American Journal Of Perinatology[JOURNAL]
Sun
200 papers
Oral Feeding Practices in NICU Infants on CPAP or HFNC: A U.S. Cross-Sectional Survey.
Koehler M, Selvakumar S, Viswanathan S
Am J Perinatol · 2026 Jul · PMID 41285382 · Publisher ↗
OBJECTIVE: Coordination of sucking-swallowing-breathing matures at 32 to 34 weeks' gestation; early oral feeds risk aspiration, while delays may increase oral aversion and length of stay. Safety of feeding on high-flow n...
OBJECTIVE: Coordination of sucking-swallowing-breathing matures at 32 to 34 weeks' gestation; early oral feeds risk aspiration, while delays may increase oral aversion and length of stay. Safety of feeding on high-flow nasal cannula (HFNC) or continuous positive airway pressure (CPAP) is uncertain, and practice variations are common. This study describes the U.S. neonatal intensive care unit (NICU) practices for oral feeding during HFNC/CPAP and decision criteria. STUDY DESIGN: National cross-sectional telephone survey (July 2024-February 2025) of key informants from level III and IV NICUs. RESULTS: Of 159 NICUs, 83.0% routinely permitted oral feeding on HFNC, 10.7% sometimes, and 6.3% never. Only 9.4% routinely allowed CPAP feeding, 7.5% sometimes, and 83.0% never. Units allowing CPAP feeding used stricter readiness criteria, continuous monitoring, and involved speech-language pathology/occupational therapy. CONCLUSION: Oral feeding on HFNC is common; CPAP feeding is rare and criteria-bound, with regional variation. Heterogeneity underscores the need for consensus guidance and trials evaluating CPAP feeding effects on feeding outcomes, length of stay, and neurodevelopment. KEY POINTS: · Oral feeding during noninvasive support is widespread for HFNC but far more selective on CPAP.. · Units that permit CPAP feeding use strict criteria and multidisciplinary evaluation.. · Considerable variability across units and regions highlights the need for standardized guidance..
Association of Fetal Heart Rate Tracing with Adverse Neonatal Outcomes at 320/7 to 366/7 Weeks.
Cortes CN, Cagino KA, Roberts AW … +5 more , Wiley RL, Patel S, Zullo F, Mendez-Figueroa H, Chauhan SP
Am J Perinatol · 2025 Nov · PMID 41253280 · Publisher ↗
The objective of this study is to determine if patterns of fetal heart rate tracings (FHRT) were associated with an increased rate of composite adverse neonatal outcomes (CANO) among preterm deliveries at 32 to 36 weeks....
The objective of this study is to determine if patterns of fetal heart rate tracings (FHRT) were associated with an increased rate of composite adverse neonatal outcomes (CANO) among preterm deliveries at 32 to 36 weeks.This was a retrospective review of intrapartum FHRT between 20 and 120 minutes before birth, among nonanomalous singletons delivered at 32 to 36 weeks. The study was conducted at a Level IV maternal center during a consecutive 15-month period. Obstetricians reviewing FHRT were blinded to the maternal characteristics, intrapartum course, and neonatal outcomes. FHRT patterns were categorized based on time spent in the final 2 hours before delivery (<50 vs. ≥50%). The primary outcome was the CANO, which included any of the following: 5-minute Apgar < 7, mechanical ventilation > 6 hours, umbilical artery pH < 7.00, bronchopulmonary dysplasia, interventricular hemorrhage, necrotizing enterocolitis, neonatal seizures, neonatal confirmed sepsis, hypoxic ischemic encephalopathy, birth injury, meconium aspiration syndrome, or neonatal death.Of 5,160 patients, 672 (13%) met the inclusion criteria. CANO occurred in 57 (8.5%) newborns. Overall, FHRT patterns that differed significantly between those without versus with CANO included minimal variability (8.8 vs. 19.3%, = 0.01, PLR = 2.2 [positive likelihood ratio], PPTP 17% [positive posttest probability]), moderate variability (76.4 vs. 52.6%, < 0.001, NLR = 2.01 [negative likelihood ratio], NPTP 15.7% [negative posttest probability]), accelerations (58.4 vs. 40.4%, = 0.009, NLR = 1.43, NPTP = 11.7%), and severe variable decelerations (3.5% = 0.003, PLR = 10.79, PPTP = 50.1%). Category III FHRT pattern was also associated with an increased posttest probably of CANO (0.3 vs. 1.8%, = 0.12, PLR = 5.39, PPTP = 27%).While moderate variability and accelerations were associated with significantly lower likelihood of CANO among newborns delivered at 32 to 36 weeks, minimal variability and severe variable decelerations were significantly more common in preterm newborns with CANO. · At 32 to 36 weeks, CANO occur in approximately 8% of neonates.. · Severe variable decelerations and minimal variability increase risk of CANO.. · The PPTP of CANO is 33%, if Category III FHRT is noted before birth.. · The PPTP is 13%, if there is persistent Category II FHRT in the last 120 minutes..
Reply: Comment on "Head Ultrasound Findings in Infants with Birth Weight >1,500 g and Gestational Age >32 Weeks Exposed to Prenatal Opioids".
