Activity restriction and risk of adverse pregnancy outcomes.

Background: Activity restriction is a common recommendation given to patients during pregnancy for various indications, despite lack of definitive data showing improvements in pregnancy outcomes.

Objective: To determine if activity restriction (AR) in pregnancy is associated with decreased odds of adverse pregnancy outcomes (APOs).

Study Design: Secondary analysis of the Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-Be (nuMoM2b) prospective cohort.

Plasma soluble fms-like tyrosine kinase 1 to placental growth factor ratio of 11.5 multiples of median predicts preeclampsia with severe features within 2 weeks of testing.

Background: Angiogenic imbalances, characterized by an excess of antiangiogenic factors (soluble fms-like tyrosine kinase 1) and reduced angiogenic factors (vascular endothelial growth factor and placental growth factor), contribute to the mechanisms of disease in preeclampsia. The ratio of soluble fms-like tyrosine kinase 1 to placental growth factor has been used as a biomarker for preeclampsia, but the cutoff values may vary with gestational age and assay platform.

Objective: This study aimed to compare multiples of the median of the maternal plasma soluble fms-like tyrosine kinase 1 to placental growth factor ratio, soluble fms-like tyrosine kinase 1, placental growth factor, and conventional clinical and laboratory values in their ability to predict preeclampsia with severe features.

Racial/Ethnic Disparities in Peripartum Pain Assessment and Management.

Objective: This study was conducted to determine if there were racial/ethnic disparities in pain assessment and management from labor throughout the postpartum period.

Methods: This was a retrospective cohort study of all births from January 2019 to December 2021 in a single urban, quaternary care hospital, excluding patients with hysterectomy, ICU stay, transfusion of more than 3 units of packed red blood cells, general anesthesia, or evidence of a substance abuse disorder. We characterized and compared patterns of antepartum and postpartum pain assessments, epidural use, pain scores, and postpartum pain management by racial/ethnic group with bivariable analyses.

Perinatal mood and anxiety disorders: biomarker discovery using plasma proteomics.

Background: Perinatal mood and anxiety disorders encompass a range of mental health disorders that occur during pregnancy and up to 1 year postpartum, affecting approximately 20% of women. Traditional risk factors, such as a history of depression and pregnancy complications including preeclampsia, are known. Their predictive utility, however, is not specific or sensitive enough to inform clinical decision-making or prevention strategies for perinatal mood and anxiety disorders.

Circulating Angiogenic Factor Levels in Hypertensive Disorders of Pregnancy.

BACKGROUND: Among women with hypertensive disorders of pregnancy, biomarkers may stratify risk for developing preeclampsia with severe features (sPE). METHODS: Across 18 U.S.

Lack of Association Between Race and Ethnicity and Timely Treatment of Severe Peripartum Hypertension.

Background: Hypertensive disorders of pregnancy are a leading cause of severe maternal morbidity and mortality. National guidelines recommend treatment within 30 to 60 minutes of confirmed severe hypertension to reduce the risk of maternal stroke. The objectives of this study were to quantify the number of patients who did not receive timely treatment of severe hypertension, identify barriers to timely treatment, and evaluate if race/ethnicity was associated with timeliness of treatment.

Immune transcriptional profiles in mothers with clinically elevated depression and anxiety symptoms several years post-delivery.

Background: Most research on maternal mental health focuses on the perinatal period and does not extend beyond 12 months postpartum. However, emerging evidence suggests that for some women (30%-50%), psychological symptoms may persist beyond the first year postpartum or even emerge later increasing the risk of chronic mood and anxiety symptoms. Despite the high prevalence rates and devastating maternal-child consequences, studies examining maternal depression, anxiety, and post-traumatic stress disorder (PTSD) beyond the first year postpartum are rare and our understanding of the underlying biological mechanisms is incomplete.

Race/ethnicity differences in response to acute antihypertensive treatment of peripartum severe hypertension.

Background: Hypertensive disorders of pregnancy increase maternal morbidity, mortality, and long-term risk for cardiovascular disease. The rising incidence of chronic hypertension and preeclampsia disproportionately affects people of color. There is a paucity of published data examining differences in the effectiveness of acute antihypertensive agents between pregnant patients of different races/ethnicities.

Care Levels for Fetal Therapy Centers.

Fetal therapies undertaken to improve fetal outcome or to optimize transition to neonate life often entail some level of maternal, fetal, or neonatal risk. A fetal therapy center needs access to resources to carry out such therapies and to manage maternal, fetal, and neonatal complications that might arise, either related to the therapy per se or as part of the underlying fetal or maternal condition. Accordingly, a fetal therapy center requires a dedicated operational infrastructure and necessary resources to allow for appropriate oversight and monitoring of clinical performance and to facilitate multidisciplinary collaboration between the relevant specialties.

Implementing an inpatient postpartum depression screening, education, and referral program: a quality improvement initiative.

Background: Perinatal mood and anxiety disorders are common and may interfere with pregnancy, delivery, and the postpartum period. Best practice includes symptom screening, patient education, and appropriate referrals; however, many hospitals struggle to identify and support perinatal mood and anxiety disorders patients.

Objective: Therefore, the Cedars-Sinai Postpartum Depression Screening, Education and Referral Program was initiated and evaluated.

Cardiovascular Health After Preeclampsia: Patient and Provider Perspective.

Preeclampsia predicts future cardiovascular disease (CVD) yet few programs exist for post-preeclampsia care. The Health after Preeclampsia Patient and Provider Engagement Network workshop was convened at the Radcliffe Institute for Advanced Study in June 2018. The workshop sought to identify: 1) patient perspectives on barriers and facilitators to CVD risk reduction; 2) clinical programs specialized in post-preeclampsia care; 3) recommendations by national organizations for risk reduction; and 4) next steps.

