Publications by authors named "Mary E D'alton"
Importance: Understanding environmental risk factors for gestational diabetes (GD) is crucial for developing preventive strategies and improving pregnancy outcomes.
Objective: To examine the association of county-level radon exposure with GD risk in pregnant individuals.
Design, Setting, And Participants: This multicenter, population-based cohort study used data from the Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-Be (nuMoM2b) cohort, which recruited nulliparous pregnant participants from 8 US clinical centers between October 2010 and September 2013.
Objective: To assess trends in risk for obstetric venous thromboembolism (VTE).
Methods: This retrospective cohort study analyzed data from the 2008-2019 Merative MarketScan Commercial Claims and Encounters and Medicaid Multi-State databases. Women aged 15-54 years with a delivery hospitalization and health care enrollment from 1 year before pregnancy to 60 days after delivery were identified.
Article Synopsis
- - The study aimed to identify clinical risk factors and obstetric complications from a woman's first delivery that could lead to severe morbidity or transfusion during a second delivery hospitalization in New York State from 2010 to 2017.
- - The researchers analyzed data from 624,500 delivery hospitalizations, finding that 0.85% of second deliveries experienced severe maternal morbidity, with significant factors including severe morbidity and transfusion during the first delivery, alongside conditions like pregestational diabetes.
- - The conclusion highlighted that complications identified in the first delivery strongly predict severe morbidity in a second delivery, with severe maternal morbidity from the first delivery posing the highest risk.
Background: Establishing local trimester-specific reference intervals for gestational TSH and free T4 (FT4) is often not feasible, necessitating alternative strategies. We aimed to systematically quantify the diagnostic performance of standardized modifications of center-specific nonpregnancy reference intervals as compared to trimester-specific reference intervals.
Methods: We included prospective cohorts participating in the Consortium on Thyroid and Pregnancy.
Routine health care visits offer the opportunity to screen older adults for symptoms of Alzheimer's disease (AD). Many women see their gynecologist as their primary health care provider. Given this unique relationship, the Women's Preventive Services Initiative and the American College of Obstetrics and Gynecology advocate for integrated care of women at all ages.
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- The study analyzed trends and risk factors related to antenatal pyelonephritis hospitalizations in the US from 2010 to 2020.
- A total of 49,140 out of 10.2 million delivery hospitalizations involved antenatal pyelonephritis, showing a 29% decrease in associated admissions over the decade.
- Despite this decline, there has been an increase in the risk of sepsis and severe maternal morbidity during these hospitalizations, indicating potential concerns for maternal health.
Background: A major goal of contemporary obstetrical practice is to optimize fetal growth and development throughout pregnancy. To date, fetal growth during prenatal care is assessed by performing ultrasonographic measurement of 2-dimensional fetal biometry to calculate an estimated fetal weight. Our group previously established 2-dimensional fetal growth standards using sonographic data from a large cohort with multiple sonograms.
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- * The study analyzed data from 65,559 participants across 25 cohorts, focusing on risk factors like maternal age, BMI, and antibody positivity while excluding those with pre-existing thyroid issues.
- * Results indicated a screening rate of 58% among high-risk cohorts, with minimal variation in risk for hypothyroidism based on age and BMI, and TPOAb/TgAb positivity significantly correlated with higher risks for overt and subclinical hypothyroidism.
Objective: This study aimed to evaluate trends, risk factors, and outcomes associated with infections and sepsis during delivery hospitalizations in the United States.
Study Design: The 2000-2020 National Inpatient Sample was used for this repeated cross-sectional analysis. Delivery hospitalizations of patients aged 15 to 54 with and without infection and sepsis were identified.
Objective: This study aimed to evaluate cesarean rates and risk for obstetric complications among deliveries with a history of prior uterine surgery.
Study Design: This serial cross-sectional study analyzed deliveries with and without prior uterine surgery in the 2016-2019 Nationwide Inpatient Sample. Unadjusted and adjusted logistic regression models were performed to assess risk of nontransfusion severe maternal morbidity (SMM) and other obstetric complications based on the presence or absence of prior uterine surgery with unadjusted and adjusted odds ratios (aORs) with 95% confidence intervals (CIs) as measures of association.
Objective: To evaluate risk for peripartum cardiomyopathy during delivery and postpartum hospitalizations, and analyze associated trends, risk factors, and clinical outcomes.
Methods: The 2010-2020 Nationwide Readmissions Database was used for this retrospective cohort study. Delivery hospitalizations along with postpartum readmissions occurring within five months of delivery discharge were analyzed.
Objective: To evaluate the prevalence, timing, clinical risk factors, and adverse outcomes associated with postpartum readmissions for maternal sepsis.
Methods: We conducted a retrospective cohort study of delivery hospitalizations and 60-day postpartum readmissions for females aged 15-54 years with and without sepsis using the 2016-2020 Nationwide Readmissions Database. Temporal trends in sepsis diagnoses during delivery hospitalizations and 60-day postpartum readmissions were analyzed with the National Cancer Institute's Joinpoint Regression Program to estimate the average annual percent change with 95% CIs.
Objective: Given that updated estimates of Ehlers-Danlos syndrome and risks for obstetric complications including postpartum readmission may be of public health significance, we sought to analyze associated obstetric trends and outcomes in a nationally representative population.
