Lauren M Kucirka’s research while affiliated with Microbiome Core Facility USA and other places

( Obstet Gynecol. 2024;143(4):582–584. doi: 10.1097/AOG.0000000000005537) Administrative data play a crucial role in understanding severe maternal morbidity (SMM) events, yet their interpretation heavily relies on coding quality. Overestimation of SMM during birth hospitalizations might occur due to International Classification of Diseases, Tenth Revision (ICD-10) codes being carried forward from predelivery events. This study aimed to describe SMM distribution across the antepartum, birth, and postpartum periods and to assess the potential false discovery rate of SMM events, hypothesizing that some events are subject to carry-forward coding. Following IRB approval and data-use agreements, a shared, deidentified database was created using the PCORnet Common Data Model at the University of North Carolina and Duke University.

Objective: We aimed to summarize the available evidence examining the association between prenatal ultrasound findings and adverse fetal, obstetric, and neonatal outcomes in pregnancies complicated by type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM) and to evaluate whether the predictive value of ultrasound findings for adverse outcomes varies between T1DM and T2DM pregnancies. Data sources: We conducted a systematic review of the existing literature through August 12, 2024. Methods of study selection: We included articles in English that reported associations between ultrasound findings and fetal, obstetric, and neonatal outcomes in pregnant people with T1DM and T2DM. Two independent reviewers examined articles at the abstract level and, if eligible, at the full-text level; disagreements were adjudicated by a third reviewer. Tabulation, integration, and results: Of the 2,088 unique citations reviewed, 12 studies met the inclusion criteria describing associations between ultrasound findings and fetal, obstetric, and neonatal outcomes among a total of 1,165 pregnant people with T1DM and 489 pregnant people with T2DM. Most studies (10/12) examined the association between ultrasound measures of growth, including estimated fetal weight (EFW) and its individual components, abdominal wall thickness, head circumference to abdominal circumference (HC/AC) ratio, and birthweight, large for gestational age (LGA) or small for gestational age (SGA). Studies did not examine stillbirth, neonatal demise, or maternal outcomes other than cesarean section. Conclusion: This systematic review synthesizes the available literature on ultrasound risk markers of adverse fetal, obstetric, and neonatal outcomes separately in pregnant people with T1DM and T2DM. We identified very few studies that distinguished between pregnant people with T1DM and T2DM, and the majority focused on surrogate outcomes (e.g., LGA, SGA) of morbidity. Our findings highlight the need for further studies investigating these distinct diseases to provide evidence for antenatal management recommendations.

Objectives To describe differences in outcomes in pregnancies complicated by polyhydramnios based on whether the diagnosis was made by maximum vertical pocket (MVP), amniotic fluid index (AFI) or both. Methods This was a retrospective cohort study examining ultrasound assessment of amniotic fluid in singleton pregnancies, June 2014 to May 2021, with amniotic fluid volume measured at ≥ 20 weeks gestation. The proportion of pregnancies with mild, moderate or severe polyhydramnios diagnosed by (1) MVP, (2) AFI and (3) both MVP and AFI was evaluated. Modified Poisson regression models estimated the relative risk of adverse outcomes for pregnancies with polyhydramnios compared to those with normal fluid. All models were adjusted for potential confounders and analyses stratified by the presence or absence of foetal anomalies. Results Of 14 883 pregnancies, 13 557 (91.1%) had both normal AFI and MVP. Polyhydramnios was most frequently diagnosed by MVP (n = 602/1326, 45.5%). All cases diagnosed by either MVP or AFI were mild. Those with polyhydramnios by both MVP and AFI had an increased risk of perinatal mortality (adjusted relative risk [aRR] = 5.94, 95% confidence interval [95% CI] 3.07−11.50), including IUFD (aRR = 5.58, 95% CI 2.81−11.09) and neonatal death (aRR = 13.07, 95% CI 1.72−99.60). Findings were similar when the analysis was stratified by the presence or absence of foetal anomalies. Conclusions The use of MVP was associated with a higher likelihood of polyhydramnios diagnosis versus AFI. Polyhydramnios, diagnosed by either MVP or AFI, was mild. Polyhydramnios diagnosed by both measures was associated with an increased risk of perinatal mortality.

Our objective was to identify birth hospitalization severe maternal morbidity (SMM) diagnoses that were also coded during prior encounters and, thus, potentially falsely carried forward as de novo SMM events. This retrospective cohort study included pregnant patients with births between 2016 and 2020. We applied the SMM algorithm to the birth hospitalization and encounters occurring prepregnancy, antepartum, and postpartum. The primary outcome was the rate of SMM diagnoses recorded during the birth hospitalization that were also coded on previous encounters. There were 1,380 (1.8%) birthing patients with SMM. Of patients with SMM codes at the birth hospitalization, 19.0% had the same SMM code during a prior encounter. Certain SMM events may be prone to carry-forward errors and may not signify a de novo birth hospitalization event.

