Faculty Bibliography

IMPORTANCE:Reproductive system and mental health disorders are commonly comorbid in women. Although the causes of this overlap remain elusive, evidence suggests potential shared environmental and genetic factors associated with risk. OBJECTIVE:To investigate the comorbidity between psychiatric and reproductive system disorders, both as broad diagnostic categories and among specific pairs of diagnoses. DATA SOURCE:PubMed. STUDY SELECTION:Observational studies published between January 1980 and December 2019 assessing prevalence of psychiatric disorders in women with reproductive system disorders and prevalence of reproductive system disorders in women with psychiatric disorders were included. The study did not include psychiatric and reproductive disorders triggered by life events (eg, trauma, infection, surgery) to address potential confounding. DATA EXTRACTION AND SYNTHESIS:A search yielded 1197 records, of which 50 met the inclusion criteria for the qualitative and 31 for the quantitative synthesis in our study. A random-effects model was used for data synthesis and Egger test and I2 to assess study bias and heterogeneity. Data were analyzed from January to December 2022. This study followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guideline. MAIN OUTCOMES AND MEASURES:Psychiatric and reproductive system disorders. RESULTS:A total of 1197 records were identified, of which 50 met the inclusion criteria for qualitative and 31 for quantitative synthesis. Diagnosis of a reproductive system disorder was associated with a 2- to 3-fold increased odds of having a psychiatric disorder (lower bound odds ratio [OR], 2.00; 95% CI, 1.41-2.83; upper bound OR; 2.88; 95% CI, 2.21-3.76). The analysis focused on specific diagnoses described in the literature and found that polycystic ovary syndrome was associated with increased odds of depression (population-based studies OR, 1.71; 95% CI, 1.19-2.45; clinical studies OR, 2.58; 95% CI, 1.57-4.23) and anxiety (population-based studies OR, 1.69; 95% CI, 1.36-2.10; clinical studies OR, 2.85; 95% CI, 1.98-4.09). Chronic pelvic pain was also associated with both depression (OR, 3.91; 95% CI, 1.81-8.46) and anxiety (OR, 2.33; 95% CI, 1.33-4.08). Few studies investigated risk of other reproductive system disorders in women with psychiatric disorders, or reverse associations (risk of reproductive system disorder among women with a psychiatric diagnosis). CONCLUSIONS AND RELEVANCE:In this systematic review and meta-analysis, a high rate of reported co-occurrence between psychiatric and reproductive disorders overall was observed. However, data for many disorder pairs were limited. The available literature focused overwhelmingly on affective disorders in polycystic ovary syndrome, overlooking a substantial portion of disease overlap. As such, the associations between the majority of mental health outcomes and conditions of the female reproductive system are largely unknown.

Irritability, characterized by anger in response to frustration, is normative in childhood. While children typically show a decline in irritability from toddlerhood to school age, elevated irritability throughout childhood may predict later psychopathology. The current study (n = 78) examined associations between trajectories of irritability in early childhood (ages 2-7) and irritability in adolescence (age 12) and tested whether these associations are moderated by parenting behaviors. Results indicate that negative emotion socialization moderated trajectories of irritability - relative to children with low stable irritability, children who exhibited high stable irritability in early childhood and who had parents that exhibited greater negative emotion socialization behaviors had higher irritability in adolescence. Further, negative parental control behavior moderated trajectories of irritability - relative to children with low stable irritability, children who had high decreasing irritability in early childhood and who had parents who exhibited greater negative control behaviors had higher irritability in adolescence. In contrast, positive emotion socialization and control behaviors did not moderate the relations between early childhood irritability and later irritability in adolescence. These results suggest that both irritability in early childhood and negative parenting behaviors may jointly influence irritability in adolescence. The current study underscores the significance of negative parenting behaviors and could inform treatment.

