The Association between Maternal Body Mass Index and the Risk of Perinatal Depression.

OBJECTIVE: The aim of this study was to evaluate whether the risk of perinatal depression is associated with body mass index (BMI) category. STUDY DESIGN: We performed a retrospective cohort study of women who completed an Edinburgh Postnatal Depression Scale (EPDS) questionnaire during the antepartum period at an integrated health system from January 2003 to May 2018. Risk of perinatal depression was defined as a score of ≥10 on the EPDS or an affirmative response to thoughts of self-harm. Risk of perinatal depression was compared by first trimester BMI category, defined as underweight (BMI: <18.5 kg/m2), normal weight (BMI: 18.5-24.9 kg/m2), overweight (BMI: 25.0-29.9 kg/m2), or obese (BMI: ≥30.0 kg/m2). Univariable analyses were performed using χ 2, Fisher's exact test, analysis of variance, Kruskal-Wallis, and Wilcoxon rank-sum tests as appropriate to evaluate the association between maternal BMI category, demographic and clinical characteristics, and risk of perinatal depression. Logistic multivariable regression models were performed to adjust for potential confounders identified as variables with p < 0.10 in univariable analysis. RESULTS: Our analysis included 3,420 obese women, 3,839 overweight women, 5,949 normal weight women, and 1,203 underweight women. The overall median gestational age at EPDS administration was 27 weeks (interquartile range: 23-29). Overweight and obese women were more likely to be non-Hispanic Black, Hispanic, multiparous, to have public insurance, prepregnancy diabetes, and chronic hypertension as compared with normal or underweight women (p < 0.001). In univariable analysis, the risk of perinatal depression was not significantly different among underweight (10.8%, odds ratio [OR]: 0.86, 95% confidence interval [CI]: 0.79-1.18) or overweight women (12%, OR: 0.96, 95% CI: 0.79-1.18); however, the risk was higher among obese women (14.7%, 95% CI: 1.21-1.55) compared with normal weight women (11.2%). In multivariable analysis, obesity remained associated with an increased risk of perinatal depression (adjusted OR: 1.19, 95% CI: 1.04-1.35). CONCLUSION: Obesity is associated with an increased risk of perinatal depression as compared with women of normal weight. KEY POINTS: · Maternal obesity is associated with an increased risk of perinatal depression.. · Maternal BMI is associated with increased risk of perinatal depression.. · Maternal obesity is an independent risk factor for perinatal depression..

Interpregnancy Body Mass Index Change and Offspring Mortality Risk following the Second Pregnancy.

OBJECTIVE: The aim of the study is to examine the impact of maternal interpregnancy body mass index (BMI) change on subsequent offspring mortality risk. STUDY DESIGN: This is a retrospective cohort study of women who had two consecutive live singleton deliveries of at least 20 weeks' gestation from the Utah Population Database. Our exposure was defined as interpregnancy BMI change from the date of first delivery to the conception date of subsequent pregnancy. We categorized BMI change as: < - 1, -1 to 0, 0 to <1 (reference), 1 to 2, 2 to 4, ≥4 kg/m2. Our primary outcome was all-cause age-specific mortality during four time periods: neonatal (≤28 days), infant (29 days to <1 year old), childhood ((≥1 to <5 years old), and late childhood (5 to <18 years old). We also examined mortality specifically attributed to congenital anomalies. Analyses used Cox proportional hazard models stratified by full term (≥37 weeks) and preterm (<37 weeks) deliveries. All models were adjusted for relevant confounders. RESULTS: Of 266,752 women, among full-term deliveries, women with a BMI increase of 4 kg/m2 or more had an increased risk of neonatal mortality in their subsequent pregnancy (hazard ratio or HR = 1.72, 95% confidence interval or CI: 1.23-2.41) Women who lost 1 kg/m2 or more between deliveries also had increased neonatal mortality (HR = 1.46, 95% CI: 1.04-2.05). There were no differences in infant, early, or late childhood mortality by interpregnancy BMI change. Maternal interpregnancy interval weight loss of 1 kg/m2 or more and weight gain of ≥4 kg/m2 also had increased risk of mortality associated with congenital anomalies or conditions arising during the neonatal period following their subsequent delivery. CONCLUSION: Women with significant interpregnancy weight gain and modest weight loss have a significant increased risk of neonatal mortality following their subsequent pregnancy. KEY POINTS: · Significant weight gain between deliveries increases the risk of neonatal death.. · Modest weight loss between deliveries increases the risk of neonatal death.. · This risk may be partially explained by increased risk of congenital malformations..

