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Uptake rate of carrier screening among consanguineous couples

Ricca, Julianne; Brandt, Justin S; Jacob, Natalie; Ashkinadze, Elena
OBJECTIVE:To quantify the uptake rates of Carrier Screening (CS) in consanguineous couples and compare this rate to that of non-consanguineous couples. METHODS:We performed a matched case control study of 82 consanguineous couples seen at Rutgers-Robert Wood Johnson Medical school who were offered carrier screening between January 1, 2012 and October 10, 2022. We then matched each consanguineous female patient to a non-consanguineous female control patient who was also offered CS at the time of their genetic counseling appointment. A 2 × 2 contingency table analysis was used to compare rates of acceptance and declination between the consanguineous and non-consanguineous groups. RESULTS:The overall acceptance rate among consanguineous couples was 82.9%, whereas the overall acceptance rate among non-consanguineous couples was 56.1%. After statistical analysis, consanguineous couples were significantly more likely to accept CS as compared to non-consanguineous couples (OR = 3.801, 95% CI; p < 0.0001). We also report the carrier couple rates and individual carrier statistics between these two groups. CONCLUSION/CONCLUSIONS:This study supports the idea that consanguineous couples are more likely to pursue CS and have a higher carrier couple yield.
PMID: 38497814
ISSN: 1097-0223
CID: 5640102

Pregnancy-associated mortality due to cardiovascular disease: Impact of hypertensive disorders of pregnancy

Lee, Rachel; Brandt, Justin S; Joseph, K S; Ananth, Cande V
BACKGROUND:Reported rates of maternal mortality in the United States have been staggeringly high and increasing, and cardiovascular disease (CVD) is a chief contributor to such deaths. However, the impact of hypertensive disorders of pregnancy (HDP) on the short-term risk of cardiovascular death is not well understood. OBJECTIVES/OBJECTIVE:To evaluate the association between HDP (chronic hypertension, gestational hypertension, preeclampsia, eclampsia, and superimposed preeclampsia) and pregnancy-associated mortality rates (PMR) from all causes, CVD-related causes both at delivery and within 1 year following delivery. METHODS:We used the Nationwide Readmissions Database (2010-2018) to examine PMRs for females 15-54 years old. International Classification of Disease 9 and 10 diagnosis codes were used to identify pregnancy-associated deaths due to HDP and CVD. Discrete-time Cox proportional hazards regression models were used to calculate adjusted hazard ratios (HR) and 95% confidence intervals (CI) for mortality at delivery (0 days) and at <30, <60, <90, <180, and <365 days after delivery in relation to HDP. RESULTS:Of 33,417,736 hospital deliveries, the rate of HDP was 11.0% (n = 3,688,967), and the PMR from CVD was 6.4 per 100,000 delivery hospitalisations (n = 2141). Compared with normotensive patients, HRs for CVD-related PMRs increased with HDP severity, reaching over 58-fold for eclampsia patients. HRs were higher for stroke-related (1.2 to 170.9) than heart disease (HD)-related (0.99 to 39.8) mortality across all HDPs. Except for gestational hypertension, the increased risks of CVD mortality were evident at delivery and persisted 1 year postpartum for all HDPs. CONCLUSIONS:HDPs are strong risk factors for pregnancy-associated mortality due to CVD at delivery and within 1 year postpartum; the risks are stronger for stroke than HD-related PMR. While absolute PMRs are low, this study supports the importance of extending postpartum care beyond the traditional 42-day postpartum visit for people whose pregnancies are complicated by hypertension.
PMID: 38375930
ISSN: 1365-3016
CID: 5634142

