American Journal Of Perinatology[JOURNAL]
Sun
200 papers
Assessing the Impact of a Digital Patient Navigation Tool for Iron Deficiency Anemia in Pregnancy: A Hybrid Effectiveness-Implementation Trial.
Kumar NR, Butt Z, Calcei JB … +4 more , Forkpa M, Mumford S, Levine LD, Hamm RF
Am J Perinatol · 2026 Jul · PMID 41106400 · Publisher ↗
OBJECTIVE: Iron deficiency anemia (IDA) is associated with adverse maternal and neonatal outcomes. Patient navigation tools have improved treatment and surveillance completion among postpartum populations. Our study aime...
OBJECTIVE: Iron deficiency anemia (IDA) is associated with adverse maternal and neonatal outcomes. Patient navigation tools have improved treatment and surveillance completion among postpartum populations. Our study aimed to evaluate the impact of prospectively implementing a digital patient navigation tool for IDA in prenatal care (PN-IDA). STUDY DESIGN: This pilot type 1 hybrid effectiveness-implementation trial utilized a difference-in-differences (DiD) design to compare pre- and postimplementation outcomes at an intervention site to a control site. The trial was performed at a tertiary academic center in the northeastern United States between April 2023 and April 2024. Patients with third-trimester Hgb < 9.5 g/dL were institutionally eligible for IV iron (IVFe) and included in this analysis. Dual primary outcomes were completion of ≥ 1 IVFe infusion and perceived health competence (validated eight-item survey). Implementation outcomes assessed penetration and fidelity. Multivariable logistical and linear regression models controlling for differences in site characteristics over time used interaction terms to estimate DiD. RESULTS: Three hundred and seventy-eight patients were included. While IVFe completion increased at both sites (66-84% at the intervention site vs. 78-83% at the control site), there was no statistically significant difference (DiD RR: 1.13, 95% CI: 0.91-1.38). Perceived health competence remained similar at both sites (median score: 3.3-3.3 at the intervention site vs. median score: 3.3-3.1 at the control site, DiD RR: 0.15, 95% CI: -0.08 to 0.38). PN-IDA had a high level of penetration (i.e., integration of practice within a service setting), but poor fidelity (i.e., degree to which an intervention is delivered as intended). Sixty-six percent of eligible patients enrolled, but only 24% accessed PN-IDA more than once. CONCLUSION: PN-IDA implementation increased IVFe completion by 18% at the intervention site, but our study was underpowered to assess this difference. Future work will refine PN-IDA to optimize fidelity. KEY POINTS: · Completion of > 1 infusion increased by 18% at the intervention versus 5% at the control site (95% CI: 0.91-1.38).. · Two-thirds of eligible patients enrolled in the tool.. · Only 24% of enrolled patients accessed the tool > 1 time..
The Association between Maternal Education Level and Infant Mortality Rates by Gestational Age among Black, White, and Hispanic Infants.
Goldman JC, Watt MJ, Trulove SG … +4 more , Tindal R, Shukla VV, Carlo WA, Travers CP
Am J Perinatol · 2026 Jul · PMID 41101346 · Full text
OBJECTIVE: This study aimed to determine if maternal educational attainment is associated with racial/ethnic disparities in gestational age (GA)-specific infant mortality rate (IMR). STUDY DESIGN: Cohort study using data...
OBJECTIVE: This study aimed to determine if maternal educational attainment is associated with racial/ethnic disparities in gestational age (GA)-specific infant mortality rate (IMR). STUDY DESIGN: Cohort study using data from the Centers for Disease Control and Prevention (CDC) WONDER expanded linked birth and infant death records database, 2017 to 2019. We included hospital-born infants from 22 to 41 weeks' gestation without major congenital anomalies. We compared GA-specific IMR by maternal race/ethnicity (Black, Hispanic, or White) and maternal education level. RESULTS: There were 9,356,130 eligible infants during the study period; 16.1% Black, 25.7% Hispanic, and 58.2% White. Black infants born at 23 and 24 weeks' gestation had lower IMR at all maternal education levels than White infants. Black infants from 36 to 40 weeks' gestation had higher IMR except at the lowest maternal education level. Hispanic infants born at 23 and 24 weeks' gestation had lower IMR than White infants across all education levels. At 36 to 40 weeks' gestation, Hispanic infants also had lower IMR except at the highest education level. CONCLUSION: The association of maternal educational attainment on GA-specific IMR among late preterm and term infants differs by race and ethnicity. Disparities in IMR persist among Black infants despite educational attainment, while Hispanic infants had lower IMR at lower levels of educational attainment compared with White infants. KEY POINTS: · The protective effect of maternal education on infant outcomes may vary by race/ethnicity.. · Black late preterm and term infants have higher GA-specific IMRs than White infants, even with similar education levels.. · Hispanic late preterm and term infants show lower mortality rates than White infants at lower education levels..
Perineal Lacerations and Obstetric Anal Sphincter Injuries in Diet-Controlled Gestational Diabetes: A Large Cohort Study.
Eshkoli T, Amit K, Bugaiski-Shaked A … +4 more , Stein L, Baumfeld Y, Weintraub AY, Rotem R
Am J Perinatol · 2026 May · PMID 41101345 · Publisher ↗
OBJECTIVE: Perineal lacerations are a common obstetric complication influenced by maternal and intrapartum factors. While gestational diabetes mellitus (GDM) is linked to adverse pregnancy outcomes, the impact of diet-co...