Sakaria RP, Rana D, Harsono M … +2 more , Cohen HL, Pourcyrous M
Am J Perinatol · 2025 Dec · PMID 41248628 · Publisher ↗
Abstract loading — click title to view on PubMed.
A Retrospective, Cross-Sectional Study of Geographic Food Environment and Diabetes in Pregnancy.
McClain S, Clinton T, Joseph J … +6 more , Speak A, Goodson M, Dickson T, Khangura R, Kim SK, Pitts D
Am J Perinatol · 2026 Jul · PMID 41232568 · Publisher ↗
OBJECTIVE: Insufficient access to healthy food has been linked to poor health outcomes in under-resourced communities. The relationship between neighborhood-level food insecurity and diabetes in pregnancy remains underst...
OBJECTIVE: Insufficient access to healthy food has been linked to poor health outcomes in under-resourced communities. The relationship between neighborhood-level food insecurity and diabetes in pregnancy remains understudied, with previous studies reporting inconsistent results. This study examined the association between living in a low-income, low access (LILA) census tract and the prevalence of pregestational type 2 diabetes (T2D) and gestational diabetes (GDM) among pregnant individuals. STUDY DESIGN: This cross-sectional study included patients who delivered a singleton pregnancy at ≥20 weeks' gestation at Henry Ford Hospital between January 2014 and December 2019 and resided within Detroit city limits at the time of delivery. Residence in a LILA census tract, as designated by the USDA Food Access Research Atlas, was the exposure, and prevalences of pregestational T2D and GDM were the outcomes, which were collected retrospectively from patient records. A total of 117 census tracts were designated as LILA. Covariates that were adjusted for included maternal age at delivery, race, body mass index (BMI), insurance status, and substance use during pregnancy (drug, alcohol, and tobacco). Multivariate logistic regression models were used to analyze the data. RESULTS: Of the 3,897 patients included in this study, 1,377 (35.3%) resided in LILA tracts and 2,520 (64.7%) resided in non-LILA tracts. When individuals residing in LILA and non-LILA tracts were compared, there were no significant differences in the prevalences of pregestational T2D (4.8 vs. 4.6%, adjusted prevalence odds ratio [aPOR] = 1.00, 95% CI: 0.72-1.38, = 0.99) and GDM (11.3 vs. 13.7%, aPOR = 0.96, 95% CI: 0.78-1.20, = 0.74). Maternal age at delivery, maternal BMI, race, and insurance status were all significantly associated with the prevalences of GDM and pregestational T2D. CONCLUSION: Our results suggest that a LILA tract is not significantly associated with the prevalences of T2D and GDM during pregnancy. KEY POINTS: · Living in a LILA tract was not linked with GDM or T2D in pregnancy.. · Age and BMI were significantly associated with T2D and GDM.. · Race and insurance status were significantly associated with T2D and GDM..
Social Determinants of Health and Oxygen Use in Preterm Infants with Bronchopulmonary Dysplasia.
Dillon B, Ashraf S, Assudani N … +2 more , Thomas R, Bajaj M
Am J Perinatol · 2026 Jul · PMID 41232558 · Publisher ↗
OBJECTIVE: This study aimed to evaluate the association between the Child Opportunity Index (COI) and postdischarge oxygen use in infants with bronchopulmonary dysplasia (BPD). STUDY DESIGN: Retrospective study of infant...
OBJECTIVE: This study aimed to evaluate the association between the Child Opportunity Index (COI) and postdischarge oxygen use in infants with bronchopulmonary dysplasia (BPD). STUDY DESIGN: Retrospective study of infants < 32 weeks' gestation with BPD, discharged on home oxygen from 2010 to 2022 and followed in a BPD clinic. Primary outcome was duration of oxygen use, secondary outcomes were emergency room (ER) visits, missed BPD appointments, and readmission. RESULTS: Of 145 infants included in the study, 88 (60.3%) infants were in the very low COI category. Mean (standard deviation) duration of home oxygen was 89.5 (92) days. Regression analysis did not show any significant association between COI and duration of home oxygen use. Number of ER visits, unplanned readmissions, and missed BPD appointments also did not vary significantly between the COI groups. CONCLUSION: Our study did not show any significant association between COI and duration of home oxygen use in infants with BPD. KEY POINTS: · COI not associated with duration of oxygen use.. · Uneven groups may have affected our results.. · Additional research in this area is needed..
Maternal, Obstetric, and Neonatal Characteristics Associated with Delayed Cord Clamping.
Zhao E, Valcarcel B, Shantz C … +5 more , Meiss LN, Xie S, Tackett S, Schwarz B, Rosner M
Am J Perinatol · 2025 Nov · PMID 41224235 · Publisher ↗
This study aimed to evaluate the factors associated with completed delayed cord clamping (DCC).We conducted a retrospective review of viable singleton deliveries at a single academic medical center from January 1, 2020 t...
