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Objective Measles immunity testing, unlike that for rubella, is not currently part of prenatal screening even though immunity to both is conferred by the measles–mumps–rubella (MMR) vaccine. Although endemic transmission of measles was declared eliminated in the United States in 2001, outbreaks have continued to occur. Given the risks associated with measles infection during pregnancy, we sought to identify risk factors for measles nonimmunity (MNI) in rubella-immune (RI) pregnant individuals. Methods We performed a retrospective observational cross-sectional study of patients receiving prenatal care and delivering at two university hospitals and a county hospital in Southern California from April 1, 2019 to February 1, 2021. Inclusion criteria were pregnant individuals ≥18 years old who had serological testing for rubella and measles during pregnancy. Demographic data were extracted from electronic medical records, including results of serological testing and chronic medical conditions. All subjects were rubella immune, and we compared measles-immune (MI) with MNI groups. Results In total, 1,813 RI individuals were identified, with 1,467 (81%) MI and 346 (19%) MNI individuals. Variables associated with an increased risk of MNI included having public health insurance (adjusted relative risk [aRR]: 1.56; 95% confidence interval [CI]: 1.24, 1.97) and Hispanic ethnicity (aRR: 1.37; 95% CI: 1.06, 1.78). Black race was associated with a decreased risk of MNI (aRR: 0.52; 95% CI: 0.29, 0.91). Birth year before 1989 demonstrated a trend toward increased risk of MNI, but this did not reach statistical significance (aRR 1.23; 95% CI: 1.00, 1.52). No differences were seen between the two groups for medical comorbidities. Conclusion Our study is the first to demonstrate risk factors for measles MNI in patients with documented rubella immunity. In the absence of universal measles serological screening recommendations, the risk factors identified could help guide clinicians in selective screening for those at risk of needing postpartum MMR vaccination. Key Points The rate of measles nonimmunity is higher than previously reported. Hispanic ethnicity and use of public insurance are risk factors for measles nonimmunity. The current recommendation for history-based screening for measles immunity is likely insufficient. [ABSTRACT FROM AUTHOR]

Objective  This work aimed to study perinatal, maternal, and neonatal characteristics of birth tourism (BT) mother–baby dyads and the rate of neonatal intensive care unit (NICU) admissions of BT infants. Study Design  Retrospective study at a regional perinatal center comparing BT mother–baby dyads to all dyads. BT infants admitted to the NICU were compared with a randomly selected group of infants admitted to the NICU during the same time period. Results  A total of 1,755 BT dyads were identified over 4 years. BT mothers were older (32 vs. 28 years, p  < 0.0001), more likely to carry multiples (5.5 vs. 1.4%, p  < 0.0001), deliver via cesarean section (40 vs. 34%, p  < 0.0001), and require postpartum intensive care (0.6 vs. 0.1%, p  < 0.0001). BT infants had significantly fewer NICU admissions 96 (5.5%) versus 3,213 (11.3%; p  < 0.0001). There were no statistically significant differences in NICU course and outcome between BT and non-BT control infants. Conclusion  Birth tourism is associated with unique determinants of health. In our study, there were fewer NICU admissions, potentially explained by the healthy migrant effect. Key Points Birthright citizenship attracts foreigners to give birth in the United States. BT is associated with unique social determinants of health. Fewer NICU admissions in our study are possibly explained by the healthy migrant effect. [ABSTRACT FROM AUTHOR]

Background: San Diego Hospice and the Institute for Palliative Medicine created one of the earliest perinatal palliative care programs in the country. Only four studies have reported outcomes for pregnant women referred to perinatal palliative care services for potentially lethal prenatal diagnoses. Objectives: To learn: (1) who is referred for perinatal palliative care at San Diego Hospice; (2) what happens after referral to perinatal palliative care; and (3) what happens after delivery for this population. Design: This was an exploratory retrospective electronic chart review of all patients referred to a home perinatal palliative program. Results: Sixty-six women were referred to the San Diego Hospice and the Institute for Palliative Care home perinatal palliative care program between October 2006 and August 2012. Mean age was 31 years. The majority of women were Hispanic, Christian/Catholic, married, with full prenatal care, and previous children. Average gestational age at referral was 27 (18-39] weeks. Thirty-two cases were referred for Trisomy 13, Trisomy 18, or anencephaly. Palliative care services were given over a mean 45 (0-132) days and 3 (0-12) visits prior to delivery. Most women completed a birth plan prior to delivery, chose palliative treatment only, and made final arrangements with the palliative team. Forty-one deliveries resulted in a liveborn infant. Twelve liveborn infants survived past 72 hours and were admitted to pediatric hospice care. Conclusions: One-third of women met with the palliative care team only once or twice prior to delivery, indicating a need for earlier referral to provide more comprehensive palliative care. [ABSTRACT FROM AUTHOR]