Neonatal outcomes in trial of vaginal birth versus repeat caesarean delivery in preterm pregnancies: A prospective cohort study.

OBJECTIVE: To characterise neonatal morbidity following preterm trial of labour (TOL) in comparison with elective repeat caesarean section (eRCS) specifically among patients without a previous vaginal delivery who may have a lower success rate of vaginal birth after caesarean. DESIGN: This is a secondary analysis of a multicentre prospective database. SETTING/POPULATION: Maternal and Fetal Medicine Unit Cesarean Section Registry. POPULATION: Singleton pregnancies in women without a previous vaginal delivery who delivered at 24+0  weeks to 36+6  weeks gestation. METHODS: Neonatal outcomes were compared between those with a TOL and those undergoing eRCS. Logistic regression was used to control for confounders, including gestational age at delivery. MAIN OUTCOME MEASURES: Composite neonatal morbidity. RESULTS: A total of 1906 patients were included, 985 with TOL and 921 with no TOL. The TOL success rate was 63.1%. The rate of uterine rupture was low, at 0.10% in the TOL group and 0.11% in the eRCS group (p = 0.32). After adjustment, neonates born to women undergoing a TOL had no statistically significant difference in outcomes including composite neonatal outcome (adjusted odds ratio 0.86, 95% CI 0.68-1.09), neonatal intensive care unit admission, respiratory distress syndrome, necrotising enterocolitis, hypoxic ischaemic encephalopathy, seizures, transient tachypnoea of the newborn, compared with patients who underwent eRCS, with the exception of decreased risk of proven/suspected sepsis (adjusted odds ratio 0.68, 95% CI 0.52-0.87) CONCLUSION: A TOL in preterm patients without a previous vaginal delivery was not found to have a statistically significant association with increased neonatal morbidity.

Society for Maternal-Fetal Medicine Consult Series #58: Use of antenatal corticosteroids for individuals at risk for late preterm delivery: Replaces SMFM Statement #4, Implementation of the use of antenatal corticosteroids in the late preterm birth period in women at risk for preterm delivery, August 2016.

The administration of antenatal corticosteroids has been widely adopted as the standard of care in the management of pregnancies at risk for preterm delivery before 37 weeks of gestation, with the primary goal of reducing neonatal morbidity. However, the long-term risks associated with antenatal corticosteroid use remain uncertain. The purpose of this Consult is to review the current literature on the benefits and risks of antenatal corticosteroid use in the late preterm period and to provide recommendations based on the available evidence. The recommendations by the Society for Maternal-Fetal Medicine are as follows: (1) we recommend offering a single course of antenatal corticosteroids (2 doses of 12 mg of intramuscular betamethasone 24 hours apart) to patients who meet the inclusion criteria of the Antenatal Late Preterm Steroids trial, ie, those with a singleton pregnancy between 34 0/7 and 36 6/7 weeks of gestation who are at high risk of preterm birth within the next 7 days and before 37 weeks of gestation (GRADE 1A); (2) we suggest consideration for the use of antenatal corticosteroids in select populations not included in the original Antenatal Late Preterm Steroids trial, such as patients with multiple gestations reduced to a singleton gestation on or after 14 0/7 weeks of gestation, patients with fetal anomalies, or those who are expected to deliver in <12 hours (GRADE 2C); (3) we recommend against the use of antenatal corticosteroids for fetal lung maturity in pregnant patients with a low likelihood of delivery before 37 weeks of gestation (GRADE 1B); (4) we recommend against the use of late preterm corticosteroids in pregnant patients with pregestational diabetes mellitus, given the risk of worsening neonatal hypoglycemia (GRADE 1C); (5) we recommend that patients at risk for late preterm delivery be thoroughly counseled regarding the potential risks and benefits of antenatal corticosteroid administration and be advised that the long-term risks remain uncertain (GRADE 1C).

