Rachel G. Sinkey

Introduction: Available data suggest that assisted reproductive technology (ART) is associated with adverse perinatal outcomes; however, prior studies have been confounded by multifetal gestations, preterm birth, and patient medical comorbidities. There are limited data on pregnancy outcomes among ART‐conceived low‐risk singleton pregnancies delivering at term. Thus, we aimed to measure the association between mode of conception and mode of delivery among low‐risk nulliparous patients delivering singleton gestations at term. Methods: Secondary analysis of the ARRIVE trial (NCT 01990612), a multicenter randomized, controlled, unmasked, parallel‐group trial of nulliparous patients delivering at term, March 2014–August 2017. Pregnancies were categorized by mode of conception as either ART or spontaneous. The primary outcome was cesarean delivery. Secondary outcomes included a composite of perinatal death and severe neonatal complications, and select maternal and neonatal adverse outcomes. Bivariate analyses compared baseline characteristics and outcomes by mode of conception. Primary and secondary outcomes were compared using multivariable logistic regression to generate odds ratios (ORs) and 95% confidence intervals (CIs). Sensitivity analyses by type of ART (in vitro fertilization [IVF] vs. ovulation induction [OI] with or without artificial insemination [AI]) and by embryo age were planned. Results: Of the 6106 participants in the original trial, 6084 met eligibility criteria: 157 (2.6%) conceived with ART and 5927 (97.4%) did not. Among those with ART, 103 (65.6%) underwent IVF and 54 (34.4%) conceived with OI or AI. Patients undergoing ART were noted to have an older age, differing race/ethnicity, lower body mass index (BMI), more likely to be married, employed full‐time, privately insured, and less likely to smoke cigarettes. Cesarean occurred more frequently in those with ART than those spontaneously conceived (29.9% vs. 20.2%; OR, 1.69; 95% CI, 1.20–2.40). This remained significant after adjusting for confounders (aOR, 1.68; 95% CI, 1.15–2.45) and was significant in subgroup analysis comparing IVF conception to spontaneous (31.1% vs. 20.2%; aOR, 1.78; 95% CI, 1.12–2.82). Additionally, there was no difference in hypertensive disorders of pregnancy (aOR, 1.65; 95% CI, 1.00–2.73), other maternal morbidities, and adverse perinatal composite (aOR, 0.90; 95% CI, 0.49–1.67). Conclusions: Nulliparas delivering a singleton fetus at term conceived by ART had an increased rate of cesarean delivery, with no difference in hypertensive disorders or pregnancy or neonatal outcomes.

Persistent racial inequities in maternal morbidity and mortality disproportionately affect non-Hispanic Black pregnant women in the United States, particularly those living in socioeconomically deprived communities. Community health worker (CHW) programs and digital health interventions (DHI) show promise for improving perinatal outcomes, yet few randomized trials have evaluated their acceptability or feasibility in high-risk perinatal populations. To conduct a pilot randomized controlled trial (RCT) to determine the feasibility of randomizing participants in a perinatal intervention trial and ascertain whether participants found the interventions acceptable. Single-center, parallel RCT including non-Hispanic Black participants, between 16-49 years, 8⁰-22⁶ weeks gestational age (GA), and residing in resource-poor communities in XXX, defined as Area Deprivation Index (ADI) 60-100. Using a 2-by-2 factorial design, participants were randomly assigned to DHI vs usual care and to CHW vs usual care; providers were blinded. The primary outcome for this pilot was acceptability of the intervention. Secondary outcomes included recruitment feasibility, participant's intervention satisfaction (1-10 scale, 10 highest satisfaction), number of prenatal care (PNC) visits, and clinical outcomes. Forty participants were successfully recruited and randomized from July-October 2023. Median age, GA at enrollment, and ADI were 29 years, 14 weeks, and 90; 78% were parous, 18% were married, 60% had ≤ a high school diploma, and 80% were publicly insured. Of those randomized to CHW, 18/21 recommended CHW care; of those randomized to DHI, 18/20 recommended DHI care. Participants randomized to CHW were highly satisfied (100% responded 10/10; n=18); DHI participants were also highly satisfied (median satisfaction score 8/10, IQR 7-10, n=18). Participants attended a median 11 PNC visits and delivered at a median GA of 37 weeks; 5 (13%) experienced pregnancy loss and 25% of neonates were admitted to the neonatal intensive care unit. Participants were successfully recruited and randomized in a perinatal intervention trial and reported high rates of satisfaction with DHI and CHW interventions, lending support for a large RCT powered for key clinical outcomes.

Introduction: CHD affect approximately 1% of live births globally and are the most common congenital anomaly. Contemporary data on CHD risk in offspring of affected mothers remains limited. This study evaluated CHD incidence in offspring of mothers with CHD at a southeastern U.S. academic medical centre. Methods: We conducted a retrospective review of patients with CHD who received prenatal care between 2015 and 2023 at a multidisciplinary Cardio-Obstetrics clinic. Patients with acquired heart disease, syndromic or inherited CHD, and deliveries at outside hospitals with missing delivery data were excluded. The primary outcome was infant CHD incidence, confirmed by postnatal echocardiography. Secondary outcomes were neonatal intensive care unit admission, early in-hospital cardiac surgery, and in-hospital infant mortality. Results: A total of 186 mothers with 195 pregnancies and 198 infants were included. CHD was diagnosed in 16 infants (8.1%), most commonly ventricular septal defect. Of affected infants, none required early in-hospital surgery, and one experienced in-hospital mortality, though this infant had severe extracardiac anomalies concerning an underlying genetic syndrome. Conclusion: The incidence of CHD among offspring of mothers with CHD in our cohort was higher than the general population; however, the majority of defects were non-critical and did not require early intervention. These findings offer important context for prenatal counselling and tailored fetal/neonatal echocardiography screening in this high-risk population.