OBJECTIVE: Perineal lacerations are a common obstetric complication influenced by maternal and intrapartum factors. While gestational diabetes mellitus (GDM) is linked to adverse pregnancy outcomes, the impact of diet-controlled GDM (GDMA1) on perineal injury remains unclear. This study explores the relationship between GDMA1 and perineal lacerations in vaginal deliveries. STUDY DESIGN: A population-based retrospective cohort study was conducted at a tertiary medical center (1988-2016), including all vaginal deliveries beyond 24 weeks gestation. Women with GDMA1 were compared with those without diabetes. The primary outcomes were the rates and severity of perineal lacerations. Univariate analysis was followed by multivariable analysis, adjusting for relevant confounders. RESULTS: Among 250,171 deliveries, 9,640 (3.8%) were in women with GDMA1. Women with GDMA1 were significantly older and delivered earlier than non-diabetic women, although both groups delivered at term. Rates of instrumental deliveries and episiotomy were significantly higher in the GDMA1 group, and newborns were significantly larger. Perineal lacerations occurred more frequently in women with GDMA1 compared with non-diabetic women (21.2 vs. 18.8%; < 0.001), with first-degree tears accounting for most of the difference. In multivariate analysis, GDMA1 was independently associated with an increased risk of perineal tears (OR = 1.12, 95% CI: 1.06-1.17), while mediolateral episiotomy was associated with a reduced risk of obstetric anal sphincter injury (OASIS; OR = 0.68, 95% CI: 0.53-0.87). CONCLUSION: GDMA1 is associated with a modestly increased risk of perineal lacerations, predominantly first-degree tears, but does not significantly impact severe perineal trauma. These findings suggest that women with GDMA1 can be reassured regarding the risk of severe perineal trauma. Nonetheless, individualized risk assessment remains important in guiding delivery management, particularly in the presence of other contributing risk factors. KEY POINTS: · GDMA1 mildly increases perineal tear risk, mainly first-degree lacerations.. · GDMA1 is not independently linked to a higher risk of OASIS.. · Women with GDMA1 can be reassured; individualized delivery planning is key..
The Effects of Antenatal Corticosteroids on Extremely Premature Neonates Born between 21 and 24 Weeks.
Yao R, Tritch N, Vedhanayagam K … +5 more , Ali N, Reimche-Vu H, Gedestad I, Karageuzian S, Contag S
Am J Perinatol · 2026 Jul · PMID 41086871 · Publisher ↗
OBJECTIVE: This study aimed to evaluate the impact of antenatal corticosteroid (ACS) administration prior to delivery on neonatal outcomes in extreme preterm neonates delivered between 21 and 23 weeks of gestation. STUDY...
OBJECTIVE: This study aimed to evaluate the impact of antenatal corticosteroid (ACS) administration prior to delivery on neonatal outcomes in extreme preterm neonates delivered between 21 and 23 weeks of gestation. STUDY DESIGN: This retrospective cohort study used data from the National Center for Health Statistics Vital Statistics database. Linked birth and infant death data files from 2015 to 2021 were included in the analysis. The study included singleton, nonanomalous pregnancies that were delivered between 21 and 24 weeks of gestation. Analysis was limited to births with known ACS status. The outcomes of interest were infant mortality, 5-minute Apgar score < 6, and neonatal intensive care unit admission. Univariate analysis was performed to determine the association between exposure and outcome. Logistic regression analysis was performed to determine the association, adjusting for potential confounders. RESULTS: There were 50,671 births included in the analysis. In this group, 15,601 (31%) received ACS prior to delivery. ACS administration prior to delivery was associated with lower neonatal death rate between 21 and 24 weeks (32.9 vs. 56.1%, < 0.0001, adjusted odds ratio [aOR]: 0.53 [0.51-0.56]). Sub-analysis based on delivery at each gestational week demonstrated a protective effect at 21 weeks (70.1 vs. 80.7%, = 0.001, aOR: 0.56 [0.34-0.91]); at 22 weeks (54.1 vs. 75.9%, aOR: 0.40 [0.35-0.47]); at 23 weeks (39.1 vs. 50.9%, aOR: 0.65, aOR [0.61-0.70]); and at 24 weeks (24.6 vs. 30.1%, aOR: 0.78 [0.73-0.83]). CONCLUSION: ACS administration in extreme preterm neonates born between 21 and 24 weeks was associated with improved survival. KEY POINTS: · ACSs lowered neonatal death from 56.1 to 32.9% at 21 to 24 weeks.. · Greatest survival benefit was seen at 22 weeks with a 60% risk reduction.. · ACSs were linked to higher use of ventilation, surfactant, and antibiotics..
A Longitudinal Assessment of Shear Wave Elastography of the Placenta in Normal Pregnancy.
Waller J, Horgan R, Sinkovskaya E … +4 more , Saade G, Kalafat E, Heeze A, Abuhamad A
Am J Perinatol · 2026 Jul · PMID 41086870 · Publisher ↗
OBJECTIVES: This study aimed to use shear wave elastography (SWE) to longitudinally evaluate placental elasticity in normal human pregnancy, and to develop reference ranges for its use at various gestational ages through...
OBJECTIVES: This study aimed to use shear wave elastography (SWE) to longitudinally evaluate placental elasticity in normal human pregnancy, and to develop reference ranges for its use at various gestational ages throughout pregnancy. STUDY DESIGN: Data were obtained from a prospective cohort within the Human Placenta Project, involving 90 pregnant participants with uncomplicated singleton gestations. Placental elasticity was measured using SWE at eight distinct gestational time points, from 12 to 37 weeks. Descriptive statistics were reported as median and interquartile for continuous variables, and number and percentage of the total for categorical variables. Distribution of response variables (elastography) were assessed with QQ-plots, skewness, and kurtosis values. Candidate models were compared with likelihood ratio tests. RESULTS: Out of the 610 pregnant participants initially enrolled, 90 met the criteria for the reference population. Mean SWE values showed a steady increase with advancing gestational age, from 1.283 m per second (m/s) at 12 to 13 weeks to 1.381 m/s at 36 to 37 weeks. Similarly, Young's modulus values increased from 4.99 kPA to 5.59 kPA across the same interval. SWE values were consistent across different placental regions and showed a continuous upward trend with gestational age. Gestational age was significantly associated with SWE values in the central placenta, with fitted reference ranges provided. CONCLUSION: SWE is a feasible and reproducible tool for assessing placental stiffness throughout gestation. KEY POINTS: · Placental SWE rises steadily from 12 to 37 weeks in normal pregnancy.. · We present gestational age-specific reference ranges for SWE throughout gestation.. · SWE values are consistent across placental regions..
