ObjectivesTo identify the incidence and resolution rates of a low‐lying placenta or placenta prev... more ObjectivesTo identify the incidence and resolution rates of a low‐lying placenta or placenta previa and to assess the optimal time to perform follow‐up ultrasonography (US) to assess for resolution.MethodsWe conducted a retrospective cohort study of women with a diagnosis of a low‐lying placenta or placenta previa at routine anatomic screening. Follow‐up US examinations were reviewed to estimate the proportion of women who had resolution. A Kaplan‐Meier survival curve was generated to estimate the median time to resolution. The distance of the placental edge from the internal cervical os was used to categorize the placenta as previa or low‐lying (0.1–10 or ≥ 10–20 mm). A time‐to‐event analysis was used to estimate predictive factors and the time to resolution by distance from the os.ResultsA total of 1663 (8.7%) women had a diagnosis of a low‐lying placenta or placenta previa. The cumulative resolution for women who completed 1 or more additional US examinations was 91.9% (95% confi...
Journal of Maternal-fetal & Neonatal Medicine, Nov 18, 2020
OBJECTIVE To use a questionnaire to determine the levels of maternal decision-related distress, c... more OBJECTIVE To use a questionnaire to determine the levels of maternal decision-related distress, clarity of the pros and cons, and certainty when considering prenatal genetic diagnostic testing; and to assess the relationship between these constructs and patient characteristics. METHOD Cross-sectional study. Voluntary, anonymous questionnaires distributed 2017-2019 to women referred for invasive prenatal genetic testing. Excluded: English or Spanish illiterate. Maternal characteristics were collected. Questions evaluated distress, decisional certainty, and decisional clarity on a 5-point Likert scale (range: 0 = low/uncertain/unclear to 4 = high/certain/clear). Analysis: non-parametric Kruskal-Wallis, correlation statistics, and ANOVA. RESULTS Forty-four female patients completed it. Most were married, white, Catholic, and multiparous. 58% had already made a testing decision. Patients expressed low distress levels (mean 1.18 ± 0.80) and expressed high decisional certainty (mean 3.28 ± 0.76) and clarity (mean 3.30 ± 0.99). Decisional certainty and clarity were positively correlated (r = 0.47, p < .01), whereas distress was negatively correlated with decisional certainty (r = -0.8136, p < .0005) and decisional clarity (r = -0.49, p = .007). No significant differences by religion or parity. Greater distress (p < .05) and less decisional clarity (p = .07) occurred between those still debating testing vs those who had decided. CONCLUSIONS Higher maternal distress scores were associated with lower decisional certainty and decisional clarity in women considering prenatal genetic testing.
Although it is tempting to construe the correlation between Black “race” and higher rates of pret... more Although it is tempting to construe the correlation between Black “race” and higher rates of preterm birth as causal, this logic is flawed. Worse, the continued use of Black “race” as a risk factor for preterm birth is actively harmful. Using Black “race” as a risk factor suggests a causal relationship that does not exist and, critically, obscures what actually causes Black patients to be more vulnerable to poorer maternal and infant outcomes: anti-Black racism. Failing to name anti-Black racism as the root cause of Black patients' vulnerability conceals key pathways and tempts us to construe Black “race” as immutably related to higher rates of preterm birth. The result is that we overlook two highly treatable pathways—chronic stress and implicit bias—through which anti-Black racism negatively contributes to birth. Thus, clinicians may underuse important tools to reduce stress from racism and discrimination while missing opportunities to address implicit bias within their practi...