This study aimed to evaluate the factors associated with completed delayed cord clamping (DCC).We conducted a retrospective review of viable singleton deliveries at a single academic medical center from January 1, 2020 to December 31, 2022. Demographics, obstetric variables, and neonatal data were extracted from the electronic medical record. Patients who received DCC were compared with those who did not. Multivariate logistic regression was used to assess factors associated with completion of 30 to 60 seconds of DCC, with a sub-analysis of preterm deliveries <30 weeks.DCC was completed in 5,018/5,889 (85.2%) eligible deliveries. Lower DCC rates were observed among non-Black, White, or Asian patients versus White patients (82.1 vs. 87.1%; adjusted odds ratio [aOR] = 0.60, 95% CI: 0.47-0.78) and in 2020 versus 2022 (83.6 vs. 86.5%; aOR = 0.74, 95% CI: 0.61-0.91). Patients who completed DCC had lower mean BMI (32.59 vs. 34.53, aOR = 0.99, 95% CI: 0.98-0.996), were less likely to be nulliparous (83.9 vs. 86.4%, aOR = 0.78, 95% CI: 0.66-0.92), less likely to have pregestational diabetes (72.8 vs. 86.1%, aOR = 0.63, 95% CI: 0.45-0.87), chorioamnionitis (72.9 vs. 85.6%, aOR = 0.51, 95% CI: 0.36-0.73), or postpartum hemorrhage (73.0 vs. 85.6%, aOR = 0.59, 95% CI: 0.41-0.86). Preterm (68.5 vs. 87.8%, aOR = 0.50, 95% CI: 0.40-0.63) and cesarean deliveries (77.2 vs. 90.0%, aOR = 0.72, 95% CI: 0.60-0.85), and infants requiring resuscitation (61.7 vs. 91.6%; aOR = 0.20, 95% CI: 0.17-0.23) were less likely to have completed DCC. Among preterm newborns <30 weeks, neonatal resuscitation was the only factor associated with not receiving DCC after adjustment.Race, delivery mode and year, maternal BMI, nulliparity, pregestational diabetes, chorioamnionitis, postpartum hemorrhage, preterm birth, and neonatal resuscitation were independently associated with completed DCC. Strategies to improve DCC execution should target preterm infants and address the challenges of performing DCC in neonates requiring urgent resuscitation. · Preterm births are less likely to receive DCC.. · Infants requiring newborn resuscitation are less likely to receive DCC.. · DCC rates increased after the implementation of an institutional DCC policy..
Umbilical Cord Blood Culture is Reliable for the Diagnosis and Management of Infants at Risk for Early-Onset Sepsis.
Murray EJ, Mattioli M, Rauscher D … +4 more , Pryzchowicz E, Winstanley M, Carola D, Aghai ZH
Am J Perinatol · 2026 Jul · PMID 41205589 · Publisher ↗
OBJECTIVE: This study aims to compare the diagnostic utility of umbilical cord blood culture (UCBC) versus neonatal blood culture (NBC) in the evaluation and management of early-onset neonatal sepsis (EONS) in late prete...
OBJECTIVE: This study aims to compare the diagnostic utility of umbilical cord blood culture (UCBC) versus neonatal blood culture (NBC) in the evaluation and management of early-onset neonatal sepsis (EONS) in late preterm and term infants and determine the contamination rate of UCBC. STUDY DESIGN: A retrospective analysis was conducted on late preterm and term neonates born between December 2020 and January 2025, who underwent EONS evaluation with UCBCs and NBCs. The study assessed detection rates of true-positive cultures, contamination rates (false positives), and incidence of culture-negative sepsis. RESULTS: A total of 336 infants had UCBCs performed, with 223 undergoing concomitant NBCs. Positive culture rates were similar: Four UCBCs (1.2%) and three NBCs (1.3%) were positive. UCBC had two contaminants (0.6%) while NBC had one (0.45%). One infant had both cultures positive for . No infants required prolonged antibiotics for culture-negative sepsis. CONCLUSION: The contamination rate of UCBC was extremely low in the cohort of infants at high risk for EONS. Our protocol and collection technique may serve as a model for others aiming to reduce contamination rates. While NBC can be positive despite a negative UCBC, and vice versa, obtaining both UCBC and NBC can improve the sensitivity of EONS diagnosis and help minimize prolonged antibiotic use in cases of culture-negative sepsis. UCBC demonstrated a low contamination rate and comparable diagnostic yield to NBC. UCBC may be considered a reliable alternative or adjunct to NBC in the evaluation and management of EONS. KEY POINTS: · UCBC and NBC together improve sepsis detection sensitivity.. · UCBC provides adequate volume for reliable neonatal cultures.. · UCBC offers a less invasive option for neonatal sepsis evaluation.. · Standardized UCBC technique reduces false-positive culture risk.. · UCBC shows low contamination in assessing early-onset sepsis..
Assessing a Longitudinal, Multi-Institutional, 3-Year Simulation-Based Boot Camp Curriculum for Neonatology Fellows: A Program Evaluation.
