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AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
101 to 125 of 289 Research Studies DisplayedHorner-Johnson W, Dissanayake M, Wu JP
Pregnancy intendedness by maternal disability status and type in the United States.
Using data from the National Survey of Family Growth, researchers studied pregnancy-intendedness among U.S. women with disabilities. They found that a higher proportion of pregnancies were unintended among women with disabilities than among women without disabilities, and that women with independent living disability had the highest proportion. They recommend further research to understand differences in unintended pregnancy by type and extent of disability, as well as the inclusion of people with disabilities in sex education and the incorporation of their routine care in discussions of reproductive planning.
AHRQ-funded; HS022981.
Citation: Horner-Johnson W, Dissanayake M, Wu JP .
Pregnancy intendedness by maternal disability status and type in the United States.
Perspect Sex Reprod Health 2020 Mar;52(1):31-38. doi: 10.1363/psrh.12130..
Keywords: Pregnancy, Women, Disabilities
Glazer KB, Danilack VA, Werner EF
Elucidating the role of overweight and obesity in racial and ethnic disparities in cesarean delivery risk.
This study’s goal was to quantify the extent to which overweight and obesity explain cesarean delivery rates among women of different racial and ethnic backgrounds. Administrative records were used from New York City for 216,481 singleton, nulliparous births from 2008 to 2013. Risk ratios, risk differences, and population attributable fractions for associations between body mass index and cesarean, stratified by race and ethnicity was calculated. Black and Hispanic women had the highest cesarean rates attributable to obesity and overweight (17.4% and 14.6%) respectively.
AHRQ-funded; HS025013.
Citation: Glazer KB, Danilack VA, Werner EF .
Elucidating the role of overweight and obesity in racial and ethnic disparities in cesarean delivery risk.
Ann Epidemiol 2020 Feb;42:4-11.e4. doi: 10.1016/j.annepidem.2019.12.012.
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Keywords: Disparities, Racial and Ethnic Minorities, Pregnancy, Labor and Delivery, Risk, Obesity, Women
Guglielminotti J, Rosenberg H, Li G
Prevalence of malignant hyperthermia diagnosis in obstetric patients in the United States, 2003 to 2014.
The goal of this study was to assess the prevalence of malignant hyperthermia (MH) diagnosis and associated factors in obstetric patients. Using data from the Nationwide Inpatient Sample, results showed that the prevalence of MH-susceptibility is about 1 in 125,000 in cesarean deliveries, similar to the prevalence reported in non-obstetrical surgery inpatients. The findings of this study suggest that stocking dantrolene in maternity units is justified.
AHRQ-funded; HS025787.
Citation: Guglielminotti J, Rosenberg H, Li G .
Prevalence of malignant hyperthermia diagnosis in obstetric patients in the United States, 2003 to 2014.
BMC Anesthesiol 2020 Jan 20;20(1):19. doi: 10.1186/s12871-020-0934-0..
Keywords: Healthcare Cost and Utilization Project (HCUP), Pregnancy, Maternal Care, Women, Diagnostic Safety and Quality, Labor and Delivery
Mabry-Hernandez I, Yan LD
AHRQ Author: Mabry-Hernandez I
Screening for hepatitis B virus in pregnant women.
This case study involves a 33-year-old U.S.-born pregnant clinician presenting for a first prenatal visit. She was pregnant once, more than two years ago; at that time she screened negative for the hepatitis B virus (HBV). She reports that she received an HBV vaccination one year ago during a work-related physical examination.
AHRQ-authored.
Citation: Mabry-Hernandez I, Yan LD .
Screening for hepatitis B virus in pregnant women.
Am Fam Physician 2020 Jan 15;101(2):115-16..
Keywords: U.S. Preventive Services Task Force (USPSTF), Hepatitis, Pregnancy, Women, Maternal Care, Screening, Pregnancy, Case Study
Klawetter S, McNitt C, Hoffman JA
Perinatal depression in low-income women: a literature review and innovative screening approach.
This paper is a literature review of perinatal depression prevalence, consequences, and screening among low-income women and women of color. The Warm Connections program has an innovative perinatal depression screening protocol and was used with WIC participants. The literature showed mixed findings of perinatal prevalence among low-income women and women of color. There were lower perinatal depression rates in the Warm Connections program in studies using less specific perinatal depression screening instruments with similar samples.
