High-risk Pregnant Patients Research Articles

Comparison of the efficacy of 75 mg aspirin versus 150 mg aspirin for prevention of preeclampsia in patients at high risk for preeclampsia

BACKGROUND & OBJECTIVE: Preeclampsia is a significant contributor to maternal health challenges. Emphasizing prevention over cure is a guiding principle in healthcare. As a reliable measure to forestall hypertension and its associated complications during pregnancy, aspirin is widely embraced. The early identification of risk factors plays a crucial role in the primary prevention of preeclampsia. Post-risk stratification, aspirin emerges as a pivotal player in the preventive strategy for individuals identified as high-risk for pre-eclampsia. To assess the effectiveness of 75 mg aspirin against 150 mg aspirin in preventing preeclampsia among individuals identified as having a high risk for the condition.
 METHODOLOGY: A quasi-experimental study was conducted in the Department of Obstetrics and Gynecology, Services Hospital, Lahore, from 27-12-2019 to 27-6-2020.240 patients were enrolled in the study, which was later divided into two groups. Group A received treatment with 75 mg aspirin, while Group B was administered 150 mg aspirin. Efficacy was determined based on whether blood pressure levels were below 140/90 mmHg, and proteinuria was rated as <+1 using the dipstick method.
 RESULTS: The mean age of the patients was 28.54±6.83 years, and the mean gestational age of the patients was 15.30±1.69 weeks. In the 75 mg group, the efficacy was achieved in 94(78.3%) patients, whereas in the 150 mg group, the efficacy was achieved in 108(90.0%) patients (p-value=0.013).
 CONCLUSION: This study concludes that the efficacy of 150 mg aspirin significantly surpasses that of 75 mg aspirin in preventing preeclampsia among high-risk pregnant patients.

Color Doppler ultrasound in high-low risk pregnancies and its relationship to fetal outcomes: a cross-sectional study.

To calculate the multivessel color Doppler indices in high-risk and low-risk pregnancies and relate these to fetal outcomes. The investigation involved 60 patients who were pregnant. The patients were separated into groups according to assessment of low and high risk. The patients underwent color Doppler ultrasonography to detect the maternal and fetal blood vessels, and the measured Doppler indices were then analyzed for any association with fetal outcomes. The gestational stages (in weeks) of the participants at the respective times of investigation and delivery were 32.06 ± 2.98 and 36.2 ± 1.78 in the low-risk group and 29.21 ± 1.95 and 29.83 ± 1.86 in the high-risk group. The pulsatility index (PI), resistive index (RI), and systolic/diastolic ratio (SD) decreased with gestation length in the low-risk group, whereas in the high-risk group, these values increased in the uterine and umbilical arteries. With increased gestational stage, MCA-PSV (peak systolic velocity) in the middle cerebral artery (MCA) increased, while PI decreased. Pulsatile and reversal flow of the uterine vein, the vein of Galen, and the umbilical vein were noted in high-risk pregnancies, and these negatively affected the fetal outcome. The fetal venous parameters were more specific and sensitive for predicting an unfavorable fetal outcome than the arterial factors, with a greater negative predictive value. The results of our study indicate that abnormal Doppler indices of the blood vessels in high-risk pregnant patients will result in adverse clinical outcomes. Therefore, the patients can be monitored and managed accordingly using Doppler ultrasonography.

