The objective of this study was to examine the effect of coronavirus disease 2019 (COVID-19) infection during pregnancy on birth outcomes, including the relationship between the trimester of COVID-19 infection and newborn size. Findings could be used to better inform appropriate management of COVID-19 during pregnancy.This retrospective chart review study included patients diagnosed with COVID-19 who received care at a single university-affiliated obstetrics practice. Pregnant patients with a diagnosis of COVID-19 between April 2022 and April 2023 were included in this study. Participant demographics and birth outcomes were extracted and analyzed.Our sample included 141 women who had COVID-19 during pregnancy, grouped based on the trimester of COVID-19 infection. In analyses adjusted for confounding background factors, those with a COVID-19 infection during the second trimester (n = 57) and third trimester (n = 50) had newborns with significantly decreased head circumference at birth compared with those infected during the first trimester (p < 0.05). In addition, compared with those with a COVID-19 infection during the first trimester, those who had COVID-19 during the third trimester had an average 1.3 cm decreased birth length.In the current study, COVID-19 infection later in pregnancy, especially in the third trimester, significantly predicted decreased birth weight, length, and head circumference. · COVID-19 infection may impact newborn size.. · Third-trimester infection was most detrimental.. · Late-term monitoring may be warranted..

Objective: This study examines the impact of age, race/ethnicity, and depression history on the development of postpartum depression (PPD) among substance-using pregnant individuals. Design: This retrospective electronic medical record review examined maternal-child dyads from one university-affiliated pediatric clinic in Michigan to assess factors associated with PPD. Materials and Methods: A retrospective chart review was conducted at one university-affiliated pediatric practices in the Midwestern U.S., focusing on maternal-child dyads with children born since July 2016. Eligible participants had linked maternal prenatal/delivery records and pediatric medical records through age 3 and had self-report of or biochemically confirmed pregnancy substance use. The primary outcome was PPD, assessed using the Edinburgh Postnatal Depression Scale (EPDS) and maternal self-report of an external diagnosis. Results: Among 173 participants, 25.2% experienced PPD. Private insurance holders were over four times as likely to develop PPD (OR = 4.30, 95% CI: 1.36–13.58), and marijuana use increased risk nearly fivefold (OR = 4.91, 95% CI: 1.41–17.12). A history of mental health conditions was associated with a nearly fourfold increase in PPD risk but was not statistically significant after adjustment. Age and minority race/ethnicity were not significant predictors. Conclusions: Marijuana use and private insurance status were the strongest predictors of PPD in this substance-exposed population. While prior mental health history, age, and minority race/ethnicity were associated with increased PPD risk, these factors were not statistically significant. These findings highlight the need for targeted maternal mental health interventions and further research on socioeconomic and substance use-related risks. Support: This project is affiliated with Central Michigan University and was funded by NIH/NICHD grant: 1 R03 HD109588-01.

The harms of combustible cigarette (CC) use in pregnancy for fetal development are well studied. Less understood are the potential impacts of newer non-combustible cigarette alternatives, including electronic cigarettes (ECs). Our goal was to examine whether EC use during pregnancy predicts increased risk of adverse birth outcomes. This retrospective cohort study used data from the Obstetrics Initiative (OBI), a statewide collaborative of 70 maternity hospitals. OBI’s clinical registry of data on nulliparous, term, singleton, and vertex fetal presentation pregnancies were from medical records. Three groups of pregnancy cigarette users (Controls (n = 26,394), CC (n = 2216), and EC (n = 493)) were compared on birth outcomes, controlling for background differences. Controls were defined as nonsmokers of ECs or CCs. Compared to the controls, the EC group had significantly lower birth weight, while the CC group had reduced birthweight and greater rates of arterial cord pH < 7.1. Compared to EC users, CC users had higher rates of neonates requiring antibiotics and NICU admission. Growing evidence suggests ECs are not safer alternatives to CCs and use during pregnancy should be discouraged. Additional research is needed, as non-significant trends for increased risk of several adverse neonatal outcomes following EC use were found, potentially significant in larger studies with average risk for adverse pregnancy outcomes and when frequency and timing of EC exposure are considered.

