Faculty Bibliography

IMPORTANCE/UNASSIGNED:Current pregnancy surveillance efforts in the US face substantial challenges in providing timely and accurate data on prenatal care use. Electronic health record (EHR) networks have the potential to enhance existing surveillance systems by providing near real-time, clinically documented data. OBJECTIVE/UNASSIGNED:To assess whether EHR network data could be used to define valid and reliable surveillance metrics of prenatal care use. DESIGN, SETTING, AND PARTICIPANTS/UNASSIGNED:This longitudinal cohort study included US adults (age ≥18 years) who received prenatal care and delivered a live birth from January 1, 2023, to December 31, 2024, at a facility that used the Epic Cosmos EHR network. EXPOSURE/UNASSIGNED:Live birth at a facility that used the selected EHR network. MAIN OUTCOMES AND MEASURES/UNASSIGNED:Prenatal care use was calculated as the proportions of patients who initiated care by the 13th week of pregnancy (early care) and who received adequate or better prenatal care (adequate care). Raking weights were applied to adjust the EHR sample to match the marginal distributions for US residents with live births by age, race and ethnicity, insurance, pregnancy risk factors, and geographic region. Electronic health records-based metrics were externally validated against published natality data estimates from National Center for Health Statistics (NCHS) using the two 1-sided test of equivalence. Patterns by demographics, state, and year were examined. RESULTS/UNASSIGNED:In total, 1 963 496 patients (mean [SD] age, 29.5 [5.7] years; 100% women) had a live birth and evidence of prenatal care at a facility using the selected EHR network during the study period. Compared with all US birthing people (n = 7 224 951), patients who gave birth at a facility using the selected EHR network had lower Medicaid coverage (40.5% vs 21.1%) and a higher prevalence of pregnancy risk factors (eg, prior preterm birth: 4.0% vs 8.8%). After weighting to the national population, EHR-based estimates of early care were consistently lower than those from NCHS data (68.0% [95% CI, 67.9%-68.2%] vs 76.1% [95% CI, 76.1%-76.1%]). However, adequacy estimates were equivalent to NCHS-based estimates (76.0% [95% CI, 75.9%-76.2%] vs 75.2% [95% CI, 75.1%-75.2%]; P < .001 at 0.01 equivalence bound), aligned with expected demographic patterns, and were stable across place and time. CONCLUSIONS AND RELEVANCE/UNASSIGNED:In this cohort study, EHR network data reliably informed surveillance of prenatal care adequacy after adjusting for nonrepresentativeness of the patient population. These findings suggest that near real-time availability of EHR data has the potential to improve the timeliness of population-level pregnancy surveillance to better inform policy, public health, and clinical efforts aimed at enhancing prenatal care access and use among individuals receiving inadequate care.

INTRODUCTION/UNASSIGNED:We synthesized evidence on racial disparities in perinatal toxicology testing among Black and White women and their infants in the United States, including testing practices and downstream consequences such as child welfare involvement. METHODS/UNASSIGNED:We systematically searched PubMed and PsycINFO for peer-reviewed studies published before January 2023 that examined perinatal toxicology testing and reported racial outcomes. Eligible studies assessed testing practices or related consequences. A random-effects meta-analysis estimated pooled rate ratios (RRs) and 95% confidence intervals (CIs) for disparities in testing. Thematic synthesis summarized qualitative findings on downstream outcomes. Sixteen studies (1993-2023) met inclusion criteria; six contributed to the meta-analysis, encompassing over 50 000 pregnant women and/or their infants. RESULTS/UNASSIGNED:Black women and their infants were significantly more likely to be tested than their White counterparts (RR = 2.58; 95% CI: 2.03-3.29). While recent studies suggest disparities in referral to child welfare services after positive tests may be narrowing, earlier research indicates disproportionate reporting and child removal among Black and Hispanic families. CONCLUSION/UNASSIGNED:Racial inequities in perinatal and infant toxicology testing persist, with implications for maternal and child health. Future research should investigate multilevel drivers of these disparities and inform equitable policy and practice.

BACKGROUND AND OBJECTIVES/OBJECTIVE:Traumatic brain injury (TBI) mechanisms are often grouped together in research. Differences in acute and long-term outcomes across mechanisms of injury (MOIs) remain unclear, partly because of confounding by age. Modeling MOI-specific effects can inform clinical triage and prognostication. We examined the relationship between motor vehicle accidents (MVAs) vs falls, the 2 most common MOIs, and acute and 1-year post-injury outcomes, after rigorous control of demographic and preinjury personal factors. METHODS:Data were analyzed from individuals with moderate-to-severe TBI requiring inpatient rehabilitation from the TBI Model Systems National Database, a multicenter prospective longitudinal cohort study. The analytic sample was restricted to individuals aged 16-79 years with an MOI due to MVA or fall occurring between April 2010 and January 2023. We used inverse probability of treatment weighting, based on propensity scores, to adjust for 14 demographic and preinjury personal characteristics and estimate the causal effect of MOI on acute and 1-year outcomes after TBI. Acute hospital and rehabilitation outcomes included the following: Glasgow Coma Scale (GCS), sedation, intubation, post-traumatic amnesia duration, time to follow commands (TFC), length of hospital stay (LOS), and Functional Independence Measure (FIM) cognitive and motor scores. One-year outcomes included the following: Disability Rating Scale and Participation Assessment with Recombined Tools Objective. RESULTS:= 0.014). At 1 year after injury, disability levels and community participation did not differ. DISCUSSION/CONCLUSIONS:MVA-related TBI was associated with worse acute outcomes. However, by 1 year after injury, disability level and community participation do not differ. This work highlights novel findings in short-term and long-term outcomes after falls and MVAs, the leading TBI causes, which are not explained by confounders such as age. Findings may not generalize beyond patients receiving inpatient rehabilitation for TBI.