AHRQ-funded; HS026370.
Citation: Klawetter S, McNitt C, Hoffman JA .
Perinatal depression in low-income women: a literature review and innovative screening approach.
Curr Psychiatry Rep 2020 Jan 7;22(1):1. doi: 10.1007/s11920-019-1126-9.
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Keywords: Depression, Pregnancy, Women, Low-Income, Social Determinants of Health, Screening, Behavioral Health, Maternal Care, Disparities, Diagnostic Safety and Quality
Gordon SH, Sommers BD, Wilson IB
Effects of Medicaid expansion on postpartum coverage and outpatient utilization.
Timely postpartum care is associated with lower maternal morbidity and mortality, yet fewer than half of Medicaid beneficiaries attend a postpartum visit. Using Medicaid claims data for 2013-2015 from Colorado, which expanded Medicaid under the Affordable Care Act, and Utah, which did not, the authors conclude that expansion may promote the stability of postpartum coverage and increase the use of postpartum outpatient care in the Medicaid program.
AHRQ-funded; HS025560.
Citation: Gordon SH, Sommers BD, Wilson IB .
Effects of Medicaid expansion on postpartum coverage and outpatient utilization.
Health Aff 2020 Jan;39(1):77-84. doi: 10.1377/hlthaff.2019.00547..
Keywords: Medicaid, Pregnancy, Women, Access to Care, Maternal Care, Ambulatory Care and Surgery, Policy, Healthcare Delivery
Rosenbloom JI, Lewkowitz AK, Lindley KJ
Expectant management of hypertensive disorders of pregnancy and future cardiovascular morbidity.
The purpose of this study was to test the hypothesis that a longer length of time between diagnosis of hypertensive disorders of pregnancy and delivery is associated with increased risk of cardiovascular morbidity in the years after delivery. The investigators concluded that prolonged expectant management of preterm hypertensive disorders of pregnancy was associated with an increased risk of maternal cardiac disease in the ensuing years.
AHRQ-funded; HS019455.
Citation: Rosenbloom JI, Lewkowitz AK, Lindley KJ .
Expectant management of hypertensive disorders of pregnancy and future cardiovascular morbidity.
Obstet Gynecol 2020 Jan;135(1):27-35. doi: 10.1097/aog.0000000000003567..
Keywords: Blood Pressure, Pregnancy, Cardiovascular Conditions, Labor and Delivery, Risk, Women
Lundsberg LS, Main EK, Lee HC
Low-interventional approaches to intrapartum care: hospital variation in practice and associated factors.
This study compared hospitals in California with low and high-interventional practices for labor and delivery. A total of 185 California hospitals completed a survey of intrapartum care, including questions on low- versus high-interventional practices. They identified 2 distinct groups of hospitals that tended to use low- or high-interventional practices. Hospitals that used low-interventional practices tended to have midwife-led or physician-midwife collaborative labor management or were in rural locations. High-interventional practice hospitals had a higher proportion of women covered by Medicaid or other safety-net programs as well as hospitals located in counties with higher liability insurance premiums. Both sets of hospitals had comparable morbidity rates but low-intervention hospitals had lower rates of cesarean birth and episiotomies. Only one-quarter of hospitals were found to use low-interventional practices.
AHRQ-funded; HS023801.
Citation: Lundsberg LS, Main EK, Lee HC .
Low-interventional approaches to intrapartum care: hospital variation in practice and associated factors.
J Midwifery Womens Health 2020 Jan;65(1):33-44. doi: 10.1111/jmwh.13017..
Keywords: Labor and Delivery, Pregnancy, Women, Maternal Care, Hospitals, Quality of Care
Moniz MH, Fendrick AM, Kolenic GE
Out-of-pocket spending for maternity care among women with employer-based insurance, 2008-15.
The Affordable Care Act (ACA) requires employer-based insurance plans to cover maternity services, but plans are allowed to impose cost sharing such as copayments and deductibles for these services. This study aimed to evaluate trends in cost sharing for maternity care among working women in employer-based plans, before and after the ACA. The investigators found that between 2008 and 2015, average out-of-pocket spending for maternity care rose among women with employer-based insurance. This increase was largely driven by increased spending among women with deductibles.