Trivedi S, Brennan G, Carlos C … +4 more , Marshall S, Linderer R, Hughes PD, Gupta A
Am J Perinatol · 2026 Jul · PMID 41202865 · Publisher ↗
OBJECTIVE: We describe and evaluate an innovative, longitudinal 3-year simulation-based boot camp curriculum designed to enhance neonatology fellows' cognitive, technical, and communication skills throughout their traini...
OBJECTIVE: We describe and evaluate an innovative, longitudinal 3-year simulation-based boot camp curriculum designed to enhance neonatology fellows' cognitive, technical, and communication skills throughout their training. STUDY DESIGN: The Midwest Neonatal Simulation Boot Camp (MNSBC) was developed by a multi-institutional executive committee composed of stakeholders from various Chicago-area neonatology programs. The curriculum was introduced in phases, starting with a first-year boot camp in 2019, followed by second- and third-year boot camps in subsequent years. Utilizing Kern's approach to curriculum development, the content and structure of each boot camp were designed to meet the learners' needs as they progressed through fellowship training. The evaluation of this curriculum consisted of pre- and postprogram surveys completed by participants. RESULTS: Since its inception, the MNSBC curriculum has trained 152 first-, 88 second-, and 57 third-year fellows from 12 programs across five Midwestern states. Participants demonstrated statistically significant improvements in self-assessed proficiency following each boot camp. Anonymous evaluations collected from fellow participants consistently highlighted enhanced clinical skills, knowledge, and confidence in managing low-frequency, high-stakes procedures and clinical scenarios. CONCLUSION: The MNSBC demonstrates that a longitudinal, multi-institutional, 3-year simulation-based curriculum is both feasible and effective in improving neonatology fellows' self-perceived proficiency in cognitive, technical, and communication skills. As pediatric residency and subspecialty fellowship training requirements evolve, the MNSBC offers a sustainable model to address educational gaps throughout fellowship training. KEY POINTS: · Longitudinal multi-center simulation boot camp.. · Educational experience for Neonatology fellows.. · Bridging educational gaps during fellowship.. · Resource pooling and allocation..
Young Birthing Age and Postpartum Outcomes.
Nandakumar T, Bader A, Brumley C … +5 more , Considine S, Wanberg L, Tessier KM, Larsen K, Jones CW
Am J Perinatol · 2026 Jul · PMID 41202864 · Publisher ↗
OBJECTIVE: Studies have identified increased perinatal risks for young birthing age (≤18 years), but less is known about postpartum outcomes. This study examines postpartum outcomes in a primiparous cohort of young birth...
OBJECTIVE: Studies have identified increased perinatal risks for young birthing age (≤18 years), but less is known about postpartum outcomes. This study examines postpartum outcomes in a primiparous cohort of young birthing patients as compared to a population aged 25 to 30 years. STUDY DESIGN: This retrospective cohort study compares postpartum outcomes in primiparous young birthing age patients ( = 520) compared to birthing patients 25 to 30 years ( = 558). Outcomes are presented as adjusted odds ratios (aOR) with 95% confidence intervals (CI). RESULTS: Primiparous young birthing patients were more likely to be prescribed contraception at hospital discharge (34.4 vs. 16.5%, aOR: 2.07, 95% CI: 1.49-2.89) than primiparous 25- to 30-year-old patients. They were also less likely to breastfeed at hospital discharge (78.4 vs. 97.1%, aOR: 0.09, 95% CI: 0.05-0.17). Additionally, young patients were significantly less likely to attend postpartum visits (39.4 vs. 47.1%, aOR: 0.69, 95% CI: 0.52-0.92), although less than half of participants overall attended a postpartum visit. Differences identified at hospital discharge persisted during postpartum care for contraceptive use (87.2 vs. 77.8%, aOR: 2.43, 95% CI: 1.35-4.51) and for breastfeeding (44.9 vs. 87.2%, aOR: 0.12, 95% CI: 0.07-0.2). There was also a trend toward decreased postpartum depression screening, with 59.5% of the young group screened, and 71.5% of the 25- to 30-year-old group screened. CONCLUSION: Young birthing age at the time of first birth is associated with lower breastfeeding rates and higher contraception use, compared to primiparous standard risk patients. Furthermore, young birthing patients appear to have a decreased rate of standardized screening for postpartum depression, although screening rates are low in both groups. These data may help tailor birthing and postpartum follow-up programs to better address specific risks for younger patients. KEY POINTS: · Postpartum outcomes differ with younger birthing age.. · Postpartum care is less likely with a younger birthing age.. · Depression screening is less frequent with younger birthing age..
Platelet Parameters as Biomarkers for Retinopathy of Prematurity in Preterm Infants Born before 30 Weeks of Gestation.
Maeda H, Iwasa H, Munakata M … +7 more , Hiruta S, Ichikawa H, Chishiki M, Sugano Y, Ogasawara K, Sekiryu T, Go H
Am J Perinatol · 2026 Jul · PMID 41202863 · Publisher ↗
OBJECTIVE: The aim of the study is to evaluate the association between platelet (PLT) parameters and the need for treatment of retinopathy of prematurity (ROP) in preterm infants. STUDY DESIGN: This single-center, retros...
