The Childhood Opportunity Index's Association with Adverse Pregnancy and Newborn Outcomes in Nulliparous Persons.

OBJECTIVE: The objective of the study was to determine if using a novel measure of social determinants of health, the Childhood Opportunity Index (COI), at the time of delivery was associated with development of adverse pregnancy outcomes (APO) in nulliparous pregnant persons. STUDY DESIGN: Data were extracted from the 779 participants from a single nuMoM2b (Nulliparous Pregnancy Outcomes Study: monitoring mothers-to-be) study site, a prospective cohort study designed to identify contributors to APOs. Residential address information at delivery was linked to the location's COI. The overall composite and component scores in education, health and environmental, and socioeconomic indices were recorded. APOs of interest included preterm birth, hypertensive disorders of pregnancy, small for gestational age at birth, stillbirth, and gestational diabetes. Participant characteristics were compared by COI category and the association of COI with APOs was analyzed by logistic regression, controlling for age and self-reported race/ethnicity. RESULTS: The overall COI distribution was very low (45%), low (17%), moderate (10%), high (15%), and very high (13%). A total of 329 (43.5%) participants experienced at least one APO. Overall COI was associated with developing an APO (p = 0.02). Each component score was also associated with developing APOs and with race/ethnicity (p < 0.05). Compared with higher COI categories, an overall low or very low categorized location was independently associated with developing an APO (odds ratio: 1.636, 95% confidence interval: 1.16-2.31). Adjusting for gestational age at birth, those in lower COI areas had newborns with lower birth weight, birth length, and head circumference (estimate [95% confidence interval] birth weight: -0.0005 g [-0.0008 to -0.0001]; length: -0.065 cm [-0.124 to -0.0091]; head circumference: -0.123 cm [-0.208 to -0.045]). COI was not associated with other newborn outcomes. CONCLUSION: COI, a marker for social determinants of health, is independently associated with APOs. The COI may be a tool for risk stratification for pregnant people to help with APO-reducing strategies. KEY POINTS: · The COI is a neighborhood-level marker for social determinants of health.. · The COI at time of delivery is associated with APO and newborn birth weight, length, and head circumference.. · The COI may be usable in pregnancy clinics to help identify resource needs to optimize outcomes for pregnant individuals and newborns..

Changes in Pelvic Floor Symptoms After Procedural Interventions for Uterine Leiomyomas: A Systematic Review.

OBJECTIVE: To conduct a systematic review to evaluate the effect of procedural interventions for leiomyomas on pelvic floor symptoms. DATA SOURCES: PubMed, EMBASE, and ClinicalTrials.gov were searched from inception to January 12, 2023, searching for leiomyoma procedures and pelvic floor disorders and symptoms, restricted to primary study designs in humans. METHODS OF STUDY SELECTION: Double independent screening for studies of any study design in all languages that reported pelvic floor symptoms before and after surgical (hysterectomy, myomectomy, radiofrequency volumetric thermal ablation) or radiologic (uterine artery embolization, magnetic resonance-guided focused ultrasonography, high-intensity focused ultrasonography) procedures for management of uterine leiomyomas. Data were extracted, with risk-of-bias assessment and review by a second researcher. Random effects model meta-analyses were conducted, as feasible. TABULATION, INTEGRATION, AND RESULTS: Six randomized controlled trials, one nonrandomized comparative study, and 25 single-group studies met criteria. The overall quality of the studies was moderate. Only six studies, reporting various outcomes, directly compared two procedures for leiomyomas. Across studies, leiomyoma procedures were associated with decreased symptom distress per the UDI-6 (Urinary Distress Inventory, Short Form) (summary mean change -18.7, 95% CI -25.9 to -11.5; six studies) and improved quality of life per the IIQ-7 (Incontinence Impact Questionnaire, Short Form) (summary mean change -10.7, 95% CI -15.8 to -5.6; six studies). There was a wide range of resolution of urinary symptoms after procedural interventions (7.6-100%), and this varied over time. Urinary symptoms improved in 19.0-87.5% of patients, and the definitions for improvement varied between studies. Bowel symptoms were inconsistently reported in the literature. CONCLUSION: Urinary symptoms improved after procedural interventions for uterine leiomyomas, although there is high heterogeneity among studies and few data on long-term outcomes or comparing different procedures. SYSTEMATIC REVIEW REGISTRATION: PROSPERO, CRD42021272678.