The specific relationship between sexual coercion, intimate partner violence (IPV) during pregnancy, and intimate partner homicide (IPH) is poorly understood. Through a scoping literature review, we identified 101 studies on sexual coercion, IPV during pregnancy, and IPH and created a conceptual model suggesting unintended pregnancies may serve as both a risk factor for and a product of IPV that may escalate to IPH. We illustrate a healthcare systems intervention implication of this model in the context of the Colorado Family Planning Initiative (CFPI). Descriptive statistics suggest an inverse association between contraception access and IPH, which declined by 62% during the first 4 years of the CFPI. Interventions aimed at improving reproductive agency, including improving contraception access and reducing unintended pregnancy, may be a useful opportunity for clinician and health systems to contribute to reducing both lethal and nonlethal IPV.

Electronic cigarette (e-cig) use in pregnancy is common, but potential effects on fetal development are largely unknown. This study’s goal was to examine the association between e-cig exposure and fetal growth. Data were extracted from medical charts in this single-site retrospective study. The sample, excluding those with known tobacco, alcohol, illicit drug, opioid, and benzodiazepine use, contained women who used e-cigs throughout pregnancy and non-e-cig user controls. Fetal size measurements from second- and third-trimester ultrasounds and at birth were expressed as percentiles for gestational age. Following adjustment for confounding factors, in the second trimester, only femur length was significant, with an adjusted deficit of 11.5 percentile points for e-cig exposure compared to controls. By the third trimester, the femur length difference was 28.5 points, with the fetal weight difference also significant (17.2 points). At birth, all three size parameter differences between groups were significant. Significant size deficits were predicted by prenatal e-cig exposure, becoming larger and impacting more parameters with increasing gestation. While additional studies are warranted to confirm and expand upon these findings, this study adds to emerging data pointing to specific harms following e-cig exposure in pregnancy and suggests that e-cigs may not be a “safer” alternative to combustible cigarette smoking in pregnancy.

BackgroundA challenge in addressing neonatal opioid withdrawal syndrome (NOWS) is knowing who has been exposed and needs monitoring for withdrawal. Women do not always get asked about or disclose opioid use, and biologic testing is neither universal nor infallible. We investigate the prevalence and effectiveness of methods for identifying prenatal opioid exposure.MethodsA review of medical charts at five delivery hospitals identified newborns with known exposure (i.e., NOWS diagnosis) for study inclusion.ResultsOver 95% of the mothers had 1+ urine drug screening (UDS) during pregnancy, 38% had UDS at delivery, 94% had documentation of self-report inquiry, and 81% of the newborns had biologic testing of meconium and/or cord tissue. Pregnancy UDS detected opioid use for 17% of the sample, UDS at delivery detected for 32%. A self-report of the use prenatally/at delivery identified 85%. Cord tissue testing was positive for 78%, meconium for 61%, and infant UDS 15%. 96% of the newborns were positive on 1+ exposure variable.ConclusionsWith drug testing only when indicated, almost all exposed pregnancies included inquiry about and biologic testing for opioid use/exposure. Reliance on any one assessment method may miss exposed newborns, but consideration of all information may identify most if not all newborns needing monitoring for NOWS.

INTRODUCTION: Preeclampsia (PreE) affects 1 in 25 U.S. pregnancies. Recognized risk factors include obesity, chronic hypertension, and diabetes, and PreE may elevate risk of cardiovascular disease (CVD) later in life. Despite shared vascular integrity concerns with known risk factors, there is no clear link between preexisting CVD, particularly ischemic heart disease (IHD), and increased risk of PreE during pregnancy. This study investigates whether preexisting IHD heightens risk of PreE in pregnant patients, and if this relationship can be explained by elevated rates of hypertension, diabetes, and obesity. METHODS: Data were obtained from the Healthcare Cost and Utilization Project (HCUP) national database, containing comprehensive de-identified patient data on U.S. hospital encounters. ICD-10 codes for IHD, chronic hypertension, gestational and preexisting diabetes, obesity, and PreE were used to identify relevant cases among delivery admissions. Data were analyzed using logistic regression, controlling for confounders. RESULTS: The sample included 1,670,527 patients who delivered between 2016 and 2019. Although no differences by race were observed, patients with IHD were significantly older and more likely to qualify for Medicaid. After controlling for age and insurance status, pregnant patients with IHD were nearly three times more likely to develop PreE than those without IHD (OR 2.75 [1.93–3.39]). With adjustment for possible mediators including chronic hypertension, preexisting and gestational diabetes, and obesity, IHD was still associated with a twofold increased risk of PreE (OR 2.07 [1.44–2.99]). CONCLUSION: Pregnant women with preexisting IHD face significantly higher risk of developing PreE, even when considering comorbidities including obesity, diabetes, and hypertension. Preeclampsia is a leading cause of maternal morbidity and mortality worldwide. As the incidence of IHD rises, understanding the potential interactions between these conditions becomes crucial. Further research is needed to clarify connections between IHD and PreE, especially in identifying IHD and its risk factors to improve PreE prophylaxis and management.

