Browsing by Subject "Pregnancy Complications"
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Item Delivery Continuity and Neonatal Disposition to Birthing Parent in Individuals with Substance Use Disorder at Parkland Health(2024-01-30) Afsari, Macy; White, Alesha; Morillos, Stephanie; Fisher, Amber; McNeil, Jessica; Faucher, Mary Ann; Cordova, Polly; Onisko, Nancy S.; Andino, Aldo; Kern, Joshua; Kleinschmidt, Kurt; McIntire, Donald D.; Adhikari, Emily H.OBJECTIVE: Infants born to individuals with substance use disorder (SUD) are at increased risk of removal from their parent. Individuals with SUD in pregnancy receive obstetric care by a multidisciplinary care team (MCT) at our safety-net hospital. We evaluated factors associated with delivery continuity and neonatal discharge to birthing parent among patients with SUD. STUDY DESIGN: This is a retrospective cohort study of pregnant patients with SUD who accessed Parkland Health (PHHS) between July 28, 2021 and June 25, 2022. We compared MCT interactions among patients who did and did not deliver at PHHS as well as neonatal disposition and outcomes for infants born to individuals with SUD and with specifically opioid use disorder (OUD). RESULTS: Among 256 pregnant individuals with SUD who accessed care in our system, 144 (56%) received care by our MCT during pregnancy or at the delivery hospitalization. 98 of these patients delivered at PHHS and 46 delivered elsewhere (68% vs 32%, p<0.001). Significantly more eligible individuals who delivered at PHHS accepted medication-assisted treatment (MAT) compared to those who did not (88% vs 70%, p=0.025). Of 139 patients with SUD who delivered at PHHS, 91 (65%) infants were discharged home with the birthing parent. Parents who went home with their infants were more likely to use cannabis (33% vs 4%, p<0.001) and less likely to use opioids (34% vs 63%, p=0.003). They attended more prenatal visits (median [IQR] 9 [5,11] vs 1 [0,4], p<0.001) and met less frequently with our multidisciplinary team providing integrated SUD treatment (1 [0,10] vs 4 [1, 14.5], p=0.026). Neonates discharged with the birthing parent were less likely to have a positive meconium (7% vs 75%, p<0.001) or urine toxicology (2% vs 67%, p<0.001) and were less likely to have a 5-minute Apgar <4 (0% vs 4%, p=0.04). Of 62 patients with OUD, 31 (50%) were discharged with their neonate. Those who used opioids alone were more likely than individuals with opioid-polysubstance misuse to retain charge of their infant (78% vs 43%, p=0.018). CONCLUSION: Increased interactions and MAT with a team specializing in care of pregnant patients with SUD is associated with delivery continuity. Neonatal disposition and outcomes are influenced more by maternal drug of choice and prenatal care attendance than by MCT interactions because of variance in SUD complexity. Opioid-polysubstance misuse is associated with separation of maternal infant dyad.Item Diabetes and pregnancy(1979-10-18) Raskin, PhilipItem Hypertension with pregnancy and the pill(1976-07-15) Kaplan, Norman M.Item Liver disease in pregnancy(1964-10-22) UnknownItem Liver dysfunction and jaundice in pregnancy(1979-12-06) Combes, BurtonItem [News](1977-03-25) Fenley, BobItem [News](1989-02-01) Harrell, AnnItem Peripartum cardiomyopathy: balancing heart failure and motherhood(2003-11-13) Drazner, Mark H.Item Predictors and Correlates of Anxiety in Women Hospitalized With High-Risk Pregnancy(2007-08-08) Labat, Dana Broussard; Evans, Harry M.Anxiety during pregnancy often negatively impacts a woman's perception of her pregnancy, as well as affects the development of the fetus and contributes to long-term negative sequelae during subsequent years post-delivery. Despite the increases in attention to the effects of anxiety in the perinatal literature, few studies utilize women with high-risk pregnancy as their population of study. These women would appear to be at a greater risk of experiencing anxiety because of the physical and psychological demands of their complicated pregnancies. Therefore, the current study attempted to determine the demographic and psychosocial correlates of anxiety in this unique population. This investigation also sought to improve significant methodological limitations found in previous published reports by employing a "gold standard" clinical diagnostic interview in addition to self-report measures of anxiety. Finally, this study examined the course of anxiety across hospitalization. From October 2005 to December 2006, 129 participants admitted to a high-risk antenatal unit participated in this investigation. Of those participants, 12% were diagnosed with an anxiety disorder. This prospective investigation revealed significant associations among anxiety symptoms and younger maternal age, lower education and income level, and Medicaid insurance status. Further multivariate analyses revealed that relationship maladjustment, greater number of and elevated perceived distress of stressful life events, and the consideration of termination were also significantly associated with the presence of anxiety symptoms. Logistic regression analyses determined that endorsed depressive symptoms predicted more than a one-and-a-half time's likelihood of increased anxiety symptoms. These findings show that anxiety symptoms are present in women hospitalized with high-risk pregnancy and directly impact the experience of pregnancy. These results demonstrate that identifying potential risk factors of anxiety through routine screenings at initial admission could lead to the development of hospital-based short-term interventions aimed at preventing negative