Fetal Mortality: United States, 2022.

Objectives: This report presents 2022 fetal mortality data by maternal race and Hispanic origin, age, tobacco use during pregnancy, and state of residence, as well as by plurality, sex, gestational age, birthweight, and selected causes of death. Trends in fetal mortality are also examined. Methods: Descriptive tabulations of data are presented and interpreted for all fetal deaths reported for the United States for 2022 with a stated or presumed period of gestation of 20 weeks or more. Cause-of-fetal-death data only are restricted to residents of the 43 states and District of Columbia where cause of death was based on the 2003 fetal death report revision and less than 50% of deaths were attributed to Fetal death of unspecified cause (P95). Results: A total of 20,202 fetal deaths at 20 weeks of gestation or more were reported in the United States in 2022. The 2022 U.S. fetal mortality rate was 5.48 fetal deaths at 20 weeks of gestation or more per 1,000 live births and fetal deaths, 4% lower than in 2021 (5.73) and a new historic low for the United States. The fetal mortality rate in 2022 for deaths occurring at 20-27 weeks of gestation was 2.79, a 5% decline from 2021 (2.95). For deaths occurring at 28 weeks of gestation or more, the rate in 2022 was 2.71, a 3% decline from 2021 (2.80). In 2022, the fetal mortality rate was highest for Native Hawaiian or Other Pacific Islander non-Hispanic (10.36) and Black non-Hispanic (10.05) females and lowest for Asian non-Hispanic females (3.70). Fetal mortality rates were highest for women ages 40 and older, for women who smoked during pregnancy, and for women with multiple gestation pregnancies. Five selected causes accounted for 90.0% of fetal deaths in the 43-state and District of Columbia reporting area.

Trends and Characteristics in Prepregnancy Diabetes: United States, 2016-2021.

Objectives-This report presents data on trends for prepregnancy diabetes mellitus (PDM), diabetes diagnosed before pregnancy, in mothers giving birth in the United States for 2016-2021, and rates by selected maternal characteristics for 2016 and 2021.

Fetal Mortality: United States, 2021.

Objectives-This report presents 2021 fetal mortality data by maternal race and Hispanic origin, age, tobacco use during pregnancy, and state of residence, as well as by plurality, sex, gestational age, birthweight, and selected causes of death. Trends in fetal mortality are also examined. Methods-Descriptive tabulations of data are presented and interpreted for all fetal deaths reported for the United States for 2021 with a stated or presumed period of gestation of 20 weeks or more. Cause-of-fetal-death data are restricted to residents of the 41 states and the District of Columbia, where cause of death was based on the 2003 fetal death report revision and less than 50% of deaths were attributed to Fetal death of unspecified cause (P95). Results-A total of 21,105 fetal deaths at 20 weeks of gestation or more were reported in the United States in 2021. The 2021 U.S. fetal mortality rate was 5.73 fetal deaths at 20 weeks of gestation or more per 1,000 live births and fetal deaths, which was essentially unchanged from the rate of 5.74 in 2020. The fetal mortality rate in 2021 for deaths occurring at 20-27 weeks of gestation was 2.95, essentially unchanged from 2020 (2.97). For deaths occurring at 28 weeks of gestation or more, the rate in 2021 (2.80) was not significantly different from 2020 (2.78). In 2021, the fetal mortality rate ranged from 3.94 for non-Hispanic, single-race Asian women to 9.89 for non-Hispanic, single-race Black women. Fetal mortality rates were highest for females under age 15 and aged 40 and over, for women who smoked during pregnancy, and for women with multiple gestation pregnancies. Five selected causes accounted for 89.9% of fetal deaths in the 41-state and District of Columbia reporting area.

Trends and Characteristics in Gestational Diabetes: United States, 2016-2020.

Objectives-This report presents data on trends for gestational diabetes mellitus (GDM) among women giving birth in the United States from 2016 through 2020, and rates by selected maternal and newborn characteristics for 2016, 2019, and 2020.

Cause-of-death Data From the Fetal Death File,2018-2020.

Objectives-This report presents data on fetal cause of death by maternal age, maternal race and Hispanic origin, fetal sex, period of gestation, birthweight, and plurality.

Fetal Mortality: United States, 2020.

Objectives-This report presents 2020 fetal mortality data by maternal race and Hispanic origin, age, tobacco use during pregnancy, and state of residence, as well as by plurality, sex, gestational age, birthweight, and selected causes of death. Trends in fetal mortality are also examined.

Changes in Home Births by Race and Hispanic Origin and State of Residence of Mother:United States, 2019-2020 and 2020- 2021.

Objectives-This report describes changes between 2020 and 2021 in the percentage of home births by month, race and Hispanic origin, and state of residence of the mother, and makes comparisons with changes occurring between 2019 and 2020.

