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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
76 to 100 of 289 Research Studies DisplayedBiel F, Darney B, Caughey A
Medical indications for primary cesarean delivery in women with and without disabilities.
The purpose of this study was to examine the associations between maternal disability status and type, mode of delivery, and medical indications for cesarean delivery in California deliveries. Findings showed that women with disabilities were less likely to labor, and these unlabored cesarean deliveries were less likely to have a medical indication for cesarean, compared to women without disabilities.
AHRQ-funded; HS022981.
Citation: Biel F, Darney B, Caughey A .
Medical indications for primary cesarean delivery in women with and without disabilities.
J Matern Fetal Neonatal Med 2020 Oct;33(20):3391-98. doi: 10.1080/14767058.2019.1572740..
Keywords: Labor and Delivery, Pregnancy, Disabilities, Women, Maternal Care
Montoya-Williams D, Passarella M, Lorch SA
The impact of paid family leave in the United States on birth outcomes and mortality in the first year of life.
The purpose of this study was to evaluate the effect of paid family leave in California on statewide rates of preterm birth, low birthweight, post-neonatal mortality, and overall infant mortality. Probabilistic methods were used to match records of live birth with maternal and newborn hospital records; only singleton births were included in the study. Rates of infant health outcomes before and after implementation of the 2004 policy in California were compared with rates in two states that had no paid family leave policy. Findings showed that implementation of paid family leave policies in California was associated with a 12-percent reduction in post-neonatal mortality after adjusting for maternal and neonatal factors.
AHRQ-funded; HS018661.
Citation: Montoya-Williams D, Passarella M, Lorch SA .
The impact of paid family leave in the United States on birth outcomes and mortality in the first year of life.
Health Serv Res 2020 Oct;55(Suppl 2):807-14. doi: 10.1111/1475-6773.13288..
Keywords: Newborns/Infants, Pregnancy, Mortality, Policy, Outcomes, Labor and Delivery
Simpson KR, Lyndon A, Spetz J
Missed nursing care during labor and birth and exclusive breast milk feeding during hospitalization for childbirth.
The purpose of this study was to determine associations between missed nursing care and nurse staffing during labor and birth, and exclusive breast milk feeding at hospital discharge. Exclusive breast milk feeding is a national quality indicator of inpatient maternity care. Nurses have substantial responsibility for direct support of infant feeding during the childbirth hospitalization. The investigators indicate that the results support exclusive breast milk feeding as a nurse-sensitive quality indicator.
AHRQ-funded; HS025715.
Citation: Simpson KR, Lyndon A, Spetz J .
Missed nursing care during labor and birth and exclusive breast milk feeding during hospitalization for childbirth.
MCN Am J Matern Child Nurs 2020 Sep/Oct;45(5):280-88. doi: 10.1097/nmc.0000000000000644..
Keywords: Labor and Delivery, Pregnancy, Maternal Care, Breast Feeding, Inpatient Care, Nursing, Women
Schafer R, Phillippi JC
Group B streptococcal bacteriuria in pregnancy: an evidence-based, patient-centered approach to care.
Screening and management of group B streptococcus (GBS) bacteriuria in pregnancy aims to reduce the incidence of pyelonephritis and GBS-related neonatal morbidity and mortality. This article used a case study approach to discuss evidence-based, patient-centered care for group B streptococcal bacteriuria in pregnancy as well as ethical incorporation of individual patient preferences and values.
AHRQ-funded; HS024733.
Citation: Schafer R, Phillippi JC .
Group B streptococcal bacteriuria in pregnancy: an evidence-based, patient-centered approach to care.
J Midwifery Womens Health 2020 May;65(3):376-81. doi: 10.1111/jmwh.13085..
Keywords: Infectious Diseases, Pregnancy, Women, Patient-Centered Healthcare, Evidence-Based Practice, Newborns/Infants, Sepsis, Case Study
Upadhya KK, Psoter KJ, Connor KA
AHRQ Author: Mistry KB
Cluster randomized trial of a pre/interconception health intervention for mothers in pediatric visits.
