Jeannie C. Kelly

Despite well‐documented harms of prenatal alcohol exposure, evidence‐based treatment guidelines for alcohol use disorder (AUD) during pregnancy remain limited. We systematically reviewed international clinical practice guidelines to examine how they address the full cascade of AUD care during pregnancy, including diagnosis, engagement, treatment initiation, and retention. We searched over 40 clinical practice guideline databases (including PubMed and Guidelines International Network) and gray literature sources globally, identifying 1045 records. Using the Population, Interventions, Comparators, Attributes, Recommendation Characteristics (PICAR) framework, we evaluated guidelines from medical organizations in English‐speaking nations addressing alcohol use and AUD management in pregnancy. Our final analysis included 18 guidelines from the United States, Canada, the United Kingdom, Australia/New Zealand, and the World Health Organization published from 2014 to the present. Two reviewers independently assessed each guideline using the Appraisal of Guidelines Research and Evaluation‐Recommendations Excellence (AGREE‐REX) framework to evaluate quality and risk of bias. We used narrative synthesis to summarize findings across key concepts and care cascade stages. Nearly all guidelines (94%) described risks of alcohol exposure and recommended counseling on cessation (89%), yet few extended beyond these early cascade stages. Only 44% mentioned medications for AUD (MAUD), and merely 17% discussed specific psychosocial treatments. Among guidelines addressing MAUD, only one cautiously supported use, while three explicitly recommended against it. Most guidelines (61%) ended treatment recommendations at referral to specialty care, with half limiting guidance to acute alcohol withdrawal management. Taken together, our findings reveal a stark misalignment between screening emphasis and treatment guidance. While guidelines consistently recommend universal screening and brief intervention, they provide minimal actionable frameworks for managing AUD throughout pregnancy. This gap leaves clinicians without evidence‐based pathways for comprehensive AUD treatment during the prenatal period, highlighting an urgent need to strengthen both the evidence base and clinical guidance for AUD management in pregnancy.

The late postpartum period, defined as greater than 6 weeks to 12 months, is a high-risk time for individuals with opioid use disorder (OUD). Discontinuation rates of buprenorphine treatment for OUD during this period are high. Little is known about patients' subjective experience with buprenorphine treatment during this time. We sought to assess patient treatment experience, goals, facilitators and barriers to continued buprenorphine treatment throughout the extended postpartum period. We performed a cross-sectional survey of postpartum patients who received buprenorphine treatment, including sublingual and long-acting injectable formulations, in an interdisciplinary, wrap-around clinic for maternal OUD between February 2022 through May 2023. Individuals participated in a brief electronic questionnaire comprised of multiple choice, Likert scale and open-ended questions adapted from validated surveys. Individuals were recruited to participate at each of three separate time points postpartum; 3 months. Descriptive statistics, Fisher exact, the Cochran-Armitage trend and chi-squared tests were used to describe survey results. Fifty individuals were approached to participate in the survey, of which 25 unique postpartum individuals participated. This captured a total of 37 responses amongst all three time points. At the time of final survey completion, the average individual was 10.68 months (SD ± 7.13) postpartum. 76% self-identified as white and 24% Black or African American. The majority (88%) were prescribed sublingual buprenorphine. Most (84%) had been prescribed buprenorphine for more than three months at the time of initial survey completion. The majority (89%) of responses across all time points reported being very satisfied or satisfied with their current treatment, being satisfied with the effectiveness of their buprenorphine in reducing opioid use (98%) and with the effectiveness at reducing other substance use (54%). Top motivators for continuing treatment included individual health, ability to care for child(ren), and social support of friends or family. No differences were detected across time points. Surprisingly, the most often reported treatment goal was to discontinue buprenorphine eventually (49% of all responses). Most strongly agreed or agreed with the following statements about social supports, including that they know they take buprenorphine (100%), support their decision to take buprenorphine (89%), believe it is treatment for OUD (78%), and want them to continue treatment (78%). However, fewer (41%) strongly agreed or agreed with the following statement: the people I am close to want me to continue buprenorphine treatment long term (i.e. several years). Less than half (46%) agreed with the statement, the people I am close to know what it takes to stay sober. Barriers to buprenorphine treatment were infrequently reported (12%) but included sizable challenges including COVID-19 infection, lack of transportation and unstable housing. During the extended postpartum period, majority of patients described treatment satisfaction with buprenorphine as overwhelmingly positive regardless of formulation. However, despite this, individuals most often reported goals to discontinue treatment, particularly during the late postpartum period. And individuals reported social supports disagreed with continuing buprenorphine treatment long term (i.e. several years). These findings highlight the need for stronger reinforcement of buprenorphine as a treatment for a chronic condition during the extended postpartum period, with an emphasis on educating and involving social supports in the process.