OBJECTIVE: The aim of the study is to evaluate the association between platelet (PLT) parameters and the need for treatment of retinopathy of prematurity (ROP) in preterm infants. STUDY DESIGN: This single-center, retrospective cohort study was conducted at the Neonatal Intensive Care Unit of Fukushima Medical University Hospital between January 1, 2011, and December 31, 2023. The present study included preterm infants born before 30 weeks of gestation. Medical records were reviewed for 1,836 infants, of whom 187 met the inclusion criteria. Data on PLT parameters and ROP treatment were extracted from the medical records. Receiver operating characteristic analysis was used to determine cutoff values for PLT parameters associated with the need for ROP treatment. Multiple logistic regression analyses were performed to assess the association between ROP treatment and PLT parameters at birth and on day of life 28. RESULTS: Among the 187 infants included, 42.8% required treatment for ROP. After adjusting for confounders, an association was found between ROP treatment and plateletcrit (PCT) values < 0.23% (odds ratio [OR]: 3.44; 95% confidence interval [CI]: 1.37-8.63) and platelet mass index (PMI) values < 2,303.0 fL/nL (OR: 4.50; 95% CI: 1.77-11.41) at birth. CONCLUSION: Infants born before 30 weeks of gestation with PCT values < 0.23% and PMI values < 2,303.0 fL/nL at birth had an increased risk of developing ROP warranting treatment. KEY POINTS: · ROP is a leading cause of preventable blindness in preterm infants.. · There are no reliable early postnatal biomarkers that can predict ROP outcomes.. · We evaluated the association between PLT parameters and the ROP treatment in preterm infants.. · PCT < 0.23% and PMI < 2,303 fL/nL at birth were associated with a risk of requiring ROP treatment.. · PLT parameters may be useful in determining the ROP screening schedule and treatment for ROP..
In Honor of Menachem Miodovnik, MD, Who Devoted His Career to Improving Lives.
Crimmins SD, Huang AM, Reece EA
Am J Perinatol · 2025 Nov · PMID 41197613 · Publisher ↗
Abstract loading — click title to view on PubMed.
Postpartum Care Utilization among Medicaid-Insured Birthing People with an Infant Hospitalized in the NICU.
Ondusko DS, Mazziotti J, Martinez Acevedo A … +2 more , Daly A, Rodriguez MI
Am J Perinatol · 2026 Jul · PMID 41187764 · Publisher ↗
OBJECTIVE: This study aimed to determine the association of neonatal intensive care unit (NICU) admission with subsequent postpartum care among Medicaid recipients. STUDY DESIGN: Retrospective cohort study using linked M...
OBJECTIVE: This study aimed to determine the association of neonatal intensive care unit (NICU) admission with subsequent postpartum care among Medicaid recipients. STUDY DESIGN: Retrospective cohort study using linked Medicaid claims and birth certificate data from Oregon and South Carolina, 2010 to 2020. Outcomes were postpartum care attendance, contraception, emergency department (ED) utilization, and readmission. Linear regression models evaluated the association between NICU admission and postpartum care. RESULTS: Our sample included 457,102 birthing people, 37,035 (8.1%) of which had a NICU-admitted infant. Medicaid recipients with NICU-admitted infants had higher rates of cesarean section, pregnancy complications, postpartum mental health conditions, and substance use. No significant differences in postpartum care attendance were noted, but NICU admission was associated with 6% greater ED use (95% CI: 0.052, 0.068, < 0.001) and 3% higher readmission (95% CI: 0.026, 0.034, < 0.001). CONCLUSION: Postpartum care receipt was similar, but ED and readmission rates are higher among those with NICU-admitted infants. Preventative postpartum care approaches must improve for at-risk populations. KEY POINTS: · Medicaid recipients have similar routine postpartum care attendance regardless of NICU admission.. · Postpartum patients with a NICU-admitted infant have greater ED utilization.. · Postpartum patients with a NICU-admitted infant have higher readmission rates..
Postpartum Presentation of a Variant of Uncertain Significance in COL3A1: A Case Report.
Khamissi FZ, Bachur C, Palatnik A … +3 more , Russo M, Shanahan MA, Polnaszek BE
Am J Perinatol · 2026 May · PMID 41173024 · Publisher ↗
OBJECTIVE: Vascular Ehlers-Danlos syndrome (vEDS) is a rare inherited connective tissue disorder associated with significant maternal morbidity and mortality during pregnancy. Conflicting recommendations exist for manage...
