Publications by authors named "Justin Brandt"
The impact of ACOG's 39-week rule on fetal death rates in the United States: A systematic review.
Eur J Obstet Gynecol Reprod Biol
March 2025
Objective: The "39-week rule," implemented in August 2009, strongly discouraged early term deliveries before 39 weeks without accepted ACOG delivery indications. In this study, we evaluated fetal death rates before and after the 39-week rule in the United States (US) by review of published series.
Study Design: Systematic literature searches were performed in PubMed, Cochrane Central Register of Controlled Trials, Embase, Cumulative Index to Nursing and Allied Health Literature, Web of Science, and Scopus databases (January 2009-June 2023).
Article Synopsis
- The symposium presents a series of reviews focused on important clinical aspects of the placenta and umbilical cord, covering conditions like placenta previa and abruption, as well as various pathologies and infections.
- It highlights the critical functions of the umbilical cord as a lifeline for the fetus, discussing how its dysfunction can lead to complications such as vasa previa.
- This collection emphasizes the significance of understanding these structures for ensuring maternal-fetal health throughout pregnancy.
Twins suffer a disproportionately higher burden of adverse perinatal outcomes than singletons. However, the degree to which preterm delivery shapes the relationship between abruption and perinatal mortality in twins is unknown. Through causal mediation decomposition, we examine how preterm delivery mediates the effect of abruption on perinatal mortality among twins using the US-matched multiple birth data (1995-2000).
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- Maternal mortality ratios (MMR) in the U.S. increased significantly from 1999-2021, rising from 9.60 to 23.5 per 100,000 live births, with higher increases noted in states with already high MMRs.
- The study found that decreases in MMRs due to clear obstetric causes were similar across low and high MMR states, but the rise in deaths from less specific causes was much more pronounced in high-MMR states like Texas than in lower-MMR ones like California.
- Overall, increases in MMRs from less-specific/potentially incidental causes were observed across all racial and ethnic groups, indicating a troubling trend in maternal health disparities.
Health equity research on sexual orientation and race: Centering at the intersections.
Paediatr Perinat Epidemiol
September 2024
Objective: To quantify the uptake rates of Carrier Screening (CS) in consanguineous couples and compare this rate to that of non-consanguineous couples.
Methods: We performed a matched case control study of 82 consanguineous couples seen at Rutgers-Robert Wood Johnson Medical school who were offered carrier screening between January 1, 2012 and October 10, 2022. We then matched each consanguineous female patient to a non-consanguineous female control patient who was also offered CS at the time of their genetic counseling appointment.
Article Synopsis
- Maternal mortality rates in the U.S. have nearly doubled from 2018 to 2021, rising from 17.4 to 32.9 deaths per 100,000 live births, potentially influenced by factors beyond obstetrical issues.
- This study examines whether these rising rates are due to changes in obstetrical factors, maternal health conditions, or shifts in how maternal mortality is tracked and reported.
- Results show a 144% increase in maternal deaths from 1999-2002 to 2018-2021 across all racial and ethnic groups, with notable rises in both direct and indirect obstetrical deaths.
Pregnancy-associated mortality due to cardiovascular disease: Impact of hypertensive disorders of pregnancy.
Paediatr Perinat Epidemiol
March 2024
Background: Reported rates of maternal mortality in the United States have been staggeringly high and increasing, and cardiovascular disease (CVD) is a chief contributor to such deaths. However, the impact of hypertensive disorders of pregnancy (HDP) on the short-term risk of cardiovascular death is not well understood.
Objectives: To evaluate the association between HDP (chronic hypertension, gestational hypertension, preeclampsia, eclampsia, and superimposed preeclampsia) and pregnancy-associated mortality rates (PMR) from all causes, CVD-related causes both at delivery and within 1 year following delivery.
Effect of the COVID-19 Pandemic on Stillbirths in Canada and the United States.
J Obstet Gynaecol Can
April 2024
Article Synopsis
- The study aimed to evaluate the impact of the COVID-19 pandemic on stillbirth rates in Canada and the U.S., analyzing data from 2015 to 2020.
- Researchers found that the onset of the pandemic in March 2020 led to a temporary increase in stillbirth rates, specifically 1.01 per 1000 total births in Canada and 0.48 per 1000 in the United States for pregnancies at or beyond 20 weeks.
- After the initial spike, stillbirth rates returned to pre-pandemic levels in the following months, indicating that the increase was not permanent.
Objective: Preeclampsia is an important risk factor for cardiovascular disease (CVD, including heart disease and stroke) along the life course. However, whether exposure to chronic hypertension in pregnancy, in the absence of preeclampsia, is implicated in CVD risk during the immediate postpartum period remains poorly understood. Our objective was to estimate the risk of readmission for CVD complications within the calendar year after delivery for people with chronic hypertension.
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- The study aimed to analyze how the COVID-19 pandemic affected obstetric interventions and perinatal outcomes in the U.S. from 2015 to 2021.
- It found significant changes during the pandemic, including decreases in preterm birth and labor induction rates, while rates of macrosomia (larger than average babies), postterm births, and perinatal deaths increased.
- High-risk groups, such as those with prepregnancy diabetes, experienced even more pronounced effects, with substantial decreases in preterm birth and labor interventions related to the pandemic onset.
Background: There are limited data on postpartum readmissions for depression in the United States (US). Specifically, the extent to which ischaemic placental disease (IPD) during pregnancy predisposes patients to develop postpartum depression remains poorly understood. We investigated whether IPD is associated with postpartum readmission for new-onset depression in the first year after delivery.
View Article and Find Full Text PDFBackground: Despite the decline in the rate of coronary heart disease (CHD) mortality, it is unknown how the 3 strong and modifiable risk factors - alcohol, smoking, and obesity -have impacted these trends. We examine changes in CHD mortality rates in the United States and estimate the preventable fraction of CHD deaths by eliminating CHD risk factors.
Methods: We performed a sequential time-series analysis to examine mortality trends among females and males aged 25 to 84 years in the United States, 1990-2019, with CHD recorded as the underlying cause of death.
Placental abruption is the premature separation of the placenta from its uterine attachment before the delivery of a fetus. The clinical manifestations of abruption typically include vaginal bleeding and abdominal pain with a wide variety of abnormal fetal heart rate patterns. Clinical challenges arise when pregnant people with this condition present with profound vaginal bleeding, necessitating urgent delivery, especially when there is a concern for maternal and fetal compromise and coagulopathy.
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