This study explored Adverse Childhood Experiences (ACEs) in relation to the COVID-19 pandemic using YRBSS survey data on youth grades 9-12 and was analyzed using weighted sample prevalence, univariant weighted analysis, and multivariable weighted logistic regressions. Models adjusted for age, sex, ethnicity, race, sexual identity, smoking, alcohol, and illicit drug use. Inclusion criteria were those aged 14 years or older. Results showed decreased violence, substance use, and sexual health risk in 2021 compared to 2019, but increased mental health risk. Black individuals had higher odds of violence and victimization and sexual health risk. Gay, lesbian, and bisexual youths faced increased odds of various risks (p < .05). Understanding ACEs post-COVID-19 is crucial for mitigating their long-term effects on health.

INTRODUCTION: Approximately 83% of U.S. deliveries include pain control, with 67% incorporating epidural analgesia, and 16% utilizing narcotics. Research suggests intrapartum fentanyl predicts poor neonatal suckling, and thus impaired breastfeeding. Unclear are potential effects of other narcotics. We examined whether use of intrapartum narcotics increases risk of adverse neonatal outcomes. METHODS: Charts of patients admitted for delivery at a single academic institution were reviewed for drugs administered in the intrapartum period and neonatal outcomes. Institutional review board approval was obtained with a waiver of informed consent. Data were summarized using logistic regression, controlling for confounders. RESULTS: Of the 519 participants, 286 (55.1%) received at least one narcotic in the intrapartum period. Compared to the control group, those who received narcotics were significantly younger, had greater pregnancy weight gain, were less likely to deliver via cesarean section, were less likely to have had preeclampsia, had greater gestational age at delivery, and gave birth to babies that weighed more. Tylenol III predicted a three times higher adjusted risk of neonatal intensive care unit admission (odds ratio [OR] 3.03 [1.06–8.62]). Norco predicted greater than 2.5 times higher risk of 1-minute (OR 2.66 [1.26–5.60]) and 5-minute Apgar scores below 7 (OR 2.61 [1.08–6.31]), and requiring oxygen at birth (OR 2.68 [1.21–5.93]). Morphine predicted a three times higher risk of 5-minute Apgar scores below 7 (OR 3.00 [1.26–7.17]). When adjusting for receipt of epidural analgesia, epidural did not significantly increase risk of any study outcomes. CONCLUSION: Adverse neonatal outcomes were observed following intrapartum Norco, morphine, and Tylenol III, and were unrelated to use of epidural analgesia. Findings support growing evidence that intrapartum narcotics pose risk to neonates, and further research is needed to elucidate potential longer-term effects.

Background While the incidence and mortality rates of cervical cancer are declining due to improved prevention, screening, and treatment, inequitable access to care may contribute to worse patient outcomes. Therefore, we sought to evaluate sociodemographic disparities in the diagnosis and prognosis of patients with cervical cancer. Methodology The Surveillance, Epidemiology, and End Results (SEER) database was queried for adult women diagnosed with cervical cancer from 2010 to 2015. Sociodemographic groups of interest included patient race/ethnicity (non-Hispanic White/Hispanic White/Black/Other), residential setting (rural/urban), and county median household income (<$45,000/$45,000-59,999/$60,000-74,999/≥$75,000). Outcomes of interest included stage at diagnosis, receipt of hysterectomy, and overall survival (OS). Outcomes were evaluated using Pearson's chi-square test, multivariable logistic regression, and multivariable Cox proportional hazards. Results A total of 5,726 patients were identified with an average age of 50.1 years (SD = 14.6). Significant differences in cancer stage at diagnosis were identified based on race/ethnicity (p < 0.001) and household income (p = 0.012). On adjusted analysis, Black patients were found to be significantly less likely to receive a hysterectomy compared to non-Hispanic White patients (odds ratio (OR) = 0.46; 95% confidence interval (CI) = 0.37-0.56). Lower household income was associated with poorer survival for stage I (<$45,000 vs. >$75,000: hazard ratio (HR) = 1.53; 95% interquartile range (IQR) = 1.00-2.33), II ($45,000-59,999 vs. >$75,000: HR = 1.67; 95% IQR = 1.19-2.35), and IV (<$45,000 vs. >$75,000: HR = 1.64; 95% IQR = 1.22-2.29) disease. Black race was associated with poorer OS for stage IV disease (HR = 1.29; 95% IQR = 1.06-1.56). Conclusions This study highlights significant disparities in disease progression at diagnosis and OS for cervical cancer patients based on race/ethnicity and household income. These findings may assist policymakers in developing strategies for mitigating these disparities.