Objective: We examined the antibody response of pregnant women who delivered at Mount Sinai Hospi... more Objective: We examined the antibody response of pregnant women who delivered at Mount Sinai Hospital with a SARS-CoV 2 infection between the study interval of March 15, 2020 through April 30, 2020. Study Design: This was a prospective observational study examining the immune response of pregnant women who delivered at Mount Sinai Hospital with a PCR confirmed SARS-CoV 2 infection. Women with a SARS-CoV 2 infection were contacted via phone and scheduled for a phlebotomy visit to assess their antibody titer levels to COVID 19. The COVID-19 ELISA IgG Antibody Test was used to evaluate the patients’ antibody titers. Results: 122 patients were identified as being diagnosed and delivered with SARS-CoV 2 in the pre-specified time frame. Of those patients, 25 women agreed to participate and were included in this study. 64.00% were Caucasian with an average age of 35 years. Demographic variables are illustrated in Table 1. The majority of women were asymptomatic for COVID-19 at the time of admission (80.00 %) and the average gestational age of delivery and diagnosis of COVID-19 was 39 weeks gestation (Table 1). The later the gestational age at the time of diagnosis, the lower the antibody titer response (Table 2). When examining interval from diagnosis to antibody titer level, patients with the highest titers (2880) tended to have a shorter interval between their COVID-19 diagnosis and the time at which the titer level was drawn (73 vs 87 vs 77 days for patients with titers of 1:2880, 960 and 320 respectively). In addition, patients with symptoms on admission were slightly more likely to have a higher antibody titer level (80.00% of symptomatic patients had a reported antibody level of 960 or 2880). Conclusion: The antibody response among women infected with COVID-19 during pregnancy, appears to be greater when the patients are diagnosed at an earlier gestational age. Antibody titers were assessed greater than 4 weeks from the time of initial diagnosis, however beyond this time period the shorter the interval between diagnosis and assessment of antibody titer level, the more robust the apparent immune response. [Formula presented] [Formula presented]
Preterm birth is a leading cause of neonatal mortality and is characterized by substantial racial... more Preterm birth is a leading cause of neonatal mortality and is characterized by substantial racial disparities in the US. Despite efforts to reduce preterm birth, rates have risen and racial disparities persist. Maternal stress is a risk factor for preterm birth; however, often, it is treated as a secondary variable rather than a primary target for intervention. Stress is known to affect several biological processes leading to downstream sequelae. Here, we present a model of stress-induced developmental plasticity where maternal stress is a key environmental cue impacting the length of gestation and therefore a primary target for intervention. Black women experience disproportionate and unique maternal stressors related to perceived racism and discrimination. It is therefore not surprising that Black women have disproportionate rates of preterm birth. The downstream effects of racism on preterm birth pathophysiology may reflect an appropriate response to stressors through the highly conserved maternal–fetal–placental neuroendocrine stress axis. This environmentally sensitive system mediates both maternal stress and the timing of birth and is a mechanism by which developmental plasticity occurs. Fortunately, stress does not appear to be an all-or-none variable. Evidence suggests that developmental plasticity is dynamic, functioning on a continuum. Therefore, simple, stress-reducing interventions that support pregnant women may tangibly reduce rates of preterm birth and improve birth outcomes for all women, particularly Black women.
European Journal of Obstetrics & Gynecology and Reproductive Biology, 2022
OBJECTIVES To determine if early-onset fetal growth restriction with abnormal individual biometri... more OBJECTIVES To determine if early-onset fetal growth restriction with abnormal individual biometric parameters, defined as head circumference, abdominal circumference and femur length less than the 10th percentile, is associated with adverse neonatal outcomes compared to fetal growth restriction with normal biometric parameters. STUDY DESIGN Retrospective cohort study including women diagnosed with fetal growth restriction between 16 and 24 weeks gestation who delivered a singleton, non-anomalous neonate at Mount Sinai Hospital from 2013 to 2019. The primary outcome was rate of small for gestational age neonate at delivery. Maternal, obstetric and neonatal outcomes were compared using multivariable regression analysis. RESULTS Patients diagnosed with fetal growth restriction with abnormal biometric parameters were more likely to be nulliparous, diagnosed with severe growth restriction and to receive antenatal corticosteroids than those with normal biometric parameters. The rate of small for gestational age neonate at delivery was higher in those with abnormal parameters (OR 4.0, 95% CI 1.7-9.2, p < 0.01) when compared to normal parameters. The rate of resolution of fetal growth restriction was higher in the normal biometric parameter group compared to those with abnormal parameters (OR 3.3, 95% CI 1.4-8.1, p < 0.01). CONCLUSIONS Fetal growth restriction and normal biometric parameters diagnosed at second trimester ultrasound is associated with an increased likelihood of resolution of growth restriction and decreased likelihood of delivering a small for gestational age neonate.
