Faculty Bibliography

BACKGROUND:Universal testing for COVID-19 on admission to the labor and delivery unit identifies asymptomatic patients. Whether or not these patients are at increased risk for adverse outcomes and go on to develop clinically significant disease is uncertain. OBJECTIVE:This study aimed to assess the prevalence of asymptomatic COVID-19 presentation among pregnant patients admitted for delivery and to determine whether these patients become symptomatic or require hospital readmission after discharge. STUDY DESIGN:weeks' gestation and who were found to have COVID-19 based on universal screening on admission for delivery at 1 of 4 medical centers in New Jersey (exposed group). The unexposed group, comprising patients who tested negative for COVID-19, were identified at the primary study site. The primary outcomes were the rates of asymptomatic COVID-19 presentation, the development of symptoms among the asymptomatic positive patients, and hospital readmission rates in the 2 weeks following discharge. We compared the frequency of the distribution of risk factors and outcomes in relation to the COVID-19 status among patients with COVID-19 across all centers and among those without COVID-19 at the primary site. Associations between categorical risk factors and COVID-19 status were expressed as relative risks with 95% confidence intervals. RESULTS:Between April 10, 2020, and June 15, 2020, there were 218 patients with COVID-19 at the 4 sites and 413 patients without COVID-19 at the primary site. The majority (188 [83.2%]) of patients with COVID-19 were asymptomatic. Compared with the negative controls, these asymptomatic patients were not at increased risk for obstetrical complications that may increase the risk associated with COVID-19, including gestational diabetes (8.2% vs 11.4%; risk ratio, 0.72; 95% confidence interval, 0.24-2.01) and gestational hypertension (6.1% vs 7.0%; risk ratio, 0.88; 95% confidence interval, 0.29-2.67). Postpartum follow-ups via telephone surveys revealed that these patients remained asymptomatic and had low rates of family contacts acquiring the disease, but their adherence to social distancing guidelines waned during the 2-week postpartum period. Review of inpatient and emergency department records revealed low rates of hospital readmission. CONCLUSION:Most of the pregnant patients who screened positive for COVID-19 are asymptomatic and do not go on to develop clinically significant infection after delivery. Routine surveillance of these patients after hospital discharge appears to be sufficient.

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BACKGROUND:Coronavirus disease 2019 may be associated with adverse maternal and neonatal outcomes in pregnancy, but there are few controlled data to quantify the magnitude of these risks or to characterize the epidemiology and risk factors. OBJECTIVE:This study aimed to quantify the associations of coronavirus disease 2019 with adverse maternal and neonatal outcomes in pregnancy and to characterize the epidemiology and risk factors. STUDY DESIGN:We performed a matched case-control study of pregnant patients with confirmed coronavirus disease 2019 cases who delivered between 16 and 41 weeks' gestation from March 11 to June 11, 2020. Uninfected pregnant women (controls) were matched to coronavirus disease 2019 cases on a 2:1 ratio based on delivery date. Maternal demographic characteristics, coronavirus disease 2019 symptoms, laboratory evaluations, obstetrical and neonatal outcomes, and clinical management were chart abstracted. The primary outcomes included (1) a composite of adverse maternal outcome, defined as preeclampsia, venous thromboembolism, antepartum admission, maternal intensive care unit admission, need for mechanical ventilation, supplemental oxygen, or maternal death, and (2) a composite of adverse neonatal outcome, defined as respiratory distress syndrome, intraventricular hemorrhage, necrotizing enterocolitis, 5-minute Apgar score of <5, persistent category 2 fetal heart rate tracing despite intrauterine resuscitation, or neonatal death. To quantify the associations between exposure to mild and severe or critical coronavirus disease 2019 and adverse maternal and neonatal outcomes, unadjusted and adjusted analyses were performed using conditional logistic regression (to account for matching), with matched-pair odds ratio and 95% confidence interval based on 1000 bias-corrected bootstrap resampling as the effect measure. Associations were adjusted for potential confounders. RESULTS:A total of 61 confirmed coronavirus disease 2019 cases were enrolled during the study period (mild disease, n=54 [88.5%]; severe disease, n=6 [9.8%]; critical disease, n=1 [1.6%]). The odds of adverse composite maternal outcome were 3.4 times higher among cases than controls (18.0% vs 8.2%; adjusted odds ratio, 3.4; 95% confidence interval, 1.2-13.4). The odds of adverse composite neonatal outcome were 1.7 times higher in the case group than to the control group (18.0% vs 13.9%; adjusted odds ratio, 1.7; 95% confidence interval, 0.8-4.8). Stratified analyses by disease severity indicated that the morbidity associated with coronavirus disease 2019 in pregnancy was largely driven by the severe or critical disease phenotype. Major risk factors for associated morbidity were black and Hispanic race, advanced maternal age, medical comorbidities, and antepartum admissions related to coronavirus disease 2019. CONCLUSION:Coronavirus disease 2019 during pregnancy is associated with an increased risk of adverse maternal and neonatal outcomes, an association that is primarily driven by morbidity associated with severe or critical coronavirus disease 2019. Black and Hispanic race, obesity, advanced maternal age, medical comorbidities, and antepartum admissions related to coronavirus disease 2019 are risk factors for associated morbidity.