Elevated Glucose Challenge Test in a Nondiabetic Index Pregnancy and Gestational Diabetes in a Subsequent Pregnancy.

OBJECTIVE: The aim of this study was to evaluate whether a 1-hour glucose challenge test (GCT) ≥140 mg/dL in a nondiabetic index pregnancy is associated with the development of gestational diabetes mellitus (GDM) in a subsequent pregnancy. STUDY DESIGN: We performed a retrospective cohort study from a single institution from June 2009 to December 2018. Women with a nondiabetic index singleton gestation who underwent a 1-hour GCT at 24 to 28 weeks and had a successive singleton delivery were included. GDM was defined by a 1-hour GCT of ≥ 200 mg/dL, ≥2 of 4 elevated values on a 3-hour GCT, or a diagnosis of GDM defined by International Classification of Disease codes in the electronic medical record. Univariable analyses were performed to evaluate the associations between an elevated 1-hour GCT result in the index pregnancy, maternal characteristics, and the development of GDM in the subsequent pregnancy. Variables found to be significant (p < 0.05) were included in multivariable analysis. RESULTS: A total of 2,423 women were included. Of these, 340 (14.0%) had an elevated 1-hour GCT in the index pregnancy. Women with an elevated 1-hour GCT in the index pregnancy compared with those without were significantly more likely to be older, married, privately insured, of Hispanic ethnicity or Asian race, chronically hypertensive, have a higher body mass index (BMI), have a shorter inter-pregnancy interval, and to develop GDM in the subsequent pregnancy (14.4 vs. 3.3%, p < 0.001). In multivariable analysis, an elevated 1-hour GCT (adjusted odds ratio [aOR]: 4.54, 95% confidence interval [CI]: 3.02-6.81), first-trimester BMI ≥30 kg/m2 in the index pregnancy (aOR: 3.10, 95% CI: 2.03-4.71), Asian race (aOR: 2.96, 95% CI: 1.70-5.12), Hispanic ethnicity (aOR: 2.11, 95% CI: 1.12-4.00), and increasing age (aOR: 1.07, 95% CI: 1.02-1.12) were significantly associated with an increased risk of GDM in the subsequent pregnancy. CONCLUSION: An elevated 1-hour GCT in a nondiabetic index pregnancy is associated with a fourfold increased risk of GDM in a subsequent pregnancy. KEY POINTS: · An abnormal 1 hour GCT in an index pregnancy is associated with GDM in a subsequent pregnancy.. · An abnormal 1 hour GCT may be an independent risk factor for GDM in a subsequent pregnancy.. · An abnormal 1 hour GCT is associated with a 4 fold increased risk of GDM in a subsequent pregnancy..

Gestational Weight Gain and Pregnancy Outcomes among Nulliparous Women.

OBJECTIVE: To determine the association between total gestational weight gain and perinatal outcomes. STUDY DESIGN: Data from the Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-To-Be (NuMoM2b) study were used. Total gestational weight gain was categorized as inadequate, adequate, or excessive based on the 2009 Institute of Medicine guidelines. Outcomes examined included hypertensive disorders of pregnancy, mode of delivery, shoulder dystocia, large for gestational age or small for-gestational age birth weight, and neonatal intensive care unit admission. RESULTS: Among 8,628 women, 1,666 (19.3%) had inadequate, 2,945 (34.1%) had adequate, and 4,017 (46.6%) had excessive gestational weight gain. Excessive gestational weight gain was associated with higher odds of hypertensive disorders (adjusted odds ratio [aOR] = 2.05, 95% confidence interval [CI]: 1.78-2.36) Cesarean delivery (aOR = 1.24, 95% CI: 1.09-1.41), and large for gestational age birth weight (aOR = 1.49, 95% CI: 1.23-1.80), but lower odds of small for gestational age birth weight (aOR = 0.59, 95% CI: 0.50-0.71). Conversely, inadequate gestational weight gain was associated with lower odds of hypertensive disorders (aOR = 0.75, 95% CI: 0.62-0.92), Cesarean delivery (aOR = 0.77, 95% CI: 0.65-0.92), and a large for gestational age birth weight (aOR = 0.72, 95% CI: 0.55-0.94), but higher odds of having a small for gestational age birth weight (aOR = 1.64, 95% CI: 1.37-1.96). CONCLUSION: Both excessive and inadequate gestational weight gain are associated with adverse maternal and neonatal outcomes.