OBJECTIVE: Vascular Ehlers-Danlos syndrome (vEDS) is a rare inherited connective tissue disorder associated with significant maternal morbidity and mortality during pregnancy. Conflicting recommendations exist for management, particularly in patients with variant of uncertain significance (VUS). STUDY DESIGN: We present a 39-year-old G2P1011 with a strong family history suggestive of vEDS who experienced an uncomplicated vaginal delivery followed by a large retroperitoneal hematoma requiring interventional radiology embolization and intensive care management for a postprocedural femoral pseudoaneurysm. RESULTS: Postpartum genetic testing revealed a heterozygous VUS in (c.1297G>A [p.Glu433Lys]). CONCLUSION: This case illustrates the challenges of counseling and managing pregnancy in patients with suspected vEDS and VUS, highlighting the importance of risk mitigation strategies, multidisciplinary care, and nuanced interpretation of genetic results. KEY POINTS: · Risk stratification imaging: Whole-body vascular imaging beyond echocardiography may identify silent arterial lesions.. · Variant reclassification: Reporting pregnancy phenotypes linked to VUS in databases (ClinVar, LOVD) can accelerate variant reclassification and improve counseling.. · Structured counseling for uncertainty: Use a systematic approach when counseling patients with both a suspicious phenotype and a VUS, incorporating multidisciplinary perspectives and clearly communicating knowns and unknowns..
Expanding the "Physiological Sequence" after Birth.
Mileder LP
Am J Perinatol · 2026 Jul · PMID 41173023 · Publisher ↗
Abstract loading — click title to view on PubMed.
Impact of Maternal Aspirin Therapy on Neonatal Epigenetic Patterns.
Varotsis D, Betal SGN, Addya S … +2 more , Aghai ZH, Boelig RC
Am J Perinatol · 2026 Jul · PMID 41167500 · Publisher ↗
BACKGROUND: Low-dose aspirin (LDA) is an intervention recommended to prevent the development of hypertensive disorders of pregnancy (HDP) in high-risk pregnancies. Maternal conditions such as HDP have been associated wit...
BACKGROUND: Low-dose aspirin (LDA) is an intervention recommended to prevent the development of hypertensive disorders of pregnancy (HDP) in high-risk pregnancies. Maternal conditions such as HDP have been associated with cord blood epigenetic changes including those related to cardiovascular processes; however, it is unclear whether maternal aspirin therapy may impact neonatal epigenetics in otherwise healthy high-risk pregnancy. OBJECTIVE: This study aimed to determine if maternal LDA exposure leads to altered DNA methylation in umbilical cord blood cells in term neonates compared with controls not exposed to aspirin, and to identify if these methylation changes alter key pathways in the development of chronic disease. METHODS: Umbilical cord blood was collected from 10 neonates without LDA exposure and 13 neonates with LDA exposure . Patients with hypertensive disorders of pregnancy, COVID-19, and chorioamnionitis were excluded. Genomic DNA was isolated from umbilical cord blood cells and genome-wide DNA methylation was performed using Illumina Methylation EPIC assay. RESULTS: A total of 155 differentially methylated loci (81 genes were hypermethylated and 74 were hypomethylated) were identified in LDA-exposed neonatal umbilical cord blood compared with the control group. Important canonical pathways identified by Ingenuity Pathway Analysis (IPA) were related to Th1 and Th2 signaling and classical (M1) macrophage activation. The genes affected by LDA exposure were associated with cardiac and renal systems. CONCLUSION: LDA exposure led to differential DNA methylation in umbilical cord blood. The differentially methylated genes were related to inflammatory pathways as well as cardiac and renal toxicity pathways. LDA exposure may promote altered health programming in the neonate in areas impacting cardiovascular health. KEY POINTS: · Maternal aspirin exposure is associated with differential DNA methylation in cord blood.. · Cord blood epigenetic changes associated with maternal aspirin relate to anti-inflammatory pathways.. · Research on potential protective impact of maternal aspirin on neonatal epigenetics is warranted..
Rural Residence and Adverse Pregnancy Outcomes in the United States: Epidemiologic Insights and Perspectives.
Appiah D, Souza R, Hinojosa N … +3 more , Ogbuagu B, Sawam M, Oladeji OE
Am J Perinatol · 2026 May · PMID 41151770 · Publisher ↗
Adverse pregnancy outcomes (APOs) such as hypertensive disorders of pregnancy, gestational diabetes, preterm birth, restricted intrauterine growth, and intrauterine fetal demise are often associated with pregnancy-relate...
Adverse pregnancy outcomes (APOs) such as hypertensive disorders of pregnancy, gestational diabetes, preterm birth, restricted intrauterine growth, and intrauterine fetal demise are often associated with pregnancy-related mortality and maternal mortality. Furthermore, APOs complicate the care of pregnant women, leading to worse short- and long-term outcomes, especially for women from underserved areas. However, the occurrence of APOs has received considerably less attention in rural areas, which are often socioeconomically disadvantaged and are burdened by significant health disparities. This review article provides epidemiologic insights into the distribution and potential determinants of APOs among women living in rural communities in the United States. Additionally, it addresses intrinsic and extrinsic factors pertaining to biology, social factors, and environmental factors that potentially influence the incidence of APOs in rural areas. Finally, the success of interventions implemented to improve access to health care to reduce APOs, perspectives, and challenges posed by APOs among women living in rural areas are also discussed. · APOs lead to substantial morbidity and mortality.. · Several APOs are less studied in rural populations.. · Rural areas often have significant health disparities that influence pregnancy outcomes.. · More epidemiological studies of APOs in rural areas are needed..
The Impact of Standardized Respiratory Care Practices on Delivery Room Intubation Frequency and NICU Ventilator Days in VLBW Infants: A Quality Improvement Initiative.