Why should we screen for male fertility?

An increasing number of studies show declining sperm counts; however, semen analyses are uncommon until the evaluation for infertility. Semen analysis is a safe, reliable and relatively inexpensive screening test, assessing male fertility and directing further work-up. In young men, the use of semen analysis may identify disease prior to attempted conception and result in improved fertility potential when combined with lifestyle changes, medical or surgical therapy. Furthermore, if sperm counts are significantly low, evaluation and management for genetic causes can be initiated. Our commentary outlines why screening for male infertility in young adult men may be beneficial. We discuss options for early intervention, including sperm cryopreservation, if defects in sperm parameters are identified.

Antepartum Drug Dependence and Pregnancy- or Birth-related Complications: A Cross-sectional Study of 19 Million Inpatients.

Objective To evaluate the demographic characteristics, hospitalization outcomes [severity, length of stay (LOS), and total expense], and comorbidities in pregnant patients with antepartum drug dependence (ADD). Methods We used the national inpatient sample (NIS) and included 19,170,561 female patients (age: 12-40 years) hospitalized for pregnancy- or birth-related complications and grouped by co-diagnosis of ADD. We used descriptive statistics and Pearson's chi-square test for categorical data and independent sample T-test for the continuous data to measure the differences in demographic and hospital outcomes. A logistic regression model was used to evaluate the odds ratio (OR) for medical and psychiatric comorbidities. Results The hospitalizations with ADD declined initially, from 2010 to 2011, followed by an increase of 50% from 2011 to 2014. White pregnant females (77.5%), and those from low-income families (<25th percentile, 37.1 %) had comorbid ADD. Among medical comorbidities, iron-deficiency anemia was the most prevalent condition in pregnant inpatients (12.0% in ADD vs. 9.2% in non-ADD) followed by obesity and hypertension. Depression (12.9%) was the most prevalent psychiatric comorbidity in ADD inpatients followed by comorbid psychosis (three-fold higher odds). Among patients with substance use disorder (SUD), opioid abuse was the most prevalent one (67.3%) followed by cannabis (11.2%), cocaine (5.7%), amphetamine (4.0%), and alcohol (2.4%). Half of the pregnant inpatients with ADD had moderate severity of illness due to pregnancy or birth-related complications with four-fold higher odds [95% confidence interval (CI): 3.67-8.88]. They also had a higher LOS with a mean difference of 0.88 days (95% CI: 0.904-0.865) and had incurred higher total charges, by USD 3,797 (95% CI: 3,927-3,666), per inpatient admission for pregnancy- or birth-related complications compared to non-ADD inpatients Conclusion ADD is associated with the worsening of severity of illness in pregnancy- or birth-related complications and requires acute inpatient care that leads to increased healthcare-related economic burden. The integration of SUD services with primary or maternal care is required to improve outcomes in at-risk women in the reproductive age group.

Transcranial Magnetic Stimulation for Major Depressive Disorder in Pregnancy: A Literature Review.

Major depressive disorder (MDD) is a growing problem among pregnant women as current treatment with antidepressants pose significant risks to the mother and fetus. Transcranial magnetic stimulation (TMS) is a neuromodulation technique that is being increasingly utilized to treat MDD in adults. We conducted a literature search using the keyword "TMS" and cross-referencing it with MDD, depression, major depressive episode, pregnancy, efficacy, safety, and clinical trial. This review explores current studies conducted to evaluate the efficacy and safety of TMS to treat MDD in pregnant females. Low-frequency TMS over the right dorsolateral prefrontal cortex, when given to pregnant women with MDD during the second and third trimester, has shown a significant response in depressive symptom reduction. TMS offers a promising alternative to current treatment options for managing MDD during pregnancy, but with limited research available, its safety and efficacy still need to be studied by conducting multicenter trials and long-term studies.