Change in Cervical Length across Pregnancies and Preterm Delivery.

OBJECTIVE: This study aimed to determine whether a decrease in midtrimester cervical length across pregnancies is associated with preterm delivery in a subsequent pregnancy. STUDY DESIGN: This is a cohort study of women who had two consecutive singleton births at the same institution. Midtrimester cervical length change across pregnancies was measured as the difference in centimeters (cm) between cervical lengths using the measurement taken closest to 200/7 weeks' gestation in each pregnancy. Cervical length shortening was defined as present if the cervical length decreased by at least one standard deviation in the subsequent pregnancy. RESULTS: Among 1,552 women, 114 (7.4%) experienced a preterm delivery in the subsequent pregnancy. Compared with women whose subsequent pregnancy cervical length remained stable or increased, women whose cervical length shortened were more likely to experience a preterm delivery (10.3 vs. 6.7%; p = 0.04). Cervical length shortening remained associated with preterm delivery even when accounting for a woman's prior preterm delivery, prior pregnancy short cervix, interdelivery interval, progesterone use, and cervical length in the subsequent pregnancy (adjusted odds ratio = 1.89; 95% confidence interval = 1.11-3.20). CONCLUSION: Midtrimester cervical length shortening across pregnancies is independently associated with an increased risk of preterm delivery.

Interdelivery Interval and Medically Indicated Preterm Delivery.

OBJECTIVE: The objective of this study was to examine whether a medically indicated preterm delivery is relatively more likely following longer interdelivery intervals. STUDY DESIGN: This is a case-control study of women with two consecutive deliveries of a live singleton at the same institution between 2005 and 2015, with the subsequent delivery occurring preterm. Preterm deliveries were classified as spontaneous if women delivered following preterm labor, preterm premature rupture of membranes, or placental abruption. Preterm deliveries were classified as medically indicated if women underwent delivery for fetal or maternal medical indications. Interdelivery interval was categorized as < 18, 18 to 59, and 60 months or more. Characteristics of women who had a medically indicated versus spontaneous preterm delivery were compared. RESULTS: Of the 1,276 women, 25.6% had a medically indicated preterm delivery and 74.4% had a spontaneous preterm delivery. Compared with women with an interdelivery interval of 18 to 59 months (of whom 25.7% had a preterm delivery for medical indications), women with a shorter interdelivery interval were less likely (19.3%), while women with a longer interdelivery interval were more likely (37.4%; p = 0.003) to have a medically indicated preterm delivery. This relationship persisted even when accounting for other factors. CONCLUSION: Preterm deliveries are more likely to be medically indicated as the interdelivery interval lengthens.

Interdelivery Interval and Diabetes Mellitus in a Subsequent Pregnancy.

OBJECTIVE: We determined whether time between deliveries is associated with developing diabetes at the time of a subsequent delivery. STUDY DESIGN: This is a case-control study of women who had two consecutive singleton births at the same institution with no pregestational diabetes in the baseline pregnancy. Cases were defined as women who were diagnosed with any type of diabetes at the time of the subsequent delivery. Controls were defined as women who had no diagnosis of diabetes at the time of the subsequent delivery. Interdelivery interval (IDI) was categorized as < 18, 18 to 60, or > 60 months. RESULTS: Of 12,263 women, 4.1% (N = 501) were diagnosed with diabetes at the subsequent delivery. Women with diabetes were more likely to have an IDI of >60 months than women without diabetes (9.0 vs. 4.2%, p < 0.001). After controlling for confounding factors, an IDI > 60 months remained associated with development of pregestational or gestational diabetes by the conclusion of the subsequent pregnancy (adjusted odds ratio = 2.13 compared with an IDI of 18-60 months, 95% confidence interval 1.44-3.15). CONCLUSION: A longer IDI is an independent risk factor for the development of diabetes at the time of a subsequent delivery.

