Feasibility of Remote Blood Pressure Monitoring for Detection and Management of Maternal Hypertension in a predominantly Black, Rural and Medicaid Population in Mississippi.

Background: Remote patient monitoring (RPM) has potential in hypertension management, but limited studies have focused on maternal hypertension, especially among vulnerable populations. The objective of this study was to integrate RPM into perinatal care for pregnant patients at elevated risk of hypertensive disorders to show feasibility, acceptability, and safety. Methods: A prospective pilot cohort study was conducted at the University of Mississippi Medical Center 2021-2023. Participants' blood pressure readings were remotely captured and monitored until 8-week postpartum, with timely assessment and intervention. Results: Out of 98 enrollees, 77 utilized RPM, and no maternal or neonatal deaths occurred within 60-day postpartum. High program satisfaction was reported at discharge. Conclusion: This study demonstrates the feasibility and acceptability of RPM for perinatal care in a vulnerable population. Positive outcomes were observed, including high patient satisfaction and no maternal or neonatal deaths. Further research should address patient engagement barriers and develop tailored protocols for improved clinical outcomes.

Perinatal quality collaboratives and birth equity.

PURPOSE OF REVIEW: The purpose of this review is to discuss how state perinatal quality collaboratives are addressing birth equity to reduce disparities in maternal morbidity and mortality. RECENT FINDING: Perinatal quality collaboratives are adopting core practices to advance birth equity, reduce disparities and confront racism and bias in obstetric care including securing leadership commitments to equity, providing education on the causes of inequities and mitigation strategies, collecting accurate race/ethnicity data, addressing social determinants of health, and integrating patient and community knowledge, experiences, and narratives in the quality improvement work. SUMMARY: Inequities in maternal morbidity and mortality particularly affecting Black birthing people are driven by racism, inequities in the social determinants of health, and variations in care practices and quality. Perinatal quality collaboratives are an important resource for driving improvement changes to mitigate these factors and improve outcomes. VIDEO ABSTRACT: Mason CL, Collier CH, Penny SC. Perinatal Quality Collaboratives and Birth Equity. Produced by CLMB Productions for use in this publication. January 10, 2022, http://links.lww.com/COAN/A86.

Immediate postpartum management of patients with severe hypertensive disorders of pregnancy: pathophysiology guiding practice.

Developing clinically-focused evidence and experience-based approaches to improve maternity care is a national priority. Safety and quality collaborative initiatives related to management of hypertensive disorders of pregnancy are vital in the implementation of improved care. We reviewed the obstetric literature to construct a concise summary of the core pathophysiologic issues, practice principles and clinical interventions which are foundational for physicians providing immediate postpartum care for patients with severe pregnancy-related hypertension (including those with eclampsia, HELLP syndrome, and superimposed preeclampsia inclusive of those with gestational hypertension that develop severe range blood pressures). While based largely upon the American College of Obstetrics and Gynecology (ACOG) Hypertension Task Force Guidelines released in 2013 as well as updated 2018 guidelines set forth by ACOG for hypertensive disorders of pregnancy, this summary goes beyond the basic safety bundles for hypertension management and lays a pathophysiologic foundation for the immediate postpartum care of patients with severe hypertensive disorders of pregnancy.

COVID-19-Associated Deaths After SARS-CoV-2 Infection During Pregnancy - Mississippi, March 1, 2020-October 6, 2021.

Pregnant and recently pregnant women are at increased risk for severe illness and death from COVID-19 compared with women who are not pregnant or were not recently pregnant (1,2). CDC recommends COVID-19 vaccination for women who are pregnant, recently pregnant, trying to become pregnant, or might become pregnant in the future.*,† This report describes 15 COVID-19-associated deaths after infection with SARS-CoV-2 (the virus that causes COVID-19) during pregnancy in Mississippi during March 1, 2020-October 6, 2021.

Preterm parturition and pre-eclampsia: The confluence of two great gestational syndromes.

