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Study Objective: To evaluate patient-level differences and decision making surrounding subsequent pregnancies (SSP) after peripartum cardiomyopathy (PPCM)., Design: Mixed methods approach to evaluate quantitative demographic and clinical differences between patients with and without a SSP and to qualitatively describe the decision-making regarding a SSP with a survey component., Setting/participants: 220 PPCM cases within the University of Pennsylvania Health System., Main Outcome Measures: Demographic, clinical and obstetrical outcomes., Results: 73 patients (33 %) had a SSP, 37 with a live birth. Those with a SSP were more likely to self-identify as Black (70 % vs. 52 %; p  = 0.04), be nulliparous in index pregnancy (68 % vs. 45 %, p  = 0.02), were younger at diagnosis (24.3 vs. 30.5 years; p  < 0.01), and a higher left ventricular ejection fraction (LVEF) at diagnosis (35 % vs. 27.5 %; p  = 0.03) compared to patients without a SSP. There was no difference in recovery rates of LVEF (62 % vs. 50 %, p  = 0.17), or need for LVAD, transplant, or death. 22 patients completed the survey (representing 44 SSPs): 41 % of SSPs ( n  = 18) resulted in termination, 18 % ( n  = 8) in a first/s trimester loss, and 41 % (n = 18) in a live-born delivery. All patients who elected termination indicated risk of recurrence/worsening heart failure to be a motivating factor., Conclusions: Less than 20 % of patients in this single-center, multi-racial cohort had a SSP and delivery after PPCM with fear of recurrence as a large driver in this decision. Patients with a SSP were younger with a higher EF at diagnosis but ultimately had similar cardiac outcomes as patients without a SSP., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Authors.)

Background: Drug use during pregnancy can have implications for maternal and fetal morbidity and mortality and legal ramifications for patients. The American College of Obstetricians and Gynecologists guideline states that drug screening policies during pregnancy should be applied equally to all people and notes that biological screening is not necessary, stating that verbal screening is adequate. Despite this guidance, institutions do not consistently implement urine drug screening policies that reduce biased testing and mitigate legal risks to the patient., Objective: This study aimed to evaluate the effects of a standardized urine drug testing policy in labor and delivery on the number of drug tests performed, self-reported racial makeup of those tested, provider-reported testing indications, and neonatal outcomes., Study Design: This was a retrospective cohort study. A urine drug screening and testing policy was introduced in December 2019. The electronic medical record was queried for the number of urine drug tests performed on patients admitted to the labor and delivery unit from January 1, 2019, to April 30, 2019. The number of urine drug tests performed between January 1, 2019, and April 30, 2019, was compared with the number of urine drug tests performed between January 1, 2020, and April 30, 2020. The primary outcome was the proportion of urine drug tests performed based on race before and after the implementation of a drug testing policy. The secondary outcomes included total number of drug tests, Finnegan scores (a proxy for the neonatal abstinence syndrome), and testing indications. To understand perceived testing indications, pre- and postintervention provider surveys were administered. Chi-square and Fisher exact tests were used to compare categorical variables. The Wilcoxon rank-sum test was used to compare nonparametric data. The Student t test and 1-way analysis of variance were used to compare means. Multivariable logistic regression was used to construct an adjusted model that included covariates., Results: In 2019, Black patients were more likely to undergo urine drug testing than White patients, even after adjusting for insurance status (adjusted odds ratio, 3.4; confidence interval, 1.55-7.32). In 2020, there was no difference in testing based on race after adjusting for insurance status (adjusted odds ratio, 1.3; confidence interval, 0.55-2.95). There was a reduction in the number of drug tests performed between January 2019 and April 2019 compared with between January 2020 and April 2020 (137 vs 71; P<.001). This was not accompanied by a statistically significant change in the incidence of neonatal abstinence syndrome measured by mean Finnegan scores (P=.4). Before the implementation of a drug testing policy, 68% of providers requested patient consent for testing; after the implementation of a drug testing policy, 93% requested patient consent for testing (P=.002)., Conclusion: The implementation of a urine drug testing policy improved consent for testing and reduced disparities in testing based on race and the overall rate of drug testing without affecting neonatal outcomes., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Objective: To estimate the incidence and identify risk factors for atypical endometrial hyperplasia (AH) and endometrial cancer (EC) in American women undergoing infertility evaluation., Design: Case-control study., Setting: Academic reproductive endocrinology and infertility practice., Patients: Female patients (18-50 years) seeking infertility evaluation from January 1, 2009 to December 1, 2018. Patients with known genetic predisposition to cancer or prior cancer diagnosis were excluded. Cases were defined as patients diagnosed with AH or EC during infertility workup (n = 22). Controls without AH or EC were randomly selected in a 10:1 ratio (n = 220) from all women undergoing infertility evaluation in the same year., Interventions: None., Main Outcome Measures: Incidence of AH or EC and odds of AH or EC accounting for age, race, body mass index (BMI), and ovulatory dysfunction., Results: Twenty-two cases of AH or EC were identified among 11,569 women undergoing infertility evaluation (incidence 2 per 1,000 women, 95% confidence interval [CI] 1.2-2.9 per 1,000). Of these women, 68% had a BMI ≥30 kg/m 2 compared with 25% of controls. In multivariable analyses, women with a BMI ≥30 kg/m 2 were 5.9 times more likely to be diagnosed with AH or EC (adjusted odds ratio 5.9, 95% CI 2.0-17.2). Women with ovulatory dysfunction were 3.4 times more likely to be diagnosed with AH or EC (adjusted odds ratio 3.4, 95% CI 1.1-10.1)., Conclusions: The incidence of AH and EC in a population of women undergoing infertility evaluation is 10 times that in the general population of premenopausal women. Obesity is the strongest independent risk factor for AH and EC in women with infertility.