Identifying Fetal Growth Disorders Using Ultrasonography in Women With Diabetes.

OBJECTIVES: We evaluated the ability of third-trimester ultrasonography (US) to diagnose disorders of fetal growth among women with diabetes mellitus. METHODS: This work was a retrospective cohort study of women with diabetes who delivered term singleton neonates at a single academic medical center and who had a US examination within 5 weeks of delivery. We characterized the sensitivity, specificity, positive predictive value, and negative predictive value of US to detect large-for-gestational age (LGA) and small-for-gestational age (SGA) infants. Large and small for gestational age were defined as a US estimated fetal weight of greater than 90% and less than 10%, respectively, based on the Hadlock formula (Radiology 1991; 181:129-133); US estimates of LGA or SGA were compared with postnatal findings of LGA or SGA based on gestational age-based weight percentiles. Test characteristics were analyzed for the total cohort and by the type of diabetes. We compared the areas under the curve for receiver operating characteristic curves for different types of diabetes. RESULTS: Of 521 women, 3 (0.6%) screened positive for SGA, and 64 (12.3%) delivered an SGA neonate. In contrast, 129 (24.8%) screened positive for LGA, and 61 (11.7%) delivered an LGA neonate. The receiver operating characteristic curves did not differ significantly for different types of diabetes (P = .68). CONCLUSIONS: Ultrasonography in women with diabetes and term or late preterm pregnancies has high specificity but poor sensitivity for SGA and a low positive predictive value for LGA. The diagnostic capability of US to detect fetal growth abnormalities did not differ significantly by the type of diabetes.

Association between Sonographic Estimated Fetal Weight and the Risk of Cesarean Delivery among Nulliparous Women with Diabetes in Pregnancy.

OBJECTIVE: The objective of this study was to examine the association between an ultrasound-estimated fetal weight (US-EFW) and mode of delivery among nulliparous diabetic women. STUDY DESIGN: This is a retrospective cohort study of nulliparous women with medication-requiring gestational or pregestational diabetes who delivered term, singleton gestations following a trial of labor. We determined whether having had an US-EFW within 35 days of delivery was associated with cesarean delivery. RESULTS: Of 304 women who met the eligibility criteria, 231 (76.0%) had an US-EFW within 35 days of delivery. An US-EFW was associated with increased likelihood of intrapartum cesarean (51.5% for those with an ultrasound vs. 27.4% for those without, p < 0.001); this finding persisted even when controlling for birth weight and other confounding factors (adjusted odds ratio: 2.23, 95% confidence interval: 1.16-4.28). Among women with a recent US-EFW, a diagnosis of a large-for-gestational-age (LGA) fetus was associated with overall intrapartum cesarean frequency (65.2% for women with an LGA fetus vs. 46.1% for those without, p = 0.009), but this association did not remain significant in multivariable models. CONCLUSION: An US-EFW within 35 days of delivery among nulliparous women with medication-requiring diabetes was positively associated with intrapartum cesarean delivery.

Management of Diabetes in the Intrapartum and Postpartum Patient.

Achieving maternal euglycemia in women with pregestational and gestational diabetes mellitus is critical to decreasing the risk of neonatal hypoglycemia, as maternal blood glucose levels around the time of delivery are directly related to the risk of hypoglycemia in the neonate. Many institutions use continuous insulin and glucose infusions during the intrapartum period, although practices are widely variable. At Northwestern Memorial Hospital, the "Management of the Perinatal Patient with Diabetes" policy and protocol was developed to improve consistency of management while also allowing individualization appropriate for the patient's specific diabetic needs. This protocol introduced standardized algorithms based on maternal insulin requirements to drive real-time maternal glucose control during labor as well as provided guidelines for postpartum glycemic control. This manuscript describes the development and implementation of this protocol to encourage other institutions to adopt a standardized protocol that allows highly individualized intrapartum care to women with diabetes.

