American Journal Of Perinatology[JOURNAL]
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200 papers
Is Fetal Sex Associated with Maternal Diabetes 10 to 14 Years after Delivery?
Field C, Wu J, Scholtens D … +4 more , Lowe W, Josefson J, Grobman WA, Venkatesh KK
Am J Perinatol · 2026 Jun · PMID 42214436 · Publisher ↗
OBJECTIVE: We examined the association between fetal sex and the risk of maternal prediabetes or diabetes 10 to 14 years after delivery. Secondarily, we assessed whether this association varied by gestational diabetes me...
OBJECTIVE: We examined the association between fetal sex and the risk of maternal prediabetes or diabetes 10 to 14 years after delivery. Secondarily, we assessed whether this association varied by gestational diabetes mellitus (GDM) status and whether measures of maternal insulin sensitivity and resistance varied by fetal sex. STUDY DESIGN: This is a secondary analysis from the prospective, international Hyperglycemia and Adverse Pregnancy Outcome Follow-Up Study (HAPO FUS). The exposure was assigned fetal sex at birth (female as the reference). The primary outcome was prediabetes or diabetes assessed 10 to 14 years after the index pregnancy. The effect modifier was GDM per the International Association of Diabetes and Pregnancy Study Group criteria. Modified Poisson regression models were used and adjusted for baseline covariates at enrollment and time from enrollment to follow-up. We secondarily assessed whether the association between fetal sex and prediabetes or diabetes varied by GDM and whether maternal insulin sensitivity at pregnancy enrollment and insulin resistance at 10- to 14-year follow-up differed by fetal sex. RESULTS: Of 4,609 individuals in the analytic sample, 48.9% of infants were assigned female sex at birth, which was 47.1% with GDM and 49.2% without GDM ( = 0.3). At a median of 11.6 years after delivery, 22.4% postpartum individuals developed prediabetes, and 2.9% developed diabetes. The risk of prediabetes or diabetes did not differ by fetal sex (female vs. male: 24.7 vs. 24.6%; adjusted risk ratio: 1.00, 95% CI: 0.89, 1.12). This association was similar regardless of GDM status (interaction = 0.6). There was no association between fetal sex and insulin sensitivity at enrollment or insulin resistance at follow-up. CONCLUSION: In the prospective HAPO FUS cohort, there was no association between fetal sex and the risk of maternal prediabetes or diabetes 10 to 14 years after delivery. Further research is needed to better understand the possible impact of fetal sex on peripartum glucose homeostasis. KEY POINTS: · Fetal sex was not associated with maternal prediabetes/diabetes 10 to 14 years postdelivery.. · Associations did not vary according to GDM status.. · Further research is needed to understand the impact of fetal sex on peripartum glucose homeostasis..
Current Practices in Hyperglycemia Management in Neonatal Encephalopathy: A Treatment of Hyperglycemia in Neonatal Encephalopathy (THiNE) Consortium Study.
Cohen SS, Montaldo P, Chavez-Valdez R … +10 more , Dizon MLV, Law JB, McAdams RM, Mietzsch U, Peeples E, Rao R, Rosenfeld E, Rozance P, Sewell EK, Tam EWY
Am J Perinatol · 2026 Jun · PMID 42214435 · Publisher ↗
OBJECTIVE: Neonatal encephalopathy (NE) is a condition with significant morbidity and mortality, and these neonates are at high risk for glucose disturbances. Growing evidence links hyperglycemia to brain injury independ...
OBJECTIVE: Neonatal encephalopathy (NE) is a condition with significant morbidity and mortality, and these neonates are at high risk for glucose disturbances. Growing evidence links hyperglycemia to brain injury independent of NE, yet long-term outcomes data to inform clinical management remain scarce. This study aimed to describe current definitions, detection methods, and management strategies for hyperglycemia in neonates with NE undergoing therapeutic hypothermia (TH). STUDY DESIGN: We conducted a cross-sectional survey of 49 Level IV neonatal intensive care units (NICUs) participating in the Children's Hospitals Neonatal Consortium (CHNC) to evaluate center-specific practices for managing hyperglycemia in patients with NE undergoing TH. Individual respondent data were analyzed as the unit of observation using descriptive statistics. RESULTS: Forty-two of 49 centers responded (86% center response rate), yielding 53 individual completed surveys, with 10 centers contributing multiple responses (range 1-3 per center). The median threshold for hyperglycemia was 180 mg/dL (interquartile range, IQR: 160-200). Glucose monitoring frequency ranged from 1 to 6 hours during TH. Point-of-care glucose monitoring was used by 51 respondents (96%); 2 respondents (4%) reported using continuous glucose monitoring in non-research clinical care. Most respondents (48/53, 91%) reported reducing glucose delivery as the initial intervention for hyperglycemia, followed by insulin initiation if hyperglycemia persisted. The lowest median (range) glucose infusion rate used was 4 (3-5) mg/kg/min. Most respondents expressed concern about the adverse effects of untreated hyperglycemia (68%), though a substantial proportion (53%) also believed treatment itself could pose risks. CONCLUSION: Substantial practice variability exists despite shared expertise in defining, monitoring, and managing hyperglycemia in neonates with NE undergoing TH. Although most centers use similar thresholds and stepwise approaches, monitoring strategies vary widely. The coexistence of concern about untreated hyperglycemia (68%) and apprehension about treatment risks (53%) reflects clinical equipoise. These findings underscore the urgent need for prospective studies and evidence-based guidelines to inform best practices in this vulnerable population. KEY POINTS: · Hyperglycemia thresholds vary widely, and glucose monitoring frequency is inconsistent.. · Many clinicians do not follow the ESPGHAN recommendations for glucose management.. · Guidelines for managing hyperglycemia in NE are lacking..
Association of Prenatal Counseling of the Mothers of In Utero Opioid Exposed Infants and the Need for Pharmacotherapy in those Infants. A Retrospective Cohort Study.
Bernick A, Yeaney N, Barsman S … +3 more , Farah A, Aly H, Das A
Am J Perinatol · 2026 May · PMID 42214433 · Publisher ↗
OBJECTIVE: A virtual prenatal counseling of mothers whose infants were exposed to opioids was started with the aim of providing an overview of what to expect for the infant after birth and how to reduce the severity of w...
