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Objective: To assess regional variation in the use of late preterm steroids use after the publication of the Antenatal Late Preterm Steroids (ALPS) Trial and to understand factors associated with a region's pace of adoption. Methods: This was a repeated cross-sectional study using US natality data across hospital referral regions (HRRs) within the US from February 2015 to October 2017. Inclusion criteria included live-born, non-anomalous, singleton, late preterm (34-36 completed weeks of gestation) neonates born to individuals without pregestational diabetes. HRRs were categorized as either a "slower" or "faster" adopter of antenatal late preterm steroids based on the observed versus expected pace of antenatal steroid adoption in a 1-year period after the trial's dissemination compared to a 1-year pre-dissemination period. Patient and regional factors hypothesized a priori to be associated with the uptake of late preterm steroids were compared between faster and slower adopters. Results: There were 666,097 late preterm births in 282 HRRs during the study period. Of the included HRRs, 136 (48.2%) were considered faster adopters and 146 (51.8%) slower adopters. Faster adopters increased their steroid use by 12.1-percentage points (5.9% to 18.0%) compared to a 5.5-point increase (3.7% to 9.2%) among slower adopters (p

OBJECTIVE Pregnant individuals are universally screened for gestational diabetes mellitus (GDM). Gestational glucose intolerance (GGI) (an abnormal initial GDM screening test without a GDM diagnosis) is not a recognized diabetes risk factor. We tested for an association between GGI and diabetes after pregnancy. RESEARCH DESIGN AND METHODS We conducted a retrospective cohort study of individuals followed for prenatal and primary care. We defined GGI as an abnormal screening glucose-loading test result at ≥24 weeks’ gestation with an oral glucose tolerance test (OGTT) that did not meet GDM criteria. The primary outcome was incident diabetes. We used Cox proportional hazards models with time-varying exposures and covariates to compare incident diabetes risk in individuals with GGI and normal glucose tolerance. RESULTS Among 16,836 individuals, there were 20,359 pregnancies with normal glucose tolerance, 2,943 with GGI, and 909 with GDM. Over a median of 8.4 years of follow-up, 428 individuals developed diabetes. Individuals with GGI had increased diabetes risk compared to those with normal glucose tolerance in pregnancy (adjusted hazard ratio [aHR] 2.01 [95% CI 1.54–2.62], P < 0.001). Diabetes risk increased with the number of abnormal OGTT values (zero, aHR 1.54 [1.09–2.16], P = 0.01; one, aHR 2.97 [2.07–4.27], P < 0.001; GDM, aHR 8.26 [6.49–10.51], P < 0.001 for each compared with normal glucose tolerance). The fraction of cases of diabetes 10 years after delivery attributable to GGI and GDM was 8.5% and 28.1%, respectively. CONCLUSIONS GGI confers an increased risk of future diabetes. Routinely available clinical data identify an unrecognized group who may benefit from enhanced diabetes screening and prevention.

To evaluate outcomes of the first pregnancy after fertility-sparing surgery in patients with early-stage cervical cancer.We performed a population-based study of women aged 18-45 years with a history of stage I cervical cancer reported to the 2000-2012 California Cancer Registry. Data were linked to the OSHPD (California Office of Statewide Health Planning and Development) birth and discharge data sets. We included patients with cervical cancer who conceived at least 3 months after a fertility-sparing surgery, which included cervical conization or loop electrosurgical excision procedure. Those undergoing trachelectomy were excluded. The primary outcome was preterm birth. Secondary outcomes included growth restriction, neonatal morbidity, stillbirth, cesarean delivery, and severe maternal morbidity. We used propensity scores to match similar women from two groups in a 1:2 ratio of case group participants to control group participants: population individuals without cancer and individuals with cervical cancer (women who delivered before their cervical cancer diagnosis). Wald statistics and logistic regressions were used to evaluate outcomes.Of 4,087 patients with cervical cancer, 118 (2.9%) conceived after fertility-sparing surgery, and 107 met inclusion criteria and were matched to control group participants. Squamous cell carcinoma was the most common histology (63.2%), followed by adenocarcinoma (30.8%). Patients in the case group had higher odds of preterm birth before 37 weeks of gestation compared with both control groups (21.5% vs 9.3%, odds ratio [OR] 2.7, 95% CI 1.4-5.1; 21.5% vs 12.7%, OR 1.9, 95% CI 1.0-3.6), but not preterm birth before 32 weeks. Neonatal morbidity was more common among the patients in the case group relative to those in the cervical cancer control group (15.9% vs 6.9%, OR 2.5, 95% CI 1.2-5.5). There were no differences in rates of growth restriction, stillbirth, cesarean delivery, and maternal morbidity.In a population-based cohort, patients who conceived after surgery for cervical cancer had higher odds of preterm delivery compared with control groups.