Effect of the COVID-19 Pandemic on Stillbirths in Canada and the United States

Joseph, K S; Lisonkova, Sarka; Simon, Sophie; John, Sid; Razaz, Neda; Muraca, Giulia M; Boutin, Amélie; Bedaiwy, Mohamed A; Brandt, Justin S; Ananth, Cande V
OBJECTIVE:There is uncertainty regarding the effect of the COVID-19 pandemic on population rates of stillbirth. We quantified pandemic-associated changes in stillbirth rates in Canada and the United States. METHODS:We carried out a retrospective study that included all live births and stillbirths in Canada and the United States from 2015 to 2020. The primary analysis was based on all stillbirths and live births at ≥20 weeks gestation. Stillbirth rates were analyzed by month, with March 2020 considered to be the month of pandemic onset. Interrupted time series analyses were used to determine pandemic effects. RESULTS:The study population included 18,475 stillbirths and 2,244,240 live births in Canada and 134,883 stillbirths and 22,963,356 live births in the United States (8.2 and 5.8 stillbirths per 1,000 total births, respectively). In Canada, pandemic onset was associated with an increase in stillbirths at ≥20 weeks gestation of 1.01 (95% confidence interval [CI] 0.56-1.46) per 1,000 total births and an increase in stillbirths at ≥28 weeks gestation of 0.35 (95% CI 0.16-0.54) per 1,000 total births. In the United States, pandemic onset was associated with an increase in stillbirths at ≥20 weeks gestation of 0.48 (95% CI 0.22-0.75) per 1,000 total births and an increase in stillbirths at ≥28 weeks gestation of 0.22 (95% CI 0.12-0.32) per 1,000 total births. The increase in stillbirths at pandemic onset returned to pre-pandemic levels in subsequent months. CONCLUSION/CONCLUSIONS:The COVID-19 pandemic's onset was associated with a transitory increase in stillbirth rates in Canada and the United States.
PMID: 38160796
ISSN: 1701-2163
CID: 5628322

Chronic Hypertension and the Risk of Readmission for Postpartum Cardiovascular Complications

Rosenfeld, Emily B; Brandt, Justin S; Fields, Jessica C; Lee, Rachel; Graham, Hillary L; Sharma, Ruchira; Ananth, Cande V
OBJECTIVE:Preeclampsia is an important risk factor for cardiovascular disease (CVD, including heart disease and stroke) along the life course. However, whether exposure to chronic hypertension in pregnancy, in the absence of preeclampsia, is implicated in CVD risk during the immediate postpartum period remains poorly understood. Our objective was to estimate the risk of readmission for CVD complications within the calendar year after delivery for people with chronic hypertension. METHODS:The Healthcare Cost and Utilization Project's Nationwide Readmission Database (2010-2018) was used to conduct a retrospective cohort study of patients aged 15-54 years. International Classification of Diseases codes were used to identify patients with chronic hypertension and postpartum readmission for CVD complications within 1 year of delivery. People with CVD diagnosed during pregnancy or delivery admission, multiple births, or preeclampsia or eclampsia were excluded. Excess rates of CVD readmission among patients with and without chronic hypertension were estimated. Associations between chronic hypertension and CVD complications were determined from Cox proportional hazards regression models. RESULTS:Of 27,395,346 delivery hospitalizations that resulted in singleton births, 2.0% of individuals had chronic hypertension (n=544,639). The CVD hospitalization rate among patients with chronic hypertension and normotensive patients was 645 (n=3,791) per 100,000 delivery hospitalizations and 136 (n=37,664) per 100,000 delivery hospitalizations, respectively (rate difference 508, 95% CI 467-549; adjusted hazard ratio 4.11, 95% CI 3.64-4.66). The risk of CVD readmission, in relation to chronic hypertension, persisted for 1 year after delivery. CONCLUSION/CONCLUSIONS:The heightened CVD risk as early as 1 month postpartum in relation to chronic hypertension underscores the need for close monitoring and timely care after delivery to reduce blood pressure and related complications.
PMCID:10662390
PMID: 37917949
ISSN: 1873-233x
CID: 5607882

Obstetric Intervention and Perinatal Outcomes During the Coronavirus Disease 2019 (COVID-19) Pandemic

