Recent Research Publications- April 2024
Costello S, Santillan D, Shelby A, Bowdler N.
Breastfeed Med. 2024 Mar;19(3):166-176. doi: 10.1089/bfm.2023.0195. Epub 2024 Feb 27. PMID: 38416483.
- Benefits of early skin-to-skin contact (SSC) between mother and newborn are widely documented, including improved breastfeeding outcomes. While promoting immediate SSC is standard practice for vaginal birth, it happens less often after cesarean birth. It is not known how changes in hospital practices and staffing shortages during the COVID-19 pandemic have influenced the practice of SSC in the operating room (OR). This study aims to identify the relationship between SSC after cesarean birth and breastfeeding and compare SSC before and during the COVID-19 pandemic at a single institution.
Materials and Methods: This was a retrospective cohort study of 244 subjects who had scheduled cesarean births during 2019 and 2020. The primary outcome was newborn feeding at hospital discharge. Secondary outcomes were time to initiate breastfeeding, newborn feeding at 4-8-weeks postpartum, and location of SSC initiation in 2019 versus 2020.
- SSC within 3 days of birth was significantly associated with feeding type on discharge and/or 4-8 weeks postpartum. More subjects intending to exclusively breastfeed met this intention at discharge with SSC in the OR. Newborns who had SSC in the OR had significantly earlier initiation of breastfeeding. There was an increase in SSC in the OR between 2019 (27%) and 2020 (39%).
- SSC in the OR was associated with improved short-term breastfeeding outcomes in our study. If immediate SSC is not possible, SSC within 3 days of birth may have breastfeeding benefits. The increase in SSC in the OR during the COVID-19 pandemic indicates that SSC practices can be implemented, despite challenging circumstances.
Evaluation of ChatGPT for Pelvic Floor Surgery Counseling
Johnson CM, Bradley CS, Kenne KA, Rabice S, Takacs E, Vollstedt A, Kowalski JT.
Urogynecology (Phila). 2024 Mar 1;30(3):245-250. doi: 10.1097/SPV.0000000000001459. PMID: 38484238.
- Large language models are artificial intelligence applications that can comprehend and produce human-like text and language. ChatGPT is one such model. Recent advances have increased interest in the utility of large language models in medicine. Urogynecology counseling is complex and time-consuming. Therefore, we evaluated ChatGPT as a potential adjunct for patient counseling.
Objective: Our primary objective was to compare the accuracy and completeness of ChatGPT responses to information in standard patient counseling leaflets regarding common urogynecological procedures.
Study design: Seven urogynecologists compared the accuracy and completeness of ChatGPT responses to standard patient leaflets using 5-point Likert scales with a score of 3 being "equally accurate" and "equally complete," and a score of 5 being "much more accurate" and much more complete, respectively. This was repeated 3 months later to evaluate the consistency of ChatGPT. Additional analysis of the understandability and actionability was completed by 2 authors using the Patient Education Materials Assessment Tool. Analysis was primarily descriptive. First and second ChatGPT queries were compared with the Wilcoxon signed rank test.
- The median (interquartile range) accuracy was 3 (2-3) and completeness 3 (2-4) for the first ChatGPT query and 3 (3-3) and 4 (3-4), respectively, for the second query. Accuracy and completeness were significantly higher in the second query (P < 0.01). Understandability and actionability of ChatGPT responses were lower than the standard leaflets.
- ChatGPT is similarly accurate and complete when compared with standard patient information leaflets for common urogynecological procedures. Large language models may be a helpful adjunct to direct patient-provider counseling. Further research to determine the efficacy and patient satisfaction of ChatGPT for patient counseling is needed.
The AUGS Presidential Address and State of the Society in 2023: Coming Together.
Bradley CS.
Urogynecology (Phila). 2024 Mar 1;30(3):167-173. doi: 10.1097/SPV.0000000000001490. PMID: 38484228.
The Interdisciplinary Doula Project: Innovations in Nursing Clinical Education.
Vignato J, Horak T, Goodrich A, Shier E, Coleman L, Nicholson A, Thompson M.
Nurs Educ Perspect. 2024 Feb 23. doi: 10.1097/01.NEP.0000000000001248. Epub ahead of print. PMID: 38407243.
People giving birth report overwhelmingly positive experiences with nursing students acting as doulas. However, no programs report on improving diversity among students, pregnant people, and curricula. This article describes the Interdisciplinary Doula Project, a program to enhance diverse perspectives and clinical skills of university students. Nursing (n = 21, 77.8%) and other health students (n = 6, 22.2%) completed doula training, diversity seminars, and 36 hours of intrapartum care. Seven nursing students were hired to work on labor and delivery upon graduation. This innovative program may increase registered nurses trained to provide culturally congruent labor support for vulnerable pregnant populations.
Rural-urban disparities in psychosocial functioning in epithelial ovarian cancer patients.
Telles R, Zimmerman MB, Thaker PH, Slavich GM, Ramirez ES, Zia S, Goodheart MJ, Cole SW, Sood AK, Lutgendorf SK.