Interdelivery weight gain and risk of cesarean delivery following a prior vaginal delivery.

BACKGROUND: Approximately one third of all deliveries in the United States are via cesarean. Previous research indicates weight gain during pregnancy is associated with an increased risk of cesarean delivery. It remains unclear, however, whether and to what degree weight gain between deliveries (ie, interdelivery weight gain) is associated with cesarean delivery in a subsequent pregnancy following a vaginal delivery. OBJECTIVES: The objective of the study was to determine whether interdelivery weight gain is associated with an increased risk of intrapartum cesarean delivery following a vaginal delivery. STUDY DESIGN: This was a case-control study of women who had 2 consecutive singleton births of at least 36 weeks' gestation between 2005 and 2016, with a vaginal delivery in the index pregnancy. Women were excluded if they had a contraindication to a trial of labor (eg, fetal malpresentation or placenta previa) in the subsequent pregnancy. Maternal characteristics and delivery outcomes for both pregnancies were abstracted from the medical record. Maternal weight gain between deliveries was measured as the change in body mass index at delivery. Women who underwent a subsequent cesarean delivery were compared with those who had a repeat vaginal delivery using χ2 statistics for categorical variables and Student t tests or analysis of variance for continuous variables. Multivariable logistic regression was used to determine whether interdelivery weight gain remained independently associated with intrapartum cesarean delivery after adjusting for potential confounders. RESULTS: Of 10,396 women who met eligibility criteria and had complete data, 218 (2.1%) had a cesarean delivery in the subsequent pregnancy. Interdelivery weight gain was significantly associated with cesarean delivery and remained significant in multivariable analysis for women with a body mass index increase of at least 2 kg/m2 (adjusted odds ratio, 1.53, 95% confidence interval, 1.03-2.27 for a body mass index increase of 2 kg/m2 to <4 kg/m2; adjusted odds ratio, 1.99, 95% confidence interval, 1.19-3.34 for body mass index increase of 4 kg/m2 or more). Furthermore, women who gained 2 kg/m2 or more were significantly more likely to undergo cesarean delivery specifically for the indications of arrest of dilation or arrest of descent (adjusted odds ratio, 2.01, 95% confidence interval, 1.21-3.33 for body mass index increase of 2 to <4 kg/m2; adjusted odds ratio, 2.34, 95% confidence interval, 1.15-4.76 for body mass index increase of ≥4 kg/m2). Contrarily, women who lost ≥2 kg/m2 were less likely to undergo any cesarean delivery (adjusted odds ratio, 0.41, 95% confidence interval, 0.21-0.78) as well as less likely to undergo cesarean delivery for an arrest disorder (adjusted odds ratio, 0.29, 95% confidence interval, 0.10-0.82). Weight gain or loss was not significantly associated with a cesarean delivery for fetal indications. CONCLUSION: Among women with a prior vaginal delivery, interdelivery weight gain was independently associated with an increased risk of intrapartum cesarean delivery in a subsequent pregnancy.

Prediction of birthweight from third-trimester ultrasound in morbidly obese women.