Thakore P, Ford B, Rancourt J … +9 more , Codrington L, Herr J, Trenbeath J, Lietz A, Low S, Motta S, Tucker L, Johnson K, Golioto A
Am J Perinatol · 2026 Apr · PMID 41145123 · Publisher ↗
Chronic lung disease (CLD) is a common morbidity affecting very low birth weight (VLBW) infants, and exposure to mechanical ventilation in this population is a well-known risk factor. Our 2018 Vermont Oxford Network outc...
Chronic lung disease (CLD) is a common morbidity affecting very low birth weight (VLBW) infants, and exposure to mechanical ventilation in this population is a well-known risk factor. Our 2018 Vermont Oxford Network outcome report demonstrated an increase in the incidence of CLD from 2017 (15%) to 2018 (30.9%).In response, we convened a multidisciplinary team to review our practices. Starting with baseline data on our delivery room (DR) and initial ventilation practices, we developed a key driver diagram to guide change ideas. We implemented sequential interventions using Plan-Do-Study-Act (PDSA) cycles.From January 2017 through January 2022, 390 infants with birthweights < 1,500 g were admitted to our level IV NICU. Special cause variation was observed in our two-outcome metrics: percent of inborn VLBW infants intubated in the DR, lowering the center line from 44 to 18% and lowering the center line from 19 to 12 total ventilation days per 100 patient days in this same population.Implementing standardized respiratory care practices resulted in significantly decreasing DR intubation rates and total ventilation days in this vulnerable population. · Employing protective lung strategies in VLBW infants is effective in limiting lung injury and preventing the development of chronic lung disease.. · Implementation of a resuscitation bundle can improve standard processes in the delivery room.. · Prophylactic surfactant replacement continues to be practiced in neonatal units..
Implementation of an Outpatient Cervical Ripening Initiative: Outcomes and Patient and Provider Perspectives.
Zhu KH, Gilani S, Suresh SC … +2 more , Adams M, Hirsch E
Am J Perinatol · 2026 Jul · PMID 41135588 · Publisher ↗
OBJECTIVE: This study aimed to examine implementation and patient/provider acceptance of an outpatient mechanical cervical ripening program for labor induction with the goal of reducing length of stay in labor and delive...
OBJECTIVE: This study aimed to examine implementation and patient/provider acceptance of an outpatient mechanical cervical ripening program for labor induction with the goal of reducing length of stay in labor and delivery (L&D) unit. STUDY DESIGN: Initially, outpatient cervical ripening was "available," and later (due to low utilization) "mandatory" for eligible patients who were induced Monday through Friday, with weekend induction available for those declining outpatient ripening. Single-balloon catheters were used, with supplemental vaginal misoprostol for inpatients. Utilization was compared for two 3-month periods (pre- and post-mandatory phases). Patient and provider surveys queried perceived benefits, risks, barriers, pain, likelihood to recommend, and satisfaction. Outcomes (length of stay in L&D, delivery mode, chorioamnionitis, hemorrhage, and NICU admission) were compared between the inpatient and outpatient groups. RESULTS: Outpatient ripening among eligible patients increased from 13.5 to 55.1% after becoming mandatory ( < 0.01), with 71.4% of patients undergoing either outpatient ripening or induction over the weekend. Staff satisfaction was high, with 91.7% "somewhat" to "very likely" to recommend outpatient ripening. Perceived benefits included decreased time in L&D. Barriers included office workflow and provider comfort with placement. Patient satisfaction and pain scores did not differ by balloon placement location. Among patients eligible for outpatient ripening ( = 224), there was no difference in length of stay in L&D (22.1 hours outpatient versus 24.2 inpatient, = 0.19). However, among all patients undergoing mechanical ripening ( = 397, a measure of the initiative's impact on L&D congestion), outpatient ripening length of stay was shorter by 4 hours (22.1 versus 26.1 hours, = 0.01). Delivery outcomes were similar between groups. CONCLUSION: Outpatient cervical ripening utilization was minimal until it became mandatory. Providers were overall satisfied. Balloon placement location did not affect patient satisfaction. Among patients undergoing mechanical ripening, those receiving an outpatient balloon had a 4-hour decreased L&D length of stay. There were no differences in delivery outcomes. KEY POINTS: · We studied adoption of outpatient cervical ripening.. · A mandatory program was required for adoption.. · Staff were satisfied with the program.. · Ripening location did not affect patient satisfaction.. · L&D time decreased without affecting outcomes..
Fetal Heart Rate Tracings and Adverse Outcomes among Term Small versus Appropriate for Gestational Age.
Patel S, Cagino KA, Roberts AW … +5 more , Wiley RL, Cortes C, Zullo F, Mendez-Figueroa H, Chauhan SP
Am J Perinatol · 2026 Jul · PMID 41135587 · Publisher ↗
OBJECTIVE: This study aimed to compare the patterns of fetal heart rate tracings (FHRTs), and outcomes among individuals with small (birth weight [BW] <10% for gestational age [GA]; SGA) versus appropriate (BW at 10-89%...
