Stephanie A. Leonard

Stanford Medicine | Stanford · Division of Neonatal and Developmental Medicine

Background: In contrast to other high-resource countries, the US has experienced increases in the rates of severe maternal morbidity. The US also has pronounced racial/ethnic disparities in severe maternal morbidity, especially for non-Hispanic Black people, who have twice the rate as non-Hispanic White people. Objective(s): The objective of thi...

Background : The American College of Obstetricians and Gynecologists (ACOG) recommends early gestational diabetes mellitus (GDM) screening for pregnant Asian people with pre-pregnancy BMI ≥23.0 kg/m², in contrast to ≥25 kg/m² for other races/ethnicities. However, there is significant heterogeneity within Asian and Pacific Islander (API) populations...

To evaluate red blood cell use during delivery in patients with placenta accreta spectrum. We searched MEDLINE, EMBASE, CINAHL, Cochrane Central, ClinicalTrials.gov, and Scopus for clinical trials and observational studies published between 2000 and 2021 in countries with developed economies. Abstracts (n=4,275) and full-text studies (n=599) were i...

Objective: To evaluate the effect of fasting compared with eating before the 1-hour oral glucose tolerance test (OGTT) on gestational diabetes mellitus (GDM) screening results. Methods: In a single-center, prospective randomized trial, participants were randomized to: 1) fasting for 6 or more hours or 2) oral intake ("fed") within 2 hours of the...

Objective Evaluate the association between small for gestational age (SGA) severity and morbidity and mortality in a contemporary, population of very preterm infants. Study design This secondary analysis of a California statewide database evaluated singleton infants born during 2008–2018 at 24–32 weeks’ gestation, with a birthweight <15th percenti...

Background: There is an increased odds of having a recurrence of clinical chorioamnionitis in patients with a diagnosis of clinical chorioamnionitis compared with those without clinical chorioamnionitis in a previous pregnancy. However, it is unclear how gestational age at delivery of the first pregnancy or interpregnancy interval may contribute t...

Background: The International Classification of Diseases Clinical Modification 10th Revision (ICD-CM-10) introduced diagnosis codes for week of gestation. Our objective was to assess the validity of these codes among live births, which could have major utility in perinatal research and quality improvement. Methods: We used linked birth certifica...

Objective: To assess whether readmission for hypertension by 6 weeks postpartum differed between patients discharged on nifedipine or labetalol. Methods: This cohort study included patients with delivery admissions from 2006 to 2017 who were discharged from the hospital on nifedipine or labetalol and were included in a large, national adjudicate...

Background Leukocyte telomere length (LTL) is a biomarker that is affected by older age, psychosocial stress, and medical comorbidities. Despite the relevance of these factors to obstetric practice, little is known about LTL in pregnancy. Our study explored longitudinal LTL dynamics in pregnant and non-pregnant people. Objective This pilot study c...

Background The high maternal mortality and severe morbidity rates in the United States compared with other high-income countries have received national attention. Characterization of postpartum hospital readmissions within the first days after delivery hospitalization discharge could help identify patients needing additional preparedness for discha...

Background : Cardiovascular disease (CVD) has emerged as the leading cause of maternal morbidity and mortality, making planned pregnancy, and thereby reliable contraception among people with CVD, vital. Objectives : We sought to compare postpartum contraceptive practices among people with CVD (cardiac cohort) cared for by a Pregnancy Heart Team to...

Cardiovascular disease is the leading cause of pregnancy mortality. Socioeconomic and racial disparities in pregnancy are well established. Despite this, little is known about the impact of social determinants of health in pregnant patients with heart disease. This study aims to determine whether pregnant patients with heart disease living in lower...

Racial disparity exists for hypertensive disorders in pregnancy (HDP), which leads to disparate morbidity and mortality worldwide. The enzyme heme oxygenase-1 (HO-1) is encoded by HMOX1 , which has genetic polymorphisms in its regulatory region that impact its expression and activity and have been associated with various diseases. However, studies...

Background: Short leukocyte telomere length is a biomarker associated with stress and morbidity in non-pregnant adults. Little is known, however, about maternal telomere dynamics in pregnancy. To address this, we examined changes in maternal leukocyte telomere length (LTL) during uncomplicated pregnancies and explored correlations with perceived s...

Objective To examine the association between severe maternal morbidity (SMM) and infant health using the additional infant costs and length of stay (LOS) as markers of added clinical complexity. Study design Secondary data analysis using California linked birth certificate-patient discharge data for 2009–2011 (N = 1,260,457). Regression models wer...

Background Sexual and/or gender minority (SGM) people account for roughly 7.1% of the U.S. population, and an estimated one-third are parents. Little is known about SGM people who become pregnant, despite this population having documented health care disparities that may impact pregnancy. Objectives Our objective was to describe parental structure...

Objective To investigate the association of infertility with atherosclerotic cardiovascular disease (ASCVD) among postmenopausal participants in the Women’s Health Initiative (WHI). We hypothesized that nulliparity and pregnancy loss may reveal more extreme phenotypes of infertility, enabling further understanding of the association of infertility...

Background Many sexual and/or gender minority individuals build families through pregnancy and childbirth, but it is unknown whether they experience different clinical outcomes than those who are not sexual and/or gender minority individuals. Objective To evaluate obstetrical and birth outcomes comparing couples who are likely sexual and/or gender...

Introduction. Prepregnancy body mass index (BMI) and gestational weight gain have been linked with severe maternal morbidity (SMM), suggesting that weight change between pregnancies may also play a role, as it does for neonatal outcomes. We assessed the association of changes in prepregnancy BMI between two consecutive singleton pregnancies with th...