An examination of the seroprevalence of torch infections and their correlation with adverse reproductive outcomes in females exhibiting a bad obstetric history

: The term TORCH infections refer to a group of diseases including Toxoplasma, Other (syphilis, varicella-zoster, parvovirus B19), Rubella, Cytomegalovirus (CMV), and Herpes infections. These are a set of pathogens capable of traversing the placental barrier, subsequently causing congenital infections. Often these infections are asymptomatic initially and pose significant diagnostic challenges during gestation, potentially leading to undesirable obstetric outcomes. This research intends to explore the correlation between TORCH infections and perinatal outcomes within pregnancies deemed high-risk.: We examined 143 high-risk pregnant patients aged 18-46 from the Obstetrics and Gynecology Department at the Baghdad Gynecology and Obstetrics Hospital. Hundreds of normal pregnancy group were also included. The high-risk group encompassed women with recurring pregnancy loss, fetal congenital anomalies, intrauterine fetal death, and low birth weight intrauterine neonatal death. The presence of IgG and IgM antibodies against TORCH agents in patients’ serum control serum were assessed using ELISA kits. We compared perinatal outcomes between TORCH seropositive and seronegative high-risk pregnant women.: Among the 143 high-risk pregnancies, a significant proportion of young, low-parity women from diverse residences were co-seropositive for Toxoplasma gondii, rubella virus, Cytomegalovirus, and Herpes Simplex infections. Of these, 55 cases (48.4%) were seropositive for all the four TORCH agents compared to 88 cases (38%) were seropositive for antibodies to one to three of the TORCH agents. IgG seropositivity was 74.5%, while IgM seropositivity was 31.8% for Toxoplasma gondii, 3.6% for CMV and 0% for RV infections, respectively. Significantly, high-risk pregnancies with TORCH seropositivities exhibited a clearly strong correlation with Habitual abortions outcomes.: High-risk manifestations demonstrated for Toxoplasma gondii, Rubella virus, Cytomegalovirus and Herpes Simplex infections strongly associated with habitual abortions compare to high but less significant association in those seropositive to one, two or three of the TORCH agents

Systematic Approach of Basic Fetal Echocardiography in Normal and High Risk Pregnancy

Background Fetal echocardiography was initially used to identify congenital heart defects (CHD) and arrhythmias. Since then, technical advances have enabled a notable improvement in the assessment of cardiac structure and function. Objective to highlight the importance of a systematic approach of basic fetal echocardiography in normal and high risk pregnancy. Patients and Methods Normal and high risk pregnant females will be studied in this research using colour doppler ultrasound. Two-dimensional imaging is still the gold standard and commonly used in fetal echocardiography. Therefore, we present standard views of the normal fetal heart obtained during the second trimester by two-dimensional ultrasound, and color and pulsed wave Doppler. Study place: Ain Shams university hospitals. Sample size: 30 normal and 30 high risk pregnant female patients. Results we have provided reference values for cardiac morphometric parameters across second trimester of pregnancy in a low-risk and high risk population including the Right and left atria longitudinal diameters, right and left ventricular longitudinal diameters, cardiothoracic ratio and heart rate and correlate low to high risk values. All dimensions showed a progressive increase with gestational age, some of the parameters show significant difference between low risk and high risk including the LV diameter with p value of 0.023, cardiothoracic ratio with p value of 0.001 and heart rate with p value of 0.001 Conclusion Fetal Echocardiography at the second trimester of pregnancy is crucial for detection of any abnormality at the high risk group and their follow up along the whole pregnancy for a better outcome.

Incidence of Pregnancy-Associated Venous Thromboembolism: Second Nationwide Study.

Pregnancy is a transient risk factor for venous thromboembolism (VTE). This second nationwide study aimed to inspect trend changes in the incidence rate of pregnancy-associated VTE (PA-VTE) during the study period (2014-2018) compared with that reported in a previous study (2006-2010). Using the Korean Health Insurance Review and Assessment Service database, we retrospectively identified all PA-VTE events using both diagnostic and medication codes. Of the 124,228 VTE events, 510 (0.4%) cases of PA-VTE were identified in 499 women (median age: 34 years; range: 20-49 years). The incidence rate of PA-VTE/10,000 deliveries (PA-VTE/104D) in this second study (2.62) was 3.2 times higher than that in the first study (0.82). In the second study, the PA-VTE/104D ratio of women in their 40s (5.46) was three times higher than that of women in their 20s (1.80) (relative risk: 3.03; 95% confidence interval: 2.04-4.51; p < 0.01). The incidence rate for women in their 40s in the second study was 2.3 times higher than that in the first study. PA-VTE/104D cases occurred more frequently in multiparous than in primiparous women, in cesarean section cases compared with vaginal delivery, and in multiple rather than single pregnancies. Most PA-VTE cases occurred during the postpartum period (321/510, 62.9%), of which pulmonary embolism was the most frequently occurring type (231/321, 72%). Advanced maternal age, cesarean section, multiparity, and multifetal pregnancies increased the risk of PA-VTE. Obstetricians need to be cautious of VTE, particularly during the postpartum period, in high-risk pregnant patients.