Gynecol Oncol. 2024 Feb 2;184:139-145. doi: 10.1016/j.ygyno.2024.01.024. Epub ahead of print. PMID: 38309031.
Objective: Although rural residence has been related to health disparities in cancer patients, little is known about how rural residence impacts mental health and quality of life (QOL) in ovarian cancer patients over time. This prospective longitudinal study investigated mental health and QOL of ovarian cancer patients in the first-year post-diagnosis.
- Women with suspected ovarian cancer completed psychosocial surveys pre-surgery, at 6 months and one-year; clinical data were obtained from medical records. Histologically confirmed high grade epithelial ovarian cancer patients were eligible. Rural/urban residence was categorized from patient counties using the USDA Rural-Urban Continuum Codes. Linear mixed effects models examined differences in psychosocial measures over time, adjusting for covariates.
Results: Although disparities were not observed at study entry for any psychosocial variable (all p-values >0.22), urban patients showed greater improvement in total distress over the year following diagnosis than rural patients (p = 0.025) and were significantly less distressed at one year (p = 0.03). Urban patients had a more consistent QOL improvement than their rural counterparts (p = 0.006). There were no differences in the course of depressive symptoms over the year (p = 0.17). Social support of urban patients at 12 months was significantly higher than that of rural patients (p = 0.04).
Conclusion: Rural patients reported less improvement in psychological functioning in the year following diagnosis than their urban counterparts. Clinicians should be aware of rurality as a potential risk factor for ongoing distress. Future studies should examine causes of these health disparities and potential long-term inequities and develop interventions to address these issues.
The role of the placenta-brain axis in psychoneuroimmune programming.
Gumusoglu SB.
Brain Behav Immun Health. 2024 Feb 6;36:100735. doi: 10.1016/j.bbih.2024.100735. PMID: 38420039; PMCID: PMC10900837.
Gestational exposures have enduring impacts on brain and neuroimmune development and function. Perturbations of pregnancy leading to placental structure/function deficits, cell stress, immune activation, and endocrine changes (metabolic, growth factors, etc.) all increase neuropsychiatric risk in offspring. The existing literature links obstetric diseases with placental involvement to offspring neuroimmune outcomes and neurodevelopmental risk. Psychoneuroimmune outcomes in offspring brain include changes to microglia, cytokine/chemokine production, cell stress, and long-term immunoreactivity. These outcomes are altered by structural, anti-angiogenic/hypoxic, inflammatory, and metabolic diseases of the placenta. This fetal programming occurs via direct placental passage or production of factors which can act directly on fetal brain substrates, or indirectly via action of circulating factors on intermediates in the placenta. Placental neuroendocrine, vascular/angiogenic, immune, and extracellular vesicular mechanisms are detailed. These mechanisms interact within various placental and pregnancy conditions. An increased understanding of the placental origins of psychoneuroimmunology will yield dividends for human health. Identifying maternal and placental biomarkers for fetal neuroimmune health may also revolutionize early diagnosis and precision psychiatry, empowering patients to make the best healthcare decisions for their families. Targeting placental mechanisms may be a valuable approach for the prevention and mitigation of intergenerational, lifelong neuropathology.
Maternal RSV Vaccine - Weighing Benefits and Risks.
Rasmussen SA, Jamieson DJ.
N Engl J Med. 2024 Mar 14;390(11):1050-1051. doi: 10.1056/NEJMe2401072. PMID: 38477994
Stanhope KK, Gunderson EP, Suglia SF, Boulet SL, Jamieson DJ, Kiefe CI, Kershaw KN.
Prev Med. 2024 Mar;180:107894. doi: 10.1016/j.ypmed.2024.107894. Epub 2024 Feb 10. PMID: 38346564; PMCID: PMC10896584.
Objective: Childhood adversity is associated with poor cardiometabolic health in adulthood; little is known about how this relationship evolves through childbearing years for parous individuals. The goal was to estimate differences in cardiometabolic health indicators before, during and after childbearing years by report of childhood maltreatment in the Coronary Artery Risk Development in Young Adults (CARDIA) cohort study.
- : Including 743 individuals nulliparous at baseline (1985-1986) with one or more pregnancies >20 weeks during follow-up (1986-2022), we fit segmented linear regression models to estimate mean differences between individuals reporting or not reporting childhood maltreatment (physical or emotional) in waist circumference, triglycerides, high-density lipoprotein cholesterol, systolic and diastolic blood pressure, fasting glucose, and body mass index (BMI) prior to, during, and following childbearing years using generalized estimating equations, allowing for interaction between maltreatment and time within each segment, and adjusting for total parity, parental education, and race (Black or white, self-reported).
Results: Individuals reporting maltreatment (19%; 141) had a greater waist circumference (post-childbearing: +2.9 cm, 95% CI (0.7, 5.0), higher triglycerides [post-childbearing: +8.1 mg/dL, 95% CI (0.7, 15.6)], and lower HDL cholesterol [post-childbearing: -2.1 mg/dL, 95% CI (-4.7, 0.5)] during all stages compared to those not reporting maltreatment. There were not meaningful differences in blood pressure, fasting glucose, or BMI. Individuals who reported maltreatment did not report faster changes over time.