Recognizing that pediatric primary care focuses on family health and is an important location of contact for women of childbearing age, this project assessed the effectiveness of a pre/interconception women's health intervention delivered during pediatric primary care using a cluster randomized trial. The investigators concluded that pediatric visits are an opportune location for addressing maternal health. They indicated that this intervention demonstrated feasibility and improved outcomes for some but not all outcome.
AHRQ-authored.
Citation: Upadhya KK, Psoter KJ, Connor KA .
Cluster randomized trial of a pre/interconception health intervention for mothers in pediatric visits.
Acad Pediatr 2020 Jul;20(5):660-69. doi: 10.1016/j.acap.2019.10.003..
Keywords: Family Health and History, Pregnancy, Women, Primary Care: Models of Care, Primary Care, Healthcare Delivery
Malhamé I, Mehta N, Raker CA
Identifying cardiovascular severe maternal morbidity in epidemiologic studies.
This study’s goal was to identify cases of cardiovascular severe maternal morbidity (CSMM) for use in epidemiologic studies. CSMM has become the leading cause of maternal mortality. The authors analyzed delivery hospitalizations at an obstetric teaching hospital from 2007 to 2017. A subset of indicators developed by the CDC based on ICD codes were utilized to form the composite variable for CSMM. Two expert clinicians manually reviewed all qualifying events using a standardized tool to determine if they were true CSMM events. They also estimated the number of CSMM cases among delivery hospitalizations without qualifying ICD codes by manually reviewing all severe preeclampsia cases and a random sample of 1000 hospitalizations without severe preeclampsia. Among 91,355 delivery admissions, they captured 113 potential CSMM cases. Of those 65 (57.5%) were true CSMM cases. Indicators for acute myocardial infarction, cardiac arrest, and cardioversion had 100% true-positive rates. An additional 70 CSMM cases in the 2102 admissions with severe preeclampsia were found.
AHRQ-funded; HS025013.
Citation: Malhamé I, Mehta N, Raker CA .
Identifying cardiovascular severe maternal morbidity in epidemiologic studies.
Paediatr Perinat Epidemiol 2020 Jul;34(4):452-59. doi: 10.1111/ppe.12571..
Keywords: Cardiovascular Conditions, Pregnancy, Women, Maternal Care, Labor and Delivery
Rosenbloom JI, Stwalley D, Lindley KJ
Latency of preterm hypertensive disorders of pregnancy and subsequent cardiovascular complications.
The objective of this retrospective cohort study was to test the hypothesis that increasing latency from diagnosis to delivery in patients with preterm hypertensive disorders of pregnancy is associated with an increased maternal risk of cardiovascular admission after delivery. The investigators found that prolonging expectant management of preterm hypertensive disorders of pregnancy was associated with an increased risk of maternal cardiovascular disease after delivery.
AHRQ-funded; HS019455.
Citation: Rosenbloom JI, Stwalley D, Lindley KJ .
Latency of preterm hypertensive disorders of pregnancy and subsequent cardiovascular complications.
Pregnancy Hypertens 2020 Jul;21:139-44. doi: 10.1016/j.preghy.2020.05.015..
Keywords: Blood Pressure, Pregnancy, Cardiovascular Conditions, Women, Maternal Care, Risk
Papaleontiou M, Haymart MR
Thyroid nodules and cancer during pregnancy, post-partum and preconception planning: addressing the uncertainties and challenges.
This article describes the challenges of treating thyroid nodules and thyroid cancer during pregnancy, in the postpartum period, and during preconception planning. The benefits and risk of treatment are discussed based on current knowledge and controversies surrounding management during pregnancy.
AHRQ-funded; HS024512.
Citation: Papaleontiou M, Haymart MR .
Thyroid nodules and cancer during pregnancy, post-partum and preconception planning: addressing the uncertainties and challenges.
Best Pract Res Clin Endocrinol Metab 2020 Jul;34(4):101363. doi: 10.1016/j.beem.2019.101363..