Osteoarthritis, especially knee osteoarthritis, is a leading cause of disability and reduced quality of life. The etiology of pain in osteoarthritis is multifactorial, and one promising potential treatment approach involves targeting chemokine systems. The present study was a phase 2, multisite, multiperiod randomized crossover trial of CNTX-6970, a small molecule and selective oral cytokine chemokine receptor type 2 (CCR2) and CCR5 antagonist, in patients with painful knee osteoarthritis (OA). It represents the first trial performed within the National Institutes of Health's Early Phase Pain Investigation Clinical Network. The primary objectives were to evaluate the safety and efficacy of CNTX-6970, relative to placebo, for the treatment of moderate to severe pain related to knee OA. A total of 55 participants were randomized in this multiperiod crossover trial. Linear mixed effects models revealed no significant pain-related benefits of active medication; indeed, trial participants reported slightly higher knee pain intensity when taking the novel chemokine antagonist CNTX-6970 than when taking placebo. In addition, biomarker analysis revealed notably higher level of serum monocyte chemoattractant protein 1 levels when patients were on CNTX-6970 compared to placebo. Overall, although CNTX-6970 was safe and relatively well-tolerated, pharmacologic blockade of specific chemokine receptors with this compound was not effective in reducing moderate-to-severe knee osteoarthritis pain.

OBJECTIVE:To determine whether administration of antenatal corticosteroids to patients with twin gestations at risk for late preterm delivery is associated with reduced risk for neonatal respiratory morbidity compared with unexposed twins. METHODS:This was a multicenter, retrospective cohort study in a large, urban health network (2013-2022) of patients with twin gestations at risk for preterm delivery between 34 0/7 and 36 6/7 weeks of gestation. Patients were excluded if they received antenatal corticosteroids before 34 weeks of gestation or had pregestational diabetes, single-twin death before 34 weeks, or oral steroid exposure during pregnancy. Neonates were excluded if they had major congenital anomalies. The primary outcome was a composite of neonatal respiratory morbidity requiring respiratory support within 72 hours of birth, including continuous positive airway pressure (CPAP) or high-flow nasal cannula for 2 hours or more, supplemental oxygen of 30% for 2 hours or more, extracorporeal membrane oxygenation, mechanical ventilation, and fetal or neonatal death. Secondary outcomes included neonatal hypoglycemia and indications for neonatal intensive care unit (NICU) admission. Adjusted and unadjusted relative risks with 95% CIs were calculated. RESULTS:During the study period, 366 twin gestations and 722 patient-neonate dyads were included: 162 gestations (321 neonates) in the exposed group and 204 (401 neonates) in the unexposed group. There was no difference in the composite outcome of respiratory morbidity in those exposed to antenatal corticosteroids (23.4% vs 20.4%, P=.40, adjusted relative risk [RR] 1.00, 95% CI, 0.71-1.42). The composite was driven mostly by rates of CPAP use (21.2% vs 18.5%, P=.41, adjusted RR 1.05, 95% CI, 0.73-1.53) and high-flow nasal cannula use (6.2% vs 2.2%, P=.02, RR 2.77, 95% CI, 1.16-6.66). Antenatal corticosteroid exposure was associated with a lower risk of need for supplemental oxygen (0.6% vs 3.5%, P=.02, RR 0.18, 95% CI, 0.04-0.79) and mechanical ventilation (0.6% vs 3.2%, P=.03, RR 0.19, 95% CI, 0.04-0.87). Although antenatal corticosteroids exposure was not associated with higher rates of hypoglycemia (44.2% vs 41.7%, P=.57, adjusted RR 0.99, 95% CI, 0.82-1.19), exposure was associated with a higher risk of having hypoglycemia as the only indication for NICU admission (10.3% vs 5.2%, P=.03, RR 1.96, 95% CI, 1.07-3.59). CONCLUSION/CONCLUSIONS:In a large, multicenter, network-wide retrospective cohort study of patients with twin gestations at risk for late preterm birth, antenatal corticosteroid use was not associated with a decrease in overall respiratory morbidity but was associated with a decreased risk of need for supplemental oxygen and mechanical ventilation, as well as a higher risk of NICU admission for hypoglycemia. These results underscore the ongoing need to elucidate the risks and benefits of late preterm antenatal corticosteroids for patients with twin gestations at risk for late preterm birth.