OBJECTIVE:This study evaluated maternal urine drug screen (UDS) at delivery and umbilical cord drug testing and its association with neonatal opioid withdrawal syndrome (NOWS) diagnosis and severity following opioid exposed pregnancy.METHODS:A retrospective chart review of 770 mother-infant dyads at five birthing hospitals in the United States Appalachian region for a five-year period was performed. Variables of interest included dyad demographics, results of maternal UDS at delivery and umbilical cord drug testing, and three neonatal outcomes: NOWS diagnosis, pharmacologic treatment administered for NOWS, and length of hospital stay (LOS) of the newborn.RESULTS:Opioid-positivity was between 8.5% and 66.3% based on maternal UDS at delivery or umbilical cord testing. Odds of NOWS diagnosis and increased infant LOS was best associated with opioid detection in maternal UDS alone (OR = 5.62, 95% CI [3.06, 10.33] and OR = 8.33, 95% CI [3.67, 18.89], respectively). However, odds of pharmacologic treatment for NOWS was best associated with opioid detection in both maternal UDS and umbilical cord testing on the same dyad (OR = 3.22, 95% CI [1.14, 9.09]).CONCLUSION:Maternal UDS is a better option compared to umbilical cord testing for evaluation of opioid-exposed infants and risk of NOWS diagnosis and increased infant LOS.

Background Studies indicate antenatal opioid use is associated with birth size deficits, as evidenced by reductions in birth weight and head circumference. However, there remains a limited understanding of how early this growth restriction occurs, and what specific parameters are affected. This novel study evaluated global and specific growth deficits associated with prenatal opioid exposure between 18-22 weeks' gestation as assessed during anatomy ultrasounds. Methods Pregnant women who completed an anatomy ultrasound were identified via electronic medical records from a large academic obstetric practice. The study group used opioids, with tobacco and/or marijuana use permitted (n = 41). The control group could have used tobacco and/or marijuana, but not opioids (n = 308). Neither group had alcohol or other drug exposure. Records were reviewed for medical history and ultrasound size parameters, coded as percentiles for gestational age. Results Demographics and medical histories were compared with several significant differences noted. After controlling for these differences, significant (p < 0.05) growth deficits were identified in opioid-exposed fetuses. Specifically, reductions >10 percentile points were observed in head circumference, biparietal diameter, and humerus length for opioid-exposed fetuses compared to controls. Additionally, intrauterine growth restriction (IUGR) was diagnosed five times more often. Femur length was significantly reduced in opioid-exposed fetuses prior to adjustment for confounding (p = .016), but this reduction was not significant (p = .072) after controlling for background differences. Estimated fetal weight (p = .274) and abdominal circumference (p = .633) were not significantly different between exposure groups. Conclusion Fetal opioid exposure predicted various bone growth deficits during routine anatomy ultrasound, indicating the effects of opioid exposure on size deficits may be evident as early as 18-22 weeks' gestation. These findings may also suggest that in utero opioid exposure negatively impacts bone growth specifically rather than weight or fat/muscle mass. Additional studies with larger sample sizes may also reveal significantly reduced femur length, further supporting a negative impact on bone growth. Future studies evaluating bone health and immune function in children after antenatal opioid exposure may help clarify this specific effect of opioids on bone development.