High rates of HIV PrEP prescriptions after standardized counseling of high-risk pregnant patients

High rates of HIV PrEP prescriptions after standardized counseling of high-risk pregnant patients

A Review of Cardiovascular Complications among Pregnant Patients with COVID-19.

Cardiovascular complications of severe acute respiratory syndrome corona virus 2 (SARS-CoV-2) infection are well-described in the general population but remain limited among pregnant patients. This review summarizes data from case reports, case series, and observational studies of cardiovascular manifestations of corona virus disease 2019 (COVID-19) in pregnant patients and provides recommendations to the cardiovascular clinician regarding management considerations in this vulnerable population. Pregna is an immunocompromised state in which cardiovascular demands are increased. Cardiovascular complications of COVID-19 that have been described in pregnancy include myocardial injury, cardiomyopathy, thromboembolism, pre-eclampsia and arrhythmia. Physiologic and cardiovascular changes in pregnancy predispose pregnant patients with COVID-19 to more severe illness than the general population. Black or Hispanic race, obesity, diabetes, hypertension and lung disease are risk factors for more severe infection, maternal death and adverse perinatal outcomes. Pregnant patients with severe COVID-19 disease compared with non-pregnant age-matched women with COVID infection are more likely to be admitted to the intensive care unit (ICU), receive mechanical ventilation and require advanced mechanical circulatory support. Cardiovascular complications of COVID-19 in pregnant patients requires further attention, particularly given the anticipated increase in birth volume and ongoing nature of COVID-19 pandemic with novel variants. Clinicians should have a lower threshold for cardiac testing and multidisciplinary management in pregnant women with severe COVID-19 disease. Given the persistence of COVID-19 within our communities, diagnostic laboratory and imaging testing for high-risk pregnant patients hospitalized with COVID-19 infection should be routine. We strongly urge the implementation of a cardio-obstetric multidisciplinary team in individually managing these high-risk patients in an effort to improve maternal and fetal outcomes.

Most Appropriate Gestational Age for OGTT amongst High-Risk Pregnant Patients? Need for RCT

High risk for gestational diabetes mellitus includes mothers with certain ethnicities, increasing maternal age, mothers with history of high or low birth weights, rising parity, previous macrosomic baby, stillborn baby, a family history or first degree relative with gestational diabetes (GDM) and type 2 diabetes mellitus, history of glucose intolerance or GDM, polycystic ovarian syndrome and maternal obesity. Timely screening, hence intervention can prevent complications of GDM to fetus and mother. Studies investigating, when during pregnancy should this high-risk group be screened, have established that 24-28 weeks OGTT have missed a few early onset GDM cases and booking visit OGTT/12 weeks gestational age OGTT may miss late onset GDM cases. All these studies have either been retrospective or comparison groups have been mis-matched. To date there is no prospective direct comparisons, comparing early OGTT results (12 weeks gestation) and late OGTT results (24—28weeks gestations). Physiologically speaking, stress of pregnancy is higher with advancing age of gestation and 24-28 weeks gestational age OGTT seems appropriate however evidence suggests that a few early onset GDM cases are missed. There is a need for prospective comparison at two different time intervals in same group of these high risk patients to answer this question.