Psychometric Evaluation of the Modified Neonatal Resuscitation Program Adherence Assessment Tool When Utilized for In Situ Simulation and Telesimulation Scenarios.
Martens S, Melendi M, Zanno A … +6 more , Cutler A, Seften LM, Soghikian S, Palnitkar T, Mallory L, Strout TD
Am J Perinatol · 2026 Jul · PMID 41086869 · Full text
OBJECTIVE: Neonatal resuscitation is a high acuity, low occurrence event that requires precision, teamwork, and rapid decision-making. Simulation using Neonatal Resuscitation Program (NRP) guidelines allows teams to buil...
OBJECTIVE: Neonatal resuscitation is a high acuity, low occurrence event that requires precision, teamwork, and rapid decision-making. Simulation using Neonatal Resuscitation Program (NRP) guidelines allows teams to build competency and preparedness, improving neonatal outcomes. Accurate, reliable performance evaluation during simulation is essential to the provision of meaningful feedback. Evidence supporting the reliability and validity of existing tools when used in telesimulation (TS) is limited. We sought to evaluate the psychometric properties of the modified NRP (mNRP) tool when assessing interprofessional team performance in onsite and TS environments. STUDY DESIGN: We employed a methodological design to conduct secondary analyses of data from a larger study using simulation to enhance resuscitation skills as assessed by the mNRP. Item-level data from 96 simulations were subjected to Classical Test Theory-based item analyses, including evaluation of item difficulty, discrimination, and item-to-total correlation; reliability; and exploratory factor analysis (EFA). Interrater reliability (IRR) between novice and expert raters was assessed for a subset of cases. RESULTS: Item difficulties reflected a desirable mix of difficulty in endorsement, suggesting that items capture a range of guideline adherence. Most item discrimination (range: 0.05-0.81) and corrected item-total correlation (range: 0.005-0.68) values had moderate-to-strong, positive correlations with total scores, indicating discriminative ability. EFA yielded three and four components for the onsite and TS groups, respectively. Cronbach's α was 0.76 (onsite) or 0.78 (TS). Lowest versus highest mNRP quartiles differed significantly in both formats ( < 0.001 for each), supporting construct validity. IRR ranged from 0.5 to 0.9, supporting moderate to good agreement between novice and expert raters. CONCLUSION: Findings provide evidence supporting the reliability and validity of the mNRP tool when applied in both the in situ and TS settings. IRR was acceptable for expert and novice evaluators. This analysis provides additional validity evidence for the mNRP when used to evaluate interprofessional team performance in both onsite and TS formats. KEY POINTS: · Neonatal resuscitation is a high-acuity, low-occurrence event.. · Many rural clinicians feel underprepared for high acuity, low occurrence events.. · Simulation-based training can improve preparedness.. · Performance is assessed using the mNRP tool.. · Psychometric features support the tool for use in onsite and TS formats..
Increasing Birth Weight above 4,000 Grams Is Associated with Adverse Outcomes among Births without Diabetes.
Hersh AR, Fitch KC, Garg B … +2 more , Caughey AB, Valent AM
Am J Perinatol · 2026 Jul · PMID 41086868 · Publisher ↗
OBJECTIVE: This study aimed to evaluate the association of increasing birth weight above 4,000 grams and adverse obstetric outcomes and explore the influence of key maternal risk factors, including prepregnancy body mass...
OBJECTIVE: This study aimed to evaluate the association of increasing birth weight above 4,000 grams and adverse obstetric outcomes and explore the influence of key maternal risk factors, including prepregnancy body mass index (BMI) and gestational weight gain (GWG), among births not complicated by diabetes. STUDY DESIGN: This was a retrospective cohort study of singleton, non-anomalous, live births between 37 and 42 weeks' gestation in the United States between 2012 and 2021. Births complicated by diabetes or with birth weights less than 3,000 g were excluded. Births were stratified into four weight categories: 3,000 to 3,999 g (referent group), 4,000 to 4,499, 4,500 to 4,999, and ≥5,000 g. We performed stratified analyses by prepregnancy BMI and GWG per the National Academy of Medicine guideline recommendations. Analyses were performed via chi-square and adjusted incidence risk ratios for statistical comparisons. RESULTS: There were 23,487,820 births included in this analysis. Higher birth weights were significantly associated with a higher risk of adverse perinatal outcomes, including cesarean delivery, blood transfusion, unplanned hysterectomy, maternal ICU admission, and obstetric anal sphincter injury. Additionally, the adjusted risk of all adverse neonatal outcomes also increased with increasing birth weight. When stratified by maternal risk factors, including BMI and GWG groups, we similarly found higher risk of adverse outcomes among higher birth weight categories, particularly among births complicated by maternal obesity or GWG above the National Academies of Medicine (NAM) recommendations. CONCLUSION: Among births without diabetes, birth weights above 4,000 g were associated with an increasingly higher risk of adverse perinatal outcomes, and adverse outcomes remained higher even after stratification by BMI and GWG. KEY POINTS: · Increasing birth weight is associated with higher rates of adverse outcomes.. · Perinatal outcomes by severity of macrosomia have not been thoroughly studied.. · Obesity and excessive weight gain in pregnancy is associated with adverse neonatal outcomes..
Prospective Economic Evaluation Alongside the Telephone-Based Nurse-Delivered Interpersonal Psychotherapy for Postpartum Depression Trial.
Hay S, Dennis CL, Ravitz P … +4 more , Grigoriadis S, Maddalone E, Dukhovny D, Zupancic J
Am J Perinatol · 2026 May · PMID 41067235 · Publisher ↗
OBJECTIVE: In a previously reported, multi-site, randomized controlled trial in women with postpartum depression (PPD), telephone-based, nurse-delivered, interpersonal psychotherapy (IPT) compared with standard postpartu...