Background: After the US Supreme Court overturned Roe v. Wade, confusion followed regarding the legality of abortion in different states across the country. Recent studies found increased Google searches for abortion-related terms in restricted states after the Dobbsv. Jackson Women’s Health Organization decision was leaked. As patients and providers use Wikipedia (Wikimedia Foundation) as a predominant medical information source, we hypothesized that changes in reproductive health information-seeking behavior could be better understood by examining Wikipedia article traffic. Objective: This study aimed to examine trends in Wikipedia usage for abortion and contraception information before and after the Dobbs decision. Methods: Page views of abortion- and contraception-related Wikipedia pages were scraped. Temporal changes in page views before and after the Dobbs decision were then analyzed to explore changes in baseline views, differences in views for abortion-related information in states with restrictive abortion laws versus nonrestrictive states, and viewer trends on contraception-related pages. Results: Wikipedia articles related to abortion topics had significantly increased page views following the leaked and final Dobbs decision. There was a 103-fold increase in the page views for the Wikipedia article Roe v. Wade following the Dobbs decision leak (mean 372,654, SD 135,478 vs mean 3614, SD 248; P<.001) and a 67-fold increase in page views following the release of the final Dobbs decision (mean 8942, SD 402 vs mean 595,871, SD 178,649; P<.001). Articles about abortion in the most restrictive states had a greater increase in page views (mean 40.6, SD 12.7; 18/51, 35% states) than articles about abortion in states with some restrictions or protections (mean 26.8, SD 7.3; 24/51, 47% states; P<.001) and in the most protective states (mean 20.6, SD 5.7; 8/51, 16% states; P<.001). Finally, views to pages about common contraceptive methods significantly increased after the Dobbs decision. “Vasectomy” page views increased by 183% (P<.001), “IUD” (intrauterine device) page views increased by 80% (P<.001), “Combined oral contraceptive pill” page views increased by 24% (P<.001), “Emergency Contraception” page views increased by 224% (P<.001), and “Tubal ligation” page views increased by 92% (P<.001). Conclusions: People sought information on Wikipedia about abortion and contraception at increased rates after the Dobbs decision. Increased traffic to abortion-related Wikipedia articles correlated to the restrictiveness of state abortion policies. Increased interest in contraception-related pages reflects the increased demand for contraceptives observed after the Dobbs decision. Our work positions Wikipedia as an important source of reproductive health information and demands increased attention to maintain and improve Wikipedia as a reliable source of health information after the Dobbs decision.

BACKGROUND After the US Supreme Court overturned Roe v. Wade, confusion followed regarding the legality of abortion in different states across the country. Recent studies found increased Google searches for abortion-related terms in restricted states after the Dobbs v. Jackson Women’s Health Organization decision was leaked. As patients and providers use Wikipedia (Wikimedia Foundation) as a predominant medical information source, we hypothesized that changes in reproductive health information-seeking behavior could be better understood by examining Wikipedia article traffic. OBJECTIVE This study aimed to examine trends in Wikipedia usage for abortion and contraception information before and after the Dobbs decision. METHODS Page views of abortion- and contraception-related Wikipedia pages were scraped. Temporal changes in page views before and after the Dobbs decision were then analyzed to explore changes in baseline views, differences in views for abortion-related information in states with restrictive abortion laws versus nonrestrictive states, and viewer trends on contraception-related pages. RESULTS Wikipedia articles related to abortion topics had significantly increased page views following the leaked and final Dobbs decision. There was a 103-fold increase in the page views for the Wikipedia article Roe v. Wade following the Dobbs decision leak (mean 372,654, SD 135,478 vs mean 3614, SD 248; P<.001) and a 67-fold increase in page views following the release of the final Dobbs decision (mean 8942, SD 402 vs mean 595,871, SD 178,649; P<.001). Articles about abortion in the most restrictive states had a greater increase in page views (mean 40.6, SD 12.7; 18/51, 35% states) than articles about abortion in states with some restrictions or protections (mean 26.8, SD 7.3; 24/51, 47% states; P<.001) and in the most protective states (mean 20.6, SD 5.7; 8/51, 16% states; P<.001). Finally, views to pages about common contraceptive methods significantly increased after the Dobbs decision. “Vasectomy” page views increased by 183% (P<.001), “IUD” (intrauterine device) page views increased by 80% (P<.001), “Combined oral contraceptive pill” page views increased by 24% (P<.001), “Emergency Contraception” page views increased by 224% (P<.001), and “Tubal ligation” page views increased by 92% (P<.001). CONCLUSIONS People sought information on Wikipedia about abortion and contraception at increased rates after the Dobbs decision. Increased traffic to abortion-related Wikipedia articles correlated to the restrictiveness of state abortion policies. Increased interest in contraception-related pages reflects the increased demand for contraceptives observed after the Dobbs decision. Our work positions Wikipedia as an important source of reproductive health information and demands increased attention to maintain and improve Wikipedia as a reliable source of health information after the Dobbs decision.