Comparative study of UTI in high-risk pregnant patients and patients attending to ANC clinics

Asymptomatic bacteriuria, UTI and pyelonephritis increase risk of preterm labour and premature rupture of the membranes which results indirectly in worse foetal outcome which was highlighted in this study. Also, the number of drug resistant pathogens are increasing as these high-risk pregnant patients are more prone for instrumentation, procedures which indirectly exposes the patients to hospital acquired pathogens. In this prospective study, a total of 200 mid-stream urine samples were collected aseptically from randomly selected high risk pregnant women (100) and (100) from normal ANC patients attending ANC clinics. Out of 100 samples in high-risk pregnancy patients, 44% yielded monobacterial growth, 8% yielded polybacterial growth. was most common (46%), (25%), (15.3%), 3.8%, 2%. 26.9% showed growth &amp;#62;10CFU/ml, 32.6% showed growth 10– 10 CFU/ml, 15.3% showed growth &amp;#60;10 CFU/ml. Out of 100 samples from normal ANC patients all showed monobacterial growth(42%). . was most common organism isolated 56.2% followed by Escherichia coli 26%, 4%, 2%, 2%. All organisms showed growth range in between 10³CFU/ml to 10⁵CFU/ml. None of the isolate was pan drug resistant as compared to complicated pregnancy subset. So, there should be a proper management guideline whenever the pregnant females presents with complication. The organism should always be tested for sensitivity before starting empirical antibiotic treatment. Also, the number of ANC visits should be monitored judiciously as to know if we are not unknowingly bombarding the pathogens in normal patients.

Utilizing labour and delivery units for remdesivir infusion for high-risk pregnant and postpartum patients with mild-to-moderate disease during a COVID-19 surge

In January 2022, as the Omicron variant of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) surged globally [1], multiple outpatient therapies showed a reduction in hospitalization rates when administered to patients with mild-to-moderate coronavirus disease 2019 (COVID-19), and were recommended for treatment of high-risk individuals by the National Institutes of Health and the Infectious Diseases Society of America. These therapies included monoclonal antibody treatment (sotrovimab) and antiviral treatment with molnupiravir, nirmatrelvir-ritonavir or remdesivir [2].

A comparative study on the maternal and foetal outcome between normal and high risk pregnancy patient

Background Pregnancies and deliveries are potentially at risk. Well supervised antenatal, intranatal and postnatal care can reduce this risk to a minimal acceptable level.&#x0D; Objective To find out perinatal outcome of high-risk pregnant patients in comparison with the normal pregnant women and to evaluate the utility of numerical scoring system in identifying high-risk pregnancy.&#x0D; Methods 200 patients were selected from the admitted patients in the obstetric ward of Bangabandhu Sheikh Mujib Medical University, Dhaka. Study patients were divided into three groups: 100 patients (control group) were normal pregnancy (score 0-2), 85 patients were high-risk ( score 3 – 6), and 15 patients were severe-risk (score 7 or more). Both case and control subjects were followed intranatally and postnatally up to the discharge from the above institutions. All types of abnormalities or complications like prolonged ist stage, 2nd stage, APH, PPH and all types of operative and non operative interventions were recorded in order to correlate with perinatal mortality, morbidity and maternal morbidity. Each patient was followed up to discharge from the hospital and abnormalities important for the study were recorded. Neonatal morbidity was defined for surviving newborn by Apgar score &lt;7 at 5 minutes or birth weight &lt; 2.5 kg.&#x0D; Results In normal pregnancy group, 43% needed to be delivered by caesarean section in comparison to 63 (74.1%) and 14 (93.33%) patients respectively in high-risk and severe-risk group (P &lt;0.001). Maternal complication following normal vaginal delivery was highest (100%) in severe-risk group, followed by highrisk group (36.36%) and normal pregnancy (19.30%). Complications following caesarean section were also highest in severe-risk group (28.47%), followed by normal pregnancy (25.59%) and high-risk pregnancy (20.63%). Neonatal complications in normal pregnancy group was 30.23% in comparison 38.46% in high risk group. 6 (6%) of neonates in the normal pregnancy group had Apgar score &lt; 7 at 5 minutes and in high risk and severe-risk groups, 10 (11.76%) and 7 (43.75%) of the neonates respectively had Apgar score &lt;7 at 5 minutes (P &lt; 0.001). In the severe-risk group, 8 (50%) of the babies had birth weight &lt;2.5kg, which is higher than high and normal pregnancy group, i.e. 25 (28.41%) and 3 (3%), respectively(P&lt;0.001). Higher perinatal deaths also occurred in high-risk and severe risk groups.&#x0D; Conclusion It can be concluded that the perinatal morbidity, mortality and maternal morbidity are significantly higher in high-risk pregnancies. This group, though represent only 20-30 percent of all pregnant patients, is responsible for 70-80 percent of the perinatal morbidity and mortality.&#x0D; JBSA 2012; 25(2): 59-65

