The Relationship between Various Measures of Perinatal Quality.

Objective: To examine the correlations between pairs of maternal, infant, and maternal-infant dyad quality measures to provide a comprehensive assessment of perinatal care.

Study Design: In a retrospective cohort study using birth and fetal death certificates linked to hospital discharge data from Michigan, Oregon, Pennsylvania, and South Carolina (2016-2018), we examined correlations between pairs of maternal, infant, and maternal-infant dyad quality measures. Maternal quality measures included nulliparous term singleton vertex (NTSV) cesarean birth, non-transfusion severe maternal morbidity (SMM), and a composite maternal outcome.

Postpartum Pharmacologic Thromboprophylaxis and Venous Thromboembolism in a U.S. Cohort.

Objective: To evaluate the effect of administering postpartum heparin-based pharmacologic thromboprophylaxis on the incidence of postpartum venous thromboembolism (VTE) and complications.

Methods: This was a multicenter retrospective cohort study of all individuals delivering at more than 20 weeks of gestation at four U.S.

Association between the dietary inflammatory index and adverse pregnancy outcomes.

Background: Limited research exists on the association between preconception pro-inflammatory diets and adverse pregnancy outcomes, and this relationship remains poorly understood.

Objective: To investigate the association between preconception dietary inflammatory potential, as measured by the Dietary Inflammatory Index (DII), and adverse pregnancy outcomes in nulliparous individuals.

Methods: This was a secondary analysis of the data from the Nulliparous Outcomes Study: Mothers-to-be (nuMoM2b).

Determinants of Racial and Ethnic Differences in Maternal Cardiovascular Health in Early Pregnancy.

Background: Suboptimal cardiovascular health (CVH) in pregnancy is associated with adverse maternal and offspring outcomes. To guide public health efforts to reduce disparities in maternal CVH, we determined the contribution of individual- and neighborhood-level factors to racial and ethnic differences in early pregnancy CVH.

Methods: We included nulliparous individuals with singleton pregnancies who self-identified as Hispanic, non-Hispanic Black (NHB), or non-Hispanic White (NHW) and participated in the nuMoM2b cohort study (Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-Be).

Radon Exposure and Gestational Diabetes.

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.

AI-based analysis of fetal growth restriction in a prospective obstetric cohort quantifies compound risks for perinatal morbidity and mortality and identifies previously unrecognized high risk clinical scenarios.

Background: Fetal growth restriction (FGR) is a leading risk factor for stillbirth, yet the diagnosis of FGR confers considerable prognostic uncertainty, as most infants with FGR do not experience any morbidity. Our objective was to use data from a large, deeply phenotyped observational obstetric cohort to develop a probabilistic graphical model (PGM), a type of "explainable artificial intelligence (AI)", as a potential framework to better understand how interrelated variables contribute to perinatal morbidity risk in FGR.

Methods: Using data from 9,558 pregnancies delivered at ≥ 20 weeks with available outcome data, we derived and validated a PGM using randomly selected sub-cohorts of 80% (n = 7645) and 20% (n = 1,912), respectively, to discriminate cases of FGR resulting in composite perinatal morbidity from those that did not.

Early pregnancy health behaviors, hypertensive disorders of pregnancy, and maternal blood pressure after pregnancy.

Background: Individual health behaviors are associated with pregnancy outcomes, but their joint effects are rarely considered. We aimed to examine associations between combinations of first trimester health behaviors and hypertensive disorders of pregnancy (HDP), normotensive adverse pregnancy outcomes (APOs), and blood pressure (BP) 2-7 years after delivery.

Methods: Participants in the nuMoM2b and follow-up Heart Health Study were included.

Early prediction of preeclampsia using the first trimester vaginal microbiome.

Preeclampsia is a severe obstetrical syndrome which contributes to 10-15% of all maternal deaths. Although the mechanisms underlying systemic damage in preeclampsia-such as impaired placentation, endothelial dysfunction, and immune dysregulation-are well studied, the initial triggers of the condition remain largely unknown. Furthermore, although the pathogenesis of preeclampsia begins early in pregnancy, there are no early diagnostics for this life-threatening syndrome, which is typically diagnosed much later, after systemic damage has already manifested.

Dilapan-S vs standard methods for cervical ripening in term pregnancies: an individual patient data meta-analysis.