Keywords: Cancer, Pregnancy, Maternal Care, Women
Dombrowski M, Illuzzi JL, Reddy UM
Trial of labor after two prior cesarean deliveries: patient and hospital characteristics and birth outcomes.
This study’s goal was to examine utilization, success rate, and maternal and neonatal outcomes of trial of labor among women with two prior cesarean deliveries. Linked hospital discharge and birth certificate data were used for a retrospective analyses of a cohort of women in California with nonanomalous, term, singleton live births, two prior cesarean deliveries, and no clear contraindications for trial of labor. Findings showed that, among women with two prior cesarean deliveries, trial of labor was rarely attempted and was successful in 39.4% of attempts. Trial of labor in this population was associated with a modest increase in severe neonatal morbidity.
AHRQ-funded; HS023801.
Citation: Dombrowski M, Illuzzi JL, Reddy UM .
Trial of labor after two prior cesarean deliveries: patient and hospital characteristics and birth outcomes.
Obstet Gynecol 2020 Jul;136(1):109-17. doi: 10.1097/aog.0000000000003845.
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Keywords: Labor and Delivery, Pregnancy, Women, Maternal Care, Outcomes
Saavedra-Avendano B, Schiavon R, Sanhueza P
Early termination of pregnancy: differences in gestational age estimation using last menstrual period and ultrasound in Mexico.
Researchers compared gestational age based on reported last menstrual period and ultrasonography among a large sample of women in Mexico City's public first trimester abortion program, Interrupcion Legal de Embarazo (ILE). They found that the majority of women can estimate gestational age using their last menstrual period date. Where available, ultrasonography can be used, but it should not be a barrier to providing care.
AHRQ-funded; HS022981.
Citation: Saavedra-Avendano B, Schiavon R, Sanhueza P .
Early termination of pregnancy: differences in gestational age estimation using last menstrual period and ultrasound in Mexico.
Reprod Health 2020 Jun 9;17(1):89. doi: 10.1186/s12978-020-00914-x..
Keywords: Pregnancy, Women
Rosenbloom J, Lewkowitz A, Sondgeroth K
Antenatal corticosteroid administration in late-preterm gestations: a cost-effectiveness analysis.
The purpose of this study was to evaluate whether administration of antenatal late-preterm betamethasone was cost-effective in the immediate neonatal period. Cost-effectiveness analysis of late-preterm betamethasone administration with a time horizon of 7.5 days was conducted using a health-system perspective The investigators concluded that administration of betamethasone in the late-preterm period was likely not cost-effective in the short-term.
AHRQ-funded; HS022330.
Citation: Rosenbloom J, Lewkowitz A, Sondgeroth K .
Antenatal corticosteroid administration in late-preterm gestations: a cost-effectiveness analysis.
J Matern Fetal Neonatal Med 2020 Jun;33(12):2109-15. doi: 10.1080/14767058.2018.1540582..
Keywords: Healthcare Cost and Utilization Project (HCUP), Newborns/Infants, Pregnancy, Respiratory Conditions, Medication, Healthcare Costs, Healthcare Utilization
Jafri SM, Vitous CA, Dossett LA
Surgeon attitudes and beliefs toward abdominal wall hernia repair in female patients of childbearing age.
This qualitative study examined surgeons’ thoughts on decision-making in repairing an abdominal wall hernia in a woman or girl of childbearing age.
AHRQ-funded; HS026030.
Citation: Jafri SM, Vitous CA, Dossett LA .
Surgeon attitudes and beliefs toward abdominal wall hernia repair in female patients of childbearing age.
JAMA Surg 2020 Jun;155(6):528-30. doi: 10.1001/jamasurg.2020.0099..
Keywords: Provider: Physician, Provider, Surgery, Women, Pregnancy, Decision Making
Kunz SN, Phibbs CS, Profit J
The changing landscape of perinatal regionalization.
This article discusses the need for consistent perinatal regionalization policies across regions and between countries to reduce neonatal morbidity and mortality. Regionalization emphasizes matching patient needs with the capabilities of the hospital in which care is provided. The need to account for geographic and other regional differences when determining the feasibility of regionalization for a specific regions is emphasized.