Anesthetic Management in Parturients With Fontan Physiology

Anesthetic Management in Parturients With Fontan Physiology

Antenatal breastfeeding promotion amongst pregnancies at high-risk for newborn admission to the NICU: A cross-sectional study.

ObjectivesTo determine the prevalence and factors associated with antenatal promotion of breastfeeding in high-risk pregnancies.Study designThis was a cross-sectional study of trends in breastfeeding promotion during antenatal consultation of pregnancies at high-risk for newborn admission to the neonatal intensive care unit (NICU) between January 2017 and December 2020. Eligible high-risk pregnant patients undergoing antenatal consultation in a tertiary-level fetal assessment unit were identified using an electronic clinic repository. Consult letters and fetal assessment reports were reviewed to determine baseline demographics, pregnancy history, fetal findings, and communication about breastfeeding. Descriptive and inferential statistics were used to present findings and compare outcomes between groups.Results316 pregnancies were included for final analysis. The mean maternal age was 28.7 years (SD 6.2) and 65 % were multiparas. Median gestational age at time of antenatal consult was 32 weeks [IQR 29–34]. The main indication for consultation was fetal anomalies (72.8%), namely cardiac defects (21.2 %). There was a significant improvement in prevalence of antenatal discussions about breastfeeding over the study period, from 48.8 % early in the study period compared to 73.7 % in the past year (p = 0.036). However, amongst consults where breastfeeding was discussed, almost one-quarter (23.8 %) of patients indicated that they were not planning on breastfeeding postnatally.ConclusionThere has been a significant improvement in promoting breastfeeding antenatally amongst high-risk pregnancies. However, no follow-up or supports were offered to one-quarter of patients who indicated no intention of breastfeeding or using donor milk postnatally. Ongoing work is required to further advance breastfeeding promotion antenatally, increase parental supports and education, and optimize breastfeeding rates postnatally for improving outcomes of this high-risk group.

Risk assessment score for adverse pregnancy outcome in systemic lupus erythematosus patients

BackgroundSystemic lupus is a chronic autoimmune multisystem disease that mainly affects females of childbearing age. SLE still possesses risks during pregnancy that lead to poor maternal and fetal outcomes. The objectives of the study were to identify factors associated with unfavorable pregnancy outcomes and develop a predictive risk score for adverse pregnancy outcomes in patients with SLE.ResultsThe main predictive factors associated with adverse pregnancy outcomes among lupus patients in multiple linear regression were an absence of remission for at least 6 months before conception, preexisting lupus nephritis, active disease at conception, C3 hypocomplementemia, and antiphospholipid antibody syndrome. Each predictor is assigned a weighted point score, and the sum of points represents the risk score. The area under the receiver operating characteristic curve (ROC) was 0.948 (95% confidence interval, 0.908–0.988), suggesting that the score had strong discriminatory power for adverse pregnancy outcomes.ConclusionsIn this study, a predictive model with a risk score classification for adverse pregnancy outcomes in SLE patients was developed. This could help rheumatologists identify high-risk pregnant patients for better disease monitoring and management, resulting in better maternal/fetal outcomes.

