We sought to analyze the rates of stillbirth at recommended gestational age epochs based on body mass index (BMI) at first prenatal visit. A total of 79,148 births with optimal dating, BMI at first prenatal visit, and absence of maternal complications (chronic hypertension, pregestational diabetes) or fetal complications (aneuploidy, major fetal malformations, fetal growth restriction) were identified from January 2013 to September 2024. Of these, 33,108 (42%) delivered ≥ 34 weeks with a BMI classified as normal, class II, or class III obesity. Adjusted hazard ratios (aHRs) were calculated due to differences in age, race/ethnicity, and parity. Among patients with class II obesity, no difference in stillbirth was observed compared with normal weight individuals at either early term (370/7 −386/7 weeks) or term (≥ 39 weeks), with aHRs of 2.19 (95% confidence interval [CI] 0.67–7.17) and 0.86 (95% CI 0.17–4.34), respectively. Neither were differences found in stillbirth risk for patients with class III obesity compared with normal weight individuals in the late preterm (340/7 −366/7 weeks), early term, or term gestational ages with aHRs of 0.78 (95% CI 0.17–3.57), 2.44 (95% CI 0.61–9.84), and 2.81 (95% CI 0.7–11.28), respectively. Based on our results, the utility of antepartum surveillance for the prevention of stillbirth in patients with class II or III obesity may be of limited benefit.
Objective The objective of this study is to evaluate the association between the degree of cervical dilation at the time of physical exam-indicated cerclage and delivery before 28 weeks of gestation. Study Design We conducted a retrospective cohort study of singleton pregnancies who underwent physical exam-indicated cerclage (painless cervical dilation >= 1 cm in the second trimester) at a single academic institution, 2014 to 2022. The primary outcome was delivery before 28 weeks. Cervical dilation was categorized as 1, 2, 3, and 4 to 5 cm. Multivariable logistic regression estimated adjusted odds ratios (aOR) with 95% confidence intervals (CI), adjusting for potential confounders. Kaplan-Meier analysis of the cerclage-to-delivery interval was examined as a sensitivity analysis. Results Of 107 singleton pregnancies, 31 (29.0%) delivered before 28 weeks. Groups were similar except for body mass index, which was higher among those who delivered before 28 weeks (34.6 +/- 8.6 vs. 30.8 +/- 7.3 kg/m(2) ; p = 0.026). Cervical dilation was greater in the early-delivery group (median, 1.5 [interquartile range, IQR, 1.0-3.0] vs. 1.0 [IQR, 1.0-2.0] cm; p = 0.016). Compared with 1 cm, dilation of 3 cm (aOR, 8.90; 95% CI, 1.75-45.30) and 4 to 5 cm (aOR, 12.95; 95% CI, 2.20-76.21) were independently associated with delivery before 28 weeks, whereas 2 cm was not (aOR, 0.74; 95% CI, 0.19-2.99); these estimates were imprecise because few patients had dilation of 3 cm or more. Median cerclage-to-delivery latency fell from 16.3 and 14.9 weeks at 1 and 2 cm to 2.4 and 1.5 weeks at 3 and 4 to 5 cm (log-rank p = 0.03). Conclusion Greater cervical dilation at physical exam-indicated cerclage was associated with delivery before 28 weeks in a dose-dependent manner, with an apparent inflection between 2 and 3 cm. Because the higher-dilation strata contained few patients, these associations should be interpreted with caution.
Objective We aimed to evaluate the frequency and characteristics of headaches across pregnancy and to examine obstetric and neonatal outcomes among pregnant patients with recurrent migraines. Study Design This was a single-site prospective observational study of pregnant patients evaluated for recurrent headaches during prenatal visits from December 2020 through September 2022. Standardized questions were used at each visit to assess headache type, frequency, and associated symptoms. Obstetric and neonatal outcomes were recorded. Statistical analyses included mixed effects logistic regression, independent t -tests, and chi-square tests to compare baseline characteristics and outcomes between groups. Results During the study period, 858 pregnant patients were evaluated for recurrent headaches. Of these, 546 (63.6%) patients were diagnosed with migraine headaches and 312 (36.4%) with tension-type headaches. Migraine frequency was highest in the second trimester. Nausea, vomiting, and photophobia were the most commonly reported associated symptoms. In the first trimester, 58.7% of patients reported nausea, 59.4% photophobia, and 31.0% vomiting. The frequency of these symptoms decreased with advancing gestation. The composite outcome of preterm delivery, preeclampsia with severe features, abruption, and stillbirth did not significantly differ between patients with migraines and matched controls without headache disorders (25.4 vs. 21.1%, p = 0.12). There were no significant differences in individual components of the composite outcome or in neonatal outcomes, including birthweight < 3%ile, birthweight < 10%ile, and need for neonatal respiratory support. Conclusion Migraines were the most common headache diagnosis among pregnant patients with recurrent headaches, and migraine frequency and associated symptoms changed across gestation. After adjustment for comorbid conditions, obstetric and neonatal outcomes were similar between patients with recurrent migraines and those without headache disorders.