OBJECTIVE: This study aimed to compare the patterns of fetal heart rate tracings (FHRTs), and outcomes among individuals with small (birth weight [BW] <10% for gestational age [GA]; SGA) versus appropriate (BW at 10-89% for GA; AGA) newborns at term (≥37.0 weeks). STUDY DESIGN: Our retrospective cohort study included consecutive deliveries over 15 months at a level IV center. FHRTs were reviewed by obstetricians blinded to maternal and neonatal outcomes. The inclusion criteria were non-anomalous singletons, cataloged as SGA or AGA birth weight using Alexander et al's nomogram. In 20-minute segments, the last 120 minutes of tracing were characterized. Rates of cesarean delivery (CD) and composite neonatal adverse outcomes (CNAOs) were compared. RESULTS: Of 5,160 deliveries, 3,029 (58.7%) met the inclusion criteria, and among them, 422 (13.9%) were SGA and 2,607 (86.1%) AGA. There were no differences in FHRT baseline, variability, or accelerations. Compared to AGA, SGA was more likely to have prolonged decelerations (11.8 vs. 8.4%, = 0.021), and recurrent decelerations with ≥50% of contractions (21.3 vs. 16.5%, = 0.014). Overall, the presence of category II FHRT or not was similar between the SGA (91.2%) and AGA (88.5%; = 0.097). Persistent category II FHRT was significantly more common among SGA (37.4%) than AGA (28.1%; aOR = 1.47; 95% CI: 1.47-1.82) newborns. The rate of CD for non-reassuring FHRT was similar among the two groups. CNAO occurred in 1.4% in both SGA and AGA neonates ( = 0.95). CONCLUSION: In our cohort of those with fetal monitoring prior to delivery at ≥37 weeks, persistent category II FHRT at the end of labor was significantly more common in SGA compared to AGA neonates; however, composite neonatal morbidity did not differ between the two groups. Our analysis provides data for shared decision-making that among SGA newborns, abnormalities of FHRT are not linked with adverse outcomes. KEY POINTS: · There were no differences in FHRT baseline, variability, or accelerations between AGA and SGA.. · SGA was more likely to have prolonged decelerations and recurrent decelerations with ≥50% of contractions.. · Persistent category II FHRT before delivery is significantly more common with SGA than AGA.. · FHRT abnormalities, however, were not associated with CD for non-reassuring FHRT, or adverse outcomes..
Induction of Labor at 40 Weeks of Gestation after Dissemination of the ARRIVE Trial.
Freret TS, Kaimal AJ, Melamed A … +1 more , Clapp MA
Am J Perinatol · 2026 May · PMID 41106401 · Publisher ↗
OBJECTIVE: The ARRIVE trial showed that induction of labor in low-risk nulliparous individuals at 39 weeks reduced cesarean delivery. We sought to determine whether publication of the ARRIVE trial was associated with cha...
OBJECTIVE: The ARRIVE trial showed that induction of labor in low-risk nulliparous individuals at 39 weeks reduced cesarean delivery. We sought to determine whether publication of the ARRIVE trial was associated with changes in the rate of induction of labor at 40 weeks, and if so, whether similar changes were seen in the rate of cesarean delivery. STUDY DESIGN: This was a repeated cross-sectional analysis using US natality data from February 2017 to August 2019. Low-risk nulliparous individuals delivering a non-anomalous, cephalic, singleton infant were included; exclusion criteria included hypertension, diabetes, or small-for-gestational age infant. The primary outcome was induction of labor at 40 weeks. Secondary outcomes included cesarean delivery and a composite of adverse neonatal outcomes. A population-level interrupted time series analysis was performed. The pre-period ran from February 2017 to January 2018, the dissemination period from February to August 2018, and the post-period from September 2018 to August 2019. RESULTS: The study included 843,133 individuals (339,978 in the pre-period; 190,479 in the dissemination or washout period; 312,676 in the post-period). The rate of induction of labor at 40 weeks increased from a predicted rate of 18.7% to an observed rate of 20.2% (IRR, 1.08, 95% CI: 1.05-1.12) in the post-period. The rate of cesarean delivery and adverse neonatal outcomes in the cohort did not change at the start of the post-period (cesarean delivery: 25.3% predicted vs. 25.2% observed, IRR, 1.00, 95% CI: 0.96-1.03; adverse neonatal outcome: 5.3% predicted vs. 5.0% observed, IRR, 0.95, 95% CI: 0.87-1.02). CONCLUSION: Dissemination of the ARRIVE trial was associated with an increase in the rate of induction at 40 weeks among patients who remained pregnant after 39 weeks. However, there was no population-level decrease in cesarean delivery, suggesting that the benefits of induction of labor may not extrapolate to this cohort. KEY POINTS: · The ARRIVE trial increased low-risk induction of labor at 40 weeks of gestation.. · Increasing 40-week induction rates did not correspond to lower rates of cesarean delivery.. · Offering induction at 40 weeks is reasonable given no associated increase in adverse outcomes..
About
- Frequency
- Sun
- Papers found
- 200
- RSS feed
- Subscribe