a new mental health disorder diagnosis in the first 24 months postpartum among women with deliveries during 2007-2019 and who did not have a mental health diagnosis before pregnancy. Cox models were used to estimate hazard ratios for common pregnancy conditions (prenatal depression, gestational diabetes [GDM], and hypertensive disorders of pregnancy [HDP]) on the new diagnosis of five mental health conditions, separately.
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- A study involving over 80,000 pregnant individuals found that receiving a COVID-19 mRNA booster shot did not increase the risk of serious health issues like thrombocytopenia, myocarditis, or stroke shortly after vaccination.
- However, the booster was linked to a higher incidence of mild symptoms such as malaise or fatigue within the first week, and lymph node swelling or inflammation in the following weeks.
- Overall, the results align with previous studies and suggest that it's safe for pregnant people to receive the COVID-19 booster.
Objective: Preliminary findings from selected health systems revealed interruptions in reproductive health care services due to the COVID-19 pandemic. We estimated changes in postpartum contraceptive provision associated with the start of the COVID-19 pandemic in Maine.
Methods: We used the Maine Health Data Organization's All Payer Claims Database for deliveries from October 2015 through March 2021 (n = 45 916).
Introduction: An increased risk of chorioamnionitis in people receiving tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccine during pregnancy has been reported. The importance of this association is unclear as additional study has not demonstrated increased adverse infant outcomes associated with Tdap vaccination in pregnancy.
Methods: We conducted a retrospective observational cohort study of pregnant people ages 15-49 years with singleton pregnancies ending in live birth who were members of 8 Vaccine Safety Datalink (VSD) sites during October 2016-September 2018.
Background Although depression is well established as an independent risk factor for cardiovascular disease (CVD) in the nonpregnant population, this association has largely not been investigated in pregnant populations. We aimed to estimate the cumulative risk of new CVD in the first 24 months postpartum among pregnant individuals diagnosed with prenatal depression compared with patients without depression diagnosed during pregnancy. Methods and Results Our longitudinal population-based study included pregnant individuals with deliveries during 2007 to 2019 in the Maine Health Data Organization's All Payer Claims Data.
View Article and Find Full Text PDFBackground: Despite the well-known association between hypertensive disorders of pregnancy and cardiovascular diseases, there are limited data on which specific cardiovascular diagnoses have the greatest risk profiles during the first 24 months after delivery. Most existing data on hypertensive disorders of pregnancy and short-term cardiovascular disease risks are limited to the immediate postpartum period; however, it is crucial to determine cardiovascular disease risk up to 24 months after delivery to inform cardiovascular disease screening protocols during the extended postpartum period.
Objective: This study aimed to delineate the risk of cardiovascular diagnoses in the first 24 months after delivery among patients with hypertensive disorders of pregnancy compared with patients without hypertensive disorders of pregnancy.
Article Synopsis
- * Initial results suggested a protective effect of vaccination against SAB within certain time periods, but this effect diminished when extending the observation to later dates.
- * The findings indicate that the timing and method of surveillance significantly influence the perceived relationship between vaccination and SAB, with no clear association observed when using a time-dependent model.
Article Synopsis
- A formal review process for severe maternal morbidity (SMM) was established at Yale-New Haven Hospital, analyzing cases over a 4-year period.
- Out of 156 SMM cases, the SMM rate was found to be 0.49%, with leading causes being hemorrhage (44.9%) and nonintrauterine infection (14.1%).
- Two-thirds of the cases were considered preventable, primarily due to issues linked to healthcare professionals (79.4%) and systemic factors (58.8%), prompting changes to improve care practices.
Background: Preeclampsia is a leading cause of maternal morbidity, and dyslipidemia has been associated with preeclampsia in observational studies. We use Mendelian randomization analyses to estimate the association between lipid levels, their pharmacological targets, and the risk of preeclampsia in 4 ancestry groups.
Methods: We extracted uncorrelated (<0.
Objectives: To estimate the association between rural residence and sequelae of hypertensive disorders of pregnancy (HDP) in the first year postpartum.
Study Design: We used the Maine Health Data Organization's All Payer Claims Data to identify women with HDP who delivered during 2007-2019 and did not have chronic hypertension or pre-pregnancy cardiac conditions (n = 8882). We used Cox proportional hazards modeling to estimate rural-urban hazard ratios (HR) and 95% confidence intervals (CI), adjusting for HDP subtype, age, insurance, nulliparity, and co-morbidities.
Background: Individuals with pregnancies complicated by hypertensive disorders of pregnancy are at increased risk of cardiovascular disease. However, not all who have hypertensive disorders of pregnancy are at risk, and not all who have uncomplicated pregnancies are without risk.
Objective: This study aimed to determine if use of first-degree family history of cardiovascular disease or chronic hypertension better identifies individuals who need postpartum cardiovascular risk screening.
Article Synopsis
- Patients with hypertensive disorders during pregnancy are at greater risk for underlying cardiovascular issues and future cardiovascular disease, particularly postpartum.
- The study aimed to evaluate the effectiveness of high-sensitivity C-reactive protein as a screening tool for cardiovascular risk in postpartum women, utilizing data from Yale University and Queen's University.
- Results indicated that women with elevated levels of high-sensitivity C-reactive protein had a higher risk of future cardiovascular events, emphasizing the importance of monitoring this biomarker in postpartum care.