Prepregnancy Body Mass Index and Infant Outcomes by Race and Hispanic Origin: United States, 2020.

Objectives-This report presents data on distributions in prepregnancy body mass index (BMI), including the three classes of obesity, by maternal race and Hispanic origin for women who gave birth in 2020. It also examines newborn outcomes by BMI by maternal race and Hispanic origin.

Changes in Home Births by Race and Hispanic Origin and State of Residence of Mother: United States, 2018-2019 and 2019-2020.

Objectives-This report describes changes between 2019 and 2020 in the percentage of U.S. home births by month, race and Hispanic origin, and state of residence of the mother and makes comparisons with changes occurring between 2018 and 2019.

Fetal Mortality: United States, 2019.

Objectives-This report presents 2019 fetal mortality data by maternal race and Hispanic origin, age, tobacco use during pregnancy, and state of residence, as well as by plurality, sex, gestational age, birthweight, and selected causes of death. Trends in fetal mortality are also examined.

Trends and Characteristics of Sexually Transmitted Infections During Pregnancy: United States, 2016-2018.

Objectives-This report presents data on recent trends for three sexually transmitted infections (STIs)-chlamydia, gonorrhea, and syphilis-reported among women giving birth in the United States from 2016 through 2018, and rates by selected characteristics for 2018. Methods-Data are from birth certificates and are based on 100% of births registered in the United States for 2016, 2017, and 2018. Birth certificate data on infections during pregnancy are recommended to be collected from the mother's medical records (1). Mothers are to be reported as having an infection if there is a confirmed diagnosis or documented treatment for the infection in their medical record (2). Results-Among women giving birth in 2018, the overall rates of chlamydia, gonorrhea, and syphilis were 1,843.9, 310.2, and 116.7 per 100,000 births, respectively. The rates for these STIs increased 2% (chlamydia), 16% (gonorrhea), and 34% (syphilis) from 2016 through 2018. In 2018, rates of chlamydia and gonorrhea decreased with advancing maternal age, whereas those for syphilis decreased with maternal age through 30-34 years and then increased for women aged 35 and over. In 2018, rates of all three STIs were highest for non-Hispanic black women, women who smoked during pregnancy, women who received late or no prenatal care, and women for whom Medicaid was the principal source of payment for the delivery. Among women aged 25 and over, rates of each of the STIs decreased with increasing maternal education.

Cause-of-death Data From the Fetal Death File, 2015-2017.

Objectives-This report presents data on fetal cause of death by maternal age, maternal race and Hispanic origin, fetal sex, period of gestation, birthweight, and plurality. Methods-Descriptive tabulations of data collected on the 2003 U.S. Standard Report of Fetal Death are presented for fetal deaths occurring at 20 weeks of gestation or more for 2015-2017 in a reporting area of 34 states and the District of Columbia, in which less than 50% of deaths were attributed to Fetal death of unspecified cause (P95). Cause-of-death reporting in this area was based on the 2003 fetal death report revision and represents 60% of fetal deaths occurring in the United States during this time. Causes of death are processed in accordance with the International Classification of Diseases, 10th Revision. Results-Five selected causes account for 89.5% of fetal deaths in the reporting area: Fetal death of unspecified cause; Fetus affected by complications of placenta, cord and membranes; Fetus affected by maternal complications of pregnancy; Congenital malformations, deformations and chromosomal abnormalities; and Fetus affected by maternal conditions that may be unrelated to present pregnancy. Conclusions-Cause-of-fetal-death data reported on vital records enable new comparisons of maternal and fetal characteristics and provide information for a larger proportion of the country than other studies. While limited variation was seen among the selected causes across the maternal and fetal characteristics examined, many of the observed variations are consistent with associations that have been documented in the research literature.

Infant Mortality by Maternal Prepregnancy Body Mass Index: United States, 2017-2018.

Objective-This report presents 2017-2018 infant mortality rates in the United States by maternal prepregnancy body mass index, and by infant age at death, maternal age, and maternal race and Hispanic origin. Methods-Descriptive tabulations of infant deaths by maternal and infant characteristics are presented using the 2017-2018 linked period birth/infant death files; the linked period birth/infant death file is based on birth and death certificates registered in all states and the District of Columbia. The 2017 linked birth/infant death file is the first year that national data on maternal prepregnancy body mass index were available. Results-Total infant, neonatal, and postneonatal mortality rates were lowest for infants of women who were normal weight prepregnancy, and then rose with increasing prepregnancy body mass index. Total, neonatal, and postneonatal rates were higher for infants of women who were underweight prepregnancy compared with infants of women who were normal or overweight before pregnancy. Mortality rates for infants of underweight women were generally, but not exclusively, lower than those of infants born to women with obesity. Infants born to women of normal weight generally had lower mortality rates than infants born to women who had obesity prepregnancy for all maternal age and race and Hispanic-origin groups.

