New Onset of Symptomatic Peptic Ulcer Disease Postpartum Secondary to Nonsteroidal Anti-Inflammatory Drug Use.

The use of nonsteroidal anti-inflammatory drug (NSAID) medications is a risk factor for peptic ulcer disease (PUD). PUD in the postpartum period is rare, despite the common use of NSAIDs. A G1P0 presented 6 days postcesarean section with fatigue, lightheadedness, melenic stools, and a hemoglobin of 5.4 g/dL after using NSAIDs and acetaminophen for postoperative pain control. An esophagogastroduodenoscopy (EGD) was performed for a suspected upper gastrointestinal bleed and found one gastric and one duodenal ulcer. Though typically used for a short course in the postpartum period, NSAIDs remain a predisposing risk factor for PUD postpartum, and patients and providers must be aware of this risk.

Effect of a Best-Practice Alert on the Rate of Smoking Cessation among Pregnant Women.

OBJECTIVE: This study aimed to determine if a best-practice alert (BPA) implementation increases the rate of smoking cessation during pregnancy and affects pregnancy outcomes associated with smoking. STUDY DESIGN: This was a pretest-posttest study design where a BPA was added to electronic medical records (EMR) of pregnant persons who reported active smoking. The BPA provided the 5A's method to conduct counseling on smoking cessation. The rates of smoking cessation during pregnancy were compared 1.5 years before and after implementation of the BPA. Secondary outcomes examined whether counseling on smoking cessation was done, the number of the counseling sessions during pregnancy, and obstetric outcomes associated with maternal smoking. RESULTS: After implementation of the BPA, the rate of smoking cessation in pregnancy increased from 17.5% prior to BPA implementation to 54.9% after BPA implementation (p < 0.001). The rate of counseling on smoking cessation increased from 66.6% prior to BPA implementation to 95.6% after BPA implementation, with an increase noted also in the number of smoking cessation counseling sessions. In multivariate analyses, after controlling for maternal demographic and clinical factors, BPA implementation was significantly associated with higher rates of smoking cessation (adjusted odds ratio [aOR]: 3.44, 95% confidence interval [CI]: 2.17-5.51), higher rates of documented smoking cessation counseling in the EMR (aOR: 12.44, 95% CI: 6.06-25.64), and higher odds of conducting the counseling more than once (aOR: 6.90 95% CI: 4.45-10.88). CONCLUSION: The rate of smoking cessation and number of times pregnant persons were counseled increased after implementation of a BPA. The BPA could be a useful EMR tool to increase smoking cessation rates during pregnancy. KEY POINTS: · Smoking during pregnancy is a maternal and fetal concern.. · Prenatal care offers the chance to address smoking.. · BPA increases rates of smoking counseling and cessation..

Incidence of Adverse Pregnancy Outcomes Based on the Degree of Short Interpregnancy Interval in Urban Milwaukee Population.

INTRODUCTION: Short interpregnancy interval is defined as conception occurring within 18 months of a previous live birth. Studies show increased risks of preterm birth, low birth weight, and small for gestational age with short interpregnancy intervals; however, it is unclear if these risks are higher for all short interpregnancy intervals or only for those less than 6 months. The objective of this study was to evaluate prevalence of adverse pregnancy outcomes among people with short interpregnancy intervals, stratified by degree: less than 6 months, 6 to 11 months, and 12 to 17 months. METHODS: We conducted a retrospective cohort study of people with 2 singleton pregnancies between 2015 and 2018 at a single academic center. The following outcomes were compared between patients with interpregnancy intervals of less than 6 months, 6 to 11 months, 12 to 17 months, and 18 months or more; hypertensive disorders of pregnancy (gestational hypertension and preeclampsia), preterm birth at less than 37 weeks, low birth weight ( < 2500 g), congenital anomalies, and gestational diabetes. Bivariate and multivariate analyses were done to examine the independent role of the degree of short interpregnancy interval and each outcome. RESULTS: A total of 1,462 patients were included in the analysis, with 80 pregnancies occurring at interpregnancy intervals less than 6 months, 181 at 6 to 11 months, 223 at 12 to 17 months, and 978 at 18 months or more. In unadjusted analysis, patients with interpregnancy intervals less than 6 months had the highest rate of preterm birth at 15.0%. In addition, patients with interpregnancy intervals less than 6 months and 12 to 17 months had higher rates of congenital anomalies versus those with interpregnancy intervals of 18 months or more. In multivariate analysis, controlling for sociodemographic and clinical confounding factors, interpregnancy intervals less than 6 months were associated with 2.3 higher odds of preterm birth (95% CI, 1.13-4.68), and those 12 to 17 months were associated with 2.52 higher odds of congenital anomalies (95% CI, 1.22-5.20). The odds of gestational diabetes were lower with interpregnancy intervals of 6 to 11 months compared to those 18 months or more (aOR 0.26; 95% CI, 0.08-0.85). CONCLUSIONS: In this single-site cohort, people with interpregnancy intervals less than 6 months had higher odds of preterm birth, while those with interpregnancy intervals 12 to 17 months had higher odds of congenital anomalies, compared with the control group with interpregnancy intervals greater than or equal to 18 months. Future research should focus on identifying modifiable risk factors for short interpregnancy intervals and interventions to reduce them.