Associations between electronic nicotine delivery systems and birth outcomes.

OBJECTIVES: Nicotine crosses the placenta and is a known teratogen. The use of electronic nicotine delivery systems (ENDS) has increased among pregnant women in the US, but there is limited knowledge about their effects on birth outcomes. We examined the associations between ENDS and cigarette use during pregnancy with birth outcomes. METHODS: We conducted a cross-sectional analysis of 57,046 respondents from 32 US states in the 2016-2017 Pregnancy Risk Assessment Monitoring System. Respondents self-reported use of ENDS and cigarettes during the last 3 months of pregnancy; this was linked with birth outcomes documented on the birth certificate, including birth weight, gestational age, small-for-gestational age, and preterm birth. RESULTS: During the last 3 months of pregnancy, 0.5% of women used ENDS only, 0.8% were dual users of ENDS and cigarettes, and 8.0% used cigarettes only. In adjusted models, infants of women who used ENDS only weighed 57.8 grams less (95% CI -134.2, 18.6; p = .14) and were born 0.21 weeks earlier (95% CI -0.45, 0.03; p = .09) than infants of non-users. Infants born to dual users were 193.9 grams less (95% CI -274.9, -112.8; p < .01) and had a 1.93 higher odds of being born small-for-gestational age (95% CI 1.31, 2.83; p < .01) than infants of non-users. CONCLUSIONS: Our results provide some indication that prenatal ENDS use may adversely affect birth outcomes by reducing birth weight and gestational age. Estimates were imprecise, suggesting that larger samples of ENDS users with more detailed information about patterns of use are needed.

Quality of vital sign monitoring during obstetric hospitalizations at a regional referral and teaching hospital in Uganda: an opportunity for improvement.

INTRODUCTION: vital sign monitoring is a key component of safe facility-based obstetric care. We aimed to assess quality of care around vital sign monitoring during obstetric hospitalizations in a tertiary-care facility in a resource-limited setting. METHODS: retrospective review of obstetric records at a tertiary care facility. We assessed documentation of vital signs including fetal and maternal heart rate, and maternal blood pressure, temperature, oxygen saturation and urine output. The primary outcome was the quality of vital sign monitoring (high- versus low-quality based on frequency of monitoring). We compared quality of monitoring with timing of admission, presence of complication, and delivery mode using chi-squared tests. RESULTS: among 360 records of obstetric admissions (94% of a planned random sample), 96% documented a delivery. Of these, 8% of pregnant women and 11% of postpartum women had high-quality vital sign monitoring documented on initial evaluation at admission. For women delivering during the hospitalization, 0.8% of women delivering had high-quality monitoring in the first four hours postpartum, with higher rates of high-quality monitoring in women delivering vaginally compared to those delivered by cesarean (1.4% versus 0%, p<0.001). There were no differences in rates of quality monitoring by time of admission, or obstetric complication. CONCLUSION: very few obstetric hospitalizations had high-quality vital sign monitoring. Attention towards improving vital sign monitoring is a critical need.

Use of ENDS and Cigarettes During Pregnancy.

INTRODUCTION: Although the use of alternative tobacco products has been increasing among women and adolescents, research on the use of ENDS during pregnancy has been limited. This study examines the prevalence and sociodemographic characteristics of ENDS and cigarette use during pregnancy. METHODS: This cross-sectional analysis of the 2016 Pregnancy Risk Assessment Monitoring System used data on self-reported use of ENDS and cigarettes during the last 3 months of pregnancy among 33,964 women from 29 states and New York City. Data were analyzed in 2019. RESULTS: The overall prevalence of prenatal ENDS use was 1.2% and cigarette use was 7.7%, varying from 0.6% and 1.8% in New York City to 4.4% and 22.7% in West Virginia. In adjusted models, white women were more likely to use ENDS (AOR=4.68, 95% CI=2.91, 7.54) than black women. Women with increasing years of education were also less likely to use ENDS. Women who used cigarettes during pregnancy were 11.05 times (95% CI=7.40, 16.48) more likely to also use ENDS prenatally. Associations between sociodemographic characteristics and cigarette use during pregnancy were consistent with the findings for ENDS. CONCLUSIONS: Pregnant women across the U.S. are using ENDS and cigarettes. Surveillance is essential to continue monitoring trends in prenatal use of tobacco products and understand the implications on pregnancy and infant outcomes.

Evaluating Facility-Based Decision-Making in Women with a Prior Cesarean Delivery and Association with Maternal and Perinatal Outcomes.

Objective To describe facility-based decision-making for women with one prior cesarean delivery (CD) in a resource-limited setting and to characterize maternal and perinatal outcomes in these groups. Methods One year retrospective study of women with one prior CD delivering at Korle-Bu Teaching Hospital (KBTH), Ghana. Women were categorized into three groups based on initial plan of management on admission [trial of labor after cesarean (TOLAC), emergency repeat CD (EMCD) or non-emergent repeat CD (RCD)]. Characteristics and outcomes across these groups were then compared. Results During the study period, 1247 women with one prior CD delivered at KBTH, of which 377 (30.2%) were triaged to RCD, 439 (35.2%) to EMCD and 431 (34.6%) to TOLAC. Twelve uterine ruptures and no maternal deaths occurred. Perinatal mortality was 4.2% (n = 52). Compared to the RCD group, the TOLAC group had a lower risk for maternal adverse events (aOR 0.3, 95% CI 0.1-1.0; p = 0.04) and non-significant higher risk of perinatal adverse events (aOR 1.6, 95% CI 0.7-3.3; p = 0.25). Compared to women triaged to RCD, the EMCD group had a non-significant increase in risk of maternal adverse events (aOR 1.6, 95% CI 0.8-3.5; p = 0.2) and a significantly higher rate of perinatal adverse events (aOR 2.4, 95% CI 1.2-4.9; p = 0.01). Conclusions for Practice Women triaged to EMCD at admission are different when compared to women allowed a TOLAC or offered a non-emergent RCD. These women bear increased rates of adverse outcomes and should be considered as a separate group for analysis in future studies conducted in similar settings.

Wireless Vital Sign Monitoring in Pregnant Women: A Functionality and Acceptability Study.

OBJECTIVE: To test the functionality and acceptability of a wireless vital sign monitor in an inpatient obstetric unit. MATERIALS AND METHODS: Pregnant women at a U.S. tertiary-care hospital wore a wireless vital sign sensor that captures heart rate, respiratory rate, and temperature. Measurements were compared with vital signs obtained by standard devices. We defined continuous capture of vital signs for 30 min with wireless data transfer to a central monitor as functional success. Acceptability was assessed per the pregnant women and nurses observing the device. Bland-Altman plots were constructed to assess agreement between the wireless sensor and standard measurements. RESULTS: Thirty of 32 enrolled pregnant women had successful monitoring; 2 cases were stopped early for non-study-related reasons. Comparing wireless sensor and standard measurements, the mean difference (limits of agreement) values at the 25th and 75th percentiles were 1.6 (±13.2) and 4.2 (±18.6) heartbeats/min, 4.2 (±6.1) and 0.7 (±5.4) respirations/min, and 0.02°C (±1.5) and 0.5°C (±1.8), respectively. Most pregnant women found the device comfortable, likeable, and useful (78%, 81%, and 97%, respectively); 80% of nurses found the monitor easy to use, and 84% would recommend it to a patient. CONCLUSIONS: We successfully obtained maternal vital signs using a simple wireless monitor with high acceptability. Well-validated monitors of this nature could significantly alleviate the human resource burden of monitoring during labor and confer greatly desired mobility to laboring pregnant women, although incorporation of blood pressure monitoring will be critical.