OBJECTIVE: A virtual prenatal counseling of mothers whose infants were exposed to opioids was started with the aim of providing an overview of what to expect for the infant after birth and how to reduce the severity of withdrawal. This study aimed to assess the characteristics of mothers who attended this type of visit and received prenatal counseling compared with those who did not. STUDY DESIGN: This was a retrospective cohort study of mother-infant dyads with gestational age of 35 weeks or more, with birth weight of≥ 2 kg, and in utero exposure to opioids. Subjects admitted to the neonatal intensive care unit for reasons other than withdrawal and with congenital anomalies were excluded. Subjects were divided into mothers compliant with the virtual prenatal appointment (Group A) and mothers who did not attend their appointment (Group B). RESULTS: Of the 153 dyads included, 80 mothers attended the virtual prenatal appointment, while 73 did not (52%). The need for pharmacotherapy was 53% lower in the compliant Group A ( = 0.044, OR: 0.464, 95% CI: 0.22-0.98), after adjusting for selected covariates. Mothers who attended the appointment were more likely to be in a drug treatment program, less likely to have completed high school, and less likely to smoke during pregnancy. These mothers were more likely to provide mother's own milk (MoM) to their infants. CONCLUSION: Attendance at prenatal visits was low. Maternal compliance with prenatal visits in opioid exposed infants is associated with a significantly lower need for pharmacotherapy in the infant. KEY POINTS: · Prenatal opioid counseling was associated with reduced pharmacotherapy for NOWS.. · Mothers attending counseling more frequently provided mother's own milk.. · Maternal treatment program participation reduced need for pharmacotherapy.. · Telehealth prenatal counseling may improve non-pharmacologic NOWS care..
Preventability of Severe Maternal Morbidity: A Scoping Review of the Literature in High-Income Countries.
Alfonso YN, Li Q, Manandhar P … +1 more , Creanga AA
Am J Perinatol · 2026 May · PMID 42214432 · Publisher ↗
OBJECTIVE: Severe maternal morbidity (SMM) affects 0.5 to 4% of pregnancies in the United States and other high-income countries (HIC). Research examining SMM preventability is limited but has emerged following recommend...
OBJECTIVE: Severe maternal morbidity (SMM) affects 0.5 to 4% of pregnancies in the United States and other high-income countries (HIC). Research examining SMM preventability is limited but has emerged following recommendations from professional organizations to identify and review SMM events, determine preventability, and derive recommendations for care improvement. This study examined existing evidence on SMM preventability in HICs, synthesizing definitions, assessment approaches, and preventability rates. STUDY DESIGN: A scoping literature review was conducted using the Joanna Briggs Institute methodology and Preferred Reporting Items for Systematic Reviews Extension for Scoping Reviews guidelines. Four databases (PubMed, Embase, Scopus, and Cochrane) were searched from January 2011 to June 2024 using terms related to SMM and preventability. Eligible studies reported SMM preventability estimates in HICs. Two reviewers independently screened articles and extracted data. Content analysis assessed methodological patterns, and narrative synthesis identified conceptual frameworks. RESULTS: Of the 1,835 studies identified, 53 underwent full-text review, and 19 studies met inclusion criteria, primarily from the United States (52.6%) and New Zealand (26.3%). Studies showed diverse assessment approaches, with 47.4% using Geller-based frameworks, and three distinct classification methods. SMM preventability ranged from 21 to 76% (weighted average: 47.9%) for events deemed preventable, potentially preventable, or where care improvements were identified. Preventability rates varied by primary cause, being highest for sepsis (25-68%, average: 57.1%), followed by hemorrhage (22-72%, average: 45.2%), hypertensive disorders (22-73%, average: 43.6%), and cardiovascular events (13-49%, average: 38.9%). Across four studies, external reviews consistently identified higher SMM preventability rates than internal facility reviews. CONCLUSION: This review revealed substantial methodological heterogeneity in SMM preventability assessment across HICs, with up to three-quarters of events having improvement opportunities. Despite variation, most studies identified substantial preventability, demonstrating the feasibility and value of conducting SMM preventability reviews. Standardized definitions and review processes are needed to enhance cross-study comparisons and establish evidence-based improvement targets. KEY POINTS: · SMM preventability assessments lack standardization.. · A wide range (21-76%) of SMM events are preventable.. · Higher SMM preventability with external versus internal facility reviews..
Cerebral Blood Volume Within 6 Hours of Birth in Hypoxic-Ischemic Encephalopathy Assessed Using Time-Resolved Near-Infrared Spectroscopy.
Imanishi T, Sumiya W, Kanno C … +3 more , Kanno M, Kawabata K, Shimizu M
Am J Perinatol · 2026 May · PMID 42208582 · Publisher ↗
OBJECTIVE: The impact of the cerebral blood volume (CBV) within 6 hours of birth (early CBV) on the prognosis of hypoxic-ischemic encephalopathy (HIE) remains unknown. Therefore, we investigated whether the early CBV, me...
OBJECTIVE: The impact of the cerebral blood volume (CBV) within 6 hours of birth (early CBV) on the prognosis of hypoxic-ischemic encephalopathy (HIE) remains unknown. Therefore, we investigated whether the early CBV, measured using time-resolved near-infrared spectroscopy (tNIRS), is an early predictor of adverse outcomes in neonates with HIE. STUDY DESIGN: This single-center retrospective study included neonates diagnosed with any grade of HIE between 2017 and 2024. Therapeutic hypothermia was initiated in neonates with moderate or severe HIE, but not in those with mild HIE. Early CBV was measured within 6 hours of birth using tNIRS. A short-term adverse outcome was defined as a moderate-to-severe injury detected on magnetic resonance imaging. A total adverse outcome included death before discharge, cerebral palsy, and unfavorable developmental assessment at approximately 2 years of age. RESULTS: Among 215 eligible neonates with mild-to-severe HIE, 94 (44%) who underwent tNIRS were enrolled in this study. Of these, 38 (40%), 46 (49%), and 10 (11%) had mild, moderate, and severe HIE, respectively. Multivariate logistic regression analyses adjusted for the initial HIE severity and therapeutic hypothermia administration revealed that early CBV was significantly associated with a short-term adverse outcome ( = 70; odds ratio, 4.78; 95% confidence interval: 1.55-14.7; = 0.006), but not with a total adverse outcome. The receiver operating characteristic curve for short-term adverse outcomes showed that the cut-off value of early CBV was 2.91 mL/100 g. The area under the curve of early CBV was 0.64 (95% confidence interval: 0.49-0.79) and when combined with amplitude-integrated electroencephalography, it was 0.75 (95% confidence interval: 0.61-0.88). CONCLUSION: Early CBV has the potential to predict short-term adverse outcomes and improves the predictive ability when combined with amplitude-integrated electroencephalography. However, further investigations are needed because of the wide confidence intervals. KEY POINTS: · An early predictor of HIE prognosis is required.. · tNIRS can monitor cerebral oxygenation and metabolism.. · CBV can be derived from tNIRS measurements.. · CBV may predict magnetic resonance imaging injury early..