Background: Treatment of gestational diabetes (GDM) reduces the risk of large for gestational age (LGA) birthweight and associated complications in infants. Pregnant people with gestational glucose intolerance (GGI, abnormal glucose loading test (GLT) without GDM) usually remain untreated. We examined the risk of LGA among women with GGI in a large cohort. Methods: In a retrospective cohort study of 44,628 singleton pregnancies delivered at an academic center at >28 weeks' gestation, pregnancies with a GLT >140 mg/dl and either a normal 3-hour 100-gram oral glucose tolerance test (OGTT) or one abnormal OGTT value were classified as GGI, and those with 2 abnormal OGTT values as GDM. We used generalized estimating equations for logistic regression to examine the risk of LGA (birthweight >90th percentile for gestational age) in GGI versus normal glucose tolerance (NGT, GLT Results: LGA was present in 7.7% of 36,964 pregnancies with NGT, 9.6% of 4357 with GGI and normal OGTT, 14.3% of 15with GGI and one abnormal OGTT value, and 14.5% of 1800 with GDM. The odds of LGA were higher in GGI than NGT pregnancies (adjusted OR 1.4 [1.3-1.5], p Conclusion: Infants of untreated people with GGI have increased risk of LGA birthweight. The risk of LGA in GGI pregnancies with one abnormal OGTT value was similar to that in GDM in a clinical setting where only GDM was treated. Disclosure J.Maya: None. D.J.Selen: None. T.Thaweethai: None. S.Hsu: None. C.Yu: None. K.James: None. A.Kaimal: None. M.Hivert: Advisory Panel; American Heart Association, Research Support; American Diabetes Association. C.E.Powe: None. Funding MGH (Physician Scientist Development Award and Claflin Distinguished Scholar's Award)

To evaluate whether the use of inhaled nitric oxide (iNO)200 improves respiratory function.This retrospective cohort study used data from pregnant patients hospitalized with severe bilateral coronavirus disease 2019 (COVID-19) pneumonia at four teaching hospitals between March 2020 and December 2021. Two cohorts were identified: 1) those receiving standard of care alone (SoC cohort) and 2) those receiving iNO200 for 30 minutes twice daily in addition to standard of care alone (iNO200 cohort). Inhaled nitric oxide, as a novel therapy, was offered only at one hospital. The prespecified primary outcome was days free from any oxygen supplementation at 28 days postadmission. Secondary outcomes were hospital length of stay, rate of intubation, and intensive care unit (ICU) length of stay. The multivariable-adjusted regression analyses accounted for age, body mass index, gestational age, use of steroids, remdesivir, and the study center.Seventy-one pregnant patients were hospitalized for severe bilateral COVID-19 pneumonia: 51 in the SoC cohort and 20 in the iNO200 cohort. Patients receiving iNO200 had more oxygen supplementation-free days (iNO200: median [interquartile range], 24 [23-26] days vs standard of care alone: 22 [14-24] days, P=.01) compared with patients in the SoC cohort. In the multivariable-adjusted analyses, iNO200 was associated with 63.2% (95% CI 36.2-95.4%; P.001) more days free from oxygen supplementation, 59.7% (95% CI 56.0-63.2%; P.001) shorter ICU length of stay, and 63.6% (95% CI 55.1-70.8%; P.001) shorter hospital length of stay. No iNO200-related adverse events were reported.In pregnant patients with severe bilateral COVID-19 pneumonia, iNO200 was associated with a reduced need for oxygen supplementation and shorter hospital stay.