Study Design: The 2016 to 2020 Nationwide Readmissions Database was used for this retrospective cohort study. Delivery hospitalizations to women aged 15 to 54 with and without Ehlers-Danlos syndrome were identified.
Article Synopsis
- * Using data from the National Inpatient Sample, the research showed a rise in SLE cases from 6.7 to 14.6 per 10,000 delivery hospitalizations, indicating a significant average annual increase of 4.5%.
- * Women with SLE experienced higher rates of severe complications, such as non-transfusion morbidity and preterm delivery, highlighting the increasing challenges associated with these conditions during pregnancy.
Article Synopsis
- Guidelines recommend using specific thyroid hormone reference intervals during pregnancy, but these are often not available, leading to alternative diagnostic methods.
- A study analyzed data from over 52,000 women and found that these alternative methods had low sensitivity (0.63-0.82) and high false discovery rates (0.11-0.35) compared to trimester-specific reference intervals.
- The results indicate that using alternative approaches for thyroid hormone testing in pregnancy can result in significant misdiagnosis, highlighting the need for better strategies for detecting thyroid dysfunction in pregnant women.
Introduction: We examined the associations of baseline telomere length (TL) and TL change with cognitive function over time in older US adults, as well as differences by sex and race.
Methods: A total of 1820 cognitively healthy individuals (median baseline age: 63 years) were included. Telomere length was measured using qPCR-based method at baseline and among 614 participants in the follow-up examination 10 years later.
Importance: Reducing rates of unnecessary cesarean deliveries is both a national and a global health objective. However, there are limited national US data on trends in indications for low-risk cesarean delivery.
Objective: To determine temporal trends in and indications for cesarean delivery among patients at low risk for the procedure over a 20-year period.
Objective: To assess clinical characteristics, trends, and outcomes associated with the diagnosis of hepatitis C virus (HCV) infection during pregnancy.
Methods: This cross-sectional study analyzed delivery hospitalizations using the National Inpatient Sample. Temporal trends in both diagnosis of HCV infection and clinical characteristics associated with HCV infection were analyzed using joinpoint regression to estimate the average annual percent change (AAPC) with 95% CIs.
Background: With improved therapies, an increasing number of patients with Fontan circulation reach reproductive age. Pregnant patients with Fontan circulation are at high risk of obstetrical complications. Most data for pregnancies complicated by Fontan circulation and associated complications stem from single-center studies, with limited national epidemiologic data available.
View Article and Find Full Text PDFPostpartum stroke trends, risk factors, and associated adverse outcomes.
Am J Obstet Gynecol MFM
May 2023
Article Synopsis
- Management of postpartum stroke has seen quality improvement efforts, but there's a lack of recent national data on readmissions.
- This study used the Nationwide Readmissions Database from 2013 to 2019 to analyze trends, risk factors, and complications related to postpartum stroke readmissions within 60 days after discharge.
- Results showed that out of over 21 million deliveries, 5,006 had stroke readmissions, with no significant change in overall readmission rates, while risk factors like preeclampsia were linked to higher odds of readmission.
Article Synopsis
- The study investigates the prevalence and outcomes of obstructive sleep apnea (OSA) among pregnant women in the U.S. during hospital deliveries from 2000 to 2019, revealing a significant increase in cases over the years.
- Out of over 76 million delivery hospitalizations analyzed, only 54,238 (0.07%) were diagnosed with OSA, but the rate jumped from 0.4 to 20.5 cases per 10,000 over the study period, indicating a concerning trend.
- Key clinical factors linked to OSA included obesity, asthma, chronic hypertension, and pregestational diabetes, with the presence of OSA associated with higher risks for serious complications, such as mechanical ventilation, acute respiratory
Background: Up-to-date data on population-level risk factors for postpartum psychosis is limited, although increasing substance use disorders, psychiatric disorders, autoimmune disorders, and other medical comorbidities in the obstetrical population may be contributing to the increased baseline risk of postpartum psychosis.
Objective: This study aimed to determine trends in and risk factors for postpartum psychosis during delivery hospitalizations and postpartum readmissions.
Study Design: Analyzing the 2016-2019 Nationwide Readmission Database, this repeated cross-sectional study identified diagnoses of postpartum psychosis during delivery hospitalizations and postpartum readmissions within 60 days of discharge.
While medications for anxiety and depression are commonly used in the United States, it is unclear to what degree they are continued during pregnancy. We used a large administrative database to determine whether psychiatric medications are continued during pregnancy and predictors of continued medication treatment. Of 2,672,656 women included in our analysis, 86,454 (3.
View Article and Find Full Text PDFObjective: To determine whether longitudinal health data accounts for end-organ injury or death in the setting of chronic hypertension.
Design: Cohort of 64 799 deliveries to 61 854 women.
Setting: US claims data for the preiod 2008-2019.
Importance: The associations of B vitamin status with metabolic syndrome (MetS) incidence among the US population remain unclear.
Objective: To investigate intakes and serum concentrations of folate, vitamin B6, and vitamin B12 in association with MetS risk in a large US cohort.
Design, Setting, And Participants: This prospective study included Black and White young adults in the US who were enrolled from 1985 to 1986 and studied until 2015 to 2016.