The Association of the Social Vulnerability Index with Acuity of Presentation to Obstetric Triage.
Bank TC, Sandoval GJ, Saade GR … +14 more , Varner MW, Tita ATN, Longo M, Bell EF, Stoll BJ, Thorp JM, Reddy UM, Costantine MM, Grobman WA, Rouse DJ, Simhan HN, Bailit JL, Parry S, Sibai BM
Am J Perinatol · 2026 Jun · PMID 42208579 · Publisher ↗
OBJECTIVE: Adverse social determinants of health are known to be associated with adverse pregnancy outcomes. The objective of this analysis was to assess the association between adverse community-level social determinant...
OBJECTIVE: Adverse social determinants of health are known to be associated with adverse pregnancy outcomes. The objective of this analysis was to assess the association between adverse community-level social determinants of health, measured with the Centers for Disease Control and Prevention/Agency for Toxic Substances and Disease Registry Social Vulnerability Index (CDC/ATSDR SVI), and acute presentation to obstetric triage. We hypothesized that adverse community-level social determinants of health would be associated with greater clinical acuity at time of presentation. STUDY DESIGN: This was a secondary analysis of an observational, multi-site cohort study of all triage visits from 20 to 34 weeks' gestation occurring from January 1, 2019, to March 31, 2019. Individuals enrolled with geocode and CDC SVI data available were included. The primary exposure was the overall CDC SVI. The primary outcome was presentation to obstetric triage with greater acuity. Secondary outcomes included adverse maternal and neonatal outcomes. Outcomes were compared between groups based on overall SVI and by the four SVI themes. Baseline characteristics were compared. Logistic and quantile regressions were used with the lowest SVI quartile (Q1) group as referent, adjusting for hospital, parity, maternal age, tobacco use, body mass index (BMI) at delivery, drug use, and existing comorbidity. RESULTS: A total of 2,659 individuals were eligible for analysis. Individuals with higher overall SVI scores were younger and had higher BMI, and were more likely to be multiparous, use tobacco or illicit drugs, and live with co-morbidities. Higher SVI quartiles were not associated with acuity of presentation to triage (Q1 reference; Q2 adjusted odds ratio [aOR]: 0.97, 95% confidence interval [CI]: 0.68-1.38; Q3 aOR: 1.10, 95% CI: 0.76-1.57; Q4 aOR: 1.04, 95% CI: 0.72-1.50). CONCLUSION: We found no consistent association between the CDC SVI and acuity of presentation to obstetrical triage. Further research is needed to understand the relationships between adverse community-level social determinants of health and adverse perinatal outcomes. KEY POINTS: · There was no association between the CDC SVI and acuity of presentation to obstetric triage, whether SVI was assessed as an overall score or by subtheme.. · This analysis adds to the understanding of the association between adverse community-level social determinants of health and conditions related to preterm delivery.. · This study indicates a need for ongoing research to better understand the mechanisms through which social vulnerability affects pregnancy outcomes..
Implementation of an Aspirin Utilization Program in an Early Pregnancy Access Center.
Muoser CA, Katehis I, Rosenthal H … +4 more , Karkowsky CE, Gurney E, Danvers A, Vani K
Am J Perinatol · 2026 Jun · PMID 42161289 · Publisher ↗
OBJECTIVE: Despite national guidelines, low-dose aspirin (LDA) for preeclampsia prevention is underutilized. Standardizing the screening process, increasing patient knowledge, and enhancing contact with the health care s...
OBJECTIVE: Despite national guidelines, low-dose aspirin (LDA) for preeclampsia prevention is underutilized. Standardizing the screening process, increasing patient knowledge, and enhancing contact with the health care system may improve utilization rates. Our objective is to evaluate whether a multifaceted intervention increases the proportion of patients who initiate LDA at the recommended gestational age as compared with routine prenatal care. STUDY DESIGN: This observational cohort study included patients entering prenatal care within a large urban medical center in the Bronx, New York, United States. Patients initiating care through our Early Pregnancy Access Center (EPAC) and receiving the intervention, including standardized screening for preeclampsia risk factors, prescribing of aspirin with education during prenatal intake, and follow-up outreach, were compared with patients initiating routine prenatal care at other sites within the institution. The primary outcome was the proportion of eligible patients who initiated aspirin by 16 weeks' gestation. Secondary outcomes included the proportion of patients who continued to utilize aspirin at 24 weeks' gestation, development of hypertensive disorders of pregnancy (HDP), and pregnancy outcomes. RESULTS: A total of 366 patients (78.5%) in the EPAC cohort and 296 patients (81.1%) in the routine prenatal care cohort had qualifying risk factors for LDA. Patients in both groups were largely Black or Hispanic and had public insurance. EPAC patients were more likely to initiate aspirin by 16 weeks (70.7 vs. 38.6%, adjusted odds ratio [aOR]: 4.39, 95% confidence interval [CI]: 2.80-6.90) and more likely to continue to utilize aspirin at 24 weeks (74.7 vs. 43.8%, aOR: 4.43, 95% CI: 2.93-6.72). HDP were highly prevalent in both groups (37.8% in EPAC vs. 34.7% in routine prenatal care, = 0.45). CONCLUSION: A concerted and standardized effort to identify, educate, and support patients at risk for preeclampsia is associated with higher LDA utilization in a high-risk population. Obstetric providers can consider similar approaches to reduce the "quality gap" in rates of LDA use. KEY POINTS: · Low-dose aspirin use can be improved.. · Early screening increases aspirin use.. · Outreach supports aspirin adherence..