Simon, Sophie; John, Sid; Lisonkova, Sarka; Razaz, Neda; Muraca, Giulia M; Boutin, Amélie; Bedaiwy, Mohamed A; Brandt, Justin S; Ananth, Cande V; Joseph, K S
OBJECTIVE:To quantify pandemic-related changes in obstetric intervention and perinatal outcomes in the United States. METHODS:We carried out a retrospective study of all live births and fetal deaths in the United States, 2015-2021, with data obtained from the natality, fetal death, and linked live birth-infant death files of the National Center for Health Statistics. Analyses were carried out among all singletons; singletons of patients with prepregnancy diabetes, prepregnancy hypertension, and hypertensive disorders of pregnancy; and twins. Outcomes of interest included preterm birth, preterm labor induction or preterm cesarean delivery, macrosomia, postterm birth, and perinatal death. Interrupted time series analyses were used to estimate changes in the prepandemic period (January 2015-February 2020), at pandemic onset (March 2020), and in the pandemic period (March 2020-December 2021). RESULTS:The study population included 26,604,392 live births and 155,214 stillbirths. The prepandemic period was characterized by temporal increases in preterm birth and preterm labor induction or cesarean delivery rates and temporal reductions in macrosomia, postterm birth, and perinatal mortality. Pandemic onset was associated with absolute decreases in preterm birth (decrease of 0.322/100 live births, 95% CI 0.506-0.139) and preterm labor induction or cesarean delivery (decrease of 0.190/100 live births, 95% CI 0.334-0.047) and absolute increases in macrosomia (increase of 0.046/100 live births), postterm birth (increase of 0.015/100 live births), and perinatal death (increase of 0.501/1,000 total births, 95% CI 0.220-0.783). These changes were larger in subpopulations at high risk (eg, among singletons of patients with prepregnancy diabetes). Among singletons of patients with prepregnancy diabetes, pandemic onset was associated with a decrease in preterm birth (decrease of 1.634/100 live births) and preterm labor induction or cesarean delivery (decrease of 1.521/100 live births) and increases in macrosomia (increase of 0.328/100 live births) and perinatal death (increase of 9.840/1,000 total births, 95% CI 3.933-15.75). Most changes were reversed in the months after pandemic onset. CONCLUSION/CONCLUSIONS:The onset of the coronavirus disease 2019 (COVID-19) pandemic was associated with a transient decrease in obstetric intervention (especially preterm labor induction or cesarean delivery) and a transient increase in perinatal mortality.
PMCID:10642704
PMID: 37826851
ISSN: 1873-233x
CID: 5604682

It's time to make adherence to gender-inclusive research practices a required part of the peer review process [Comment]

Dunn, Morgan C; Ananth, Cande V; Brandt, Justin S
PMID: 37813305
ISSN: 2589-9333
CID: 5604782

Articles rejected by the American Journal of Obstetrics & Gynecology MFM that were subsequently published in another journal: a bibliometric study [Letter]

Dahiya, Asha K; Berghella, Vincenzo; Brandt, Justin S
PMID: 37704165
ISSN: 2589-9333
CID: 5593222

Response to the Commentary 'Causes of ART-related outcomes in the COVID-19 era' [Letter]

Lisonkova, Sarka; Bone, Jeffrey N; Muraca, Giulia M; Razaz, Neda; Boutin, Amelie; Brandt, Justin S; Bedaiwy, Mohamed A; Ananth, Cande V; Joseph, K S
PMID: 37185987
ISSN: 1365-3016
CID: 5544122

Epidemiology and trends in stroke mortality in the USA, 1975-2019

Ananth, Cande V; Brandt, Justin S; Keyes, Katherine M; Graham, Hillary L; Kostis, John B; Kostis, William J
BACKGROUND:Whether changes in stroke mortality are affected by age distribution and birth cohorts, and if the decline in stroke mortality exhibits heterogeneity by stroke type, remains uncertain. METHODS:We undertook a sequential time series analysis to examine stroke mortality trends in the USA among people aged 18-84 years between 1975 and 2019 (n = 4 332 220). Trends were examined for overall stroke and by ischaemic and haemorrhagic subtypes. Mortality data were extracted from the US death files, and age-sex population data were extracted from US census. Age-standardized stroke mortality rates and incidence rate ratio (IRR) with 95% confidence interval [CI] were derived from Poisson regression models. RESULTS:Age-standardized stroke mortality declined for females from 87.5 in 1975 to 30.9 per 100 000 in 2019 (IRR 0.27, 95% CI 0.26, 0.27; average annual decline -2.78%, 95% CI -2.79, -2.78). Among males, age-standardized mortality rate declined from 112.1 in 1975 to 38.7 per 100 000 in 2019 (RR 0.26, 95% CI 0.26, 0.27; average annual decline -2.80%, 95% CI -2.81, -2.79). Stroke mortality increased sharply with advancing age. Decline in stroke mortality was steeper for ischaemic than haemorrhagic strokes. CONCLUSIONS:Stroke mortality rates have substantially declined, more so for ischaemic than haemorrhagic strokes.
PMID: 36343092
ISSN: 1464-3685
CID: 5391772

