Risk factors for postpartum depressive symptoms among mothers of Colorado-born preterm infants
OBJECTIVE:Identify risk factors of postpartum depressive symptoms (PDS) among preterm infants' mothers. STUDY DESIGN:Retrospective cross-sectional analysis of Colorado's Pregnancy Risk Assessment Monitoring System from 2012 to 2018 included weighted nâ€‰=â€‰33,633 mothers of preterm infants. Multivariate regression models calculated adjusted risk factors of PDS. RESULTS:PDS risk factors include history of maternal depression (adjusted risk ratio [aRR] 1.98, 95% confidence interval [CI] 1.28-3.05), early preterm birth <34wga (aRR 1.48, 95% CI 1.05-2.08), no prenatal care (aRR 3.19, 95% CI 1.52-6.71), non-Hispanic other (Asian/Pacific Islander, American Indian/Alaskan, or mixed) race/ethnicity (aRR 1.76, 95% CI 1.10-2.82), and pre-pregnancy public insurance (aRR 2.34, 95% CI 1.46-3.76). CONCLUSION:PDS risk factors among Colorado mothers of preterm infants slightly differ from identified risk factors among mothers of term infants. These findings can improve PDS screening and diagnosis so effective therapies and support can be offered during and after NICU hospitalization.
Sex-dependent outcomes following elective endovascular aortic repair
BACKGROUND:Evidence has shown that women derive less benefit from endovascular aortic repair (EVAR) in large part due to more challenging aortoiliac anatomy. This study sought to examine whether sex-dependent outcomes exist following elective EVAR cases. METHODS:An institutional retrospective review was performed on patients who underwent elective EVAR procedures between 2008 and 2014. Outcome data collected included procedural and hospital morbidity, mortality, and overall EVAR durability based on the incidence of unplanned graft-related secondary interventions (SIs) (e.g., open conversion, proximal or distal extensions, and coil embolizations). RESULTS:One hundred eighty-one patients (150 men, 31 women) met the study inclusion criteria. Median follow-up was 40.3 mo. Women had more challenging anatomy compared to men including smaller overall iliac diameters (6.8Â mm versus 8.0Â mm, PÂ <Â 0.001) and more severe iliac angulation (77% moderate to severe versus 44%, PÂ <Â 0.001). Women had increased risk of postoperative complications compared to men (41.9% versus 11.3%, PÂ =Â 0.003). There was no perioperative mortality in our series of elective EVAR cases. Median 5-y survival following EVAR was 64.4% for men and 76.3% for women (PÂ =Â 0.599). Late SI rates following EVAR was 10.5% with 16 (10.7%) men and 3 (9.7%) women needing interventions (PÂ =Â 0.870). Overall durability of EVAR extrapolated as time to SIs was 91% at 2 y and 85% at 5 y. Factors predisposing SIs were iliac tortuosity (PÂ =Â 0.046), aortic neck angle (PÂ =Â 0.022), and endoleak at the follow-up (PÂ =Â 0.030). CONCLUSIONS:In this study, immediate outcomes following EVAR were different between men and women, with women having increased rates of postoperative complications. Mortality and overall long-term durability of EVAR, however, were the same between sexes despite anatomical differences. EVAR durability was significantly dependent on the severity of iliac tortuosity, aortic neck angulation, and presence of endoleak at the follow-up.