AHRQ-funded; HS025465; HS023784.
Citation: Moniz MH, Fendrick AM, Kolenic GE .
Out-of-pocket spending for maternity care among women with employer-based insurance, 2008-15.
Health Aff 2020 Jan;39(1):18-23. doi: 10.1377/hlthaff.2019.00296..
Keywords: Pregnancy, Women, Maternal Care, Health Insurance, Healthcare Costs, Policy
Carlson NS, Breman R, Neal JL
Preventing cesarean birth in women with obesity: influence of unit-level midwifery presence on use of cesarean among women in the Consortium on Safe Labor data set.
The primary goal of this study was to examine associations between midwifery unit-level presence and unplanned cesarean birth in women with different body mass index (BMI) ranges. Data from the Consortium on Safe Labor was used to analyze information on low-risk, healthy women who labored and gave birth in medical centers with or without the unit-level presence of midwives. Results indicate that the odds of unplanned cesarean birth among women who gave birth in centers with midwives were 16% lower than the odds of cesarean birth among similar women who gave birth at centers without midwives. However, women whose BMI was above 35.00 kg/m at labor admission had similar odds of cesarean birth, regardless of unit-level midwifery presence. Although integration of midwives into the caregiving environment of medical centers in the United States was associated with overall decrease in the incidence of cesarean birth, increased maternal BMI nevertheless remained positively associated with these outcomes.
AHRQ-funded; HS024733
Citation: Carlson NS, Breman R, Neal JL .
Preventing cesarean birth in women with obesity: influence of unit-level midwifery presence on use of cesarean among women in the Consortium on Safe Labor data set.
J Midwifery Womens Health 2020 Jan;65(1):22-32. doi: 10.1111/jmwh.13022..
Keywords: Labor and Delivery, Pregnancy, Obesity, Women, Prevention, Maternal Care
Tilden EL, Phillippi JC, Ahlberg M
Describing latent phase duration and associated characteristics among 1281 low-risk women in spontaneous labor.
Recent research suggests that latent phase of labor may terminate at 6 rather than 4 centimeters of cervical dilation. The objectives of this study were to: (a) characterize duration of the latent phase of labor among term, low-risk, United States women in spontaneous labor using the women's self-identified onset; and (b) quantify associations between demographic and maternal/newborn health characteristics and the duration of the latent phase.
AHRQ-funded; HS024733.
Citation: Tilden EL, Phillippi JC, Ahlberg M .
Describing latent phase duration and associated characteristics among 1281 low-risk women in spontaneous labor.
Birth 2019 Dec;46(4):592-601. doi: 10.1111/birt.12428..
Keywords: Labor and Delivery, Pregnancy, Women
Tan M, Lipman S, Lee H
Evaluation of electronic medical records on nurses' time allocation during cesarean delivery.
The impact of the electronic medical record (EMR) on nursing workload is not well understood. The objective of this descriptive study was to measure the actual and perceived time that nurses spend on the EMR in the operating room during cesarean births. The investigators found that on average, nurses spent 40% of their intraoperative time on the EMR during cesarean births, and this time burden was distributed across the perioperative period.
AHRQ-funded; HS023506.
Citation: Tan M, Lipman S, Lee H .
Evaluation of electronic medical records on nurses' time allocation during cesarean delivery.
J Patient Saf 2019 Dec;15(4):e82-e85. doi: 10.1097/pts.0000000000000467..
Keywords: Electronic Health Records (EHRs), Labor and Delivery, Provider: Nurse, Health Information Technology (HIT), Provider, Pregnancy
Neal JL, Carlson NS, Phillippi JC
Midwifery presence in United States medical centers and labor care and birth outcomes among low-risk nulliparous women: a Consortium on Safe Labor study.
This study compared labor care and birth outcomes between medical centers with interprofessional care (midwives and physicians) versus noninterprofessional care (physicians only). A retrospective cohort study was conducted using Consortium on Safe labor data from low-risk nulliparous women who birthed in interprofessional (7393) or noninterprofessional (6982). Women at interprofessional medical centers were 74% less likely to undergo labor induction and 75% less likely to have oxytocin augmentation. In addition, the cesarean rate was 12% lower.
