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Remote Patient Monitoring for Management of Diabetes Mellitus in Pregnancy Is Associated With Improved Maternal and Neonatal Outcomes

Kantorowska, Agata; Cohen, Koral; Oberlander, Maxwell; Jaysing, Anna R.; Akerman, Meredith B.; Wise, Anne Marie; Mann, Devin M.; Testa, Paul A.; Chavez, Martin R.; Vintzileos, Anthony M.; Heo, Hye J.
SCOPUS:85180013996
ISSN: 0029-7828
CID: 5620962

Reply to "Artificial intelligence in writing of papers: some considerations" [Comment]

Vintzileos, Anthony M; Chavez, Martin R; Romero, Roberto
PMID: 37290562
ISSN: 1097-6868
CID: 5589962

A role for artificial intelligence chatbots in the writing of scientific articles [Editorial]

Vintzileos, Anthony M; Chavez, Martin R; Romero, Roberto
PMID: 37117103
ISSN: 1097-6868
CID: 5465632

Remote patient monitoring for management of diabetes mellitus in pregnancy is associated with improved maternal and neonatal outcomes

Kantorowska, Agata; Cohen, Koral; Oberlander, Maxwell; Jaysing, Anna R; Akerman, Meredith B; Wise, Anne-Marie; Mann, Devin M; Testa, Paul A; Chavez, Martin R; Vintzileos, Anthony M; Heo, Hye J
BACKGROUND:Diabetes mellitus is a common medical complication of pregnancy, and its treatment is complex. Recent years have seen an increase in the application of mobile health tools and advanced technologies, such as remote patient monitoring, with the aim of improving care for diabetes mellitus in pregnancy. Previous studies of these technologies for the treatment of diabetes in pregnancy have been small and have not clearly shown clinical benefit with implementation. OBJECTIVE:Remote patient monitoring allows clinicians to monitor patients' health data (such as glucose values) in near real-time, between office visits, to make timely adjustments to care. Our objective was to determine if using remote patient monitoring for the management of diabetes in pregnancy leads to an improvement in maternal and neonatal outcomes. STUDY DESIGN/METHODS:This was a retrospective cohort study of pregnant patients with diabetes mellitus managed by the maternal-fetal medicine practice at one academic institution between October 2019 and April 2021. This practice transitioned from paper-based blood glucose logs to remote patient monitoring in February 2020. Remote patient monitoring options included (1) device integration with Bluetooth glucometers that automatically uploaded measured glucose values to the patient's Epic MyChart application or (2) manual entry in which patients manually logged their glucose readings into their MyChart application. Values in the MyChart application directly transferred to the patient's electronic health record for review and management by clinicians. In total, 533 patients were studied. We compared 173 patients managed with paper logs to 360 patients managed with remote patient monitoring (176 device integration and 184 manual entry). Our primary outcomes were composite maternal morbidity (which included third- and fourth-degree lacerations, chorioamnionitis, postpartum hemorrhage requiring transfusion, postpartum hysterectomy, wound infection or separation, venous thromboembolism, and maternal admission to the intensive care unit) and composite neonatal morbidity (which included umbilical cord pH <7.00, 5 minute Apgar score <7, respiratory morbidity, hyperbilirubinemia, meconium aspiration, intraventricular hemorrhage, necrotizing enterocolitis, sepsis, pneumonia, seizures, hypoxic ischemic encephalopathy, shoulder dystocia, trauma, brain or body cooling, and neonatal intensive care unit admission). Secondary outcomes were measures of glycemic control and the individual components of the primary composite outcomes. We also performed a secondary analysis in which the patients who used the two different remote patient monitoring options (device integration vs manual entry) were compared. Chi-square, Fisher's exact, 2-sample t, and Mann-Whitney tests were used to compare the groups. A result was considered statistically significant at P<.05. RESULTS:Maternal baseline characteristics were not significantly different between the remote patient monitoring and paper groups aside from a slightly higher baseline rate of chronic hypertension in the remote patient monitoring group (6.1% vs 1.2%; P=.011). The primary outcomes of composite maternal and composite neonatal morbidity were not significantly different between the groups. However, remote patient monitoring patients submitted more glucose values (177 vs 146; P=.008), were more likely to achieve glycemic control in target range (79.2% vs 52.0%; P<.0001), and achieved the target range sooner (median, 3.3 vs 4.1 weeks; P=.025) than patients managed with paper logs. This was achieved without increasing in-person visits. Remote patient monitoring patients had lower rates of preeclampsia (5.8% vs 15.0%; P=.0006) and their infants had lower rates of neonatal hypoglycemia in the first 24 hours of life (29.8% vs 51.7%; P<.0001). CONCLUSION/CONCLUSIONS:Remote patient monitoring for the management of diabetes mellitus in pregnancy is superior to a traditional paper-based approach in achieving glycemic control and is associated with improved maternal and neonatal outcomes.
PMID: 36841348
ISSN: 1097-6868
CID: 5434182