Perinatal Outcomes of High-Risk Patients Delivered by Resident Versus Private Practice Physicians [A138

INTRODUCTION: This study compared perinatal outcomes of deliveries performed by resident and private practice physicians. METHODS: This is a secondary analysis of a large institutional review board‒approved, National Institutes of Health–funded retrospective cohort study of pregnant patients with chronic hypertension, diabetes, and/or fetal growth restriction who delivered singletons at a tertiary-care maternity hospital from January 2002 to March 2013. Maternal and neonatal outcomes of deliveries by resident physicians were compared to those of private practice physicians. The primary outcome was mode of delivery. RESULTS: The cohort included 9,744 deliveries: 1,928 resident and 7,816 private. Compared to private patients, resident patients were younger; more likely to be non-White, multiparous, or cigarette-smoking; and more likely to have public or no insurance, low BMI, or chronic hypertension. Private practice patients were more likely to have fetal macrosomia and diabetes. After adjusting for these factors, resident patients had 18% lower risk of cesarean delivery (CD) overall (aRR, 0.82; 95% CI, 0.76–0.88), driven by a 45% reduction in elective CD (aRR, 0.55; 95% CI, 0.43–0.70). Resident patients also had lower rates of episiotomy (aRR, 0.71; 95% CI, 0.58–0.88), but higher rates of endometritis (aRR, 1.93; 95% CI, 1.49–2.49) and NICU admission (aRR, 1.19; 95% CI, 1.04–1.36). CONCLUSION: In this cohort of high-risk pregnant patients, delivery by resident physicians was associated with a reduction in CD, particularly elective CD, and episiotomy. A focus on understanding the choice of private practice patients to undergo elective cesarean delivery and their providers to perform elective cesarean delivery may help reduce preventable morbidity.

Pregnant Women's Opinions on the COVID-19 Vaccination in Pregnancy [A301

INTRODUCTION: Pregnant women are at increased risk of severe disease with COVID-19. Despite strong recommendations from ACOG and the Society for Maternal-Fetal Medicine for vaccination, COVID-19 vaccination hesitancy persists. With this study, we aim to evaluate opinions about the COVID-19 vaccine in a cohort of high-risk pregnant patients. METHODS: Institutional review board approval was obtained. Patients attending a regional Maternal-Fetal Medicine clinic were surveyed about the COVID-19 vaccine using a standardized questionnaire. Demographic, obstetrical, and medical information were abstracted using medical records. The vaccinated and unvaccinated groups were evaluated using student t-tests and a hierarchical Bayesian logistic regression. RESULTS: Among the 157 participants, 38.2% received the vaccine. There were no significant differences between the groups in age, BMI, employment, race and ethnicity, gestational age, or gravity. There was no correlation with influenza or Tdap vaccination rates, nor tobacco or alcohol use. Education level was negatively correlated with vaccination status and had the largest effect size. Those with education at or less than eighth grade level were least likely to be vaccinated (95% CI, −4.46 to −0.41). Those with children in the home were less likely to be vaccinated (95% CI, −1.36 to −0.59). Unvaccinated patients chose lack of data in pregnancy (66%) as their primary concern. Most patients prefer to learn about vaccines via conversation with their doctor (46.7% for vaccinated and 59.8% for unvaccinated). CONCLUSION: The vaccination rate is low in our population. A provider-initiated conversation about COVID-19 vaccination included with routine prenatal care could increase the vaccination rate.

