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.

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.

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.

Perinatal Mortality in the United States, 2020-2021.

Perinatal mortality(late fetal deaths at 28 completed weeks of gestation or more and early neonatal deaths younger than age 7 days) can be an indicator of the quality of health care before, during, and after delivery, and of the health status of the nation (1,2). The U.S. perinatal mortality rate declined 30% from 1990 through 2011, was stable from 2011 through 2016, and declined 4% from 2017 through 2019 (1,3-5). This report describes changes in perinatal mortality, as well as its components, late fetal and early neonatal mortality, from 2020 to 2021, during the COVID-19 pandemic. Also shown are perinatal mortality rates by mother's age, the three largest race and Hispanic-origin groups, and state for 2021 compared with 2020.

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 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.

Cognitive-affective processes and suicidality in response to repetitive transcranial magnetic stimulation for treatment resistant depression.

BACKGROUND: Repetitive transcranial magnetic stimulation (rTMS) can elicit 45-55 % response rates and may alleviate suicidality symptoms in treatment resistant depression (TRD). Blunted anticipatory reward sensitivity and negatively biased self-referential processing may predict trajectories of depressive and suicidality symptoms in rTMS for TRD and be modulated during treatment. METHODS: Fifty-five individuals with TRD received four weeks of low-frequency rTMS applied to the right dorsolateral prefrontal cortex (LFR-rTMS) and were followed until 17 weeks post-baseline. Participants completed behavioral measures of anticipatory reward sensitivity and self-referential processing at baseline and five weeks post-baseline (approximately one-week post-treatment). We examined whether baseline anticipatory reward sensitivity and self-referential processing predicted trajectories of depressive and suicidality symptoms from baseline to follow-up and whether these cognitive-affective variables showed change from baseline to week five. RESULTS: Anticipatory reward sensitivity and negative self-referential encoding at baseline were associated with higher overall depressive symptoms and suicidality from baseline to 17 weeks post-baseline. At week five, participants self-attributed a higher number of positive traits and a lower number of negative traits and had a lesser tendency to remember negative relative to positive traits they had self-attributed, compared to baseline. LIMITATIONS: The specificity of these results to LFR-rTMS is unknown in the absence of a comparison group, and our relatively small sample size precluded the interpretation of null results. CONCLUSIONS: Baseline blunted anticipatory reward sensitivity and negative biases in self-referential processing may be risk factors for higher depressive symptoms and suicidality during and after LFR-rTMS, and LFR-rTMS may modulate self-referential processing.

Impact of medications, mood state, and electrode placement on ECT outcomes in treatment-refractory psychosis.

BACKGROUND: Treatment-refractory psychosis (TRP) is a significant clinical challenge. While clozapine is frequently effective, alternate or augmentation strategies are often necessary. Evidence supports effectiveness of electroconvulsive therapy (ECT), but questions remain about optimal treatment parameters and impacts of concomitant pharmacotherapy. OBJECTIVE: /Hypothesis: To analyze the impact of clozapine, anticonvulsant medication, mood state, and ECT electrode placement on outcomes in TRP. We hypothesized that ECT would lead to greater reduction in positive symptoms, particularly in patients receiving clozapine. METHODS: Retrospective study in a tertiary TRP program. The Positive and Negative Syndrome Scale (PANSS) was used for clinical outcomes, with positive subscore as primary outcome. Clinical and ECT data were analyzed using a linear modelling approach, controlling for relevant covariates. RESULTS: A total of 309 patients were included. ECT plus clozapine associated with greater improvement in positive, general, and total symptoms than ECT alone. ECT associated with greater improvement in negative symptoms in depressed patients. Bifrontal placement was mostly equivalent to bitemporal, with greater reduction of positive symptoms in patients receiving clozapine, and associated with lower electrical dose in patients on anticonvulsants. Clozapine increased seizure duration, while anticonvulsants decreased it. Anticonvulsant use in ECT patients associated with equivalent to slightly improved symptom reduction. CONCLUSIONS: ECT's benefit in TRP may be greatest in patients receiving clozapine. ECT can improve negative symptoms in depressed TRP patients. Bifrontal placement is effective in TRP. Clozapine and anticonvulsants have opposite effects on seizure duration, but anticonvulsants may not adversely affect clinical outcomes of ECT for TRP.