Objectives: Dilapan-S is a cervical ripening agent approved by the FDA that has been found to be just as effective as other agents and can be utilized for outpatient ripening. No large-scale studies have been conducted to compare cesarean delivery rates between Dilapan-S and other ripening methods. Our objective was to combine these trials to compare cesarean delivery rates for Dilapan-S with other cervical ripening methods, overall and in sub-groups.

Relationship between Intrapartum Continuous Glucose Monitoring Values and Neonatal Hypoglycemia in Individuals with Diabetes.

Objective:  We aimed to evaluate the relationship between intrapartum continuous glucose monitoring (CGM) and neonatal hypoglycemia (NH) in individuals with diabetes.

Study Design:  a multicenter prospective study (November 2021-December 2022) of laboring individuals with pregestational or gestational diabetes at ≥34 weeks. Cohorts had a blinded CGM placed from admission through delivery and were monitored with fingerstick (FS) according to usual care.

Screening tests for preeclampsia: in search of clinical utility.

The research and implementation process for a new screening test should involve two steps. First, one has to demonstrate that the test can predict a certain outcome or appropriately stratify the patients based on risk for the outcome. The second step requires evidence of clinical utility.

The Relationship Between Perceived Discrimination and Reported Nutrient Intake Among Pregnant Individuals of Minoritized Racial and Ethnic Groups.

Background: Implications of lifelong, perceived discrimination on nutrient intake during the preconception period are unclear.

Objective: The objective was to identify associations between perceived discrimination and consumption of specific nutrients associated with risk of adverse pregnancy outcomes.

Design: This is a secondary data analysis of the prospective Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-Be cohort.

An Organ-Specific Approach to the Management of Gestational Hypertension: Evidence versus Tradition.

The management of hypertensive disease in pregnancy is currently guided by practice recommendations based largely on observational data from a half century ago and has changed only superficially since that time. These recommendations are both narrowly prescriptive (women without traditional features of severe disease should all be delivered at exactly 37 weeks) and at the same time frustratingly ambiguous (the presence of epigastric pain unresponsive to repeat analgesics precludes expectant management at any gestational age, regardless of laboratory studies). Guidelines that ignore recent data from the obstetric, pediatric, and internal medicine literature too often lead practitioners to be more aggressive than necessary in the delivery of very premature pregnancies, and, conversely, more complacent than patient safety would support in prolonging pregnancy with advanced fetal maturity.

Peripheral Use of Vasopressors in Shock: Clinical Considerations and Recommendations for Use in Obstetrics.

Objective:  This study aimed to evaluate the safety of peripheral administration of vasopressor agents among patients with circulatory shock.

Study Design:  We reviewed the published literature evaluating the use of peripheral norepinephrine in patients with shock and proposed a protocol for use in labor and delivery units.

Results:  Peripheral administration of norepinephrine is a safe and potentially lifesaving intervention for patients in labor and delivery with extremely low complication rates.

Tranexamic acid for postpartum bleeding: a systematic review and individual patient data meta-analysis of randomised controlled trials.

Background: Tranexamic acid is a recommended treatment for women with a clinical diagnosis of postpartum haemorrhage, but whether it can prevent bleeding is unclear. We conducted a systematic review and individual patient data (IPD) meta-analysis of randomised controlled trials to assess the effects of tranexamic acid in women giving birth.

Methods: In this systematic review and IPD meta-analysis, we searched the WHO International Clinical Trials Registry Platform from database inception to Aug 4, 2024 for randomised trials that assessed the effects of tranexamic acid in women giving birth.

Impact of Attempted Mode of Delivery on Neonatal Outcomes in Nulliparous Individuals According to Body Mass Index.

Objective:  This study aimed to compare neonatal and maternal outcomes based on the attempted mode of delivery, stratified by prepregnancy body mass index (BMI; kg/m) in nulliparous individuals.

Study Design:  This was a repeated cross-sectional analysis of U.S.

Association between iron deficiency anemia and severe maternal morbidity: A retrospective cohort study.

Purpose: We examined the association between iron deficiency anemia (IDA) and severe maternal morbidity (SMM) during delivery and up to 1-year postpartum.

Methods: In a retrospective cohort study across 3 states, we computed adjusted relative risks (aRR) for SMM comparing individuals with IDA versus those without, using modified Poisson regression models.

Results: Among 2459,106 individuals, 10.