BACKGROUND:Inferring risk for malignant transformation (MT) in patients with lesions diagnosed as mild or moderate oral epithelial dysplasia (low-grade OED) remains challenging. We developed two models assessing the risk of progression to high-grade OED (severe dysplasia or carcinoma in situ) or OSCC in patients with low-grade OED lesions. METHODS:We included demographic, risk habit and clinical data from participants with low-grade OED lesions enrolled in the BC Oral Cancer Prevention Program's Oral Cancer Prediction Longitudinal study. Cox proportional hazard models were fit to estimate the effects of anatomic site and toluidine blue findings and adjusted for confounders, as both are associated with MT in the literature but without a North American-specific cohort analysis. Our primary model included both variables of interest. A secondary model included only anatomic site since toluidine blue is not in widespread use. RESULTS:Five hundred and thirty-four participants with 605 lesions met final inclusion criteria, with 339 mild and 266 moderate OED at baseline. In the primary model, lesions at a high-risk anatomic site or with positive toluidine blue staining were associated with a 2.6 and 2.4-fold increased risk of progression, respectively. In the second model that did not incorporate toluidine blue, high-risk anatomic site remained a highly associated risk factor (2.7-fold increased risk of progression). CONCLUSION/CONCLUSIONS:Lesion anatomic site is associated with higher risk of MT for the general practitioner, while a specialist with access to toluidine blue results can assume additional risk associated with positive staining. These models may inform decisions for surveillance and intervention for OED.

Electronic health records (EHRs) present opportunities to study uterine fibroids uterine fibroids and endometriosis within diverse populations. When using EHR data, it is important to validate outcome classification via diagnosis codes. We performed a validation study of three approaches (1: ICD-10 code alone, 2: ICD-10 code + diagnostic procedure, and 3: ICD-10 code + all diagnostic information) to identify incident uterine fibroids and endometriosis patients among n=750 NYU Langone Health 2016-2023. Chart review was used to determine the true diagnosis status. When using a binary classification system (incident vs. non-incident patient), Approaches 2 and 3 had higher positive predictive values (PPVs) for uterine fibroids (0.86 and 0.87 vs. 0.78) and for endometriosis (0.70 and 0.73 vs. 0.66), but Approach 1 outperformed the other two in negative predictive values (NPVs) for both outcomes. When using a three-level classification system (incident vs. prevalent vs. disease free patients), PPV for prevalent patients was low for all approaches, while PPV/NPV of disease-free patients was generally above 0.8. Using ICD-10 codes alone yielded higher NPVs but resulted in lower PPVs compared with the other approaches. Continued validation of uterine fibroids/endometriosis EHR studies is warranted to increase research into these understudied gynecologic conditions.

OBJECTIVE:Maternal morbidity and mortality (MMM) rates from drug overdoses have increased, especially among pregnant and postpartum women aged 35-44. However, there is limited understanding of how current toxicology testing practices are implemented in hospital settings and how well they support, or undermine, linkage to care. The goal of the study is to understand variations in toxicology testing use among pregnant and postpartum women, explore hospital- and individual-level differences, and assess outcomes. METHODS:Using the Socio-cultural Framework for the Study of Health Service Disparities (SCF-HSD) we will perform a mixed-methods study to understand testing policies and practices in NY State. Aim 1 will employ multilevel statistical models using New York State Medicaid claims data (2021-2024) to identify predictors of perinatal toxicology testing and characterize hospital-level variation across hospitals. Aim 2 will involve one-on-one interviews with hospital administrators and clinical staff to document and analyze testing policies and practices, capturing diverse perspectives on testing rationales, attitudes, and adherence. Aim 3 will integrate quantitative and qualitative evidence through a mixed-methods design, incorporating perspectives of individuals with lived experience, via focus group sessions to inform and refine hospital policy recommendations. DISCUSSION/CONCLUSIONS:Our findings will inform how to improve disparities in toxicology testing for pregnant and postpartum women. Addressing these challenges requires shifting emphasis toward standardized, evidence-based toxicology testing protocols, strengthening pathways to supportive services, and advancing policy reforms that reduce stigma and inequities in care.

Many communities are oftentimes labeled as "hard to reach communities" by health researchers. Instead, what may be a more appropriate framing is that conventional research approaches are a mismatch for recruiting and retaining these understudied communities. This paper describes an inclusive research process with particular attention to engaging multilingual communities in the U.S. that we have developed while implementing a community-level nutrition program. The program, Harvest Share, is an equity-centered, systems-based strategy to improve diet for neighborhood residents in Brooklyn, NY. Our research approach involves three components: participatory mapping, cultural adaptation/transcreation and language justice, and two cross-cutting areas: researcher positionality and research team diversity. The application of these methods in research resulted in our research program being highly accepted by partner organizations and participants. Applying inclusive research practices in addition to centering the community/es of interest will aid in the implementation of solutions that are feasible and culturally and linguistically responsive, ensuring successful recruitment and retention; and in the long run, sustainable, community-engaged solutions that have high acceptability and promote community well-being.