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.

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.

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.

Increases in Prepregnancy Obesity: United States, 2016-2019.

Obesity (body mass index [BMI] of 30.0 and over) has risen in the United States in recent decades (1). Obesity varies by demographic factors, such as age, race and Hispanic origin, and socioeconomic status (2,3). Maternal obesity has been linked to a variety of adverse health outcomes for mothers and newborns, including gestational diabetes, hypertension, preeclampsia, cesarean delivery, preterm delivery, large size for gestational age, and infant death (4-10). The 2016 natality data file is the first for which prepregnancy BMI is available for all states and the District of Columbia (D.C.). This report presents trends in prepregnancy obesity for 2016 through 2019 by maternal race and Hispanic origin, age, and educational attainment. Trends by state for 2016-2019 and 2019 rates also are shown.

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.

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.

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.

Lack of Change in Perinatal Mortality in the United States, 2014-2016.

Perinatal mortality (late fetal death at 28 weeks or more and early neonatal death under age 7 days) can be an indicator of the quality of health care before, during, and after delivery (1,2). The U.S. perinatal mortality rate based on the date of the last normal menses (LMP) declined 30% from 1990-2011, but was stable from 2011-2013 (1,3). In 2014, National Center for Health Statistics (NCHS) transitioned to the use of the obstetric estimate of gestational age (OE), introducing a discontinuity in perinatal measures for earlier years (4,5). This report presents trends in perinatal mortality, as well as its components, late fetal and early neonatal mortality, for 2014-2016. Also shown are perinatal mortality trends by mother's age, race and Hispanic origin, and state for 2014-2016 and state perinatal rates for 2016.

Cause of Fetal Death: Data From the Fetal Death Report, 2014.

Objectives-This report presents, for the first time, data on cause of fetal death by selected characteristics such as maternal age, Hispanic origin and race, fetal sex, period of gestation, and birthweight. 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 in a reporting area of 35 states, New York City, and the District of Columbia. This area represents 66% of fetal deaths in the United States. Causes of death are processed in accordance with the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision. Final data for 2014 are reported. Results-Five selected causes account for about 90% 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 are not subject to tightly controlled study protocols, but they provide data for a larger proportion of the country than other studies. While there was limited variation among the selected causes across the maternal and fetal characteristics examined, many variations observed are consistent with associations that have been documented in research literature.

Prepregnancy Body Mass Index by Maternal Characteristics and State: Data From the Birth Certificate, 2014.

Objectives-This report describes prepregnancy body mass index (BMI) among women giving birth in 2014 for the 47-state and District of Columbia reporting areas that implemented the 2003 U.S. Standard Certificate of Live Birth by January 1, 2014.

Fetal and Perinatal Mortality: United States, 2013.

OBJECTIVES: This report presents 2013 fetal and perinatal mortality data by maternal age, marital status, race, Hispanic origin, and state of residence, as well as by fetal birthweight, gestational age, plurality, and sex. Trends in fetal and perinatal mortality are also examined. METHODS: Descriptive tabulations of data are presented and interpreted. RESULTS: A total of 23,595 fetal deaths at 20 weeks of gestation or more were reported in the United States in 2013. The U.S. fetal mortality rate was 5.96 fetal deaths at 20 weeks of gestation or more per 1,000 live births and fetal deaths, not significantly different from the rate of 6.05 in 2012. The lack of decline in fetal mortality in recent years, coupled with declines in infant mortality, meant that more fetal deaths than infant deaths occurred in the United States for 2011­2013 (although the rates were essentially the same). In 2013, the fetal mortality rate for non-Hispanic black women (10.53) was more than twice the rate for non-Hispanic white (4.88) and Asian or Pacific Islander (4.68) women. The rate for American Indian or Alaska Native women (6.22) was 27% higher, and the rate for Hispanic women (5.22) was 7% higher, than the rate for non-Hispanic white women. Fetal mortality rates were highest for teenagers, women aged 35 and over, unmarried women, and women with multiple pregnancies.