Parental Perspectives on Prenatal Counseling and Communication at the Time of Initial Evaluation and Diagnosis of Congenital Heart Disease.
Canella R, Paidas Teefey C, Christofferson J … +7 more , McWhorter LG, Demianczyk AC, Kazak AE, Moldenhauer JS, Mitta M, Taboada C, Sood E
Am J Perinatol · 2026 Jun · PMID 42155484 · Full text
OBJECTIVE: This study aimed to investigate essential domains of prenatal counseling and communication in the specialized obstetric setting at the time of initial evaluation and diagnosis of congenital heart disease (CHD)...
OBJECTIVE: This study aimed to investigate essential domains of prenatal counseling and communication in the specialized obstetric setting at the time of initial evaluation and diagnosis of congenital heart disease (CHD), including suggestions to improve parental preparation and support. STUDY DESIGN: Qualitative data were collected using crowdsourcing methods. Thirty-two parents of children across the United States with a prenatal diagnosis of CHD responded to 37 open-ended questions over 6-months. Responses reflecting experiences with ultrasound evaluation of the fetus or interactions with maternal-fetal medicine (MFM) specialists were coded/analyzed using a thematic analytic approach. RESULTS: Five themes representing domains of prenatal counseling and communication were identified: (1) quality of initial communication including clarity of information, sensitivity/empathy, and opportunities for engagement and questions; (2) laying the foundation for emotional adjustment and coping through validating and normalizing emotional responses and providing multidisciplinary psychosocial support; (3) early provision of trusted resources, including educational resources, guidance on financial planning, and peer/community connections; (4) support for managing referrals and follow-up appointments by guiding parents through scheduling procedures and establishing streamlined provider communication; and (5) support for navigating next steps in diagnostic care, including setting clear expectations regarding provider roles and empowering parents in information-seeking and advocacy. CONCLUSION: By investigating the experiences of parents in the specialized obstetric setting at the time of initial evaluation of CHD, this study highlights critical concepts in prenatal counseling and communication and underscores actionable steps to enhance parental preparation and support. Study results emphasize the need for standards of care and training models that apply a person-centered, trauma-informed, socioecological approach to prenatal counseling delivered by MFM specialists. Results underscore the importance of incorporating multiple disciplines into prenatal care, including psychosocial providers and care coordinators, to enhance parental support, understanding, and preparedness and to mitigate stress and trauma during an early and ambiguous time. KEY POINTS: · Parents often describe the experience of prenatal diagnosis as emotionally traumatic.. · Counseling and communication in the obstetric setting play a critical role in parental coping.. · Parents in this study identified five actionable domains of prenatal counseling and communication.. · Gaps exist in prenatal counseling and communication in the specialized obstetric setting.. · Person-centered, trauma-informed standards of care and tailored counseling approaches are needed..
The Influence of Maternal and Paternal Race on Perinatal Outcomes.
Jones S, Furukawa N, Kawakita T
Am J Perinatol · 2026 May · PMID 42128370 · Publisher ↗
OBJECTIVE: This study aimed to examine associations between maternal-paternal racial pairings and adverse perinatal outcomes in the United States. STUDY DESIGN: We conducted a retrospective population-based cohort study...
OBJECTIVE: This study aimed to examine associations between maternal-paternal racial pairings and adverse perinatal outcomes in the United States. STUDY DESIGN: We conducted a retrospective population-based cohort study using 2016-2023 U.S. birth certificate data from the CDC National Vital Statistics System. Singleton live births with complete data on maternal and paternal race were included. Parental race was categorized as non-Hispanic White, non-Hispanic Black, Hispanic, or Asian, resulting in 16 racial dyads. Outcomes included preterm birth (PTB, <37 weeks), hypertensive disorders of pregnancy (HDP), gestational diabetes mellitus (GDM), and small for gestational age (SGA, <10th percentile). Adjusted relative risks (aRRs) were estimated using multivariable Poisson regression with robust error variance, adjusting for maternal age, body mass index, parity, insurance status, nativity, chronic hypertension, pregestational diabetes, smoking, and Social Vulnerability Index. RESULTS: Of 26,284,090 births, 12,595,260 (47.9%) had White, 9,147,469 (34.8%) had Hispanic, 3,131,956 (11.9%) had Black, and 1,409,405 (5.4%) had Asian fathers. Compared to White fathers, PTB risk was higher with Black (aRRs = 1.09-1.21) and Hispanic fathers (1.14-1.31), and lower among Asian fathers (0.84-0.93), regardless of maternal race. HDP risk was consistently lower among Asian (0.72-0.87) and Black fathers (0.86-0.93), while associations with Hispanic fathers were inconsistent. GDM risk was lower among Black fathers (0.87-0.94). For Hispanic fathers, GDM risk decreased among White and Black mothers but increased in Hispanic mothers. Asian fathers were associated with higher GDM risk compared to White fathers only among Asian mothers. SGA risk was higher for all non-White paternal groups, highest with Asian fathers (1.40-1.86). CONCLUSION: Paternal race was associated with perinatal risk. Non-White paternal race was associated with higher risks of PTB and SGA, whereas risks of HDP and GDM varied according to the specific maternal-paternal racial pairing. KEY POINTS: · Parental racial pairings influence perinatal risk.. · Paternal race shows independent effects.. · Risks differ across racial dyads..
Decreasing Trends of Tobacco Use Disorder among Pregnant People in the United States.
Yao JA, Lim AE, Yamaguchi A … +4 more , Hong CE, Keymeulen S, Ouzounian JG, Matsuo K
Am J Perinatol · 2026 May · PMID 42127949 · Publisher ↗
OBJECTIVE: A recent analysis of the Centers for Disease Control and Prevention's National Vital Statistics System found that pregnant people with tobacco use disorder have decreased in the United States. To further valid...