Remote patient monitoring for diabetes management in pregnancy associated with improved maternal and neonatal outcomes [Meeting Abstract]

Kantorowska, Agata; Cohen, Koral; Oberlander, Maxwell; Jaysing, Anna; Akerman, Meredith; Wise, Anne-Marie; Mann, Devin; Chavez, Martin; Vintzileos, Anthony; Heo, Hye J.
ISI:000909337400087
ISSN: 0002-9378
CID: 5496512

Ultrasound differential diagnosis between amniotic fluid sludge and blood clot from placental edge separation

Kantorowska, Agata; Kunzier, Nadia N B; Kidd, Jennifer J M; Vintzileos, Anthony M
PMID: 35490793
ISSN: 1097-6868
CID: 5215722

A new index for obstetrics safety and quality of care: integrating cesarean delivery rates with maternal and neonatal outcomes

Ramani, Sangeeta; Halpern, Tara A; Akerman, Meredith; Ananth, Cande V; Vintzileos, Anthony M
BACKGROUND:Cesarean rates have been used as obstetrical quality indicators. However, these approaches do not take into consideration the accompanying maternal and neonatal morbidity. A challenge in the field of obstetrics has been to establish a valid outcomes quality measure that encompasses pre-existing high-risk maternal factors, as well as associated maternal and neonatal morbidity that is universally acceptable to all stakeholders including patients, health care providers, payers, and governmental agencies. OBJECTIVES/OBJECTIVE:The objectives of this study were to: (i) establish a new single metric for obstetric quality improvement among nulliparous with term, singleton, vertex (NTSV) patients, which integrates cesarean rates adjusted for pre-existing high risk maternal factors with the associated maternal and neonatal morbidity; this single metric has been termed obstetric safety and quality index (OSQI); and (ii) determine if obstetrician quality ranking by this new metric is different as compared to the rating based on individual crude and/or risk-adjusted cesarean rates. STUDY DESIGN/METHODS:This is a cross-sectional study that identified all NTSV patients delivered by 12 randomly chosen obstetricians in a single institution. A review of all records was performed including maternal high-risk factors, maternal and neonatal outcomes. Maternal and neonatal charts were reviewed to determine crude and adjusted cesarean rates by obstetrician, and to quantify maternal and neonatal complications. We estimated the obstetrician-specific crude cesarean rates, as well as rates adjusted for obstetrician-specific maternal and neonatal complications from logistic regression models. From this model, we derived the OSQI index for each obstetrician. The final ranking based on the OSQI was compared to the initial ranking by crude cesarean rates. Maternal and neonatal morbidities were analyzed as ≥1 and as well as ≥2 maternal and/or neonatal complications. RESULTS:These 12 obstetricians delivered a total of 535 women; thus, 1070 (535 maternal and 535 neonatal) charts were reviewed to determine crude and adjusted cesarean rates by obstetrician, and to quantify maternal and neonatal complications. The ranking of crude cesarean delivery rates was not correlated (rho=0.05, 95% confidence interval -0.54, 0.60) to the final ranking based on the OSQI index. Eight of 12 obstetricians shifted their rank quartiles following adjustments for high-risk maternal conditions and maternal and neonatal outcomes. There was a strong correlation between the ranking based on ≥1 vs. ranking based on ≥2 CMM/CNM (rho=0.63, 95% confidence interval 0.08, 0.88). CONCLUSIONS:Ranking based on crude cesarean rates varies significantly after considering high-risk maternal conditions and the associated maternal and neonatal outcomes. Therefore, the OSQI is a single metric which may potentially help to identify ways to improve upon clinician practice standards within an institution. Use of this novel quality measure may help to change initiatives geared towards patient safety balancing cesarean rates with maternal and neonatal mortality. This metric could potentially be also used to compare obstetric quality not only among individual obstetricians but also among hospitals which practice obstetrics.
PMID: 34634261
ISSN: 1097-6868
CID: 5030262

The role of the fetal biophysical profile in the management of fetal growth restriction