Objectives Novel coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndr... more Objectives Novel coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) virus has been declared a pandemic by the World Health Organization as of March 11, 2020. Pregnant women naturally have a reduced immune system due to immunological changes and decreased lung capacity due to respiratory adaptations, making them more susceptible to coronavirus complications. Within the Mount Sinai Health system, more than 15,000 deliveries are performed annually. We began to care for pregnant women with known COVID-19 infections in late March of 2020. In early April 2020, a policy was implemented to perform universal COVID-19 testing for all women planning to deliver within the Mount Sinai Health system. We examined the antibody response of postpartum women who delivered at Mount Sinai Hospital with a SARS-CoV-2 infection between the study intervals during March 15, 2020, through April 30, 2020. Study Design This was a prospective observatio...
The Journal of Maternal-Fetal & Neonatal Medicine, 2020
OBJECTIVE To use a questionnaire to determine the levels of maternal decision-related distress, c... more OBJECTIVE To use a questionnaire to determine the levels of maternal decision-related distress, clarity of the pros and cons, and certainty when considering prenatal genetic diagnostic testing; and to assess the relationship between these constructs and patient characteristics. METHOD Cross-sectional study. Voluntary, anonymous questionnaires distributed 2017-2019 to women referred for invasive prenatal genetic testing. Excluded: English or Spanish illiterate. Maternal characteristics were collected. Questions evaluated distress, decisional certainty, and decisional clarity on a 5-point Likert scale (range: 0 = low/uncertain/unclear to 4 = high/certain/clear). Analysis: non-parametric Kruskal-Wallis, correlation statistics, and ANOVA. RESULTS Forty-four female patients completed it. Most were married, white, Catholic, and multiparous. 58% had already made a testing decision. Patients expressed low distress levels (mean 1.18 ± 0.80) and expressed high decisional certainty (mean 3.28 ± 0.76) and clarity (mean 3.30 ± 0.99). Decisional certainty and clarity were positively correlated (r = 0.47, p < .01), whereas distress was negatively correlated with decisional certainty (r = -0.8136, p < .0005) and decisional clarity (r = -0.49, p = .007). No significant differences by religion or parity. Greater distress (p < .05) and less decisional clarity (p = .07) occurred between those still debating testing vs those who had decided. CONCLUSIONS Higher maternal distress scores were associated with lower decisional certainty and decisional clarity in women considering prenatal genetic testing.
ObjectivesTo identify the incidence and resolution rates of a low‐lying placenta or placenta prev... more ObjectivesTo identify the incidence and resolution rates of a low‐lying placenta or placenta previa and to assess the optimal time to perform follow‐up ultrasonography (US) to assess for resolution.MethodsWe conducted a retrospective cohort study of women with a diagnosis of a low‐lying placenta or placenta previa at routine anatomic screening. Follow‐up US examinations were reviewed to estimate the proportion of women who had resolution. A Kaplan‐Meier survival curve was generated to estimate the median time to resolution. The distance of the placental edge from the internal cervical os was used to categorize the placenta as previa or low‐lying (0.1–10 or ≥ 10–20 mm). A time‐to‐event analysis was used to estimate predictive factors and the time to resolution by distance from the os.ResultsA total of 1663 (8.7%) women had a diagnosis of a low‐lying placenta or placenta previa. The cumulative resolution for women who completed 1 or more additional US examinations was 91.9% (95% confi...
Journal of Maternal-fetal & Neonatal Medicine, Nov 18, 2020
OBJECTIVE To use a questionnaire to determine the levels of maternal decision-related distress, c... more OBJECTIVE To use a questionnaire to determine the levels of maternal decision-related distress, clarity of the pros and cons, and certainty when considering prenatal genetic diagnostic testing; and to assess the relationship between these constructs and patient characteristics. METHOD Cross-sectional study. Voluntary, anonymous questionnaires distributed 2017-2019 to women referred for invasive prenatal genetic testing. Excluded: English or Spanish illiterate. Maternal characteristics were collected. Questions evaluated distress, decisional certainty, and decisional clarity on a 5-point Likert scale (range: 0 = low/uncertain/unclear to 4 = high/certain/clear). Analysis: non-parametric Kruskal-Wallis, correlation statistics, and ANOVA. RESULTS Forty-four female patients completed it. Most were married, white, Catholic, and multiparous. 58% had already made a testing decision. Patients expressed low distress levels (mean 1.18 ± 0.80) and expressed high decisional certainty (mean 3.28 ± 0.76) and clarity (mean 3.30 ± 0.99). Decisional certainty and clarity were positively correlated (r = 0.47, p < .01), whereas distress was negatively correlated with decisional certainty (r = -0.8136, p < .0005) and decisional clarity (r = -0.49, p = .007). No significant differences by religion or parity. Greater distress (p < .05) and less decisional clarity (p = .07) occurred between those still debating testing vs those who had decided. CONCLUSIONS Higher maternal distress scores were associated with lower decisional certainty and decisional clarity in women considering prenatal genetic testing.