OBJECTIVE: In a previously reported, multi-site, randomized controlled trial in women with postpartum depression (PPD), telephone-based, nurse-delivered, interpersonal psychotherapy (IPT) compared with standard postpartum care showed a reduction of 24% in the incidence of PPD (Dennis et al, , 2020). The economic implications of this therapy have not been explored. We aimed to determine the cost-effectiveness of telephone-based, nurse-delivered IPT compared with standard postpartum care, using resource utilization data collected alongside the clinical study. STUDY DESIGN: We conducted a prospectively planned economic evaluation using patient-level data from the IPT trial, which enrolled 241 mothers with PPD. We considered costs from a societal perspective, measuring direct medical costs from study logs and secondary sources, as well as evaluating costs borne by the mother and family (including both medical and non-medical expenditures) and wage losses through questionnaires. We used a time horizon of 12 weeks post-randomization, corresponding to the endpoint of the clinical trial. Costs are reported in (2022) Canadian dollars. RESULTS: Patients in the IPT group had more phone calls with public health nurses external to those provided by the study protocol (IPT 73% versus control 55%, = 0.007) and fewer visits to psychiatrists (9% versus 22%, = 0.008). However, there were no statistically significant differences in any of the cost categories or total societal expenditures (IPT group $6,653, control group $5,336, = 0.234). When costs and effects were combined, the societal expenditure was $5,397 for each additional patient without PPD. CONCLUSION: Telephone-based, nurse-delivered IPT, as employed in this trial, showed no statistically significant differences in costs compared with standard care but resulted in improved clinical outcomes. Although associated with moderate uncertainty, the resulting incremental cost-effectiveness was well within the acceptable range for medical interventions in this population, and telephone-based, nurse-delivered IPT should be considered for patients with PPD. KEY POINTS: · Telephone-based, nurse-delivered IPT is effective in treating PPD.. · We performed an economic evaluation alongside a randomized controlled trial of IPT, using patient-level data and considering costs from a societal perspective.. · Patients in the IPT group had more phone calls with public health nurses and fewer visits to psychiatrists, with overall similar costs between the two groups.. · The societal expenditure was $5,397 for each additional patient without PPD, which is well within the acceptable range for medical interventions in this population.. · Telephone-based, nurse-delivered IPT should be considered for cost-effective care of patients with PPD..
Repeat versus Single Course of Antenatal Corticosteroid in Management of Preterm Premature Rupture of Membranes: A Systematic Review and Meta-analysis.
Da Costa Y, Ramanathan V, Oliveira JA … +2 more , Brito J, Yousif A
Am J Perinatol · 2026 May · PMID 41067234 · Publisher ↗
OBJECTIVE: A single course of antenatal corticosteroids is standard for women at risk of preterm birth, including those with ruptured membranes. The benefit of repeat courses in the setting of preterm premature rupture o...
OBJECTIVE: A single course of antenatal corticosteroids is standard for women at risk of preterm birth, including those with ruptured membranes. The benefit of repeat courses in the setting of preterm premature rupture of membranes (PPROM) remains uncertain. This study aimed to assess the safety and effectiveness of repeat versus single course of corticosteroid in women with PPROM. STUDY DESIGN: We searched PubMed, Cochrane, and Embase databases from inception to September 17, 2025, with no language restrictions, using the terms related to PPROM and corticosteroids. Randomized and non-randomized clinical trials enrolling women with PPROM and comparing repeat with single course were included. Studies without PPROM or comparator group were excluded. Screening and quality assessment were performed by two authors, with a third author participation in case of disagreements. Statistical analysis used Review Manager 5.4 and R studio 4.5.0, with risk ratio (RR), random effects, Cochran Q test and I-squared statistics, and sensitivity analysis. This study was registered with PROSPERO (identifier: CRD420251069007). RESULTS: Six studies comprising 2,434 patients were included. Sensitivity analysis showed that repeat course of corticosteroids increased the risk of endometritis compared to a single course (RR = 1.63; 95% CI: 1.10 to 2.43). In the subgroup analysis the mixed hours corticosteroid favored the outcome of chorioamnionitis (RR = 1.62; 95% CI: 1.12 to 2.36; = 0.001) with no overall subgroup difference. No difference was observed for the outcomes of respiratory distress syndrome, neonatal sepsis, necrotizing enterocolitis, and intraventricular hemorrhage. CONCLUSION: Repeat corticosteroid courses in PPROM may increase maternal infections morbidity without clear neonatal benefit. Further large, well-designed randomized trials are needed to clarify safety. KEY POINTS: · Repeat course of corticosteroid might increase maternal infections morbidity.. · A cautious approach due to potential increase in maternal morbidity related to repeat corticoid use.. · No significant neonatal benefit was observed with repeat courses of antenatal corticosteroids..
Impact of Maternal Obesity on Neonatal TSH Levels: A Prospective Study on the Influence of BMI.
Çıplak G, Kadıoğlu Şimşek G, Akyol Ö … +3 more , Kayalı Akyol A, Kanmaz Kutman HG, Canpolat FE
Am J Perinatol · 2026 May · PMID 41061764 · Publisher ↗
OBJECTIVE: Thyroid hormones are crucial for fetal growth, especially the development of the central nervous system. The impact of maternal obesity on neonatal thyroid-stimulating hormone (TSH) levels, however, remains un...
OBJECTIVE: Thyroid hormones are crucial for fetal growth, especially the development of the central nervous system. The impact of maternal obesity on neonatal thyroid-stimulating hormone (TSH) levels, however, remains underexplored. This study aimed to evaluate the influence of maternal body mass index (BMI) on neonatal TSH (nTSH) levels. STUDY DESIGN: A prospective observational study was conducted involving 934 newborns with a gestational age greater than 35 weeks, born between July 2021 and January 2022. nTSH levels were measured from capillary blood samples obtained during routine congenital hypothyroidism screening. Maternal data, including age, pre-pregnancy BMI, weight gain during pregnancy, and thyroid function, were collected. RESULTS: The mean maternal BMI was 24 ± 4 kg/m, and the mean nTSH level was 2 ± 2.7 mIU/L. No significant difference in nTSH levels was observed between infants of mothers with BMI ≥25 and BMI <25 ( = 0.069). When mothers were categorized into five BMI groups, the only significant difference observed between the groups was in weight gain during pregnancy ( = 0.001). Additionally, a positive correlation between maternal BMI and neonatal birth weight, height, and head circumference was observed. A weak positive correlation between maternal weight gain and nTSH levels ( = 0.204, = 0.001) was also noted. CONCLUSION: Our study indicates a potential relationship between maternal obesity and nTSH levels, suggesting that maternal BMI may influence neonatal thyroid function. KEY POINTS: · There is a potential relationship between maternal obesity and neonatal TSH levels.. · Maternal BMI and weight gain might influence neonatal thyroid function.. · The study emphasizes the need for close monitoring of pregnant women with obesity..