Baschat, Ahmet A; Galan, Henry L; Lee, Wesley; DeVore, Greggory R; Mari, Giancarlo; Hobbins, John; Vintzileos, Anthony; Platt, Lawrence D; Manning, Frank A
Growth-restricted fetuses are at risk of hypoxemia, acidemia, and stillbirth because of progressive placental dysfunction. Current fetal well-being, neonatal risks following delivery, and the anticipated rate of fetal deterioration are the major management considerations in fetal growth restriction. Surveillance has to quantify the fetal risks accurately to determine the delivery threshold and identify the testing frequency most likely to capture future deterioration and prevent stillbirth. From the second trimester onward, the biophysical profile score correlates over 90% with the current fetal pH, and a normal score predicts a pH >7.25 with a 100% positive predictive value; an abnormal score on the other hand predicts current fetal acidemia with similar certainty. Between 30% and 70% of growth-restricted fetuses with a nonreactive heart rate require biophysical profile scoring to verify fetal well-being, and an abnormal score in 8% to 27% identifies the need for delivery, which is not suspected by Doppler findings. Future fetal well-being is not predicted by the biophysical profile score, which emphasizes the importance of umbilical artery Doppler and amniotic fluid volume to determine surveillance frequency. Studies with integrated surveillance strategies that combine frequent heart rate monitoring with biophysical profile scoring and Doppler report better outcomes and stillbirth rates of between 0% and 4%, compared with those between 8% and 11% with empirically determined surveillance frequency. The variations in clinical behavior and management challenges across gestational age are better addressed when biophysical profile scoring is integrated into the surveillance of fetal growth restriction. This review aims to provide guidance on biophysical profile scoring in the in- and outpatient management of fetal growth restriction.
PMID: 35369904
ISSN: 1097-6868
CID: 5201542

Barriers to obstetric patient utilization of remote patient monitoring for blood pressure [Meeting Abstract]

Kidd, Jennifer; Patberg, Elizabeth; Kantorowska, Agata; Alku, Dajana; Akerman, Meredith; Vertichio, Rosanne; Wise, Anne-Marie; Vintzileos, Anthony; Heo, Hye
ISI:000737459400401
ISSN: 0002-9378
CID: 5208552

Use of Cervical Elastography at 18 to 22 Weeks Gestation in the Prediction of Spontaneous Preterm Birth

Patberg, Elizabeth; Wells, Matthew; Vahanian, Sevan; Zavala, Jose; Bhattacharya, Sarmistha; Richmond, Diana; Akerman, Meredith; Demishev, Michael; Kinzler, Wendy; Chavez, Martin R; Vintzileos, Anthony
OBJECTIVES/OBJECTIVE:To develop standard cervical elastography nomograms for singleton pregnancies at 18-22 weeks gestation using the E-cervix ultrasound application; assess intra-observer reliability of the E-cervix elastography parameters; and determine if these cervical elastography measurements can be used in the prediction of spontaneous preterm birth. METHODS:This was a prospective cohort study of pregnant women undergoing cervical length screening assessment via transvaginal ultrasound examination at 18 - 22 weeks gestation. A semi-automatic, cervical elastography application (E-cervix) was utilized during the transvaginal examination to calculate five quantitative parameters (Internal Os Stiffness, External Os Stiffness, Internal to External Os Stiffness Ratio, Hardness Ratio, Elasticity Contrast Index) and create a standard nomogram for each one of them. The intra-observer reliability was calculated using Shrout-Fliess reliability. Cervical elastography parameters were compared between those who delivered preterm (<37 weeks) spontaneously versus full term. A multivariable logistic regression model was performed to determine the ability of the cervical elastography parameters to predict spontaneous preterm birth. RESULTS:742 women were included of which 49 (6.6%) had a spontaneous preterm delivery. A standard nomogram was created for each of the cervical elastography parameters from those who had a full term birth in the index pregnancy (n=693). Intra-observer reliability was good or excellent (intraclass correlation (ICC) = 0.757 - 0.887) for each of the cervical elastography parameters except External Os Stiffness which was poor (ICC = 0.441). In univariate analysis, none of the cervical elastography parameters were associated with a statistically significant increased risk of spontaneous preterm birth. In a multivariable model adjusting for history of preterm birth, gravidity, ethnicity, cervical cerclage and vaginal progesterone use, increasing Elasticity Contrast Index was significantly associated with an increased risk of spontaneous preterm birth (OR 1.15, 95%CI [1.02, 1.30]; P=0.02). CONCLUSIONS:Cervical elastography parameters are reliably measured and are stable across 18-22 weeks gestation. Based on our findings, the Elasticity Contrast Index was associated with an increased risk for spontaneous preterm birth and may be the parameter useful for future research.
PMID: 34051170
ISSN: 1097-6868
CID: 4890612