BACKGROUND:The Relative Citation Ratio is a novel bibliometric tool that quantifies the impact of research articles. The objectives of this study were to identify the 100 obstetrics and gynecology articles with the highest relative citation ratios, evaluate how characteristics of these articles changed over time, and compare characteristics of these articles with top-cited obstetrics and gynecology articles. OBJECTIVE:We undertook a cross-sectional bibliometric study to examine the 100 obstetrics and gynecology articles with the highest relative citation ratios and the top 100 cited articles in the National Institutes of Health Open Citations Collection from 1980 to 2019. STUDY DESIGN:We identified every obstetrics and gynecology article published from 1980 to 2019 that was indexed in the National Institutes of Health Open Citations Collection. The top 100 articles with the highest relative citation ratios and the top 100 cited articles were selected for further review. Each article was evaluated using metrics of influence, translation, and other characteristics. We compared the top 100 articles with the highest relative citation ratios published from 1980 to 1999 versus 2000 to 2019 and characteristics of the top 100 articles with the highest relative citation ratios versus the top 100 top-cited articles (after excluding those on both lists). Means, standard deviations, and mean differences with corresponding 95% confidence intervals were calculated. Associations were expressed as relative risks (95% confidence interval). RESULTS:A total of 323,673 obstetrics and gynecology articles were published between 1980 and 2019. Among the top 100 articles with the highest relative citation ratios, most were observational studies (36%), reviews (26%), and consensus statements (21%). There were only 5 randomized clinical trials. Compared with the articles with the highest relative citation ratios published from 1980 to 1999, articles published from 2000 to 2019 were more likely about benign gynecology (relative risks, 1.3; 95% confidence interval, 0.6-2.8) and less likely about gynecology-oncology (relative risks, 0.6; 95% confidence interval, 0.2-1.9) and urogynecology (relative risks, 0.6; 95% confidence interval, 0.1-3.3). The articles after 2000 were more likely about systematic reviews (relative risks, 7.7; 95% confidence interval, 1.0-58.3) and consensus statements (relative risks, 5.1; 95% confidence intervals, 1.6-16.3) and were published as open access articles (relative risks, 1.3; 95% confidence interval, 0.9-2.0). There were 60 articles in common between the top 100 articles with the highest relative citation ratios and the top 100 cited articles. Compared with articles that were top cited (after excluding articles on both lists), articles with the highest relative citation ratios received fewer mean citations (266.9 [135.3] vs 514.3 [54.6]; mean differences, 247.4; 95% confidence interval, 201.5-293.3) but had higher numbers of citations per year (37.5 [4.1] vs 31.6 [8.1]; mean difference, -5.9; 95% confidence interval, -14.6 to -2.7). Compared with the articles with the highest relative citation ratios, top-cited articles were more likely to address gynecology topics (relative risk, 1.6; 95% confidence interval, 1.1-2.5), less likely to be randomized clinical trials (relative risk, 0.7; 95% confidence interval, 0.1-3.8), and less likely to be published as open access articles (relative risk, 0.52; 95% confidence interval, 0.31-0.86). CONCLUSION:The Relative Citation Ratio is a novel bibliometric tool that does not rely on absolute citation rates and provides unique insight into the dissemination of knowledge in obstetrics and gynecology. Nearly half of the influential obstetrics and gynecology articles identified with this metric would not have been recognized as citation classics by conventional bibliometric analysis.