BACKGROUND: Preterm birth (PTB) and pre-eclampsia independently, and frequently concurrently, adversely affect the pregnancy outcomes of millions of mothers and infants worldwide each year. OBJECTIVES: To fill the gap between PTB and pre-eclampsia, which continue to constitute the two most important current global challenges to maternal and perinatal health. METHODS: Pubmed, Embase, and Cochrane databases were searched from inception until December 2019 using the terms spontaneous PTB (SPTB), indicated preterm delivery (IPTD), early-onset pre-eclampsia, and pre-eclampsia. RESULTS: History of PTB and pre-eclampsia were the strongest risk factors contributing to the occurrence of SPTB or IPTB. The risk of PTB and pre-eclampsia among non-Hispanic African American women was higher than the rate among all other racial/ethnic groups in the United States. Low-dose aspirin (LDA) has been reported to reduce the risk of pre-eclampsia by at least 10% and PTB by at least 14%. Lastly, women and their fetuses who develop early-onset pre-eclampsia are at higher risk for developing hypertension and cardiovascular disease later in life. CONCLUSIONS: While better clarity is needed, efforts to coordinate prevention of both PTB and pre-eclampsia, even though imperfect, are critically important as part of any program to make motherhood as safe as possible.

Maternal Mortality From Coronavirus Disease 2019 (COVID-19) in the United States.

Individual state maternal mortality review committees aim to comprehensively review all maternal deaths to not only evaluate the cause of death, but also to assess preventability and make recommendations for action to prevent future deaths. The maternal mortality review committee process remains critical during the coronavirus disease 2019 (COVID-19) pandemic. Maternal deaths due to COVID-19 have been reported in the United States. Some state maternal mortality review committees may choose to expedite review of these deaths in an effort to quickly provide clinicians with information intended to prevent other deaths during the ongoing pandemic. If states opt to pursue rapid review, entry of data into the Maternal Mortality Review Information Application system for submission to the Centers for Disease Control and Prevention will allow for aggregation nationally without duplication. It will be important to review not only deaths directly attributed to COVID-19, but also those that may be indirectly related to the COVID-19 pandemic, such as those influenced by changes in care practices or delays in seeking care during the pandemic. Therefore, regardless of the timing of the review, maternal deaths that occur during the time of the COVID-19 pandemic must be evaluated within that framework to ensure that all factors contributing to the death are considered to better understand the context of each of these tragic events.

The Effect of Stressful Life Events on Postpartum Depression: Findings from the 2009-2011 Mississippi Pregnancy Risk Assessment Monitoring System.

Objectives To determine the prevalence of postpartum depression (PPD) among new mothers in Mississippi during 2009-2011 and evaluate the effects of different stressful life events in the year before delivery on the likelihood of PPD. Methods We used Mississippi Pregnancy Risk Assessment Monitoring System (PRAMS) 2009-2011 data (n = 3695) to evaluate the effects of different stressful life events on PPD. We categorized 13 stressors into 4 groups: financial, relational, trauma-related, and emotional. A composite score of the mothers' responses (≥10) to the three items: "I felt down, depressed, or sad", "I felt hopeless", and "I felt slowed down" was used to measure PPD. The items were rated on a Likert scale from (1) never to 5 (always). Descriptive statistics, Chi square tests, t tests, and logistic regression analyses were conducted using SAS 9.3 Proc Survey procedure (SAS Institute, Cary, NC, USA). Results The overall prevalence of self-reported PPD was 14.8 %. Mothers who experienced high relational with low financial and high trauma related stresses had the highest likelihood of PPD diagnosis after adjusting for confounders (OR = 8.6; 95 % CI, 3.5-21.3), followed by those who reported high relational stress with low financial and low trauma stresses (OR = 5.9; 95 % CI, 3.5-10.2). Those with high financial, low relational, and low trauma had the least likelihood of PPD (OR = 2.2; 95 % CI, 1.6-3.0) compared to women with low stress in all three categories. Conclusion Our findings showed that the likelihood of PPD was higher among women who had high relational stress, indicating that efforts to effectively prevent PPD need to focus on healthy relationships between partners during pregnancy.

Contraceptive implant knowledge and practices of providers serving an urban, low-income community.

Contraceptive implants are highly effective but infrequently used by low-income women, who are at high risk of unintended pregnancy. Provider factors that may affect implant acceptance merit further exploration. We surveyed 66 clinicians serving an urban, low-income community from adult primary care, women's health, and adolescent practices. We assessed implant education, knowledge, perceptions of accessibility and cost, and patient selection practices. Education about implants varied from 15% in adult primary care to 30% in adolescent practice and 75% in women's health. Among women's health providers, 54% were trained to insert implants. Despite having eligible candidates, some providers were unlikely to recommend implants to patients who are nulliparous (8%), teens (22%), depressed (24%) or obese (22%). Forty-one percent of providers reported insertion wait-times of at least three weeks. Among low-income women, deficits in provider education, restrictive practice patterns, and long insertion wait times may affect contraceptive implant use.