OBJECTIVE: A recent analysis of the Centers for Disease Control and Prevention's National Vital Statistics System found that pregnant people with tobacco use disorder have decreased in the United States. To further validate their findings in a different data source, this study assessed the temporal trends of pregnant people with tobacco use disorder in the Agency for Healthcare Research and Quality's data source. STUDY DESIGN: This cross-sectional study queried the Healthcare Cost and Utilization Project's National Inpatient Sample. The study population included 24,976,627 hospital deliveries from 2016 to 2022. Prevalence rates of pregnant people with a diagnosis of tobacco use disorder were summarized in each year. A multivariable generalized linear model was created to assess the temporal trend, adjusting for maternal age, race/ethnicity, primary payer, census-level median household income, region, other substance use disorder, and mental health disorder. RESULTS: A total of 1,237,415 (5.0%) hospital deliveries had a diagnosis of tobacco use disorder. Annualized prevalence rate of tobacco use disorder decreased by 27.3% from 5.5% in 2016 to 4.0% in 2022 over the 7-year study period (adjusted-prevalence rate ratio [aRR] for 2022 compared with 2016, 0.72, 95% confidence interval [CI]: 0.71-0.72). The relative-decrease from 2016 to 2022 in tobacco use disorder was particularly high among younger (age < 25, 7.1% in 2016 to 4.7% in 2022, aRR: 0.63, 95% CI: 0.62-0.64; and age 25-29, 6.3% in 2016 to 4.3% in 2022, aRR: 0.67, 95% CI: 0.67-0.68), those in New England (5.2% in 2016 to 3.2% in 2022, aRR: 0.67, 95% CI: 0.65-0.70), Mid-Atlantic (4.9% in 2016 to 3.3% in 2022, aRR: 0.65, 95% CI: 0.64-0.66), and East North Central (8.4% in 2016 to 6.0% in 2022, aRR: 0.69, 95% CI: 0.68-0.70), and those with mental health condition (anxiety disorder, 15.9% in 2016 to 8.5% in 2022, aRR: 0.62, 95% CI: 0.61-0.64; and depressive disorder, 16.4% in 2016 to 9.6% in 2022, aRR: 0.66, 95% CI: 0.65-0.68). CONCLUSION: This national-level assessment externally validated a prior study that pregnant people with tobacco use disorder have decreased in the United States. A nearly 30% decrease over a 7-year period is clinically significant and encouraging. KEY POINTS: · Tobacco use disorder among pregnant people has decreased in the United States.. · Decrease in tobacco use disorder occurred more in younger pregnant people.. · Decrease in tobacco use disorder was prominent among mental health conditions..
The Association of Community Social Vulnerability and Racial Disparities with Infant Preterm Birth and Low Birthweight.
Coughlin CG, Donohue KJ, Douglas K … +5 more , D'Ambrosi G, Monuteaux MC, Economy KE, Mannix R, Lee LK
Am J Perinatol · 2026 May · PMID 42127948 · Full text
OBJECTIVE: This study aimed to examine the association of community-level social vulnerability with infant preterm birth (PTB) and low birth weight (LBW). IRTHW: National Center for Health Statistics Restricted Vitals St...
OBJECTIVE: This study aimed to examine the association of community-level social vulnerability with infant preterm birth (PTB) and low birth weight (LBW). IRTHW: National Center for Health Statistics Restricted Vitals Statistics birth cohort linked files of infants born preterm (<37 weeks gestation) and with LBW (<2,500 g). The exposure was the CDC's Social Vulnerability Index (SVI) (five quintiles, ranked from lowest to highest social vulnerability). We performed multivariable logistic regression for each outcome with SVI as the exposure (referent Quintile 1). We assessed for effect modification of SVI by Black and White race with stratum-specific estimates for other racial groups. All models were adjusted for maternal characteristics and reported adjusted odds ratios (aOR) with 95% confidence intervals (CI). RESULTS: There were 3,791,712 infants analyzed: 379,777 (10%) with PTB and 314,568 (8.3%) with LBW. In the multivariable models the association between higher SVI counties and PTB was higher among Black (Quintile 4: aOR [95% CI] = 1.17 [1.07, 1.28]; Quintile 5: 1.21 [1.11, 1.32]) compared with White infants (Quintile 4: 1.06 [1.02, 1.10]; Quintile 5: 1.09 [1.01, 1.18]). There was effect modification for SVI by race for PTB, but not LBW. LBW was associated with higher SVI counties in a step-wise fashion (Quintile 3: 1.04 [1.01, 1.08]; Quintile 4: 1.08 [1.04, 1.12]; Quintile 5: 1.12 [1.07, 1.18]), with higher odds for infants of Asian (1.45 [1.39, 1.51]) and Black (1.92 [1.85, 2.00]) compared with White race, and Hispanic ethnicity (1.05 [1.01, 1.09]). CONCLUSION: PTB and LBW are associated with increased community-level social vulnerability and with racial disparities. KEY POINTS: · Preterm birth associated with SVI.. · Low birth weight associated with SVI.. · Effect modification occurs for SVI by race and preterm birth..
Validation of the Revised Maternal-Fetal Medicine Units Network Vaginal Birth after Cesarean Calculator at an Academic Community Hospital.
Syed S, McFadden M, Haas M … +3 more , Rochon ML, Dayon T, Quiñones-Rivera JN
Am J Perinatol · 2026 May · PMID 42119697 · Publisher ↗
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Amniotomy versus Deferral at cm during Standardized Induction of Labor: A Propensity Score-Matched Study.
Gleason E, Levine LD, Hamm RF
Am J Perinatol · 2026 May · PMID 42114706 · Publisher ↗
The present study aimed to determine the specific impact of artificial rupture of membranes (AROM) at first examination ≥ 4 cm versus deferring AROM at that examination while undergoing otherwise standardized labor induc...