Abstract The objective of this study is to evaluate whether structured multidisciplinary team huddles with standardized indication documentation before unscheduled cesarean delivery (CD) were associated with changes in nulliparous, term, singleton, vertex (NTSV) CD rates. This retrospective cohort study included 2,051 NTSV deliveries from a single faculty practice at a large urban academic medical center from September 1, 2023, to June 30, 2025. A structured team huddle intervention requiring a standardized paper form before unscheduled, nonelective CD was implemented October 1, 2024. Patients were categorized into preintervention (N = 1,160), transition (N = 46), intervention (N = 606), and postintervention (N = 239) periods by delivery date. The primary outcome was NTSV CD rate by period. Secondary outcomes included CD indication, labor and delivery characteristics, maternal and neonatal outcomes, and compliance. Categorical variables were compared using chi-square tests, and continuous variables were compared using independent-samples t-tests or analysis of variance. CD rates differed significantly across the preintervention, intervention, and postintervention periods (34.9% [405/1,160], 28.9% [175/606], and 32.6% [78/239], respectively; p = 0.037). The odds of CD were lower during the intervention period versus preintervention (odds ratio: 0.76, 95% confidence interval: 0.61–0.94). Among 228 eligible unscheduled, nonelective CDs, form completion differed significantly by period (33.3% [5/15] transition, 42.6% [63/148] intervention, 0% [0/65] postintervention; p < 0.001). Maternal and neonatal outcomes were similar across periods. Among completed forms, partial or no agreement between form- and chart-documented indications occurred in 36.8% (25/68). A structured multidisciplinary team huddle before CD was associated with reduced CD rates without adverse maternal or neonatal outcomes. The effect was not sustained after discontinuation of the intervention. These findings suggest real-time, team-based clinical decision support may be an effective, low-cost strategy to reduce potentially avoidable CDs.
This study aimed to evaluate the prevalence of large-for-gestational age (LGA) births and hypertensive disorders of pregnancy (HDP) among pregnant individuals with gestational diabetes mellitus (GDM) following the 2014 U.S. Preventive Services Task Force (USPSTF) universal screening recommendation. We analyzed linked U.S. birth and infant death datasets for singleton, non-anomalous births delivered between 23 (0/7) and 42 (6/7 )weeks' gestation from 2014 to 2022. Multivariate Poisson regression models estimated the independent association between GDM and LGA, small for gestational age (SGA), or HDP. Among the 31,791,459 total births included in the analysis, 6.8% had GDM, and the LGA prevalence declined from 17.9% in 2014 to 14.9% in 2022 (risk ratio [RR] 0.83; 95% confidence interval [CI] 0.82-0.84; rate difference - 3.06%) without an increase in rates of SGA infants. However, the overall frequency of LGA among pregnancies complicated by GDM was higher than in pregnancies that were not complicated by GDM in the United States during this study period ([GDM] 16.2% vs. [non-GDM] 10.8%, p < 0.001; RR 1.53 [95% CI 1.52-1.54]). In contrast, HDP prevalence increased from 11.1 to 15.5% during the same period among pregnancies complicated by GDM (RR 1.40; 95% CI 1.38-1.42; rate difference 4.46%). GDM remained independently associated with LGA (adjusted RR [aRR] 1.34 [95% CI 1.33-1.34]) and HDP (aRR 1.67 [1.66-1.68]). While universal GDM screening and current management strategies have reduced LGA at the population level, LGA still remains persistently higher than in non-GDM pregnancies, and HDP rates continue to rise. Future studies should focus on innovative interventions to improve outcomes.