AHRQ-funded; HS024733.
Citation: Neal JL, Carlson NS, Phillippi JC .
Midwifery presence in United States medical centers and labor care and birth outcomes among low-risk nulliparous women: a Consortium on Safe Labor study.
Birth 2019 Nov 11;46(3):475-86. doi: 10.1111/birt.12407..
Keywords: Labor and Delivery, Pregnancy, Maternal Care, Women, Outcomes
Mills J, Day B
AHRQ Author: Mills J
Interventions to prevent perinatal depression.
This case study relates to interventions to prevent perinatal depression. It includes a case description as well as follow up questions and answers.
AHRQ-authored.
Citation: Mills J, Day B .
Interventions to prevent perinatal depression.
Am Fam Physician 2019 Sep 15;100(6):365-66..
Keywords: U.S. Preventive Services Task Force (USPSTF), Pregnancy, Depression, Behavioral Health, Prevention, Women, Case Study
Lewkowitz AK, Rosenbloom JI, Keller M
Association between stillbirth >/=23 weeks gestation and acute psychiatric illness within 1 year of delivery.
This study analyzed whether women experiencing a stillbirth had a higher risk of psychiatric morbidity and/or substance misuse within 1 year of delivery compared to women having a live birth. Higher risk was found for both using data from the Florida State Inpatient and State Emergency Department databases from 2005-2014. Women with an ICD-9 classification of stillbirth at or greater than 23 weeks gestation were included. Emergency department encounters or admissions with a diagnosis code of a psychiatric disorder were used.
AHRQ-funded; HS019455.
Citation: Lewkowitz AK, Rosenbloom JI, Keller M .
Association between stillbirth >/=23 weeks gestation and acute psychiatric illness within 1 year of delivery.
Am J Obstet Gynecol 2019 Nov;221(5):491.e1-91.e22. doi: 10.1016/j.ajog.2019.06.027..
Keywords: Healthcare Cost and Utilization Project (HCUP), Maternal Care, Pregnancy, Behavioral Health, Women, Labor and Delivery
Lewkowitz AK, Rosenbloom JI, Lopez JD
Association between stillbirth at 23 weeks of gestation or greater and severe maternal morbidity.
Researchers conducted this retrospective cohort study to estimate whether stillbirth at 23 weeks of gestation or more is associated with increased risk of severe maternal morbidity compared with live birth, when stratified by maternal comorbidities. Data from HCUP’s Florida State Inpatient Database was used. The researchers found that, although severe maternal morbidity is overall uncommon, delivering a stillborn fetus at 23 weeks of gestation or greater is associated with increased likelihood of severe maternal morbidity, particularly among women with comorbidities. They conclude that health care providers must be vigilant about severe maternal morbidity during stillbirth delivery.
AHRQ-funded; HS019455.
Citation: Lewkowitz AK, Rosenbloom JI, Lopez JD .
Association between stillbirth at 23 weeks of gestation or greater and severe maternal morbidity.
Obstet Gynecol 2019 Nov;134(5):964-73. doi: 10.1097/aog.0000000000003528..
Keywords: Healthcare Cost and Utilization Project (HCUP), Pregnancy, Maternal Care, Women, Adverse Events
Li J, Pesko MF, Unruh MA
Effect of the Medicaid primary care rate increase on prenatal care utilization among Medicaid-insured women.
The purpose of this study was to evaluate the effect of the 2013-2014 ACA Medicaid Primary Care Rate Increase on Medicaid-insured women's prenatal care utilization, overall and by race and ethnicity. The investigators concluded that the Medicaid "fee bump" improved prenatal care utilization for non-Hispanic Black and White women. They suggest that policymakers may consider reinstating higher Medicaid reimbursements to improve access to care for disadvantaged populations.
AHRQ-funded; HS024357.
Citation: Li J, Pesko MF, Unruh MA .
Effect of the Medicaid primary care rate increase on prenatal care utilization among Medicaid-insured women.