Abstract Background It is almost 100 years ago since Mahaim described the so-called paraspecific connections between the ventricular conduction axis and the crest of the muscular ventricular septum, believing such pathways to be ubiquitous. These pathways, however, have yet to be considered as potential pathways for septal activation during His bundle pacing. Materials So as to explore the hypothesis that specialised septal pathways might provide the substrate for septal activation during His bundle pacing, we compared the findings from 22 serially sectioned histological datasets and 34 different individuals undergoing His bundle pacing. Results We found histologically specialised pathways connecting the branching component of the atrioventricular conduction axis with the crest of the muscular ventricular septum in almost four-fifths of the histological datasets. In 32 of 34 patients undergoing His bundle pacing, the QRS complex closely resembled published images of known conduction through fasciculo-ventricular pathways. In only two patients was a delta wave not seen at any pacing voltages. Capture of these connections varied according to pacing voltage, a finding which correlated with the distance of the pathways from the site of penetration of the ventricular conduction axis. Ventricular activation times remained normal in the presence of the delta wave at higher pacing voltage but were prolonged at lower voltages. Conclusions Our histologic findings confirm fasciculo-ventricular connections, initially described by Mahaim as being paraspecific, are likely ubiquitous. Analysis of 12-lead electrocardiograms leads us to conclude that fasciculo-ventricular pathways, concealed during sinus rhythm, become manifest with His bundle pacing.

Background Diabetic retinopathy (DR) is the leading cause of blindness in the working-age population, and it increases in severity during pregnancy. Methods Systematic review of literature from PubMed, Cochrane Library and Web of Science using keywords 'diabetic retinopathy' and 'pregnancy' and 'progression' from inception to 2021 was completed. Included studies were (1) peer-reviewed observational studies addressing progression/development of DR in pregnancy, (2) provided the number of diabetic patients that developed/progressed in DR during pregnancy, and (3) included differential data on variables between progression and non-progression groups. This was applied by two independent researchers and referred to a third researcher as necessary. Twenty-seven of the original 138 studies met this criterion. Data were pooled and analysed using fixed-effects in meta-analysis. Results From 27 studies, 2537 patients were included. Pre-eclampsia [Risk Ratio (RR) 2.62 (95% CI = 1.72, 4.00)] and hypertension treatment during pregnancy [RR 2.74 (95% CI = 1.72, 4.00)] were significantly associated with the development/progression of DR. HbA1c at baseline [MD 0.82 (95% CI = 0.59, 1.06)], duration of diabetes [mean difference (MD) 5.97 (95% CI = 5.38, 6.57)], and diastolic blood pressure at baseline [MD 3.29 (95% CI = 0.46, 6.12)] were all significantly higher in the progression group while only mean birth weight [MD -0.17 (95% CI = -0.31, -0.03)] was significantly higher in the non-progression group. Conclusions This study fills a gap in the literature and provide physicians with more information on the risk factors associated with the progression of DR in pregnancy and how to counsel this vulnerable patient population appropriately.

INTRODUCTION: COVID-19 poses health risks in pregnancy including increased rates of cesarean sections, preeclampsia, and miscarriage. However, less is known about newborn effects and the effect of severity of infection. We evaluated the link between pregnancy COVID-19 infection status and severity, and newborn outcomes. METHODS: Participants in this IRB-approved retrospective chart review study were identified via medical records from a single university-affiliated obstetric practice and grouped as COVID-19 positive during pregnancy (n=69), or COVID-19 negative delivering pre-COVID (n=59). Severity of infection was based on emergency department visit, hospitalization, oxygen treatment, steroids, antibodies, or ventilation. Information on socioeconomic factors, medical history, and birth outcomes was also abstracted. RESULTS: Compared to controls, and after adjustment for background differences, those with COVID-19 infection during pregnancy had newborns 242 g lighter and were 4.3 times more likely to deliver preterm, 2.6 times more likely to have a newborn with a 1-minute Apgar score less than 8, and 2.9 times more likely to remain hospitalized a week or more. Differences were largely driven by earlier delivery. Finally, severe COVID-19 infection (which occurred for 41% of participants with COVID-19) was a strong predictor of preterm delivery, low birth weight, receipt of oxygen, neonatal intensive care unit admission, and longer hospital stay. CONCLUSION: COVID-19 infection during pregnancy predicts adverse newborn outcomes, especially as a result of reduced gestational duration. Additionally, severity of infection may predict worse outcomes. A larger, more diverse sample is needed to confirm findings, and to examine potential effect of vaccination in reducing the effect of COVID-19 infection during pregnancy.