Introduction The objectives of this study were to include readmissions and physician costs in the estimates of total costs of severe maternal morbidity (SMM), to consider the effect of SMM on maternal length of stay (LOS), and to examine these for the more restricted definition of SMM that excludes transfusion-only cases. Methods California linked...

Background: While people with cardiac disease are known to be at increased lifetime risk of depression, little is known about postpartum depression rates in this population. Describing rates of positive postpartum depression screens and identifying risk factors that are unique to cardiac patients may help inform risk reduction strategies. Methods...

Objective Investigate the association between maternal homelessness at the time of delivery and perinatal outcomes, with a focus on neonatal health outcomes. Study design Population-based cohort using California’s statewide database included 1,520,253 women with linked birth and maternal discharge data, 2008–2012. Multivariable analysis assessed h...

(Am J Obstet Gynecol. 2021;224:219.e1–15) A persistent difference in the rate of severe maternal morbidity (SMM) continues to exist between White women and those of other racial and ethnic groups. This is especially true for Black women, who are up to 3 times more likely to experience SMM than White women. The factors underlying this inequity are u...

Background A recently developed obstetric comorbidity scoring system enables comparisons of severe maternal morbidity rates independent of health status at the time of birth hospitalization. However, the scoring system has not been evaluated in racial-ethnic and socioeconomic groups or used to assess disparities in severe maternal morbidity. Objec...

Objective: To evaluate severe maternal morbidity (SMM) among patients with epilepsy and patients without epilepsy. Methods: We retrospectively examined SMM using linked birth certificate and maternal hospital discharge records in California between 2007 and 2012. Epilepsy present at delivery admission was the exposure and was subtyped into gener...

Objective To develop and validate a preconception risk prediction index for severe maternal morbidity (SMM), defined by the Centers for Disease Control and Prevention as indicators of a life-threatening complication, among infertile patients. Design Retrospective analysis of live births and stillbirths from 2007 to 2017 among infertile women. Set...

OBJECTIVE The COVID-19 pandemic necessitated rapid adjustment of obstetrical delivery models including fewer antenatal appointments and increased use of telehealth. We hypothesized that an increase in telemedicine and a decrease in antepartum visits owing to the COVID-19 pandemic led to a decreased proportion of people with a postpartum contracepti...

Objective: To examine the association of preconception paternal health and risk of adverse maternal outcomes among healthy mothers. Study design: Retrospective analysis of live births from 2009-2016 among healthy women 20-45 years of age in the IBM Marketscan® research database. Infants were linked to paired mothers and fathers using family ID....

Objectives Serum biomarkers are used to diagnose and manage severe infections, but data on their utility during labor are limited. We compared lactate and procalcitonin levels in women with and without intraamniotic infection to determine if they are useful biomarkers for infection during labor. Study Design We performed a prospective observationa...

Research Question Is the karyotype of the first clinical miscarriage (CM) in an infertile patient predictive of the outcome of the subsequent pregnancy? Design Retrospective cohort study of infertile patients undergoing manual vacuum aspiration with chromosome testing at the time of the first (index) CM with a genetic diagnosis and a subsequent pr...

BACKGROUND Operative vaginal delivery (OVD) is a critical tool in reducing primary cesarean birth, but declining OVD rates and concerns about provider skill necessitate a clear understanding of risks. These risks are ambiguous because most studies compare outcomes with OVD to spontaneous vaginal delivery, rather than to second stage cesarean which...

Objective: To assess whether placenta accreta spectrum occurs more frequently among women with twin gestations compared with singleton gestations. Methods: All live births in California from 2016 to 2017 were identified from previously linked records of birth certificates and birth hospitalization discharges. The primary outcome was placenta acc...

Background: Rates of maternal mortality and severe maternal morbidity (SMM) are higher in the United States than in other high-resource countries and are increasing further. Objective: To examine the association of maternal comorbid conditions, age, body mass index, and previous cesarean birth with occurrence of SMM. Design: Population-based c...

Objective: To develop and validate an expanded obstetric comorbidity score for predicting severe maternal morbidity that can be applied consistently across contemporary U.S. patient discharge data sets. Methods: Discharge data from birth hospitalizations in California during 2016-2017 were used to develop the score. The outcomes were severe mate...

Background Birth hospital has recently emerged as a potentially key contributor to disparities in severe maternal morbidity, but investigations remain limited. Objectives We leveraged state-wide data from California to examine whether birth hospital explained racial/ethnic differences in severe maternal morbidity. Methods This cohort study used d...

Objective The aim of this study is to evaluate the contribution of pre-pregnancy obesity and overweight to peripartum cardiomyopathy. Study Design This population-based study used linked birth record and maternal hospital discharge data from live births in California during 2007 to 2012 (n = 2,548,380). All women who had a diagnosis of peripartum c...

Background: High and low prepregnancy BMI are risk factors for severe maternal morbidity (SMM), but the contribution of gestational weight gain (GWG) is not well understood. Objectives: We evaluated associations between GWG and SMM by prepregnancy BMI group. Methods: We analyzed administrative records from 2,483,684 Californian births (2007-20...

(BJOG. 2019;126:581–588) Obesity is a risk factor for pregnancy-related venous thromboembolism (VTE), a leading cause of maternal death. Recommendations for VTE prevention specific to maternal body mass index (BMI) are limited and inconsistent across various organizations such as the Royal College of Obstetricians and Gynecologists and the American...