Repetitive Transcranial Magnetic Stimulation Shows Longitudinal Improvements in Memory in Patients With Treatment-Resistant Depression.

BACKGROUND: Cognitive dysfunction (CD) is a commonly reported symptom of major depressive disorder (MDD). Patients with treatment-resistant depression (TRD) tend to experience greater rates of CD; however, treatment options are limited. Repetitive transcranial magnetic stimulation (rTMS) is effective in treating affective symptoms in patients with TRD, but its potential effect on CD in TRD has not been established. OBJECTIVES: This study sought to establish the potential cognitive benefits of rTMS in patients with TRD. MATERIALS AND METHODS: This study used data from a noninferiority clinical trial investigating two excitatory rTMS protocols to the left dorsolateral prefrontal cortex in unipolar outpatients with TRD. Cognitive testing was performed at baseline and three months posttreatment in 47 patients and a demographically matched cohort of 22 healthy volunteers. Changes in cognitive performance from baseline to posttreatment were assessed using repeated-measures analysis of variance, using both normative and individualized cognitive scoring methods. RESULTS: Patients with baseline neurocognitive dysfunction showed significant changes in verbal memory at three months posttreatment when using individualized cognitive scoring. Furthermore, improvement in verbal memory within this subset was associated with improvements in affective symptoms. LIMITATIONS: This analysis was performed on a relatively small sample of patients with TRD who were not prescreened for CD and did not include a clinical comparator group. CONCLUSIONS: rTMS may be associated with improvements in verbal memory in patients with TRD who present with global CD and who are clinical responders to the treatment. These findings warrant replication in a larger sample as well as further investigations into the neural mechanisms of cognitive improvement after rTMS.

Assessing the Quality of Medical and Health Data From the 2003 Birth Certificate Revision: Results From New York City.

Objectives-A primary goal of the 2003 revision of the U.S. Standard Certificate of Live Birth was to improve data quality.This report evaluates the quality of selected 2003 revision-based medical and health data by comparing birth certificate data for New York City with information abstracted from hospital medical records.Methods-A random sample of records for 900 births occurring in New York City in 2013 was reviewed. Birth certificate and hospital medical records data were compared for these categories: pregnancy history, prenatal care, gestational age, birthweight, pregnancy risk factors, source of payment, characteristics of labor and delivery, fetal presentation, method of delivery, abnormal conditions of the newborn, infant living, and infant breastfed. Levels of missing data, exact agreement, kappa scores, sensitivity, and false discovery rates are presented where applicable. Results-Exact agreement or sensitivity between birth certificate and medical record data was high (90.0% or greater) for a number of items (e.g., number of previous cesarean deliveries, cephalic presentation, cesarean delivery, vaginal/spontaneous delivery, obstetric estimate of gestation [within 2 weeks], Medicaid as source of payment for the delivery, birthweight [within 500 grams]), but extremely low (less than 40.0%) for several items (e.g., gestational hypertension, previous preterm birth, augmentation of labor, assisted ventilation, maternal transfusion). Levels of agreement or sensitivity for several items (e.g., obstetric estimate of gestation at delivery [exact number of weeks], previous cesarean delivery, private insurance as the source of payment for delivery, and total number of prenatal care visits [within two visits]), were substantial (between 75.0% and 89.9%) or moderate (between 60.0% and 74.9%). Data quality often varied by hospital.

Emotional gist: the rapid perception of facial expressions.

While it has been established that expression perception is rapid, it is unclear whether early appraisal mechanisms invoke holistic perception. In the current study, we defined gist perception as the appraisal of a stimulus within a single glance (<125 ms). We employed the expression composite task used previously by Tanaka and colleagues in a 2012 study, with several critical modifications: (i) we developed stimuli that eliminated contrast artifacts, (ii) we employed a masking technique to abolish low-level cues, and (iii) all the face stimuli were composite stimuli compared to mix of natural and composite stimuli previously used. Participants were shown a congruent (e.g. top: angry/ bottom: angry) or incongruent (e.g. top: angry/ bottom: happy) expression for 17, 50 or 250 ms and instructed to selectively attend to the cued expression depicted in the top (or bottom) half of the composite face and ignore the uncued portion. Compared to the isolated condition, a facilitation effect was found for congruent angry expressions, as well as an interference effect for incongruent happy and angry expressions at the shortest exposure duration of 17. Together these results provide evidence that the holistic gist perception of expression cannot be overridden by selective attention.

U.S. stillbirth surveillance: The national fetal death file and other data sources.