BACKGROUND:Multifetal Pregnancy Reduction is a technique used to reduce the fetal number with the goal of mitigating risks of adverse outcomes associated with multiple gestations. Monochorionic diamniotic twin pregnancies are subject to unique complications, contributing to adverse pregnancy outcomes. Thus, patients have an option to electively reduce one fetus with the goal of improving outcomes. OBJECTIVE:Our objective was to compare outcomes of elective reduction of monochorionic diamniotic twins by radiofrequency ablation to planned ongoing monochorionic diamniotic twins. STUDY DESIGN/METHODS:We performed a retrospective review of 315 monochorionic diamniotic twin gestations that underwent first-trimester ultrasound within one institution. Planned electively reduced twins were compared with ongoing monochorionic diamniotic twins. All reductions were performed via radiofrequency ablation of the cord insertion site into the fetal abdomen. The primary outcome was preterm birth less than 36 weeks. Secondary outcomes included gestational age at delivery, preterm birth less than 37, 34, 32, and 28 weeks, unintended loss, and adverse perinatal outcomes. RESULTS:Among 315 monochorionic diamniotic pregnancies, 14 (4.4%) underwent elective multifetal pregnancy reduction and 301 (95.6%) were planned ongoing twins. The mean GA of RFA in the elective MPR group was 15.1 ± 0.68 weeks. Patients who underwent elective multifetal pregnancy reduction had significantly higher maternal age (p<0.01) and were more likely to be Asian (p<0.01). They were also more likely to have undergone in vitro fertilization (p=0.03) and chorionic villus sampling (p<0.01). There was a significantly higher rate of term deliveries in the elective radiofrequency ablation group compared to ongoing twins (GA 38 weeks (IQR, 36.1, 39.1) vs. 35.9 weeks (IQR, 34, 36.9), (p<0.01)). Patients with ongoing pregnancies had a trend of increased rate of preterm birth less than 36 weeks (OR 3.4, 95% CI 1.0-12.0; p=0.06), a significantly increased risk of preterm birth less than 37 weeks (OR 8.0, 95% CI 2.4-26.4; p<0.01), and no difference less than 34, 32, or 28 weeks. All patients who underwent elective radiofrequency ablation had successful pregnancies with no pregnancy losses or terminations. Of ongoing gestations, 36 required procedures including 16 (5.3%) medically-indicated radiofrequency ablation, 14 (4.6%) laser ablation, and six (1.9%) amnioreductions. Twenty-two patients (7.3%) with planned ongoing twins had total pregnancy loss less than 24 weeks. Twelve (4.0%) had unintended loss of one fetus before 24 weeks in the ongoing pregnancy cohort and 12 (4.0%) had unintended loss of both fetuses before 24 weeks. Five patients (1.7%) in the ongoing pregnancy group had intrauterine fetal demise greater than 24 weeks and 10 patients (3.3%) electively terminated both fetuses. There was no significant difference in loss rates between the two groups. CONCLUSION/CONCLUSIONS:In this study of monochorionic diamniotic twins, patients who elected to undergo multifetal pregnancy reduction had significantly lower rates of preterm birth less than 37 weeks and a lower trend of preterm birth less than 36 weeks without an increased risk of pregnancy loss. Median gestational age at delivery was significantly higher at 38 weeks in the elective multifetal pregnancy reduction group, as compared to 35.9 weeks in the ongoing pregnancy group. Further research is needed to clarify if multifetal pregnancy reduction improves long-term outcomes.

OBJECTIVE: This study aims to estimate the association between abnormal placental histopathology, fetal growth restriction (FGR), and preeclampsia (PEC) in twin pregnancies. STUDY DESIGN/METHODS:-tests were used for analysis. RESULTS: = 0.46; aOR: 0.79, 95% CI: 0.53-1.18). CONCLUSION/CONCLUSIONS: In twin pregnancies, FGR and PEC are not associated with abnormal placental histopathology. This suggests that the pathologic placental manifestations of these conditions may differ in twins and include factors other than those commonly described in singletons.