OBJECTIVE: The gestation-adjusted projection method (GAP method) uses third trimester ultrasound fetal weight to predict birthweight. Our study sought to assess if the accuracy of the GAP method in morbidly obese women depended on (1) ultrasound timing or (2) extreme elevations in maternal body mass index (BMI). STUDY DESIGN: We conducted a diagnostic accuracy study from 2007 to 2012 of all singleton pregnancies with BMI >40 kg/m(2) at the time of delivery that had fetal growth assessment between 30+0 and 35+0 weeks (EARLY) and greater than 35+0 weeks (LATE). Next, a 'reference' BMI group (30-35) was compared with subcategories of women with BMI ≥40. Paired t tests, χ(2) tests and analysis of variance were used to determine significance. RESULTS: A total of 235 pregnancies for the first objective and 430 for the second objective were included. The mean absolute percent error was comparable between the 2 periods (EARLY 7.9 ± 6.7%, LATE 7.4 ± 5.6%; P = .33) and across BMI categories (30-35: 7.6 ± 6.3%, 40-50: 7.2 ± 5.7%, >50: 7.8 ± 6.0%; P = .79). The sensitivity and specificity of the GAP method to predict macrosomia during the EARLY time period was 46% (95% confidence interval 28-66) and 97% (94-99) and in the 40-50 BMI subcategory was 72% (47-90) and 96% (90-99), respectively. CONCLUSION: Prediction of birthweight using the GAP method in obese women does not appear to be influenced by timing of ultrasound or extreme BMI. In a population where clinical estimated fetal weight is difficult, the GAP method may aid in delivery planning.

Racial and ethnic disparities in short interval pregnancy following delivery in Catholic vs non-Catholic hospitals among California Medicaid enrollees.

OBJECTIVES: We examined the impact of Catholic hospital delivery on short interval pregnancy in the California 2010-2014 Medicaid population. STUDY DESIGN: We used Cox regression to estimate the association between hospital affiliation and short interval pregnancy, adjusting for patient factors. RESULTS: Catholic hospital delivery had increased the risk of pregnancy within 6 months for Black (hazard ratio [HR] 1.11, 95% CI 1.06, 1.17) and Hispanic (HR 1.07, 95% CI 1.05, 1.09) but not for White women (HR 1.02, 95% CI 0.98, 1.05). CONCLUSIONS: Among California women with Medicaid, Catholic hospital delivery was associated with short interval pregnancy only among women of color.

Human Immunodeficiency Virus in Pregnancy.

Approximately 5000 people living with human immunodeficiency virus (HIV) give birth each year. Perinatal transmission of HIV will occur in about 15% to 45% of pregnancies without treatment. With appropriate antiretroviral therapy for pregnant people as well as appropriate intrapartum and postpartum interventions, the rate of perinatal transmission can be reduced to less than 1%. Antiretroviral therapy will also reduce health risks for pregnant patients living with HIV. All pregnant people should be offered the opportunity to learn their HIV status and access treatment as needed.

Adherence to Sexually Transmitted Infection Screening in Pregnancy.

Objective: Professional guidelines and state law require screening for sexually transmitted infections (STI) during pregnancy. Our objective was to evaluate adherence to these recommendations. Methods: This is a retrospective cohort study of patients initiating prenatal care before 20 weeks' gestation. Demographic characteristics and STI screening were abstracted from prenatal records. Tests of interest included initial syphilis, human immunodeficiency virus (HIV), hepatitis B, chlamydia, and gonorrhea tests, as well as repeat (third trimester) syphilis and HIV tests. All patients were eligible for initial screening. Patients were eligible for analysis of whether they received adherent repeat third trimester screening for syphilis (mandated by state law) and HIV (institutional protocol) if they delivered at or after 32 weeks' gestation. Adherent screening was defined as performance of all recommended screening. Results: Of 2370 patients, 1816 (76.6%) received adherent initial STI screening and 181 (7.8% of 2308 patients who delivered at or after 32 weeks' gestation) received adherent repeat third trimester STI screening. After adjusting for covariates, private insurance (adjusted odds ratio [aOR] 1.45, confidence interval [95% CI] 1.12-1.95) was associated with adherent initial screening, whereas being non-Hispanic Black or Hispanic were associated with lower odds of adherent initial screening. Factors associated with adherent repeat third trimester STI screening were younger age (aOR 0.93, 95% CI 0.90-0.97) and non-Hispanic Black race (aOR 3.24, 95% CI 1.94-5.42). Those with private insurance (aOR 0.10, 95% CI 0.06-0.15) were less likely to receive adherent repeat third trimester screening. Conclusion: STI screening rates remain suboptimal. Multiple disparities exist in performance both of initial and repeat third trimester screening.