Gender-inclusive research instructions in author submission guidelines: results of a cross-sectional study of obstetrics and gynecology journals

Dunn, Morgan C; Rosenfeld, Emily B; Ananth, Cande V; Hutchinson-Colas, Juana; Brandt, Justin S
BACKGROUND:People with marginalized gender identities, including people with transgender and gender-expansive identities, have been historically excluded from research. Professional societies recommend the use of inclusive language in research, but it is uncertain how many obstetrics and gynecology journals mandate the use of gender-inclusive research practices in their author guidelines. OBJECTIVE:This study aimed to evaluate the proportion of "inclusive" journals with specific instructions about gender-inclusive research practices in their author submission guidelines; to compare these journals with "noninclusive" journals based on publisher, country of origin, and several metrics of research influence; and to qualitatively evaluate the components of inclusive research in author submission guidelines. STUDY DESIGN:A cross-sectional study of all obstetrics and gynecology journals in the Journal Citation Reports, a scientometric resource, was conducted in April 2022. Of note, One journal was indexed twice (due to a name change), and only the journal with the 2020 Journal Impact Factor was included. Author submission guidelines were reviewed by 2 independent reviewers to identify inclusive vs noninclusive journals based on whether journals had gender-inclusive research instructions. Journal characteristics, including publisher, country of origin, impact metrics (eg, Journal Impact Factor), normalized metrics (eg, Journal Citation Indicator), and source metrics (eg, number of citable items), were evaluated for all journals. The median (interquartile range) and median difference between inclusive and noninclusive journals with bootstrapped 95% confidence interval were calculated for journals with 2020 Journal Impact Factors. In addition, inclusive research instructions were thematically compared to identify trends. RESULTS:Author submission guidelines were reviewed for all 121 active obstetrics and gynecology journals indexed in the Journal Citation Reports. Overall, 41 journals (33.9%) were inclusive, and 34 journals (41.0%) with 2020 Journal Impact Factors were inclusive. Most inclusive journals were English-language publications and originated in the United States and Europe. In an analysis of journals with 2020 Journal Impact Factors, inclusive journals had a higher median Journal Impact Factor (3.4 [interquartile range, 2.2-4.3] vs 2.5 [interquartile range, 1.9-3.0]; median difference, 0.9; 95% confidence interval, 0.2-1.7) and median 5-year Journal Impact Factor (3.6 [interquartile range, 2.8-4.3] vs 2.6 [interquartile range, 2.1-3.2; median difference, 0.9; 95% confidence interval, 0.3-1.6) than noninclusive journals. Inclusive journals had higher normalized metrics, including a median 2020 Journal Citation Indicator (1.1 [interquartile range, 0.7-1.3] vs 0.8 [interquartile range, 0.6-1.0]; median difference, 0.3; 95% confidence interval, 0.1-0.5) and median normalized Eigenfactor (1.4 [interquartile range, 0.7-2.2] vs 0.7 [interquartile range, 0.4-1.5]; median difference, 0.8; 95% confidence interval, 0.2-1.5) than noninclusive journals. Moreover, inclusive journals had higher source metrics, including more citable items, total items, and Open Access Gold subscriptions, than noninclusive journals. The qualitative analysis of gender-inclusive research instructions revealed that most inclusive journals recommend that researchers use gender-neutral language and provide specific examples of inclusive language. CONCLUSION:Fewer than half of obstetrics and gynecology journals with 2020 Journal Impact Factors have gender-inclusive research practices in their author submission guidelines. This study underscores the urgent need for most obstetrics and gynecology journals to update their author submission guidelines to include specific instructions about gender-inclusive research practices.
PMID: 36870534
ISSN: 2589-9333
CID: 5541932