Knowledge of pelvic floor disorders in a population of community-dwelling women.

OBJECTIVE: The objective of the study was to investigate baseline knowledge and demographic factors associated with a lack of knowledge about urinary incontinence (UI) and pelvic organ prolapse (POP). STUDY DESIGN: This study was a community-based, cross-sectional survey of 431 racially and socioeconomically diverse women aged 19-98 years. The Prolapse and Incontinence Knowledge Questionnaire was used to assess participants' knowledge. Primary endpoints were the total number of correct responses on the UI and POP scales, respectively. Percentages of individuals answering each item or group of items correctly were explored as secondary outcomes. RESULTS: All women lacked knowledge proficiency about UI and POP, although knowledge about UI was slightly greater than knowledge about POP. Overall, 71.2% of subjects lacked UI proficiency (<80% correct), whereas 48.1% lacked proficiency in POP knowledge (<50% correct). Black women demonstrated significantly less knowledge about UI and POP than white women, both before and after adjustment for age, education, and household income. When combined into 1 group, Asian, Hispanic, and other women also showed significantly less UI and POP knowledge than white women. Most women who reported symptoms of UI had not received treatment for their problems. CONCLUSION: There is a global lack of knowledge about UI and POP among community-dwelling women, with more pronounced knowledge gaps among nonwhite women. UI and POP are chronic medical conditions that should be included in routine screening questions for well-woman care. Further studies are needed to explore how best to educate and improve women's awareness of these prevalent pelvic floor disorders.

How early elective deliveries impact infant health in Mississippi.

BACKGROUND: Infants delivered early for non-medical reasons are at increased risk of poor birth outcomes. Trends and associated health outcomes were unexamined in Mississippi. OBJECTIVE: Determine elective delivery trends and impacts on infant mortality. METHODS: Identify cesarean deliveries and inductions without medical indications from birth certificate records linked with death certificate records. Assess differences in death rates between those born electively during 37 and 38 weeks compared to 39 weeks gestation. RESULTS: Early elective delivery rates increased significantly (p < .01) from 8.5% in 2001 to a peak of 17.8% in 2008. The rate began to decline in 2008 and was 16.5% in 2011. Neonates born electively before 39 weeks gestation had three-fold higher death rates [2.1 per 1,000] than neonates born at 39 weeks gestation [0.6 per 1,000], a statistically significant difference. CONCLUSION: Early elective deliveries in Mississippi are associated with increased infant mortality. Reducing this common practice could improve birth outcomes in the state.

Maternal infection in pregnancy and risk of asthma in offspring.

This study estimates the effect of maternal infections during pregnancy on childhood asthma. One-thousand four-hundred and twenty-eight pregnant women were prospectively followed using structured interviews and chart review until their child's 6th year of life. Infections were identified from outpatient and hospital visits. Childhood asthma was defined as physician diagnosis with symptoms at age six. Adjusted odds ratios were calculated from multivariable logistic regression models. Six-hundred and thirty-five women experienced an infection during pregnancy. Among antepartum infections, maternal urinary tract infections were significantly associated with childhood asthma (aOR 1.60, 95 % CI 1.12-2.29). Chorioamnionitis and maternal group beta streptococcus colonization were not significantly associated with an increased risk in childhood asthma. This study found an increased risk of asthma in children of women diagnosed with urinary tract infections during pregnancy, while other maternal infections did not increase the risk.

Family planning and contraceptive decision-making by economically disadvantaged, African-American women.

BACKGROUND: Significant racial disparities exist in the US unplanned pregnancy rate. We conducted a qualitative study using the theory of planned behavior as a framework to describe how low-income, African-American women approach family planning. STUDY DESIGN: Structured focus groups were held with adult, low-income, nonpregnant, African-American women in Connecticut. Data were collected using a standardized discussion guide, audio-taped and transcribed. Four independent researchers coded the transcripts using the constant comparative method. Codes were organized into overarching themes. RESULTS: Contraceptive knowledge was limited, with formal contraceptive education often occurring after sexual debut. Attitudes about contraception were overtly negative, with method effectiveness being judged by the presence of side effects. Family and friends strongly influence contraceptive decisions, while male partners are primarily seen as a barrier. Contraceptive pills are perceived as readily accessible, although compliance is considered a barrier. CONCLUSIONS: Contraception education should occur before sexual debut, should involve trusted family and community members and should positively frame issues in terms of achieving life goals.