Antihypertensive Treatment in the Postpartum Care of Preeclampsia: A Hemodynamic-Based Approach.
Ogamba-Alphonso I, Miller E, Brown-Thomas TM … +15 more , Katehis I, Gitlin S, Maldonado D, Fernandez De Salvo G, Asfour T, Ginsberg I, Gunabalan S, Rajan A, Shah K, Kapoor M, Gubernikoff G, Kinzler W, Chavez M, Heo H, Rekawek P
Am J Perinatol · 2026 May · PMID 41061763 · Publisher ↗
OBJECTIVE: Labetalol and nifedipine are first-line antihypertensives for hypertensive disorders of pregnancy. However, there is limited research comparing their effectiveness based on hemodynamic profiles seen in preecla...
OBJECTIVE: Labetalol and nifedipine are first-line antihypertensives for hypertensive disorders of pregnancy. However, there is limited research comparing their effectiveness based on hemodynamic profiles seen in preeclampsia, such as high cardiac output (CO) and high systemic vascular resistance (SVR). This study assesses whether concordance of antihypertensive treatment with the hemodynamic status on echocardiogram reduces time to achieve target postpartum blood pressure (BP) before discharge. STUDY DESIGN: This retrospective cohort study included patients with preeclampsia with severe features who received a postpartum echocardiography, excluding patients with cardiac etiology. Antihypertensive choices were provider-dependent. The CO and SVR were calculated retrospectively from the echocardiogram in collaboration with cardiology. Concordance was defined as patients with high CO (>6 L/min) started on labetalol and high SVR (>1,200 dynes·sec·cm) started on nifedipine; opposite pairings were discordant. The primary outcome was time to achieve target BP, defined as the period from the start of antihypertensive therapy to when no titration was needed to sustain BPs of less than 140/90 mm Hg. Chi-square and Fisher's tests were used for categorical variables, and Mann-Whitney U test for continuous variables. RESULTS: Of 298 patients, 155 (52%) received concordant therapy and 143 (48%) discordant. Of the cohort, 229 (76.8%) had high SVR and 69 (23.2%) had high CO. Median time to target BP was not significantly different (concordant: 32 hours [interquartile range, IQR: 0-61], discordant: 41 hours [IQR: 4-75], = 0.13). The concordant group needed fewer titrations to achieve target BP (1 [IQR: 0-2] vs. 2 [IQR: 1-3]; = 0.008) and were less likely to be discharged home on multiple antihypertensive medications compared with the discordant group (28.9 vs. 42.7%, = 0.014). Maternal demographics were similar between groups. CONCLUSION: While time to target BP did not differ, concordance of antihypertensive therapy to postpartum hemodynamics in patients with severe preeclampsia reduced medication adjustments and increased the likelihood of discharge on a single-agent regimen. KEY POINTS: · Echocardiography can be used to assess maternal hemodynamics.. · Aligning BP meds to hemodynamics cuts the need for a second agent.. · Aligning BP meds to hemodynamics reduces dose adjustments..
The Association between Maternal-Fetal Medicine Physician Density and Pregnancy Outcomes.
Kawakita T, Atwani R, Hayasaka M … +2 more , Robbins L, Saade G
Am J Perinatol · 2026 Jul · PMID 41061751 · Full text
OBJECTIVE: We sought to examine the association between maternal-fetal medicine (MFM) physician density and adverse pregnancy outcomes at the state level. STUDY DESIGN: This was a cross-sectional analysis of publicly ava...
OBJECTIVE: We sought to examine the association between maternal-fetal medicine (MFM) physician density and adverse pregnancy outcomes at the state level. STUDY DESIGN: This was a cross-sectional analysis of publicly available, state-level data from 2018 to 2021, including Natality, Multiple Cause-of-Death, and Fetal Death databases. The number of active MFM physicians per year was obtained for each state from the American Medical Association Masterfile. The primary exposure was the density of MFM per state, categorized into three groups: (1) low density (<30 MFM physicians per 100,000 live births), (2) moderate density (30-59 MFM physicians per 100,000 live births), and (3) high density (≥60 MFM physicians per 100,000 live births). Our primary outcome was maternal mortality during pregnancy and up to 42 days postdelivery. Our secondary outcomes were pregnancy-related mortality up to 365 days postdelivery and stillbirth. We calculated adjusted incident rate ratios (aIRR) and average marginal effect (AME) with 95% confidence intervals (95% CI) using multivariable negative binomial mixed effects regression models. RESULTS: Overall, there were 14,792,743 live births, 3,440 maternal mortalities, 4,980 pregnancy-related mortalities, and 90,848 stillbirths included. The median MFM density across states was 31.6 per 100,000 live births (interquartile range: 21.9-42.5). States with high MFM density had a reduced risk of maternal mortality (aIRR: 0.70; 95% CI: 0.58-0.85) and pregnancy-related mortality (aIRR: 0.83; 95% CI: 0.71-0.98) compared with states with low MFM density, corresponding to 7.29 (AME: 95% CI: 3.58-11.00) and 5.57 (AME: 95% CI: 0.74-10.40) less mortality per 100,000 live births, respectively. States with moderate MFM density had a similar risk of maternal mortality compared with low MFM density states (aIRR: 1.02; 95% CI: 0.87-1.20). CONCLUSION: High MFM-density states have a decreased risk of maternal mortality compared with low MFM-density states, suggesting a critical role of MFM in reducing maternal mortality. KEY POINTS: · An association between MFM physician density and maternal mortality is unclear.. · States with higher MFM density had a lower risk of maternal mortality than those with fewer.. · This study highlights the importance of increasing MFM access in underserved areas to potentially reduce maternal mortality..