OBJECTIVE/UNASSIGNED:To evaluate which parameters of a sonographic cervical length measurement are associated with preterm birth in women with ultrasound- or exam-indicated cerclage. METHODS/UNASSIGNED:This was a retrospective cohort study of women with singleton pregnancies who underwent ultrasound- or exam-indicated Shirodkar cerclage by a single maternal-fetal medicine practice between 2011 and 2019. All patients underwent sonographic cervical length measurement 2-3 weeks after cerclage placement, and then every 2-4 weeks up to 32 weeks. The images from the first and second post-cerclage cervical lengths were reviewed. Total cervical length, upper cervical length (from the internal cervical os to the cerclage), and lower cervical length (from the cerclage to the external os) were measured. The primary outcome for this study was gestational age at delivery. RESULTS/UNASSIGNED:=.166, respectively, for the second scan). CONCLUSIONS/UNASSIGNED:Postcerclage total cervical length and upper cervical length are both associated with gestational age at delivery and risk of preterm birth, but not independently. After ultrasound- or exam-indicated cerclage, sonographic monitoring of either the total cervical length or the upper cervical length might be predictive of gestational age at delivery and the risk of preterm birth.

OBJECTIVE:Calculate the risk of miscarriage in women with a viable (defined as presence of fetal heart rate on ultrasound) first trimester singleton pregnancy and to create a model for stratified risk-assessment for pregnancy loss based on significant risk factors. STUDY DESIGN/METHODS:Retrospective cohort study of unselected women with singleton pregnancies in a large obstetrical practice who presented for prenatal care prior to 14 weeks over a three-year period. All women underwent a formal first-trimester ultrasound, and we only included women with viable pregnancies with fetal heart activity seen on that ultrasound. Our primary outcome was pregnancy loss prior to 20 weeks. Statistical modeling was used to create a risk-assessment tool from adjusted likelihood ratios of pregnancy loss based on risk factors independently associated with this outcome. RESULTS:From January 2015-December 2017, 2,446 women met the inclusion criteria for the study and 132 (5.4%) had a pregnancy loss <20 weeks. On regression analysis, the independent risk factors for pregnancy loss were earlier gestational age (aOR 0.72, 95% CI 0.65-0.80) and increasing number of prior miscarriages (aOR 1.56, 95% CI 1.32-1.83). Using these risk factors, we calculated the stratified risk of pregnancy loss, which ranged from 0.8% in women at 13 weeks of gestation with no prior miscarriages to 33.7% in women at six weeks of gestation with three or more prior miscarriages. CONCLUSION/CONCLUSIONS:In first trimester singleton pregnancies, the overall risk of pregnancy loss <20 weeks after confirmation of fetal heart activity is 5.4%, but can be stratified for each woman and ranges from 0.8% to 33.7% based on the gestational age and number of prior pregnancy losses.

OBJECTIVE: This study was aimed to compare maternal and neonatal outcomes between women with twin pregnancies who underwent induction of labor with those women who had planned Cesarean delivery (CD). STUDY DESIGN/METHODS: This is a retrospective cohort study of women with twin pregnancies ≥ 24 weeks with an indication for delivery but not in labor. Two groups were examined, women who underwent induction and women who underwent planned CD. Maternal and neonatal outcomes were compared between groups both for deliveries at gestational age ≥ 37 weeks and < 37 weeks. RESULTS: < 0.01), but this was not significant on adjusted odds ratio analysis (aOR = 0.71, 95% CI: 0.19-2.66). CONCLUSION/CONCLUSIONS: Labor induction in twin gestations have improved maternal outcomes and similar neonatal outcomes compared with planned CD.

INTRODUCTION/BACKGROUND: Data regarding transplacental passage of maternal coronavirus disease 2019 (COVID-19) antibodies and potential immunity in the newborn is limited. CASE REPORT/METHODS: We present a 25-year-old multigravida with known red blood cell isoimmunization, who was found to be COVID-19 positive at 27 weeks of gestation while undergoing serial periumbilical blood sampling and intrauterine transfusions. Maternal COVID-19 antibody was detected 2 weeks after positive molecular testing. Antibodies were never detected on cord blood samples from two intrauterine fetal cord blood samples as well as neonatal cord blood at the time of delivery. CONCLUSION/CONCLUSIONS: This case demonstrates a lack of passive immunity of COVID-19 antibodies from a positive pregnant woman to her fetus, neither in utero nor at the time of birth. Further studies are needed to understand if passage of antibodies can occur and if that can confer passive immunity in the newborn. KEY POINTS/CONCLUSIONS:· Passive immunity should not be assumed in COVID-19 infection in pregnancy.. · Isoimmunization may impair passive immunity of certain antibodies.. · Vaccination to or maternal infection of COVID-19 may not be protective for the fetus..