Matern Child Health J 2019 Nov;23(11):1564-72. doi: 10.1007/s10995-019-02804-6..
Keywords: Medicaid, Primary Care, Maternal Care, Pregnancy, Women, Healthcare Utilization, Racial and Ethnic Minorities, Disparities
Vanderlaan J, Dunlop A, Rochat R
Methodology for sampling women at high maternal risk in administrative data.
This study compared the net benefits of using the Obstetric Comorbidity Index (OCI) to identify women at high maternal risk compared to conventional risk identification methods. Hospitalization discharge and vital records data for women experience singleton births in George from 2008 to 2012 was used. Results found there was a small but positive net benefit in using the OCI and conventional risk identification methods actually performed worse than using no risk identification methods at all. The researchers suggest that using OCI helps reduce misclassification.
AHRQ-funded; HS024655.
Citation: Vanderlaan J, Dunlop A, Rochat R .
Methodology for sampling women at high maternal risk in administrative data.
BMC Pregnancy Childbirth 2019 Oct 21;19(1):364. doi: 10.1186/s12884-019-2500-7..
Keywords: Research Methodologies, Health Services Research (HSR), Pregnancy, Maternal Care, Risk, Women
Lewkowitz AK, Rosenbloom JI , Keller M
Association between severe maternal morbidity and psychiatric illness within 1 year of hospital discharge after delivery.
The purpose of this study was to estimate whether severe maternal morbidity is associated with increased risk of psychiatric illness in the year after delivery hospital discharge. Results showed that although absolute numbers were modest, severe maternal morbidity was associated with increased risk of severe postpartum psychiatric morbidity and substance use disorder. The highest period of risk extended to 4 months after hospital discharge.
AHRQ-funded; HS019455.
Citation: Lewkowitz AK, Rosenbloom JI , Keller M .
Association between severe maternal morbidity and psychiatric illness within 1 year of hospital discharge after delivery.
Obstet Gynecol 2019 Oct;134(4):695-707. doi: 10.1097/aog.0000000000003434..
Keywords: Healthcare Cost and Utilization Project (HCUP), Maternal Care, Pregnancy, Behavioral Health, Hospital Discharge, Risk, Women
O'Leary ST, Narwaney KJ, Wagner NM
Efficacy of a web-based intervention to increase uptake of maternal vaccines: an RCT.
Tetanus, diphtheria, and acellular pertussis (Tdap) and influenza vaccines are recommended for pregnant women in each pregnancy, yet uptake is suboptimal. This study tested the efficacy of an online vaccine resource in increasing uptake of Tdap and influenza vaccines among pregnant women. The investigators concluded that Web-based vaccination information sent to pregnant women can positively influence maternal influenza vaccine uptake.
AHRQ-funded; HS021492.
Citation: O'Leary ST, Narwaney KJ, Wagner NM .
Efficacy of a web-based intervention to increase uptake of maternal vaccines: an RCT.
Am J Prev Med 2019 Oct;57(4):e125-e33. doi: 10.1016/j.amepre.2019.05.018..
Keywords: Vaccination, Pregnancy, Women, Health Information Technology (HIT), Social Media, Influenza
Jefferson UT, Zachary I, Majee W
Employing a user-centered design to engage mothers in the development of a mHealth breastfeeding application.
The Mother's Milk Connection mHealth application was designed to improve breastfeeding duration and access to support. This article describes a user-centered design process to engage mothers in the development of the Mother's Milk Connection application. Stakeholder and user engagement indicated the integration of four distinct features acceptable for use as a comprehensive mHealth intervention to improve access to breastfeeding support. Further, mHealth has the potential to be a useful strategy for providing breastfeeding support, and a clinical trial regarding the efficacy of the Mother's Milk Connection application is needed.
AHRQ-funded; HS022140.
Citation: Jefferson UT, Zachary I, Majee W .
Employing a user-centered design to engage mothers in the development of a mHealth breastfeeding application.
Comput Inform Nurs 2019 Oct;37(10):522-31. doi: 10.1097/cin.0000000000000549..