The present study aimed to determine the specific impact of artificial rupture of membranes (AROM) at first examination ≥ 4 cm versus deferring AROM at that examination while undergoing otherwise standardized labor induction.This is a secondary analysis of a prospective cohort evaluating the implementation of standardized induction of labor (IOL) management of patients undergoing ≥37 weeks of induction at two sites from 2018 to 2022 with a singleton pregnancy, intact membranes, and an unfavorable cervix without prior cesarean delivery (CD). Patients were grouped by whether AROM was performed at the first examination ≥4 cm, or deferred. A 1:1 propensity score matching balanced parameters associated with AROM at the ≥4 cm examination. The primary outcome was time to delivery. Secondary outcomes included length of each stage, CD, and maternal/neonatal morbidity. Time-to-event regression analyses for labor length, censored for CD, were modeled with a Cox proportional hazard model.Among 8,509 inductions in the parent study, 5,784 (67.0%) remained unruptured by the first examination ≥4 cm. After propensity score matching, 1,412 were included ( = 706/group). Overall, AROM was associated with shorter time to delivery compared with deferral at first examination ≥4 cm (21.4 [14.6-29.3] vs. 22.6 hours [16.4-31.3]), = 0.002), a finding consistent across parity. Once censored for CD, these findings remained significant (hazard ratio [HR] = 1.17, 95% confidence interval [CI]: [1.04-1.31]). There were no differences in CD or morbidity.Even when matching for the induction course prior to the first examination at ≥4 cm, AROM at ≥4 cm is associated with shortened time to delivery without increasing maternal or neonatal morbidity. · Early amniotomy has been variably defined in prior literature.. · No prior studies evaluate early AROM within a standardized induction protocol.. · AROM at first examination ≥4 cm shortens the time to delivery regardless of parity.. · AROM at first examination ≥4 cm is not associated with differences in morbidity..
Antenatal Corticosteroid Administration in Late Preterm Singleton Pregnancies: A Propensity Score-weighted Analysis of Neonatal Outcomes.
Yildiz GA, Goc G, Sut H … +3 more , Kaplan NB, Aslan B, Okulu E
Am J Perinatol · 2026 May · PMID 42097165 · Publisher ↗
OBJECTIVE: This study aimed to evaluate the association between antenatal corticosteroid (ACS) exposure in late preterm singleton pregnancies (34-36 weeks) and neonatal outcomes using propensity score-weighted analysis....
OBJECTIVE: This study aimed to evaluate the association between antenatal corticosteroid (ACS) exposure in late preterm singleton pregnancies (34-36 weeks) and neonatal outcomes using propensity score-weighted analysis. STUDY DESIGN: Retrospective single-center cohort of 1,012 singleton late preterm deliveries (2017-2022), excluding 75 pregnancies with ACS exposure before 34 weeks. Late-preterm exposure occurred in 126 pregnancies; 886 were unexposed. Stabilized inverse probability of treatment weighting, trimmed at the 1st and 99th percentiles, used prespecified maternal, obstetric, delivery, and fetal covariates. The primary outcome was documented initial respiratory support at birth. RESULTS: Initial respiratory support occurred in 34.1% (43/126) of exposed neonates versus 25.2% (223/886) of unexposed neonates; weighted analysis did not show lower odds with exposure (odds ratio, 1.40; 95% confidence interval, 0.90-2.18; = 0.130). Among exposed pregnancies, 85.7% received a single documented dose and 55.6% delivered within 24 hours. Neonatal hypoglycemia occurred in 3.2 versus 1.1% (odds ratio, 2.14; 95% confidence interval, 0.63-7.28; = 0.224). No secondary outcomes remained significant after false discovery rate correction. CONCLUSION: In this real-world cohort with predominantly single-dose exposure and short ACS-to-delivery intervals, late preterm ACS was not associated with reduced initial respiratory support. These hypothesis-generating findings support selective rather than routine administration with individualized risk assessment and neonatal glucose monitoring. KEY POINTS: · In a real-world cohort with predominantly single-dose exposure and short ACS-to-delivery intervals, late-preterm ACS exposure was not associated with reduced initial respiratory support at birth after propensity score weighting.. · The respiratory support signal was driven mainly by low-intensity hood oxygen, whereas higher-intensity support and hospitalization course duration outcomes did not show clinically clear benefit.. · Findings are hypothesis-generating and support selective rather than routine administration, with attention to ACS timing, course completion when feasible, and neonatal glucose monitoring..
Disproportionate Rise in Congenital Syphilis Compared with Adult Syphilis Trends in Texas, United States: A Population-Based Analysis, 2016-2023.
Toro D, Chiu T, Alkassar L … +1 more , Stansbury N
Am J Perinatol · 2026 May · PMID 42091060 · Publisher ↗
OBJECTIVE: This study aimed to compare temporal trends in congenital syphilis with adult primary and secondary syphilis incidence in Texas, United States. STUDY DESIGN: Population-based retrospective trend analysis using...
OBJECTIVE: This study aimed to compare temporal trends in congenital syphilis with adult primary and secondary syphilis incidence in Texas, United States. STUDY DESIGN: Population-based retrospective trend analysis using Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research data from 2016 to 2023. RESULTS: Congenital syphilis incidence increased from 17.5 to 238.6 per 100,000 live births, representing a 12.6-fold increase. The annual percent change (APC) was 29.7% (95% CI: 27.9-31.6; < 0.001). Adult primary and secondary syphilis increased from 7.0 to 15.0 per 100,000 population (113% increase), with an APC of 13.1% (95% CI: 12.5-13.8; < 0.001). The increase in congenital syphilis significantly outpaced adult trends (interaction < 0.001). CONCLUSION: Congenital syphilis in Texas, United States, has increased at a markedly greater rate than adult syphilis, suggesting failures in prenatal screening, treatment, or care access beyond rising community transmission alone. KEY POINTS: · Congenital syphilis in Texas, United States, increased 12.6-fold from 2016 to 2023.. · Congenital syphilis rates rose faster than adult syphilis, indicating system failures.. · Findings highlight gaps in prenatal screening, treatment, and care access..
Life Course Perspectives of Adverse Pregnancy Outcomes in Kersa, Eastern Ethiopia: Accelerated Cohort Design.
Tadele A, Dheresa M, Abera M
Am J Perinatol · 2026 May · PMID 42091059 · Publisher ↗
OBJECTIVE: Adverse pregnancy outcomes (APOs) are major drivers of maternal and child mortality, especially in low-income countries like Ethiopia. Studies examining such inequities from a life course lens are lacking. Hen...