Objective: The United States (US) reports disparities in maternal health outcomes across states, regions, and racial/ethnic groups. Few studies in the US South have sought to understand the perspectives of Non-Hispanic Black (NHB) women about their experiences of maternity care. This study examines NHB women's maternity care experiences in three Southern states. Methods: Through in-depth interviews (February—September 2023), we explored maternity care experiences of NHB women experiencing adverse maternal outcomes ( n = 18), and family members of deceased NHB women or infants ( n = 2), in Alabama, Georgia and North Carolina. Grounded in the World Health Organization’s Quality of Care Framework for Maternal and Newborn Health Care, our study elucidated the experiences of these NHB women and family members with racial and other discrimination, and their preferences for treatment during maternity care. We adopted a mixed deductive and inductive thematic approach to analyze the data using NVivo software. Results: Three major themes emerged: 1) experience of care, 2) perceptions of racial and other discrimination during maternity care, and 3) preferred manner of treatment in maternity services. Perceptions about discrimination due to race and other identities were shared. Issues related to provider-patient communication, respect, and emotional support were identified as main factors that influenced NHB women’s experiences of maternity care. Conclusion: Both positive and negative maternity care experiences, including instances of overt racism and discrimination were reported by NHB women and families who had experienced adverse pregnancy outcomes. Our findings highlight the need to prioritize respectful maternity care through targeted quality measures.

Background Data on long-term maternal quality of life following a periviable delivery are lacking. We investigated quality of life measures among patients who delivered a periviable infant. Methods We conducted a retrospective cohort study of patients who delivered between gestational ages 22^0/7 to 25^6/7 weeks at a single institution from 2013 to 2019 and who completed the validated World Health Organization Quality of Life–Brief Version (WHOQOL–BREF) questionnaire between 2021 and 2022. Mothers who had a surviving infant discharged from the hospital were compared with mothers who had an intrauterine or neonatal demise. Baseline characteristics were summarized, and scores were evaluated based on the 4 prespecified WHOQOL–BREF domains: physical health, psychological health, social relationships, and environment. Results Overall, 58 patients participated: 32 mothers with a surviving infant and 26 mothers with a demise. Maternal age was lower in the mothers with a surviving infant (25.2 ± 3.9 years vs 29.0 ± 6.0 years; P=0.01). Mean duration from delivery to study start date was not different between the groups (5.1 ± 2.0 years vs 4.5 ± 2.1 years; P=0.31). Mothers with surviving infants scored higher (indicating higher quality of life) in the WHOQOL–BREF psychological health and social relationships domains compared to mothers with a demise. Mothers with a surviving infant were more likely to be satisfied with their own health than mothers with a demise, but overall quality of life was not different between the 2 groups. Conclusion In this small cohort, mothers with an infant who survived a periviable delivery, despite possible long-term health complications for the infant, reported improved quality of life in some domains compared to mothers whose infants did not survive.

Recent studies have shown that maternal mortality continues to increase for all racial and ethnic groups in the United States. The recent changes in reproductive legal policies combined with unacceptably high morbidity and mortality rates have made it crucial for every cardiologist to understand and engage with reproductive planning. The risk of cardiovascular complications during pregnancy is prohibitively high for patients in the modified World Health Organization Risk Class IV with maternal cardiovascular event rates of >40%, and pregnancy is not recommended. It is critical that cardiologists partner with primary care providers, Obstetrics and Gynecology, Complex Family Planning subspecialist, Maternal‐Fetal Medicine specialists, Anesthesia, and Pharmacist and Nursing to implement available contraception strategies and understand termination options that can be offered to these high‐risk patients. The aim of this article is to review risks and advantages of available contraception and pregnancy termination options as it pertains to these high‐risk cardiac patients.

Background: Preeclampsia is a serious pregnancy complication affecting 5% to 8% of pregnancies globally. preeclampsia is a leading cause of maternal and neonatal morbidity and death. Despite its prevalence, the underlying mechanisms of preeclampsia remain unclear. This study investigated the role of vasorin in preeclampsia pathogenesis by examining its levels in extracellular vesicles ( EVs ) and effects on vascular function. Methods and Results: We conducted unbiased proteomics on urine‐derived EVs from women with severe preeclampsia and normotensive pregnancies, identifying differentially abundant proteins. Vasorin expression levels were measured in urinary EVs, plasma EVs, and placental tissue. EVs were generated from human and murine placental explants. Vascular functions were assessed using murine aortic rings and human aortic endothelial cells. Vasorin expression was manipulated in human aortic endothelial cells via overexpression and knockdown followed by RNA sequencing. One hundred twenty proteins showed ≥±1.5‐fold regulation ( P <0.05) between severe preeclampsia and NTP. Vasorin levels decreased in severe preeclampsia in urinary EVs, plasma EVs, and placental tissue. Vasorin levels increased with gestational age in murine pregnancy and were diminished in a murine model of preeclampsia. Severe preeclampsia and murine preeclampsia EVs impaired human aortic endothelial cell migration and inhibited murine aortic ring vasorelaxation. Vasorin overexpression counteracted these effects. RNA sequencing showed that vasorin manipulation in human aortic endothelial cells differentially regulated hundreds of genes linked to vasculogenesis, proliferation, migration, and apoptosis. Conclusions: The data suggest that vasorin, delivered to the endothelium via EVs, regulates vascular function and that the loss of EV vasorin may be one of the mechanistic drivers of preeclampsia.