AHRQ-funded; HS025749.
Citation: Kunz SN, Phibbs CS, Profit J .
The changing landscape of perinatal regionalization.
Semin Perinatol 2020 Jun;44(4):151241. doi: 10.1016/j.semperi.2020.151241..
Keywords: Pregnancy, Maternal Care, Women, Policy, Hospitals
Friedman Peahl A, Heisler M, Essenmacher LK
A comparison of international prenatal care guidelines for low-risk women to inform high-value care.
The authors compared U.S. to international prenatal care consensus guidelines for low-risk women to inform care delivery reforms. They found that U.S. and peer-country guidelines recommended similar prenatal education and psychosocial services for low-risk women; however, peer countries generally recommended fewer visits, longer intervals between visits, and less reliance on obstetrician-gynecologists for routine, low-risk prenatal care. They recommended that further investigation evaluate associations between recommended care and actual practice, as well as the effects of different components of prenatal care and delivery models on maternal-infant outcomes, patient-centeredness, and health care expenditures in the U.S.
AHRQ-funded; HS025465.
Citation: Friedman Peahl A, Heisler M, Essenmacher LK .
A comparison of international prenatal care guidelines for low-risk women to inform high-value care.
Am J Obstet Gynecol 2020 May;222(5):505-07. doi: 10.1016/j.ajog.2020.01.021..
Keywords: Maternal Care, Pregnancy, Women, Guidelines, Evidence-Based Practice, Healthcare Delivery
Danilack VA, Hutcheon Triche, EW EW
Development and validation of a risk prediction model for cesarean delivery after labor induction.
The goal of this study was to develop and validate a prediction model for cesarean delivery after labor induction that included factors known before the start of induction. The model contained eight variables, was well calibrated with good risk stratification at the extremes of predicted probability, and performed well on internal validation. The authors concluded that their prediction model can help providers estimate a woman's risk of cesarean delivery when planning a labor induction.
AHRQ-funded; HS025013.
Citation: Danilack VA, Hutcheon Triche, EW EW .
Development and validation of a risk prediction model for cesarean delivery after labor induction.
J Womens Health 2020 May;29(5):656-69. doi: 10.1089/jwh.2019.7822.
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Keywords: Labor and Delivery, Pregnancy, Women, Risk
Peahl AF, Novara A, Heisler M
Patient preferences for prenatal and postpartum care delivery: a survey of postpartum women.
The objective of this study was to describe patients' preferences for prenatal and postpartum care delivery. The investigators concluded that current prenatal and postpartum care delivery did not match patients' preferences for visit number or between-visit contact, and patients were open to alternative models of prenatal care, including remote monitoring.
AHRQ-funded; HS025465.
Citation: Peahl AF, Novara A, Heisler M .
Patient preferences for prenatal and postpartum care delivery: a survey of postpartum women.
Obstet Gynecol 2020 May;135(5):1038-46. doi: 10.1097/aog.0000000000003731.
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Keywords: Pregnancy, Maternal Care, Women, Healthcare Delivery
Peahl AF, Gourevitch RA, Luo EM
Right-sizing prenatal care to meet patients' needs and improve maternity care value.
In this manuscript, investigators present a new conceptual model for prenatal care that incorporates both patients' medical and social needs into four phenotypes, and use human-centered design methods to describe how better matching patient needs with prenatal services can increase the use of high-value services and decrease the use of low-value services. They also address some of the key challenges to implementing right-sized prenatal care, including capturing outcomes through research and payment.
AHRQ-funded; HS000055; HS025465.
Citation: Peahl AF, Gourevitch RA, Luo EM .
Right-sizing prenatal care to meet patients' needs and improve maternity care value.
Obstet Gynecol 2020 May;135(5):1027-37. doi: 10.1097/aog.0000000000003820..
Keywords: Maternal Care, Pregnancy, Women, Quality Improvement, Quality of Care
Sherman JP, Hedli LC, Kristensen-Cabrera AI
Understanding the heterogeneity of labor and delivery units: using design thinking methodology to assess environmental factors that contribute to safety in childbirth.