Administrative data, including International Classification of Disease (ICD) codes and birth certificate records, are often used for retrospective gestational diabetes mellitus (GDM) research investigations, to describe associations of GDM with perinatal complications and long-term outcomes, and to determine GDM prevalence. Research investigating the validity of using ICD codes and birth certificates for GDM ascertainment shows varying degrees of reliability.To evaluate the accuracy of both ICD codes and birth certificate diagnosis for GDM ascertainment in a large hospital-based cohort of pregnant individuals, using laboratory criteria for GDM as the reference.We studied individuals who received prenatal care at an academic hospital and affiliated community health centers between 1998 and 2016. In the setting of universal two-step screening for GDM, pregnant individuals were classified as having GDM if greater than or equal to two oral glucose tolerance test values met or exceeded National Diabetes Data Group (NDDG) thresholds. We calculated the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for ICD code and birth certificate ascertainment of GDM, along with their exact binomial 95% confidence intervals (95% CI).In a cohort of 51,059 pregnancies with complete glucose screening, 1303 (2.6%) met NDDG laboratory criteria for GDM. GDM ICD codes had moderate sensitivity of 70.5% (95% CI: 67.9%, 72.9%), high specificity of 99.3% (95% CI: 99.3%, 99.4%), a PPV of 73.3% (95% CI: 70.8%, 75.8%), and a NPV of 99.2% (95% CI: 99.1%, 99.3%). In the 46,512 pregnancies linked to birth certificate data, birth certificate diagnosis had moderate sensitivity (66.3% [95% CI: 63.6%, 69.0%]), high specificity (98.9% [95% CI: 98.8%, 99.0%]), moderate PPV (62.1% [95% CI: 59.8%, 64.4%]), and high NPV (99.1% [95% CI: 99.0%, 99.2%]).Ascertainment of GDM using administrative data, including ICD codes or birth certificates, has moderate sensitivity, moderate PPV, high specificity, and high NPV. Our findings provide context for interpreting the validity of studies that depend on administrative data for ascertainment of GDM and comparing them to prospective studies that use laboratory-based GDM criteria.

Women often seek antidepressant alternatives for major depressive disorder (MDD) in anticipation of or during pregnancy. In this preliminary study, EnBrace HR, a prenatal supplement containing methylfolate, was investigated for depressive relapse prevention and for acute treatment of MDD in women planning pregnancy or during pregnancy.This 12-week open-label study included women with histories of MDD who were planning pregnancy or pregnant28 weeks. At enrollment, Group 1 participants were well (not depressed) and planned to discontinue antidepressants for pregnancy. Group 2 participants were depressed. Primary outcome variables by group included MDD relapse and depressive symptoms, verified with the Mini-International Neuropsychiatric Interview and the Montgomery-Åsberg Depression Rating Scale (MADRS), respectively. Biomarkers of inflammation and the folate cycle were collected.Group 1 participants (N = 11) experienced lower rates of depressive relapse (27.3%Results suggest EnBrace HR is a well-tolerated intervention with potential efficacy for prevention and treatment of perinatal depression. Larger controlled trials are necessary.

Women who are pregnant or in the postpartum period have a fourfold to fivefold increased risk of thromboembolism compared with nonpregnant women (). Approximately 80% of thromboembolic events in pregnancy are venous (), with a prevalence of 0.5-2.0 per 1,000 pregnant women (). Venous thromboembolism (VTE) is one of the leading causes of maternal mortality in the United States, accounting for 9.3% of all maternal deaths ().The prevalence and severity of this condition during pregnancy and the peripartum period warrant special consideration of management and therapy. Such therapy includes the treatment of acute thrombotic events and prophylaxis for those at increased risk of thrombotic events. The purpose of this document is to provide information regarding the risk factors, diagnosis, management, and prevention of thromboembolism, particularly VTE in pregnancy. This Practice Bulletin has been revised to reflect updated guidance regarding screening for thromboembolism risk and management of anticoagulation around the time of delivery.

To evaluate the neonatal outcomes of infants delivered to mothers with early-onset preeclampsia.This is a retrospective cohort of 1709 infants delivered at 24 0/7 to 29 6/7 weeks gestation was examined. Neonatal outcomes of 235 infants delivered prematurely because of preeclampsia were compared with 1474 infants delivered preterm because of other etiologies. Primary outcomes examined included: small for gestational age (SGA), respiratory distress syndrome (RDS), and neonatal death (NND). Multivariable logistic regression was used to analyze the association between preeclampsia and the neonatal outcomes, controlling for potential confounders.Infants of women with preeclampsia were more likely to be SGA (17.8% vs. 5.6%, AOR 3.9, CI 2.5-6.2) and have RDS (70.6% vs. 60.7%, AOR 1.5, 95% CI 1.1-2.2); however, they were less likely to suffer a NND (11.1% vs. 18.1%, AOR 0.6, 95% CI 0.4-0.9).Compared with neonates delivered prematurely because of other etiologies, neonates born to preeclamptic mothers were more likely to be SGA and have RDS, but had a decrease in mortality. This may be a reflection of the differences in the underlying pathophysiology behind indicated preterm birth due to preeclampsia.