Impact of labor and delivery unit policy modifications on maternal and neonatal outcomes during the coronavirus disease 2019 pandemic.

Background: In response to the coronavirus disease 2019 pandemic, hospitals nationwide have implemented modifications to labor and delivery unit practices designed to protect delivering patients and healthcare providers from infection with severe acute respiratory syndrome coronavirus 2. Beginning in March 2020, our hospital instituted labor, and delivery unit modifications targeting visitor policy, use of personal protective equipment, designation of rooms for triage and delivery of persons suspected or infected with coronavirus disease 2019, delivery management, and newborn care. Little is known about the ramifications of these modifications in terms of maternal and neonatal outcomes.

Routine Multidisciplinary Review of Severe Maternal Morbidity Is Associated with a Reduction in Preventable Cases of Severe Maternal Morbidity.

Objective: Severe maternal morbidity (SMM) has increased by 45% in the United States and is estimated to affect up to 1.5% of all deliveries. Research has not yet been conducted that demonstrates a benefit to multidisciplinary review of SMM.

Cardiovascular and pregnancy outcomes in women with coronary microvascular dysfunction: a case series.

Background: Coronary microvascular dysfunction (CMD) is associated with adverse cardiovascular outcomes. Coronary microvascular dysfunction is observed in women of childbearing age, however, the frequency of adverse pregnancy outcomes (APO) is unknown.

Case Summary: Women previously enrolled in a single centre prospective CMD registry diagnosed using invasive coronary reactivity testing were included.

Vascular Function and Serum Lipids in Women with Spontaneous Preterm Delivery and Term Controls.

Spontaneous preterm delivery (sPTD) is associated with a twofold increased risk of future maternal cardiovascular disease. We hypothesized that women with sPTD would demonstrate greater vascular dysfunction postpartum compared to women with term delivery. In a case-controlled, matched pilot study, we enrolled 20 women with sPTD (gestation ≤34 weeks), and 20 term control women (gestation ≥39 weeks) were matched for age (±5 years), parity, ethnicity, and route of delivery.

Obstetric Care Consensus #9: Levels of Maternal Care: (Replaces Obstetric Care Consensus Number 2, February 2015).

Maternal mortality and severe maternal morbidity, particularly among women of color, have increased in the United States. The leading medical causes of maternal mortality include cardiovascular disease, infection, and common obstetric complications such as hemorrhage and vary by timing relative to the end of pregnancy. Although specific modifications in the clinical management of some of these conditions have been instituted, more can be done to improve the system of care for high-risk women at facility and population levels.

Putting the "M" back in maternal-fetal medicine: A 5-year report card on a collaborative effort to address maternal morbidity and mortality in the United States.

The Centers for Disease Control and Prevention have demonstrated continuous increased risk for maternal mortality and severe morbidity with racial disparities among non-Hispanic black women an important contributing factor. More than 50,000 women experienced severe maternal morbidity in 2014, with a mortality rate of 18.0 per 100,000, higher than in many other developed countries.

Timely treatment of severe maternal hypertension and reduction in severe maternal morbidity.

Objective: To determine if timely treatment within 60 min of confirmed diagnosis of severe maternal hypertension with antihypertensive medications was associated with reduction in severe maternal morbidity.

Study Design: Medical records of women with severe hypertension (at least two severe blood pressures, systolic ≥160 mmHg and/or diastolic ≥110 mmHg, within 60 min) were accessed for timing of severe blood pressures, timing of treatment, and blood pressure response to treatment. Severe maternal morbidity was confirmed by multidisciplinary case review.

Levels of Maternal Care Verification Pilot: Translating Guidance Into Practice.

Development of systems for perinatal regionalization and for the provision of risk-appropriate maternal care is a key strategy to decrease maternal morbidity and mortality. Regionalized systems pertaining to neonatal care are broadly implemented in many states, but networks for risk-appropriate maternal care are lacking. In response to increases in maternal morbidity and mortality over the past decade, the American College of Obstetricians and Gynecologists (ACOG) and the Society for Maternal-Fetal Medicine (SMFM) developed and published the levels of maternal care guidelines in 2015.

Maternal Mortality in the Twenty-First Century.

Maternal mortality plagues much of the world. There were 303,000 maternal deaths in 2015 representing an overall global maternal mortality ratio of 216 maternal deaths per 100,000 live births. In the United States, the maternal mortality ratio had been decreasing until 1987, remained stable until 1999, and then began to increase.

Association of Spontaneous Preterm Delivery and Future Maternal Cardiovascular Disease.

Cardiovascular disease (CVD) risk factors are well established. However, little is known about a woman's cardiovascular response to pregnancy, which appears to be an early marker of future maternal CVD risk. Spontaneous preterm delivery (sPTD) has been associated with a ≤3-fold increased risk of maternal CVD death later in life compared with having a term delivery.

Understanding Severe Maternal Morbidity: Hospital-based Review.

Cases of severe maternal morbidity (SMM) share similarities to maternal deaths, including increasing in frequency and having similar rates of preventability. This article will review steps to organizing and implementing standard reviews of all cases of SMM. These steps include create multidisciplinary SMM review committee; identify potential SMM cases and confirm true SMM; identify the morbidity; abstract and summarize data; present case to review committee for discussion; determine events leading to morbidity; determine opportunities to improve outcome; assess provider, system and patient factors in cases with opportunities to improve outcome; make recommendations; and effect change and evaluate improvement.