There is limited research exploring the relationship between design and patient safety outcomes, especially in maternal and neonatal care. In this study, the investigators employed design thinking methodology to understand how the design of labor and delivery units impacted safety and identified spaces and systems where improvements are needed.
AHRQ-funded; HS023506.
Citation: Sherman JP, Hedli LC, Kristensen-Cabrera AI .
Understanding the heterogeneity of labor and delivery units: using design thinking methodology to assess environmental factors that contribute to safety in childbirth.
Am J Perinatol 2020 May;37(6):638-46. doi: 10.1055/s-0039-1685494..
Keywords: Labor and Delivery, Pregnancy, Patient Safety, Maternal Care, Women, Newborns/Infants
Mills J, Hulse S
AHRQ Author: Mills J
Screening for asymptomatic bacteriuria in adults.
This case study poses three questions concerning a 33-year-old woman presenting for a first prenatal visit at 8 weeks' gestation. The woman reported morning nausea and breast tenderness. A review of systems and physical examination were consistent with early pregnancy but were otherwise unremarkable.
AHRQ-authored.
Citation: Mills J, Hulse S .
Screening for asymptomatic bacteriuria in adults.
Am Fam Physician 2020 Apr 15;101(8):493-94..
Keywords: U.S. Preventive Services Task Force (USPSTF), Screening, Prevention, Urinary Tract Infection (UTI), Pregnancy, Maternal Care, Women, Case Study
Kahwati LC, Clark R, Berkman N
Screening for bacterial vaginosis in pregnant adolescents and women to prevent preterm delivery: updated evidence report and systematic review for the US Preventive Services Task Force.
Researchers sought to update the evidence on screening and treatment of asymptomatic bacterial vaginosis in pregnancy for the USPSTF. They found that the evidence suggests no difference in the incidence of preterm delivery and related outcomes from treatment for asymptomatic bacterial vaginosis in a general obstetric population but was inconclusive for women with a prior preterm delivery. Maternal adverse events from treatment appear to be infrequent and minor, but the evidence about harms from in utero exposure was inconclusive.
AHRQ-funded; 290201500011I.
Citation: Kahwati LC, Clark R, Berkman N .
Screening for bacterial vaginosis in pregnant adolescents and women to prevent preterm delivery: updated evidence report and systematic review for the US Preventive Services Task Force.
JAMA 2020 Apr 7;323(13):1293-309. doi: 10.1001/jama.2020.0233..
Keywords: U.S. Preventive Services Task Force (USPSTF), Screening, Evidence-Based Practice, Prevention, Women, Children/Adolescents, Pregnancy, Maternal Care, Antibiotics, Medication
Bartsch SM, Stokes-Cawley OJ, Buekens P
The potential economic value of a therapeutic Chagas disease vaccine for pregnant women to prevent congenital transmission.
Currently, there are no solutions to prevent congenital transmission of Chagas disease during pregnancy, which affects 1-40% of pregnant women in Latin America and is associated with a 5% transmission risk. In this study the investigators sought to determine the economic value of therapeutic vaccines to prevent congenital transmission. The investigators delineated the thresholds at which therapeutic vaccination of Chagas-positive pregnant women would be cost-effective and cost-saving, providing economic guidance for decision-makers to consider when developing and bringing such a vaccine to market.
AHRQ-funded; HS023317.
Citation: Bartsch SM, Stokes-Cawley OJ, Buekens P .
The potential economic value of a therapeutic Chagas disease vaccine for pregnant women to prevent congenital transmission.
Vaccine 2020 Apr 3;38(16):3261-70. doi: 10.1016/j.vaccine.2020.02.078..
Keywords: Vaccination, Healthcare Costs, Pregnancy, Women
Darney BG, Fuentes-Rivera E, Polo G
Con la ley y sin la ley/With and without the law: utilization of abortion services and case fatality in Mexico, 2000-2016.