Background Research has identified a link between prenatal marijuana exposure and multiple outcomes in children, including cognitive development. Several studies have found specific differences in sensory processing and attention, with visual perception especially impacted in school age children. The current study explored whether this effect is evident at an earlier age, and thus our goal was to investigate the relationship between in-utero marijuana exposure and sensory processing capabilities in toddlers. We hypothesized that in-utero marijuana exposure throughout pregnancy would specifically predict visual sensory hyperactivity in children as young as 15 months of age. Methods Participants were 225 15-month-old children whose mothers were recruited during pregnancy. Substance exposure was prospectively collected and biochemically verified, with marijuana coded as no exposure, 1st trimester exposure only, or exposure throughout pregnancy. The Infant Toddler Sensory Profile evaluated 5 domains of sensory processing (visual, auditory, tactile, vestibular, oral). Results Prenatal marijuana exposure throughout pregnancy, but not when limited to the first trimester, predicted a two-fold increased likelihood of scoring in a range indicating high levels of seeking out and potentially over-attending to visual stimulation after controlling for potentially confounding factors including other prenatal exposures. Marijuana exposure was not significantly related to other processing domains. Conclusion Results indicate that links previously identified between prenatal marijuana exposure and visual function and attention may already be evident at 15 months of age, and also suggest an impact related to continuous/later pregnancy exposure. Our findings, as well as those from previous studies, all suggest visual processing differences for exposed children, differences that may predict emerging issues with visual attention and habituation. As legalization of marijuana continues to increase, further research is clearly needed to examine specific teratologic effects associated with use during pregnancy.

ObjectiveTo examine whether timing of in utero marijuana exposure independently and negatively impacts fetal growth, and if these effects are global or specific to certain growth parameters.Study designThe two study groups were marijuana users (N = 109) and a randomly selected control group of biochemically verified non-users (n = 171). Study data were obtained via manual abstraction of electronic medical records.ResultsAfter control for significant confounders, regression results indicated significant (p < .05) decrease in newborn weight following first trimester marijuana exposure only (−154 g) and following marijuana exposure throughout gestation (−185 g) compared to controls. There were also significant deficits in head circumference following marijuana exposure in the first and second trimester only (−.83 cm) and marijuana exposure throughout pregnancy (−.79 cm) compared to controls. Newborn length was not significantly predicted by marijuana exposure.ConclusionsTiming of marijuana exposure appears to play a key role in specific fetal growth deficits, with exposure throughout gestation most detrimental. However even first trimester exposure may result in decreased weight. Timing and amount of use could be confounded in this study as those who quit early in pregnancy may have been lighter users than those who continued throughout pregnancy. More research is clearly needed to better understand the role of amount and timing of in utero marijuana exposure in predicting different aspects of fetal growth, however, this study suggests that women should be encouraged to avoid marijuana use at any point in pregnancy.

Vaccination efforts have limited the burden of the pandemic caused by the coronavirus disease 2019 (COVID-19) with substantial evidence showing reduced hospitalization rates among vaccinated populations. However, few studies have explored correlations between vaccination status and inpatient COVID-19 outcomes. This observational case-control study involved a retrospective chart review of adult patients hospitalized for COVID-19 infection at a medium-sized hospital in Central Michigan between May 1, 2021 and September 30, 2021. Unadjusted analyses involved t-tests and chi-square tests followed by adjusted analyses using binary logistic and linear regression models. Of the 192 screened patients, 171 subjects met the inclusion criteria. Vaccinated patients were significantly older (71.09 vs 57.45, p < 0.001), more likely to identify as white (89.4% vs 66.9%, p = 0.026), and had a lower baseline 10-year survival rate predicted by the Charlson Comorbidity Index (42% vs 69%, p < 0.001) compared to unvaccinated patients. Common symptoms between both groups included shortness of breath (50%), malaise (23%-37%), cough (28%-32%), and fever or chills (25%). Upon matching, adjusted analysis showed significantly higher rates of remdesivir administration to unvaccinated patients (41.3% vs 13.3%, odds ratio (OR): 4.63, 90% confidence interval (CI): 1.98-11.31). Despite higher intensive care unit admission rates among unvaccinated patients (39.1% vs 23.9%, OR: 1.83, 90% CI: 0.74-4.64), this difference did not reach statistical significance. Accordingly, immunization status strongly correlates with patient demographics and differences in inpatient treatment. Larger studies are needed to further assess the vaccine's impact on inpatient outcomes outside of our community.