The National Vital Statistics System is the primary source of information on fetal deaths of 20 weeks of gestation or more in the United States. Data are cooperatively produced by jurisdiction vital statistics offices and the National Center for Health Statistics. In order to promote the uniformity of data, the National Center for Health Statistics issues The Model State Vital Statistics Act and Regulations, and produces standard certificates and reports, developed in collaboration with the states, to inform the development of jurisdictional vital records laws and regulations and data collection. While there are challenges in collecting national fetal death data, there are ongoing data quality improvement efforts to address them. Improved national fetal death data and data from other sources will continue to add insights into the risks, causes and prevention of fetal death.

Clinical examination findings and electrolyte abnormalities of dogs with marijuana/tetrahydrocannabinol toxicity: 223 cases (January 2017-July 2021).

OBJECTIVE: The goal of this study was to describe the historical, physical, neurologic, and clinicopathologic findings in dogs with a definitive diagnosis of marijuana/tetrahydrocannabinol toxicity. ANIMALS: A total of 223 dogs with known ingestion of marijuana or a positive tetrahydrocannabinol result on human urine multidrug test. METHODS: Retrospective study from January 2017 to July 2021. RESULTS: Median age was 1 year (1 month to 12 years). A common history was becoming acutely neurologic after going outside or to a public place (62/223 [27.8%]). Most owners denied possibility of exposure (152/223 [68%]). Median vitals were normal, but hyperthermia (38/212 [22.6%]), tachycardia (82/222 [37%]), and systemic hypertension (37/61 [60.7%]) were common abnormalities. The most common clinical signs included ataxia (197/223 [88.3%]), hyperesthesia (168/223 [75.3%]), urinary incontinence (102/223 [45.7%]), lethargy (140/223 [62.5%]), and vomiting (58/223 [26%]). The most common combinations of neurologic signs included ataxia and hyperesthesia (157/223 [70.4%]) and ataxia, hyperesthesia, and urinary incontinence (81/223 [36.3%]). Mild hyperkalemia (39/76 [51.3%]) and mild hypercalcemia (53/67 [79.1%]) were common. Twenty-two dogs were hospitalized. Survival was 100%. CLINICAL RELEVANCE: A common presentation for marijuana toxicosis included young dogs with acute ataxia and hyperesthesia, with and without urinary incontinence, after going outside or to a public place. Vitals were often normal, but hyperthermia, tachycardia, and hypertension were common. Bloodwork was mostly normal, but mild hyperkalemia and mild ionized hypercalcemia were common. Marijuana should be high on the differential list with these history, physical examination, neurologic, and electrolyte abnormalities, regardless of owner denial or negative human urine multidrug test.

Trends and Characteristics in Maternal Syphilis Rates During Pregnancy: United States, 2016-2022.

After reaching historic lows in 2000 and 2001, rates of primary and secondary syphilis in the overall U.S. population have increased nearly every year through 2022 (1). For 2017-2022, rates of syphilis for women of reproductive age and congenital syphilis (a disease that occurs when a mother with syphilis passes the infection on to her baby during pregnancy) increased by more than 250% (1,2). Congenital syphilis can cause adverse pregnancy outcomes such as fetal and neonatal death, low birthweight, preterm birth, and brain and nerve disorders (2). This report presents trends in maternal syphilis rates in women giving birth in the United States for 2016-2022 by selected maternal demographic and health factors.

Trajectories of suicidal ideation during rTMS for treatment-resistant depression.

BACKGROUND: rTMS is a safe and effective intervention for treatment-resistant depression (TRD). However, there is limited data on its specific impact on suicidal ideation (SI), and the trajectory of SI over the treatment course. OBJECTIVE: This open-label clinical trial investigated SI outcomes and trajectories in patients with TRD receiving low-frequency rTMS (LFR) to the right dorsolateral prefrontal cortex (DLPFC; N = 55). METHODS: A latent class mixed-effect model was used to identify response trajectories for SI as well as core mood symptoms. Logistic regression analyses investigated risk factors associated with identified trajectories. RESULTS: For each symptom domain, we identified two distinct trajectories during LFR, one tracking improvement (SI: n = 35, 60 %; mood: n = 29, 53 %) and the other tracking no improvement (SI: n = 20, 40 %; mood: n = 26, 47 %). Male sex, higher baseline anxiety, and higher baseline SI were risk factors for no improvement of SI; while higher baseline anxiety and benzodiazepine use were risk factors for no improvement of mood. Mediation analyses showed that anxiety was a risk factor for no improvement of SI and mood independent of benzodiazepine treatment. CONCLUSIONS: This is the first study to investigate trajectories of response to LFR to the right DLPFC. SI and mood improved with LFR in most patients but the severity of anxiety symptoms was a factor of poor prognosis for both. Nuanced characterization of SI response to rTMS may lead to critical insights for individualized targeting strategies.