Use of aspirin 100 mg / day to prevent Preeclampsia, in high risk pregnancies, in a cohort from Argentina

The objective of the present study was to analyse the use of 100 g aspirin dose as prevention method for preeclampsia in high risk pregnant patients. A retrospective cohort study was performed in high risk pregnant patients with a blood pressure protocol, and the use of 100 mg of aspirin vs. its non-use was evaluated in the incidence of PREEC. Estimations between the two groups were performed with and without variable adjustment by means of binary logistic regression models. 633 high risk pregnant patients were evaluated. The average age was 30±7 years old, and 25±8 weeks of pregnancy. 281 women (44.3 %) within this group received aspirin. The total prevalence of PREEC in our sample was 151 pregnant women (23.8 %). Pregnant patients under the aspirin treatment developed less PREEC events (19.2% vs 27.5%, p=0.019); with OR not adjusted 0.62 (IC95% 0.43-0.91 p= 0.017). The risk was similar when it was adjusted by age, preeclampsia history, diabetes mellitus and chronic high blood pressure. (OR adjusted 0.63 IC95% 0.43-0.92 p= 0.017). The use of 100 mg of aspirin a day before the 20th week of pregnancy in high risk pregnant patients decreased the risk of developing PREEC, regardless the age and risk factors.

How can Secondary Thromboprophylaxis in High-Risk Pregnant Patients be Improved?

Low-molecular-weight heparin (LMWH) is suggested for thromboprophylaxis in pregnant women with previous venous thromboembolism (VTE). Anyway, there is only limited amount of studies evaluating the effect of LMWH on hemostatic parameters during pregnancy of patients with previous VTE and the need of secondary thromboprophylaxis. We therefore provide results of prospective and longitudinal assessment of changes in hemostasis in high-risk pregnant women at four times during pregnancy (T1–T4) and one time after the postpartum period (T5) used for individualized modification of thromboprophylaxis. In this study, the results of coagulation factor VIII (FVIII) and protein S (PS) activity, ProC Global ratio and anti-Xa activity were evaluated. Despite the thromboprophylaxis, an increased predisposition to thromboembolic complications was detected (significant increase in FVIII activity and decrease in PS function, ProC Global ratio not normalized even after the postpartum period – p < .0001 between controls and T5 for PS and ProC Global). These results indicate that hemostasis may not be restored even 6 to 8 weeks after delivery and pose the question when is it safe to withdraw the anticoagulant thromboprophylaxis in high-risk patients with prior VTE.

Outpatient portal use in prenatal care: differential use by race, risk, and area social determinants of health.

To report the relationship of outpatient portal (OPP) use with clinical risk, area social determinants of health (SDoH), and race/ethnicity among pregnant women. Regression models predicting overall and individual portal feature use (main effects and interactions) based on key variables were specified using log files and clinical data. Overall OPP use among non-Hispanic Black women or patients who lived in lower SDoH neighborhoods were significantly less. High-risk pregnancy patients were likely to use the OPP more than those with normal-risk pregnancy. We found similar associations with individual OPP features, like Visit (scheduling) and My Record (test results). We also found significant interactive associations between race/ethnicity, clinical risk, and SDoH. Non-Hispanic Black women and those living in lower SDoH areas used OPP less than non-Hispanic White women from similar or affluent areas. More research must be conducted to learn of OPP use implications for pregnant women with specific clinical diagnoses.

Pneumonia in pregnancy

Pneumonia is a common disease worldwide and the coexistence with pregnancy increase its morbidity and mortality. Physiologic changes in pregnancy can augment susceptibility to pulmonary diseases and change their clinical course. This review article attempts to make an assessment of current information on the risks, maternal and fetal effects, etiology, clinical features and management of pneumonia in pregnancy. A systematic literature electronic search for journal articles and guidelines regarding pneumonia and respiratory disease in pregnancy was undertaken. Pathogens, clinical course and treatment of pneumonia in pregnancy is similar to the non-pregnant circumstances, with particular consideration on obstetric and fetal outcomes and drug safety during pregnancy. Prompt diagnosis and treatment reduce potential complications. Vaccination may reduce severity of pneumonia in high-risk pregnant patients.