OBJECTIVE: Evaluate associations between prenatal cannabis use (PCU) and perinatal outcomes. METHODS: We performed an interval analysis of a prospective cohort study of pregnant individuals with pre-pregnancy cannabis use and negative self-report of nicotine use, comparing those who continued cannabis through pregnancy with those who stopped. Patients underwent interviews and urine drug screening for cannabis and cotinine, a nicotine metabolite, in each trimester. The primary outcome was small for gestational age (SGA) at delivery. Secondary outcomes included antenatal and postpartum complications, mode of delivery, and neonatal outcomes. Secondary analyses included stratification by intensity of cannabis use and urinary cotinine positivity. RESULTS: Birthing persons with PCU differed in age (25.5 vs 27.8 years, p=0.001), body mass index (BMI; 27.4 vs 30.9, p=0.001), area deprivation index percentiles (92% PCU vs 88%, p=0.013), cotinine positivity (42.8% vs 10.8%, pth percentile, compared to PCU cases without nicotine exposure (17.4% vs 8.3%, aRR 2.7 [1.21-5.38], 35.8% vs 18.6%, aRR 2.4 [1.51-3.48]), and controls (35.8% vs 12.9%, aRR 2.75 [1.64-4.13]). Cotinine-negative PCU patients and controls did not differ. CONCLUSION: PCU was not independently associated with adverse birthing person outcomes. Many patients demonstrated nicotine exposure, either via inadvertent exposure or undisclosed use. While neonates exposed to cannabis alone did not differ from unexposed neonates, those exposed to both cannabis and nicotine were at increased risk of SGA.

Opioid use among pregnant and postpartum women and people (PPWP) has significant health repercussions. This study explores how substance-use behaviors may vary by stage in recovery among PPWP with opioid use disorder (OUD). We recruited 29 PPWP with OUD. “High-risk” participants self-identified as “not being engaged in treatment” or “new or early in their recovery” (n = 11); “low-risk” participants self-identified as being “well-established” or “in long-term recovery” (n = 18). Participants were queried regarding sociodemographic, mental health, and drug-misuse factors; urine drug screens were collected at baseline. Univariate group comparisons between high-risk and low-risk PPWP were conducted. High-risk PPWP were more likely to self-identify as non-Hispanic African American and more likely to report current opioid use, other illicit drugs, and tobacco. High-risk PPWP had higher opioid cravings versus low-risk PPWP. High-risk PPWP were more likely to screen positive on urine tests for non-opioid drugs and on concurrent use of both non-opioid drugs and opioids versus low-risk participants. PPWP earlier in recovery are at higher-risk for opioid and other illicit drug misuse but are willing to disclose aspects of their recent use. PPWP early in recovery are an ideal population for interventions that can help facilitate recovery during the perinatal period and beyond.

(Am J Obstet Gynecol. 2022;227:513.e1–513.e8) Infection- or noninfection-mediated intrapartum maternal fever (≥38 °C) is a frequent complication of childbirth, affecting 1 in 15 deliveries. Associations with increased risk for neonatal morbidity include low Apgar score, sepsis, encephalopathy, seizures, respiratory distress, meconium aspiration, and NICU admission. Risk for maternal morbidity as defined by labor dystocia, hemorrhage, instrumental vaginal delivery, and cesarean delivery is also heightened. Studies investigating the correlation of fever severity to increased neonatal and maternal morbidity are conflicting and have been conducted in homogenous patient populations with labor management differing from the standard of care in the United States. The aim of this study was to evaluate the relationship between increased severity of intrapartum fever and maternal and neonatal morbidity in a diverse, contemporary cohort, and medical practice. The authors hypothesized that risk would be independent from the duration of the time from the maximum fever temperature (Tmax) through to delivery.