Keywords: Breast Feeding, Maternal Care, Pregnancy, Women, Health Information Technology (HIT), Patient and Family Engagement, Patient Adherence/Compliance, Health Promotion, Education: Patient and Caregiver, Caregiving
Alexander LT, Fuentes-Rivera E, Saavedra-Avendano B
Utilisation of second-trimester spontaneous and induced abortion services in public hospitals in Mexico, 2007-2015.
This study examined data on utilization of in-facility second-trimester abortion services in Mexico. Data from Mexico’s Automated Hospital Discharge System (SAEH) from 2007-2015 was used to identify second-trimester abortions in public hospitals across Mexico’s 32 states. A total 145,956 second-trimester abortion services or 13.4% of total documented hospitalizations for abortion were identified. The rate remained constant for women aged 15-44 years. Women living in poorer socioeconomic conditions or highly marginalized municipalities were most likely to have second-trimester abortions compared to women in higher socioeconomic conditions who were able to utilize services in their first trimester.
AHRQ-funded; HS025155; HS022981.
Citation: Alexander LT, Fuentes-Rivera E, Saavedra-Avendano B .
Utilisation of second-trimester spontaneous and induced abortion services in public hospitals in Mexico, 2007-2015.
BMJ Sex Reprod Health 2019 Oct;45(4):283-89. doi: 10.1136/bmjsrh-2018-200300..
Keywords: Pregnancy, Women, Healthcare Utilization, Hospitals, Healthcare Delivery
Campbell AD, Turok DK, White K
Fertility intentions and perspectives on contraceptive involvement among low-income men aged 25 to 55.
In this study the authors examined the pregnancy-related attitudes and behaviors among men older than 24, who are involved in the majority of pregnancies ending in a birth. Between December 2015 and August 2016, in-depth interviews were conducted with 26 low-income men in Alabama who were aged 25-55, were sexually active and did not want more children. The investigators found that some low-income adult men were uncertain about their pregnancy desires, and many lacked contraceptive knowledge that would help them avoid unwanted pregnancy.
AHRQ-funded; HS013852.
Citation: Campbell AD, Turok DK, White K .
Fertility intentions and perspectives on contraceptive involvement among low-income men aged 25 to 55.
Perspect Sex Reprod Health 2019 Sep;51(3):125-33. doi: 10.1363/psrh.12115..
Keywords: Sexual Health, Low-Income, Men's Health, Pregnancy
Carlson NS, Neal JL, Tilden EL
Influence of midwifery presence in United States centers on labor care and outcomes of low-risk parous women: a Consortium on Safe Labor study.
The authors analyzed the association between midwifery presence in maternity care teams and the birth processes and outcomes of low-risk parous women. They found that parous women have significantly higher rates of vaginal birth, including vaginal birth after cesarean, and a lower likelihood of labor induction when cared for in centers with midwives. They concluded that their findings support integrated, team-based models of perinatal care to improve maternal outcomes.
AHRQ-funded; HS024733.
Citation: Carlson NS, Neal JL, Tilden EL .
Influence of midwifery presence in United States centers on labor care and outcomes of low-risk parous women: a Consortium on Safe Labor study.
Birth 2019 Sep;46(3):487-99. doi: 10.1111/birt.12405..
Keywords: Labor and Delivery, Pregnancy, Maternal Care, Women, Outcomes
Carter EB, Cahill AG, Olsen MA
Practical considerations with 17-Hydroxyprogesterone caproate for preterm birth prevention: does timing of initiation and compliance matter?
This study examined whether early initiation and compliance with use of 17-OHPC can reduce the risk of preterm birth (PTB) risk more than later medication initiation. A retrospective cohort study was conducted using MarketScan® data. Rates of PTB were compared for women with medication initiation at 16-21 weeks versus 21-29 weeks. Women with an early 17-OHPC start were less likely to delivery preterm than those with a later start. Less compliant patients also had a higher PTB rate.
AHRQ-funded; HS019455.
Citation: Carter EB, Cahill AG, Olsen MA .
Practical considerations with 17-Hydroxyprogesterone caproate for preterm birth prevention: does timing of initiation and compliance matter?
J Perinatol 2019 Sep;39(9):1182-89. doi: 10.1038/s41372-019-0401-2..
Keywords: Pregnancy, Labor and Delivery, Women, Medication, Patient Adherence/Compliance