OBJECTIVE: Adverse pregnancy outcomes (APOs) are major drivers of maternal and child mortality, especially in low-income countries like Ethiopia. Studies examining such inequities from a life course lens are lacking. Hence, this study investigates generational disparities in the risk of APOs. STUDY DESIGN: An accelerated cohort design was utilized, recruiting 7,286 women from three birth cohorts (1970s, 1980s, and 1990s) in Kersa, Eastern Ethiopia. A generalized linear mixed-effects model using STATA version 17.0 was used. RESULTS: Pregnancy outcomes varied across generations. Stillbirths were highest in earlier life course (13.8%) and lowest in later (7.3%). Preterm births declined slightly (9.5% to 8.1%), but risks were greater in later life course. Miscarriages were lowest in Cohort 2 (2.9%). Poor maternal nutrition (MUAC <21 cm; AOR = 2.87 for preterm birth, AOR = 1.71 for stillbirth) and high gravidity (AOR = 2.26 for preterm birth, AOR = 1.51 for stillbirth) were strongly associated with adverse pregnancy outcomes, while lack of maternal education (AOR = 1.45) also increased risk of preterm birth. In contrast, later age at first birth (AOR = 0.43 for preterm birth) and higher household wealth (medium AOR = 0.73; highest AOR = 0.63 for preterm birth) were protective factors. These findings underscore the importance of maternal nutrition, reproductive history, and socioeconomic conditions in determining pregnancy outcomes. CONCLUSION: Generational disparities highlight the need for multilevel strategies addressing social determinants and maternal care. Future studies to elucidate the biological pathways, such as epigenetic changes, linking early-life exposures to pregnancy outcomes are recommended. KEY POINTS: · Adverse pregnancy outcomes were observed.. · Study used an accelerated cohort design. · Findings were interpreted through life course perspectives..
Exploring the Effects of Obesity on Postpartum Hemorrhage Risk.
Hasan N, Moss K, Conklin A … +1 more , Schafer B
Am J Perinatol · 2026 May · PMID 42091058 · Publisher ↗
OBJECTIVE: This study aims to analyze rates of postpartum hemorrhage according to body mass index (BMI) and investigate relative risks for postpartum hemorrhage based on BMI. STUDY DESIGN: We conducted a retrospective ch...
OBJECTIVE: This study aims to analyze rates of postpartum hemorrhage according to body mass index (BMI) and investigate relative risks for postpartum hemorrhage based on BMI. STUDY DESIGN: We conducted a retrospective chart review of all deliveries occurring in 2022 at two large urban hospitals in Indianapolis, IN, resulting in a cohort of 5,686 patients. After excluding patients for missing data, a total of 4,493 patients were included in the final analysis. Patients were categorized according to the Centers for Disease Control and Prevention (CDC) BMI definitions. We analyzed rates of postpartum hemorrhage according to patient variables. RESULTS: The rates of postpartum hemorrhage for patients with BMI categorized as healthy weight, overweight, Class I obesity, Class II obesity, and Class III obesity were 16.3, 19.6, 23.0, 21.3, and 27.7%, respectively ( < 0.0001). Relative risk for postpartum hemorrhage by BMI categories was investigated using logistic regression analysis, where patients in the healthy weight cohort (BMI 18 to <25) were used as the reference for risk of postpartum hemorrhage. We found that patients with Class III obesity had an increased risk of postpartum hemorrhage by 57% after adjusting for mode of delivery and race (adjusted risk ratio [aRR] = 1.57, 95% CI: 1.20-2.04). Despite increased relative risk in all categories, we found no statistical significance for patients with BMI in the overweight category (aRR = 1.19, 95% CI: 0.92-1.54) or the Class II obesity category (aRR = 1.24, 95% CI: 0.05-1.63). CONCLUSION: This study shows a significantly increased risk of postpartum hemorrhage among obese patients, particularly those with Class III obesity. Notably, we did not observe a dose-dependent effect of BMI on rates of postpartum hemorrhage, as there was, in fact, a marginal decrease in rates of postpartum hemorrhage when comparing Class I and Class II obesity. This study supports risk-based initiatives to address increasing postpartum hemorrhage rates in the United States. KEY POINTS: · The relationship between obesity and postpartum hemorrhage was investigated.. · There was an increase in postpartum hemorrhage after 40+ BMI.. · Mode of delivery and maternal age also alter postpartum hemorrhage risk.. · These data support the use of risk-assessment tools for obesity..
It's Best to Test in Hospital: Improved Testing Rates with Immediate Postpartum Diabetes Testing in Patients with Gestational Diabetes in a Community-Academic Medical Center.
Pimentel VM, Brown M, Barreto N … +2 more , Wakefield D, Crowell R
Am J Perinatol · 2026 Jun · PMID 42086073 · Publisher ↗
OBJECTIVE: Immediate postpartum diabetes (IPD) testing on day 1 or 2 shows similar diagnostic value to testing at 4 to 12 weeks' postpartum and achieves higher completion rates. Our institution implemented IPD testing on...
OBJECTIVE: Immediate postpartum diabetes (IPD) testing on day 1 or 2 shows similar diagnostic value to testing at 4 to 12 weeks' postpartum and achieves higher completion rates. Our institution implemented IPD testing on December 1, 2023, before the American College of Obstetricians and Gynecologists' endorsement, to compare pre and postimplementation testing rates and to assess associated maternal and neonatal outcomes. STUDY DESIGN: We conducted a retrospective cohort study of patients with gestational diabetes mellitus (GDM) who delivered at our community-academic medical center before (September 1, 2022-November 15, 2023) and after (December 1, 2023-October 31, 2024) IPD implementation. The preimplementation group underwent outpatient testing 4 to 12 weeks' postpartum. The postimplementation group was tested in-hospital 1 or 2 days' postpartum. Both groups received a 2-h our glucose challenge test. Electronic medical records were queried for demographics, medical and obstetric history, GDM information, and postpartum diabetes testing results. Completion rates, maternal, and neonatal factors were compared across and within cohorts using chi-square tests and -tests. RESULTS: Across 155 patients (63 preimplementation, 92 postimplementation), baseline characteristics were similar, excluding age. Testing completion increased nearly 5-fold postimplementation (14.3% [9/63] vs. 68.5% [63/92], < 0.01). In the postimplementation group, 49% of tested patients had abnormal results (43% impaired glucose metabolism, 6% overt diabetes). Non-English speakers and those with a postpartum length of stay > 1 day were more likely to be tested (22.2 vs. 3.45%, = 0.02; 98.4 vs. 48.3%, < 0.01). Neonates in the tested group had a lower mean birth weight (3,137.1 ± 665.1 vs. 3,374.4 ± 484.7 g; = 0.05), longer nursery stay (2.55 ± 2.2 vs. 1.83 ± 0.69 days; = 0.03), and more neonatal intensive care unit admissions (20.63 vs. 0%; = 0.01). CONCLUSION: IPD testing dramatically improved testing and identified a high prevalence of persistent dysglycemia immediately postpartum. Hospital systems should consider implementing this practice change to improve testing rates and early intervention in postpartum care of patients with GDM. KEY POINTS: · IPD testing is a feasible and replicable practice.. · IPD testing increased rates nearly 5-fold compared with traditional timing.. · Persistent dysglycemia was identifiable immediately postpartum.. · Longer hospital stays increased the likelihood of testing.. · In-hospital testing may reduce language barriers..