Although it is tempting to construe the correlation between Black “race” and higher rates of pret... more Although it is tempting to construe the correlation between Black “race” and higher rates of preterm birth as causal, this logic is flawed. Worse, the continued use of Black “race” as a risk factor for preterm birth is actively harmful. Using Black “race” as a risk factor suggests a causal relationship that does not exist and, critically, obscures what actually causes Black patients to be more vulnerable to poorer maternal and infant outcomes: anti-Black racism. Failing to name anti-Black racism as the root cause of Black patients' vulnerability conceals key pathways and tempts us to construe Black “race” as immutably related to higher rates of preterm birth. The result is that we overlook two highly treatable pathways—chronic stress and implicit bias—through which anti-Black racism negatively contributes to birth. Thus, clinicians may underuse important tools to reduce stress from racism and discrimination while missing opportunities to address implicit bias within their practi...
Objective: We examined the antibody response of pregnant women who delivered at Mount Sinai Hospi... more Objective: We examined the antibody response of pregnant women who delivered at Mount Sinai Hospital with a SARS-CoV 2 infection between the study interval of March 15, 2020 through April 30, 2020. Study Design: This was a prospective observational study examining the immune response of pregnant women who delivered at Mount Sinai Hospital with a PCR confirmed SARS-CoV 2 infection. Women with a SARS-CoV 2 infection were contacted via phone and scheduled for a phlebotomy visit to assess their antibody titer levels to COVID 19. The COVID-19 ELISA IgG Antibody Test was used to evaluate the patients’ antibody titers. Results: 122 patients were identified as being diagnosed and delivered with SARS-CoV 2 in the pre-specified time frame. Of those patients, 25 women agreed to participate and were included in this study. 64.00% were Caucasian with an average age of 35 years. Demographic variables are illustrated in Table 1. The majority of women were asymptomatic for COVID-19 at the time of admission (80.00 %) and the average gestational age of delivery and diagnosis of COVID-19 was 39 weeks gestation (Table 1). The later the gestational age at the time of diagnosis, the lower the antibody titer response (Table 2). When examining interval from diagnosis to antibody titer level, patients with the highest titers (2880) tended to have a shorter interval between their COVID-19 diagnosis and the time at which the titer level was drawn (73 vs 87 vs 77 days for patients with titers of 1:2880, 960 and 320 respectively). In addition, patients with symptoms on admission were slightly more likely to have a higher antibody titer level (80.00% of symptomatic patients had a reported antibody level of 960 or 2880). Conclusion: The antibody response among women infected with COVID-19 during pregnancy, appears to be greater when the patients are diagnosed at an earlier gestational age. Antibody titers were assessed greater than 4 weeks from the time of initial diagnosis, however beyond this time period the shorter the interval between diagnosis and assessment of antibody titer level, the more robust the apparent immune response. [Formula presented] [Formula presented]
Preterm birth is a leading cause of neonatal mortality and is characterized by substantial racial... more Preterm birth is a leading cause of neonatal mortality and is characterized by substantial racial disparities in the US. Despite efforts to reduce preterm birth, rates have risen and racial disparities persist. Maternal stress is a risk factor for preterm birth; however, often, it is treated as a secondary variable rather than a primary target for intervention. Stress is known to affect several biological processes leading to downstream sequelae. Here, we present a model of stress-induced developmental plasticity where maternal stress is a key environmental cue impacting the length of gestation and therefore a primary target for intervention. Black women experience disproportionate and unique maternal stressors related to perceived racism and discrimination. It is therefore not surprising that Black women have disproportionate rates of preterm birth. The downstream effects of racism on preterm birth pathophysiology may reflect an appropriate response to stressors through the highly conserved maternal–fetal–placental neuroendocrine stress axis. This environmentally sensitive system mediates both maternal stress and the timing of birth and is a mechanism by which developmental plasticity occurs. Fortunately, stress does not appear to be an all-or-none variable. Evidence suggests that developmental plasticity is dynamic, functioning on a continuum. Therefore, simple, stress-reducing interventions that support pregnant women may tangibly reduce rates of preterm birth and improve birth outcomes for all women, particularly Black women.