Predicting Dexamethasone-Associated Extubation Success in Preterm Infants.
Denhard KA, Fairchild KD, Sullivan BA
Am J Perinatol · 2026 Jul · PMID 41061750 · Full text
OBJECTIVE: Dexamethasone improves respiratory status in some preterm infants with lung disease. Dexamethasone increases heart rate (HR) variability, which decreases the heart rate characteristics index (HRCi), a sepsis r...
OBJECTIVE: Dexamethasone improves respiratory status in some preterm infants with lung disease. Dexamethasone increases heart rate (HR) variability, which decreases the heart rate characteristics index (HRCi), a sepsis risk score that reflects inflammation. Respiratory improvement can be measured by the ability to wean support, quantified by a respiratory severity score (RSS). We hypothesized that HRCi and RSS early in dexamethasone treatment are associated with respiratory improvement marked by successful extubation. STUDY DESIGN: We retrospectively reviewed neonatal intensive care unit (NICU) patients born at < 32 weeks gestational age (GA) admitted from 2012 to 2022 who received > 3 days of dexamethasone for lung disease while on mechanical ventilation. Daily mean FiO, HRCi, and RSS (mean airway pressure × FiO) were calculated for the dexamethasone start day and 2 days before and after. Successful extubation was defined as occurring during the dexamethasone course without reintubation within 7 days. We compared variables between infants with and without successful extubation. RESULTS: A total of 65 infants (mean GA: 25 ± 1 weeks) were included. HRCi, FiO, and RSS significantly decreased by day 3 of dexamethasone. Successful extubation ( = 38) was associated with higher postmenstrual age (PMA), lower FiO and RSS, and being on conventional rather than high-frequency ventilation (all < 0.05). Multivariable analysis found that RSS and PMA, but not HRCi, predicted successful extubation. CONCLUSION: Dexamethasone treatment decreased the HRCi, but this was not associated with extubation success. Higher PMA and lower respiratory support were associated with successful extubation during dexamethasone treatment. KEY POINTS: · Fifty-eight percent of preterm infants were successfully extubated during dexamethasone treatment.. · Higher PMA and lower RSS were associated with extubation success.. · HRCs improved with dexamethasone but did not predict extubation success..
Perspectives on Clinicians' Roles and Postpartum Opioid Pain Management: A Qualitative Analysis.
Merchant T, DiTosto JD, Soyemi E … +2 more , Yee LM, Badreldin N
Am J Perinatol · 2026 May · PMID 41056971 · Publisher ↗
OBJECTIVE: Pain is a common postpartum complaint, yet data suggest that approaches to postpartum pain management vary widely. Given the goal of improving quality and equity in postpartum pain management, we aimed to exam...
OBJECTIVE: Pain is a common postpartum complaint, yet data suggest that approaches to postpartum pain management vary widely. Given the goal of improving quality and equity in postpartum pain management, we aimed to examine whether and how clinicians' perspectives on postpartum pain management differed by clinician roles. STUDY DESIGN: This is a qualitative study at a large, tertiary, and academic medical center. From November 2021 to June 2022, obstetric clinicians, including attending physicians, trainee physicians, and advanced practice providers (APPs), were recruited to complete in-depth interviews regarding their clinical experience managing postpartum pain using a semi-structured interview guide. Participants were asked to reflect both on their own role and that of the other clinician types. Purposive sampling was used to enroll a cohort representative of the institutional workforce in terms of clinician type and demographics. Data were analyzed using the constant comparative method. RESULTS: Of 46 participants, 47.8% ( = 22) were attending physicians, and 91% ( = 42) were female. Emergent themes were both self-reflected and externally directed. Data demonstrated that postpartum pain management differs by clinician type and level of experience. Themes related to the role of attending physicians included responsibilities as teachers for trainees, supervisory roles, and perceptions that attendings have greater comfort with prescribing opioids. Themes related to the role of trainee physicians included the impact of patient load on trainees' management, limitations of morning rounds, familiarity with emerging data, and perceptions of hesitancy to prescribe opioids. Themes related to the role of APPs included less reliance on opioids for postpartum pain management and emphasis on nonpharmacological approaches. CONCLUSION: Perspectives on postpartum pain management vary by clinician role. Consideration of these differences and the interplay between roles is essential when examining opioid prescribing patterns and developing interventions to improve postpartum pain management. KEY POINTS: · Pain management differs by role and experience.. · Attendings have more comfort with opioid prescriptions.. · Trainees are perceived as more hesitant to prescribe opioids.. · APPs rely more on nonopioid management strategies..
Glucagon-Like Peptide-1 Receptor Agonists among Pregnancies with Pregestational Diabetes and Its Relationship with Congenital Malformations.
Lewin Z, Snow S, Lee JA … +1 more , Wilkie G
Am J Perinatol · 2026 May · PMID 41052622 · Publisher ↗
OBJECTIVE: Pregestational diabetes is a common complication seen in pregnancy, with significant increase seen in the use of glucagon-like peptide-1 receptor agonists (GLP-1 RA) for diabetes management in reproductive-age...