antenatal and postpartum outcomes.Item Predictors of Depression in a High-Risk Hospitalized Pregnancy Population: A Prospective Longitudinal Study(2007-08-08) Miltenberger, Paula Dianne; Evans, Harry M.Research is beginning to elucidate the prevalence and effects of antenatal depression on the mother and fetus. However, relatively little focus has been paid to the woman diagnosed with a high-risk pregnancy requiring hospitalization. The present study investigated the predictors and trajectory of depression in women hospitalized on an antepartum unit. The sample consisted of 129 who were hospitalized due to complications during pregnancy. At admission, the women completed self-report measures to assess depressive symptoms, life events as well as personality. Women who exceeded set thresholds on depressive measures were administered a structural clinical interview to assess for a formal diagnosis of Major Depressive Disorder. Additionally, women's depressive symptoms were assessed weekly across hospitalization until discharge. Forty-four percent of the sample exceeded set threshold at admission, indicating they were experiencing high levels of depressive symptoms. Logistic regression was used to determine predictors of group status at admission, based on depressive measures. Results indicated that only life events were predictive of those women exceeding set thresholds. Furthermore, consideration of pregnancy termination and prior psychiatric diagnosis were predictive of Major Depressive Disorder. Growth curve modeling was used to identify trajectory and changes in depressive symptoms over the course of hospitalization. The results indicated that most women experienced a decrease in symptoms over time. In measuring personality, the Depressive Experiences Questionnaire (Blatt, D'Affliti, & Quinlan, 1976) was used to determine if women characterized as self-critical would report more depression during pregnancy than women characterized as dependent. No significant differences were found between the personality scales and depression severity. However, those women who were high on both self-criticism and dependency had the highest scores on the depressive measures. These results suggests that women who score high on both self-criticism and dependency scales appear to be the most vulnerable to depressive symptoms during the antepartum period.Item Pregnancy and Lupus Nephritis: A Review(2017-03-31) Bansal, Sukriti; Rajora, Nilum; Nwariaku, Fiemu; Saxena, RameshBACKGROUND: Systemic lupus erythematosus (SLE) is a multisystem autoimmune disorder often affecting women of reproductive age, whose fertility is typically unaltered by their disease. SLE - and lupus nephritis (LN) in particular - has a significant impact on the course of pregnancy, as well as the outcomes for mother and fetus. Ideally patients have been in remission for a minimum of 6 months prior to conception. LN in pregnancy increases the patient's risk of SLE flare, as well poor outcomes including fetal loss, pre-eclampsia, and maternal death. Good outcomes are achievable for these patients, and have been well documented in the developed world, but less is known about patients in developing nations. METHODS: A literature review was performed of the available literature in regards to lupus nephritis and pregnancy in developing nations. Few studies were available, primarily retrospective case series. A review of these studies was performed, and analyzed for trends in regards to the impact of active disease at conception or lupus nephritis on flare rates, live birth rates, and fetal loss rates. The studies were also examined for any notable geographic trends. RESULTS: Based on the studies reviewed, there is a trend observed between active disease at conception and a lower rate of live birth. A trend was observed between high rates of LN and higher rates of flare, which many studies reported as being statistically significant. A relationship between high rates of LN and higher rates of fetal loss was also observed. With regards to geographic trends, lower overall live birth rates and higher rates of active disease at conception were noted in Indian studies. Interestingly, lower rates of pre-eclampsia were also noted in the Indian studies. Higher rates of flare were observed in the Asian studies. CONCLUSION: Good outcomes are possible for patients with lupus nephritis seeking pregnancy, even in low resource settings. More research is necessary to fully understand the relationships between active disease at conception or lupus nephritis on flare rates, live birth rates, and fetal loss rates.Item Pregnancy and renal disease(1977-05-05) Hull, Alan R.Item Substance use in pregnancy: impacts of state policies on maternal and child outcomes(2023-05-09) Faherty, Laura J.The opioid crisis has had a substantial effect on pregnant women, with the number of pregnant women with an opioid use disorder diagnosis at delivery quadrupling from 1999 to 2014, and the incidence of neonatal opioid withdrawal syndrome increasing nearly seven fold from 2000 to 2014. The speaker, a clinician-researcher with extensive experience for this population, will discuss (1) the evolution of state policies related to substance use in pregnancy over the past two decades, (2) her research on the effects of these policies on the mother-infant dyad, (3) the rapidly-growing evidence base on the harmful impacts of punitive policies towards substance use in pregnancy, and (4) future research directions and opportunities to improve care for maternal-infant dyads affected by opioid use in the perinatal period.Item [UT News](1986-12-01) Nelson, Emme