European Journal of Obstetrics & Gynecology and Reproductive Biology, 2022
OBJECTIVES To determine if early-onset fetal growth restriction with abnormal individual biometri... more OBJECTIVES To determine if early-onset fetal growth restriction with abnormal individual biometric parameters, defined as head circumference, abdominal circumference and femur length less than the 10th percentile, is associated with adverse neonatal outcomes compared to fetal growth restriction with normal biometric parameters. STUDY DESIGN Retrospective cohort study including women diagnosed with fetal growth restriction between 16 and 24 weeks gestation who delivered a singleton, non-anomalous neonate at Mount Sinai Hospital from 2013 to 2019. The primary outcome was rate of small for gestational age neonate at delivery. Maternal, obstetric and neonatal outcomes were compared using multivariable regression analysis. RESULTS Patients diagnosed with fetal growth restriction with abnormal biometric parameters were more likely to be nulliparous, diagnosed with severe growth restriction and to receive antenatal corticosteroids than those with normal biometric parameters. The rate of small for gestational age neonate at delivery was higher in those with abnormal parameters (OR 4.0, 95% CI 1.7-9.2, p < 0.01) when compared to normal parameters. The rate of resolution of fetal growth restriction was higher in the normal biometric parameter group compared to those with abnormal parameters (OR 3.3, 95% CI 1.4-8.1, p < 0.01). CONCLUSIONS Fetal growth restriction and normal biometric parameters diagnosed at second trimester ultrasound is associated with an increased likelihood of resolution of growth restriction and decreased likelihood of delivering a small for gestational age neonate.
Objectives Novel coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndr... more Objectives Novel coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) virus has been declared a pandemic by the World Health Organization as of March 11, 2020. Pregnant women naturally have a reduced immune system due to immunological changes and decreased lung capacity due to respiratory adaptations, making them more susceptible to coronavirus complications. Within the Mount Sinai Health system, more than 15,000 deliveries are performed annually. We began to care for pregnant women with known COVID-19 infections in late March of 2020. In early April 2020, a policy was implemented to perform universal COVID-19 testing for all women planning to deliver within the Mount Sinai Health system. We examined the antibody response of postpartum women who delivered at Mount Sinai Hospital with a SARS-CoV-2 infection between the study intervals during March 15, 2020, through April 30, 2020. Study Design This was a prospective observatio...
The Journal of Maternal-Fetal & Neonatal Medicine, 2020
OBJECTIVE To use a questionnaire to determine the levels of maternal decision-related distress, c... more OBJECTIVE To use a questionnaire to determine the levels of maternal decision-related distress, clarity of the pros and cons, and certainty when considering prenatal genetic diagnostic testing; and to assess the relationship between these constructs and patient characteristics. METHOD Cross-sectional study. Voluntary, anonymous questionnaires distributed 2017-2019 to women referred for invasive prenatal genetic testing. Excluded: English or Spanish illiterate. Maternal characteristics were collected. Questions evaluated distress, decisional certainty, and decisional clarity on a 5-point Likert scale (range: 0 = low/uncertain/unclear to 4 = high/certain/clear). Analysis: non-parametric Kruskal-Wallis, correlation statistics, and ANOVA. RESULTS Forty-four female patients completed it. Most were married, white, Catholic, and multiparous. 58% had already made a testing decision. Patients expressed low distress levels (mean 1.18 ± 0.80) and expressed high decisional certainty (mean 3.28 ± 0.76) and clarity (mean 3.30 ± 0.99). Decisional certainty and clarity were positively correlated (r = 0.47, p < .01), whereas distress was negatively correlated with decisional certainty (r = -0.8136, p < .0005) and decisional clarity (r = -0.49, p = .007). No significant differences by religion or parity. Greater distress (p < .05) and less decisional clarity (p = .07) occurred between those still debating testing vs those who had decided. CONCLUSIONS Higher maternal distress scores were associated with lower decisional certainty and decisional clarity in women considering prenatal genetic testing.
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