OBJECTIVE: Pregestational diabetes is a common complication seen in pregnancy, with significant increase seen in the use of glucagon-like peptide-1 receptor agonists (GLP-1 RA) for diabetes management in reproductive-age individuals. The objective of this study was to describe the perinatal outcomes and prevalence of congenital malformations associated with the use of GLP-1 RA in individuals with pregestational diabetes using a national dataset. STUDY DESIGN: This study was a retrospective cohort study of patients with pregestational diabetes and pregnancies using data obtained from the Epic Cosmos database between May 1, 2022 and April 30, 2025. Demographics, perinatal outcomes, and prevalence of congenital malformations were compared by GLP-1 RA exposure in pregnancy. Categorical variables were compared with Chi-square and continuous variables were compared using student -tests for two comparisons. No individual level data were available, so covariate adjustment was not performed. RESULTS: The total sample population was 143,593 patients with pregestational diabetes, with 24.4% ( = 35,083) of patients using a GLP-1 RA at some time point in pregnancy. Patients with GLP-1 RA usage were more likely to develop pre-eclampsia (13.1 versus 11.9%, < 0.00001), have a cesarean delivery (44.4 vs. 38.9%, < 0.0001), have a first trimester pregnancy loss/termination (9.8 vs. 7.5%, < 0.00001), and a preterm delivery (23.1 vs. 20.8%, < 0.0001) when compared with patients without GLP-1 RA use. There was no statistically significant difference in the overall rate of any congenial malformation by GLP-1 RA use (3.3% in both groups, = 0.63). However, patients with GLP-1 RA usage were more likely to have fetuses with genital malformations (0.7 vs. 0.6%, = 0.02) and urinary malformations (0.5 vs. 0.4%, = 0.01) compared with patients without GLP-1 RA use. CONCLUSION: GLP-1 RA therapy in a large cohort of pregnant patients with pregestational diabetes was associated with an overall low rate of malformations but found to have a possible increase in genital and urinary malformations. Counseling of patients prior to use of this medication in the preconception period is required. KEY POINTS: · GLP-1 receptor agonist therapy exposure is common in pregnancy among patients with diabetes.. · GLP-1 receptor agonist therapy was not associated with an increased risk of overall malformations.. · GLP-1 receptor agonist therapy was associated with increased genital and urinary malformations..
The Effect of Continuous Neuromuscular Blockade in a Cohort of Patients with Evolving or Grade 3 Bronchopulmonary Dysplasia.
Cosnahan A, Farraj FA, Mitchell J … +3 more , Bauer SE, Conlon S, Rose R
Am J Perinatol · 2026 May · PMID 41052539 · Publisher ↗
OBJECTIVE: This study aimed to describe the use of continuous neuromuscular blockade (NMBA) in patients with life-threatening hypoxia and/or hypercarbia secondary to evolving or grade 3 bronchopulmonary dysplasia (BPD) a...
OBJECTIVE: This study aimed to describe the use of continuous neuromuscular blockade (NMBA) in patients with life-threatening hypoxia and/or hypercarbia secondary to evolving or grade 3 bronchopulmonary dysplasia (BPD) and its association with short-term death, as well as clinical measures of respiratory severity. STUDY DESIGN: We identified a cohort of patients with evolving or grade 3 BPD at Riley Children's Health who received continuous infusion vecuronium for greater than 48 hours. We analyzed data using descriptive and inferential statistics. RESULTS: Of the 18 patients identified, 77% survived beyond 7 days after discontinuation of a single course of continuous vecuronium. All but one patient demonstrated decreased respiratory severity score (RSS) and oxygenation saturation index (OSI) across the period of NMBA administration. Mean RSS and OSI decreased significantly across the time of administration ( = 0.003) and was higher in the group that died versus the group that survived ( < 0.001, = 0.001). Of those that survived to discharge, six received a tracheostomy, and one was discharged in room air. CONCLUSION: A majority of a cohort of patients with life threatening hypoxia and/or hypercarbia and evolving or grade 3 BPD exposed to continuous NMBA demonstrated a clinically significant incidence of short-term survival and reduced respiratory severity. KEY POINTS: · Evidence for NMBA use in BPD is limited.. · Unstable gas exchange on high BPD ventilator settings may necessitate NMBA use.. · NMBA use may decrease respiratory support needed and improve clinical stability in unstable BPD patients..
Maternal Exit from Employment after Premature Birth.
Taylor KD, Rickenbach ON, Syed A … +1 more , Tumin D
Am J Perinatol · 2026 May · PMID 41043472 · Publisher ↗
OBJECTIVE: We sought to evaluate whether infants' preterm birth (PTB) or low birth weight (LBW) were associated with maternal exit from employment after birth. STUDY DESIGN: We analyzed data from the National Longitudina...
OBJECTIVE: We sought to evaluate whether infants' preterm birth (PTB) or low birth weight (LBW) were associated with maternal exit from employment after birth. STUDY DESIGN: We analyzed data from the National Longitudinal Survey of Youth 1979 cohort, tracking maternal employment after each birth. Births were included if the mother was working at the beginning of the birth month. Time to exit from paid employment (becoming unemployed or leaving the labor force) was tracked up to 2 years after birth. RESULTS: Of 2,647 births to cohort members, 243 infants were born preterm (13%) and 192 were LBW (7%). On multivariable Cox regression, LBW was independently associated with 34% greater hazard of maternal exit from employment (hazard ratio: 1.34; 95% confidence interval: 1.08, 1.66; = 0.007). CONCLUSION: LBW, but not PTB, was independently associated with increased risk of maternal exit from employment. KEY POINTS: · Maternal labor force exit can exacerbate financial concerns associated with preterm birth.. · Low birth weight was independently associated with maternal exit from labor force.. · Controlling for birth weight, preterm birth was not associated with labor force exit..
Chlorothiazide Is Associated with a Weaker Diuretic Response than Furosemide in Infants with Bronchopulmonary Dysplasia.
Nelin TD, Huber M, Morris H … +9 more , Jensen EA, Gibbs K, DeMauro SB, Zierk AW, Novick NPG, Rub DM, O'Brien A, Lorch SA, Bamat NA
Am J Perinatol · 2026 May · PMID 41043471 · Full text
OBJECTIVE: This study aimed to compare the acute diuretic effect of furosemide versus chlorothiazide in preterm infants with high-grade bronchopulmonary dysplasia (BPD). STUDY DESIGN: We conducted a retrospective cohort...