Neonatal Intensive Care Unit Cultural Familiarity Shows Limited Impact on Outcomes among Asian American, Native Hawaiian, and Pacific Islander Very Low Birth Weight Infants.
Olatunji I, Cui X, Main EK … +3 more , Shariff-Marco S, Gomez S, Profit J
Am J Perinatol · 2026 May · PMID 42082160 · Publisher ↗
OBJECTIVE: This study aims to assess whether cultural familiarity, measured by Asian American, Native Hawaiian, and Pacific Islander (AANHPI) hospital patient volume, is associated with care processes and outcomes among...
OBJECTIVE: This study aims to assess whether cultural familiarity, measured by Asian American, Native Hawaiian, and Pacific Islander (AANHPI) hospital patient volume, is associated with care processes and outcomes among very low birth weight (VLBW) infants. STUDY DESIGN: We analyzed 43,067 infants, including 6,534 (15.2%) AANHPI infants, from 142 California neonatal intensive care units (NICUs) in the California Perinatal Quality Care Collaborative (2011-2019). Hospitals were grouped into tertiles by AANHPI VLBW admissions. Multivariable Poisson regression was adjusted for infant, maternal, and hospital factors. RESULTS: Mortality and major morbidities did not differ by AANHPI patient volume. Unadjusted analyses showed higher human milk use at discharge in high- and middle-tertile NICUs (79.2% and 77.0 vs. 69.6%, < 0.001), and higher growth velocity in high-tertile NICUs compared to low-tertile NICUs (13.3 vs. 12.8 g/kg/day, < 0.001), but these differences were attenuated after adjustment. CONCLUSION: NICU AANHPI VLBW patient volume was associated with feeding-related outcomes but not neonatal morbidity and mortality. KEY POINTS: · Higher AANHPI NICU volume was linked to greater human milk use at discharge.. · High-volume NICUs showed higher growth velocity among VLBW infants.. · Mortality and major morbidities did not differ by AANHPI patient volume.. · Feeding advantages in high-volume NICUs attenuated after adjustment.. · Cultural familiarity may influence feeding practices more than survival..
Risk Factors, Trends, and Outcomes Associated with Anorexia Nervosa and Bulimia Nervosa Diagnoses during Delivery Hospitalizations.
Darbouze M, Wen T, Huang Y … +1 more , Friedman AM
Am J Perinatol · 2026 May · PMID 42066791 · Publisher ↗
OBJECTIVE: The objective of this study is to evaluate trends, risk factors, and outcomes associated with anorexia and/or bulimia nervosa diagnoses during delivery hospitalizations in the United States. STUDY DESIGN: The...
OBJECTIVE: The objective of this study is to evaluate trends, risk factors, and outcomes associated with anorexia and/or bulimia nervosa diagnoses during delivery hospitalizations in the United States. STUDY DESIGN: The 2000 to 2022 National Inpatient Sample was used for this repeated-cross sectional analysis. Delivery hospitalizations of patients aged 15 to 54 with anorexia and/or bulimia nervosa diagnoses were identified. Temporal trends were analyzed with joinpoint regression reporting the average annual percent change (AAPC). The associations between anorexia and/or bulimia nervosa diagnoses and adverse outcomes including (1) transfusion, (2) nontransfusion severe maternal morbidity, (3) postpartum hemorrhage, (4) hypertensive disorders of pregnancy (including gestational hypertension and preeclampsia), (5) cesarean delivery, (6) preterm delivery at <37 and <32 weeks, and (7) anemia were analyzed with unadjusted and adjusted logistic regression models with unadjusted and adjusted odds ratios (aORs) with 95% confidence intervals (CIs) as measures of association. RESULTS: Of 87,151,598 delivery hospitalizations identified, 6,309 (7.2 per 100,000) had an anorexia nervosa and/or bulimia nervosa diagnosis, including 3,308 diagnoses of bulimia (3.8 per 100,000) and 3,324 diagnoses of anorexia (3.8 per 100,000). Diagnoses increased significantly over the study period for bulimia (AAPC: 6.6%, 95% confidence interval [CI]: 5.0%, 8.8%), anorexia (AAPC: 11.3%, 95% CI: 9.4%, 14.6%), and either diagnosis (AAPC: 9.2%, 95% CI: 7.8%, 11.4%). Anorexia nervosa and/or bulimia nervosa diagnoses were associated with increased adjusted odds of transfusion (aOR: 1.55, 95% CI: 1.02, 2.34), nontransfusion severe maternal morbidity (aOR: 1.79, 95% CI: 1.17, 2.73), preterm delivery at <37 weeks (aOR: 1.65, 95% CI: 1.34, 2.04) and <32 weeks (aOR: 1.65, 95% CI: 1.05, 2.59) and anemia (aOR: 1.55, 95% CI: 1.35, 1.77). CONCLUSION: Anorexia nervosa and bulimia nervosa diagnoses increased in a representative sample of U.S. delivery hospitalizations over a 23-year study period and were associated with a range of adverse obstetrical outcomes. KEY POINTS: · Eating disorder diagnoses increased among delivery hospitalizations on a population basis.. · Eating disorder diagnoses were associated with a range of adverse obstetrical outcomes.. · Diagnoses increased significantly for both bulimia and anorexia..
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