The objective of this paper is to discuss the complexities of identifying prenatal care visits in insurance claims databases, review existing methods to identify prenatal care encounters, and explore how different study goals should inform the definition of prenatal care employed by investigators. Insurance claims data are routinely used to conduct perinatal epidemiology studies focused on the effects of medical interventions. Prenatal care, an important medical intervention and an indicator of ongoing pregnancy, lacks a consistent definition among clinical and research-based sources. We have categorized definitions of prenatal care in three groups: all healthcare received while pregnant, pregnancy-specific healthcare, and guideline-concordant healthcare. In studies using insurance claims data, we found five common methods to identify prenatal care encounters. Using example study goals, we outline important considerations investigators must make when applying different methods to identify prenatal care visits in studies using insurance claims data.

Importance The incidence of pregnancy-related acute kidney injury is increasing and is associated with significant maternal morbidity including progression to end-stage kidney disease (ESKD). Little is known about characteristics and long-term outcomes of patients who develop pregnancy-related ESKD. Objectives To examine the characteristics and clinical outcomes of patients with pregnancy-related ESKD and to investigate associations between pre-ESKD nephrology care and outcomes. Design, Setting, and Participants This was a cohort study of 183 640 reproductive-aged women with incident ESKD between January 1, 2000, and November 20, 2020, from the US Renal Data System and maternal data from births captured in the US Centers for Disease Control and Prevention publicly available natality data. Data were analyzed from December 2022 to June 2023. Exposure Pregnancy-related primary cause of ESKD, per International Classification of Diseases, Ninth Revision (ICD-9) and ICD-10 codes reported at ESKD onset by the primary nephrologist on Centers for Medicare and Medicaid Services form 2728. Main Outcomes Measures Multivariable Cox proportional hazards and competing risk models were constructed to examine time to (1) mortality, (2) access to kidney transplant (joining the waiting list or receiving a live donor transplant), and (3) receipt of transplant after joining the waitlist. Results A total of 341 patients with a pregnancy-related primary cause of ESKD were identified (mean [SD] age 30.2 [7.3]). Compared with the general US birthing population, Black patients were overrepresented among those with pregnancy-related ESKD (109 patients [31.9%] vs 585 268 patients [16.2%]). In adjusted analyses, patients with pregnancy-related ESKD had similar or lower hazards of mortality compared with those with glomerulonephritis or cystic kidney disease (adjusted hazard ratio [aHR], 0.96; 95% CI, 0.76-1.19), diabetes or hypertension (aHR, 0.49; 95% CI, 0.39-0.61), or other or unknown primary causes of ESKD (aHR, 0.60; 95% CI, 0.48-0.75). Despite this, patients with pregnancy-related ESKD had significantly lower access to kidney transplant compared with those with other causes of ESKD, including (1) glomerulonephritis or cystic kidney disease (adjusted subhazard ratio [aSHR], 0.51; 95% CI, 0.43-0.66), (2) diabetes or hypertension (aSHR, 0.81; 95% CI, 0.67-0.98), and (3) other or unkown cause (aSHR, 0.82; 95% CI, 0.67-0.99). Those with pregnancy-related ESKD were less likely to have nephrology care or have a graft or arteriovenous fistula placed before ESKD onset (nephrology care: adjusted relative risk [aRR], 0.47; 95% CI, 0.40-0.56; graft or arteriovenous fistula placed: aRR, 0.31; 95% CI, 0.17-0.57). Conclusion and Relevance In this study, those with pregnancy-related ESKD had reduced access to transplant and nephrology care, which could exacerbate existing disparities in a disproportionately Black population. Increased access to care could improve quality of life and health outcomes among these young adults with high potential for long-term survival.

Objective: Unilateral absence of a pulmonary artery (UAPA) is a rare congenital malformation associated with hemoptysis, pulmonary hypertension, and infection. Little is known about the impact on pregnancy outcomes. We sought to synthesize the existing literature on pregnancy outcomes in patients with maternal UAPA Study Design: We report a case of maternal UAPA and performed a systematic review of the existing literature. Articles in English reporting pregnancy outcomes among women with unilateral absence or hypoplasia of the pulmonary artery were included. Articles were reviewed at the abstract level and, if eligible, at the full-text level by two independent reviewers with disagreements adjudicated by a third reviewer. Data were abstracted by two independent reviewers. Outcomes of interest were mode of delivery, gestational age at delivery, intensive care admission, maternal death, and length of stay. Summary statistics for each outcome are presented. Results: We identified 14 studies, including the presented case, reporting outcomes in 22 pregnancies impacted by maternal UAPA. Median age at diagnosis was 21 years. Concurrent cardiac comorbidities were reported in 6/13 (46.2%) with pulmonary hypertension in 5/20 (25%) of cases where this information was reported. We observed high rates of preterm birth (4/12, 33.3%), cesarean delivery (10/15, 66.7%), and operative vaginal delivery (2/5, 40.0%). There was one maternal death occurring in the immediate postpartum period for a mortality rate of 4.5%. Conclusion: Our study provides a comprehensive review of existing literature on maternal UAPA. Our findings suggest increased rates of adverse outcomes and underscore the importance of early diagnosis, identification of pulmonary hypertension, and multidisciplinary care.