OBJECTIVE: This study aimed to compare the acute diuretic effect of furosemide versus chlorothiazide in preterm infants with high-grade bronchopulmonary dysplasia (BPD). STUDY DESIGN: We conducted a retrospective cohort study of infants with grade 2 or 3 BPD admitted to a level IV NICU between 36 and 60 weeks postmenstrual age. Novel diuretic exposures were defined as administration of furosemide or chlorothiazide without prior exposure to the same agent in the preceding 7 days. The primary outcome was the within-subject change in net fluid balance (mL/kg) in the 24 hours before and after diuretic initiation. Multivariable linear regression was performed adjusted for diuretic dosing, route, frequency, and clinical covariates. RESULTS: Among 300 infants contributing 136 furosemide and 215 chlorothiazide exposures, furosemide was most often dosed every 24 hours (73%) and chlorothiazide every 12 hours (90%). After covariate adjustment, furosemide was associated with a threefold greater reduction in net fluid balance compared to chlorothiazide (-32.0 vs. -10.5 mL/kg; < 0.001). More frequent dosing (every 12 hours) was associated with greater diuretic effect than every 24-hour dosing for both agents (-22.4 vs. -11.3 mL/kg; = 0.032). Concomitant use of both agents was common, yet the order of administration did not significantly influence fluid balance. No other clinical or biochemical characteristics were significantly associated with diuretic response. CONCLUSION: Furosemide has a significantly greater acute diuretic effect than chlorothiazide in infants with high-grade BPD. These findings may inform short-term fluid management strategies and support further investigation into optimal diuretic selection and dosing in this population. KEY POINTS: · Furosemide has a greater acute diuretic effect than chlorothiazide in infants with grade 2/3 BPD.. · More frequent dosing was associated with greater diuretic effect than daily dosing for both agents.. · Concomitant use of both agents was common; the order of administration did not impact fluid balance..
Racial Variation in Cerebral Near-Infrared Spectroscopy Accuracy among Infants in a Cardiac Intensive Care Unit.
Marshall C, Diggs S, Pfeiffer M … +3 more , Gerst A, Brumfiel A, Vesoulis Z
Am J Perinatol · 2026 May · PMID 41043470 · Publisher ↗
OBJECTIVE: Pulse oximeters overestimate arterial oxygen saturations in Black versus White adults, children, and infants. While race's impact on near-infrared spectroscopy (NIRS) accuracy is less studied, some adult resea...
OBJECTIVE: Pulse oximeters overestimate arterial oxygen saturations in Black versus White adults, children, and infants. While race's impact on near-infrared spectroscopy (NIRS) accuracy is less studied, some adult research suggests decreased accuracy in Black patients. This study investigates the effect of race on NIRS accuracy in infants in a cardiac intensive care unit (CICU). STUDY DESIGN: A retrospective chart review was conducted for infants admitted to St. Louis Children's Hospital CICU from 2017 to 2023. Bland-Altman plots, Pearson correlations, and mean biases were analyzed. RESULTS: About 254 infants (13% Black, 87% White) provided 3,687 central venous oxygen saturation (ScvO)-cerebral regional oxygen saturation (rScO) pairs. Measurement bias was -3.2% in Black infants and +0.1% in White infants ( < 0.01). CONCLUSION: Cerebral NIRS underestimates ScvO in Black infants but maintains negligible measurement bias in White infants. This is the first study to assess race and NIRS accuracy in infants; the difference is statistically significant but not clinically relevant in most contexts. KEY POINTS: · Light-based measures of oxygen saturation risk interference from melanin.. · Bias of cerebral NIRS is low (-0.6%) against central venous oxygenation.. · Cerebral NIRS error is disproportionate by race, with an underestimate of 3.2% in Black infants..
Nutrition Pattern and Adverse Pregnancy Outcomes in Nulliparous Individuals: A Cluster Analysis.
Kawakita T, Diab YH, Onishi K … +1 more , Saade G
Am J Perinatol · 2026 May · PMID 41022129 · Publisher ↗
OBJECTIVE: This study aimed to develop a k-means clustering algorithm to identify distinct food intake patterns through cluster analysis. STUDY DESIGN: This was a secondary analysis of the Nulliparous Pregnancy Outcomes...
OBJECTIVE: This study aimed to develop a k-means clustering algorithm to identify distinct food intake patterns through cluster analysis. STUDY DESIGN: This was a secondary analysis of the Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-Be (nuMoM2b), including nulliparous individuals with singleton pregnancies. Dietary intake data from the 3 months preceding pregnancy were collected using a validated questionnaire. The primary outcome was a composite measure including preterm birth, stillbirth, preeclampsia, eclampsia, gestational diabetes, and small for gestational age. Clusters were formed using a k-means clustering algorithm with Euclidean distance, based on 335 dietary variables. The association between dietary clusters and adverse pregnancy outcomes (APOs) was assessed. Relative risks with 95% confidence intervals (95% CIs) were calculated using modified Poisson regression, adjusting for predefined confounders. A random forest model was also employed to identify features predictive of cluster allocation. RESULTS: The analysis included 7,599 participants, distributed across three clusters: Cluster 1 ( = 4,243, 55.8%), Cluster 2 ( = 2,768, 36.4%), and Cluster 3 ( = 588, 7.7%). Cluster 2, which serves as the referent cluster, is characterized by a higher intake of vitamin E as α-tocopherol, vitamin A retinol activity equivalents, vegetables, and fruits, aligning most closely with a healthy diet pattern. Compared with Cluster 2, Cluster 1, characterized by a lower intake of the same nutrients, did not show a significant association with increased odds of APOs (22.7 vs. 25.4%; adjusted relative risk [aRR], 1.07 [95% CI: 0.98-1.18]). In contrast, Cluster 3, characterized by higher intake of trans fats, dietary polyunsaturated fatty acids 20:4, red meat, and sugary beverages, was significantly associated with APOs compared with Cluster 2 (31.0 vs. 22.7%; aRR, 1.19 [95% CI: 1.01-1.39]). CONCLUSION: A dietary pattern characterized by a high intake of trans fats, polyunsaturated fatty acids, red meat, and sugary beverages is significantly associated with an increased risk of APOs. KEY POINTS: · Diets high in trans fats, polyunsaturated fatty acids, red meat, and sugary beverages are associated with increased APOs.. · Diets rich in vitamin E, vitamin A, vegetables, and green salads are linked to a lower risk of these outcomes.. · This study underscores the significant role of nutrition in influencing APOs..
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