This study examined abortion and case-fatality rate trends in Mexico and Mexico City from 2000 to 2016. The rate nationally was 6.7 per 1000 in 2000, peaked in 2011, and plateaued in 2016. In Mexico City the utilization rate peaked in 2014 and then plateaued. Nationwide and in Mexico City (where abortion was legalized in 2007) case-fatality rates declined over time. After abortion became legal in Mexico City, the rate decreased more rapidly than in the other states of Mexico.
AHRQ-funded.
Citation: Darney BG, Fuentes-Rivera E, Polo G .
Con la ley y sin la ley/With and without the law: utilization of abortion services and case fatality in Mexico, 2000-2016.
Int J Gynaecol Obstet 2020 Mar;148(3):369-74. doi: 10.1002/ijgo.13077..
Keywords: Pregnancy, Healthcare Utilization, Women, Healthcare Delivery
Gregory EF, Upadhya KK, Cheng TL
AHRQ Author: Mistry KB
Enabling factors associated with receipt of interconception health care.
This study examined factors associated with receipt of preventive health care between pregnancies (interconception) using data from a study at four health centers in the Baltimore metropolitan area. The Anderson’s Model of Health Services Use model was used to identify data on factors up to 15 months postpartum. Factors included health history, self-rated health, demographics, predisposing factors, and enabling factors. The cohort included 376 women who were predominantly non-Hispanic Black (84%), and low income. Two enabling factors were associated with receipt of care: having a personal doctor or nurse and having non-Medicaid insurance.
AHRQ-authored
Citation: Gregory EF, Upadhya KK, Cheng TL .
Enabling factors associated with receipt of interconception health care.
Matern Child Health J 2020 Mar;24(3):275-82. doi: 10.1007/s10995-019-02850-0..
Keywords: Maternal Care, Prevention, Pregnancy, Healthcare Utilization, Women, Access to Care
Dissanayake MV, Darney BG, Caughey AB
Miscarriage occurrence and prevention efforts by disability status and type in the United States.
This study compares miscarriage rates among women by disability and type in the United States. Data from the 2011-2015 National Survey of Family Growth was used to examine outcomes in women with at least one completed pregnancy within the past 5 years. Analyses was conducted for women in six disability categories (any, hearing, vision, cognitive, physical, independent living) who had experienced miscarriage within the past 5 years. Overall, 21.83% women without disabilities and 31.63% of women with disabilities experienced a miscarriage. Women with any, cognitive, physical, and independent living had higher adjusted odds of experiencing miscarriage. A higher proportion of women with any, vision, physical, or independent living received recommendations for bedrest (65%) than women without (34%).
AHRQ-funded; HS022981; HS025155.
Citation: Dissanayake MV, Darney BG, Caughey AB .
Miscarriage occurrence and prevention efforts by disability status and type in the United States.
J Womens Health 2020 Mar;29(3):345-52. doi: 10.1089/jwh.2019.7880..
Keywords: Pregnancy, Women, Maternal Care, Disabilities
Birru Talabi M, Clowse MEB, Blalock SJ
Perspectives of adult rheumatologists regarding family planning counseling and care: a qualitative study.
This qualitative study sought to assess rheumatologists' perspectives, attitudes, and practices regarding family planning counseling and reproductive health care (FPCC). A geographically diverse sample of U.S. rheumatologists were interviewed and the transcripts of the interviews developed into a code book based on their content. Findings showed that rheumatologists feel a sense of responsibility to provide some aspects of FPCC to reproductive-age female patients. However, their own apprehensions about managing complicated pregnancies may negatively influence how they advise patients about pregnancy planning or avoidance. Future work should focus on eliminating barriers and identifying solutions that support rheumatologists' efforts to provide high-quality FPCC to patients.
AHRQ-funded; HS022989.
Citation: Birru Talabi M, Clowse MEB, Blalock SJ .
Perspectives of adult rheumatologists regarding family planning counseling and care: a qualitative study.
Arthritis Care Res 2020 Mar;72(3):452-58. doi: 10.1002/acr.23872..
Keywords: Arthritis, Pregnancy, Sexual Health, Provider: Physician, Women