- : Differences in some aspects of cardiometabolic health between individuals reporting versus not reporting childhood maltreatment were sustained across reproductive life stages, suggesting potentially persistent impacts of childhood adversity.
Stanhope KK, Gunderson EP, Suglia SF, Boulet SL, Jamieson DJ, Kiefe CI, Kershaw KN.
Ann Epidemiol. 2024 Mar;91:30-36. doi: 10.1016/j.annepidem.2024.01.007. Epub 2024 Jan 23. PMID: 38266664; PMCID: PMC10922764.
- To estimate associations between facets of the maternal childhood family environment with gestational diabetes (GDM) and to test mediation by pre-pregnancy waist circumference.
- We used data from CARDIA, a cohort of individuals aged 18-30 years at baseline (1985-86), followed over 30 years (2016). We included participants with one or more pregnancies ≥ 20 weeks after baseline, without pre-pregnancy diabetes. The primary exposure was the Childhood Family Environment Scale (assessed year 15), including the total score and abuse, nurture, and stability subscales as continuous, separate exposures. The outcome was GDM (self-reported at each visit for each pregnancy). We fit log binomial models with generalized estimating equations to calculate risk ratios (RR) and 95% confidence intervals (CI), adjusting for age at delivery, parity, race (Black or White), and parental education. We used regression models with bootstrapped CIs to test mediation and effect modification by excess abdominal adiposity at the last preconception CARDIA visit (waist circumference ≥ 88 cm).
Results: We included 1033 individuals (46% Black) with 1836 pregnancies. 130 pregnancies (7.1%) were complicated by GDM. For each 1 point increase on the abuse subscale (e.g., from "rarely or never" to "some or little of the time") there was a 30% increased risk of GDM (RR: 1.3, 95% CI: 1.0, 1.7). There was evidence of effect modification but not mediation by preconception abdominal adiposity.
Conclusions: A more adverse childhood family environment was associated with increased risk of GDM, with a stronger association among individuals with preconception waist circumference ≥ 88 cm.
Increased Maternal BMI at Time of Delivery Associated with Poor Maternal and Neonatal Outcomes.
Steffen H, Swartz S, Kenne K, Wendt L, Jackson JB, Rysavy M.
Am J Perinatol. 2024 Feb 22. doi: 10.1055/a-2274-0463. Epub ahead of print. PMID: 38387610.
Objective: Current literature on the risks and outcomes of obesity in pregnancy almost exclusively utilizes pre-pregnancy body mass index (BMI). Given the rising obesity rate across the United States along with a paucity of available information on the relationship between delivery BMI and maternal and neonatal outcomes, our study aimed to determine the association of maternal BMI at delivery with antepartum, intrapartum, and neonatal complications at an academic referral hospital.
Study design: This study is a secondary analysis of data collected for a prospective cohort study of COVID-19 in pregnancy. This analysis included all patients who delivered term singleton infants between May 1, 2020, and April 30, 2021, at the University of Iowa Hospitals and Clinics. Demographic and clinical data were obtained from the electronic medical record. The relationship between maternal BMI and maternal and neonatal characteristics of interest was assessed using logistic regression models. A statistical significance threshold of 0.05 was used for all comparisons.
- : There were 1,996 women who delivered term singleton infants during the study period. The median BMI at delivery was 31.7 (interquartile range 27.9, 37.2), with 61.1% of women having a BMI >30.0. Increasing BMI was significantly associated with non-reassuring fetal status, unscheduled cesarean birth, overall cesarean birth rate, postpartum hemorrhage, prolonged postpartum stay, hypertensive diseases of pregnancy, neonatal hypoglycemia, neonatal intensive care unit admission, decreased APGAR score at one minute, and increasing neonatal birth weight. Even when controlling for pre-existing hypertension in a multivariate model, increasing BMI was associated with gestational hypertension and pre-eclampsia.
Conclusion: Increased maternal BMI at delivery was associated with adverse perinatal outcomes. These findings have implications for clinical counseling regarding risks of pregnancy and delivery for overweight and obese patients and may help inform future studies to improve safety, especially by examining reasons for high cesarean rates.
Levine MD, Wagner VM, Riedinger CJ, Khadraoui W, Haight PJ, Morton M, Barrington DA, Calo CA, Castaneda AV, Lightfoot M, Chalif J, Gonzalez A, Cohn DE.
Gynecol Oncol Rep. 2024 Jan 29;52:101327. doi: 10.1016/j.gore.2024.101327. PMID: 38390623; PMCID: PMC10881305.
•Leadership training is under-emphasized in traditional medical education.
•An effective leadership curriculum must be dynamic and requires genuine investment from participants.
•Through didactic education, self-reflection, and real-world perspective we can actively mold future leaders in gynecologic oncology.