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Research Studies is a monthly compilation of research articles funded by AHRQ or authored by AHRQ researchers and recently published in journals or newsletters.
Results1 to 15 of 15 Research Studies Displayed
Flannery DD, Mukhopadhyay S, Morales KH
Delivery characteristics and the risk of early-onset neonatal sepsis.
This retrospective cohort study identified term and preterm infants at lowest risk of culture-confirmed early-onset sepsis (EOS) using delivery characteristics and also determined antibiotic use among them. The study cohort included term and preterm infants born 2009 to 2014 with blood culture with or without cerebrospinal fluid culture obtained ≤72 hours after birth. Low EOS risk criteria included: cesarean delivery, without labor or membrane rupture before delivery, and no antepartum concern for intraamniotic infection or nonreassuring fetal status. Among 53,575 births, 7549 (14.1%) were evaluated and 41 (0.5%) of those infants had EOS. For 1121 evaluated infants there were low-risk delivery characteristics and none had EOS. Duration of antibiotics administered to infants born with and without low-risk characteristics was not different.
Citation: Flannery DD, Mukhopadhyay S, Morales KH . Delivery characteristics and the risk of early-onset neonatal sepsis. Pediatrics 2022 Feb;149(2). doi: 10.1542/peds.2021-052900..
Keywords: Newborns/Infants, Sepsis, Risk, Labor and Delivery, Antibiotics, Medication
Williams D, Stout MJ, Rosenbloom JI
Preeclampsia predicts risk of hospitalization for heart failure with preserved ejection fraction.
Preeclampsia is associated with increased risk of future heart failure (HF), but the relationship between preeclampsia and HF subtypes are not well-established. The objective of this analysis was to identify the risk of HF with preserved ejection fraction (HFpEF) following a delivery complicated by preeclampsia/eclampsia. The investigators concluded that preeclampsia/eclampsia was an independent risk factor for future hospitalizations for HFpEF.
Citation: Williams D, Stout MJ, Rosenbloom JI . Preeclampsia predicts risk of hospitalization for heart failure with preserved ejection fraction. J Am Coll Cardiol 2021 Dec 7;78(23):2281-90. doi: 10.1016/j.jacc.2021.09.1360..
Keywords: Healthcare Cost and Utilization Project (HCUP), Heart Disease and Health, Cardiovascular Conditions, Hospitalization, Risk, Labor and Delivery, Pregnancy, Women
Calthorpe LM, Baer RJ, Chambers BD
The association between preterm birth and postpartum mental healthcare utilization among California birthing people.
This study’s objective was to determine whether preterm birth is associated with postpartum inpatient and emergency mental healthcare utilization. The study sample was taken from a database of live-born neonates delivered in California, 2011-2017, and included all births to singleton infants between the gestational ages of 20 and 44 weeks. The findings indicate found that preterm birth is an independent risk factor for postpartum mental healthcare utilization. These findings suggest that screening for and providing mental health resources to birthing people after delivery are crucial, particularly among people giving birth to preterm infants, regardless of mental health history.
Citation: Calthorpe LM, Baer RJ, Chambers BD . The association between preterm birth and postpartum mental healthcare utilization among California birthing people. Am J Obstet Gynecol MFM 2021 Jul;3(4):100380. doi: 10.1016/j.ajogmf.2021.100380..
Keywords: Behavioral Health, Pregnancy, Women, Labor and Delivery, Risk
Wilson BL, Butler RJ
Identifying optimal labor and delivery nurse staffing: the case of cesarean births and nursing hours.
Numerous studies have identified a relationship between nurse staffing and adverse patient outcomes in medical / surgical patient populations. However, little is known about the impact of labor and delivery (L&D) nurse staffing and adverse birth outcomes, such as unintended cesarean delivery, in low-risk term-gestation women. In this study the investigators examined nurse staffing patterns on the likelihood of cesarean sections (C-sections) among low- risk, full gestation births and provided a testing framework to distinguish optimal from ineffective levels of nurse staffing.
Citation: Wilson BL, Butler RJ . Identifying optimal labor and delivery nurse staffing: the case of cesarean births and nursing hours. Nurs Outlook 2021 Jan-Feb;69(1):84-95. doi: 10.1016/j.outlook.2020.07.003..
Keywords: Provider: Nurse, Provider, Workforce, Labor and Delivery, Pregnancy, Quality of Care, Risk, Women
Guglielminotti J, Li G
Exposure to general anesthesia for cesarean delivery and odds of severe postpartum depression requiring hospitalization.
This retrospective cohort study evaluated the risk of general anesthesia use in cesarean delivery versus neuraxial anesthesia on maternal mental health. Cesarean deliveries performed in New York State hospitals between 2006 and 2013 were included. Exclusion criteria included having more than 1 cesarean delivery during the study period, residing outside of New York State, and having a general anesthetic for other surgery or delivery in the year before or after the index case. The primary outcome looked at was severe postpartum depression (PPD), and secondary outcomes were suicidal ideation, anxiety disorders, and posttraumatic stress disorder (PTSD). The majority of cesareans used neuraxial anesthesia and only 8% (34,356) had general anesthesia. Severe PPD requiring hospitalization occurred in 1158 women with 60% identified during readmission. General anesthesia was found to be associated with a 54% increased odds of PPD, and a 91% increased odds of suicidal ideation or self-inflicted injury. There was insufficient evidence for increased risk of anxiety orders.
Citation: Guglielminotti J, Li G . Exposure to general anesthesia for cesarean delivery and odds of severe postpartum depression requiring hospitalization. Anesth Analg 2020 Nov;131(5):1421-29. doi: 10.1213/ane.0000000000004663..
Keywords: Labor and Delivery, Pregnancy, Women, Depression, Behavioral Health, Surgery, Risk, Hospitalization, Medication, Adverse Drug Events (ADE), Adverse Events
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.
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.
Keywords: Labor and Delivery, Pregnancy, Women, Risk
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.
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.
Keywords: Disparities, Racial / Ethnic Minorities, Pregnancy, Labor and Delivery, Risk, Obesity, Women
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.
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: Hypertension, Pregnancy, Cardiovascular Conditions, Labor and Delivery, Risk
Brenes-Monge A, Saavedra-Avendano B, Alcalde-Rabanal J
Are overweight and obesity associated with increased risk of cesarean delivery in Mexico? A cross-sectional study from the National Survey of Health and Nutrition.
Researchers conducted a cross-sectional study to test the association between overweight and obesity and cesarean delivery in Mexico using data from the 2012 National Survey of Health and Nutrition (ENSANUT). They found that multiparous women with obesity are at higher risk of cesarean delivery in Mexico than multiparous women with normal body mass index. They recommend that efforts to reduce the cesarean deliveries rate take the obesity epidemic into account.
Citation: Brenes-Monge A, Saavedra-Avendano B, Alcalde-Rabanal J . Are overweight and obesity associated with increased risk of cesarean delivery in Mexico? A cross-sectional study from the National Survey of Health and Nutrition. BMC Pregnancy Childbirth 2019 Jul 11;19(1):239. doi: 10.1186/s12884-019-2393-5..
Keywords: Labor and Delivery, Obesity, Pregnancy, Risk, Women
Hefele JG, Santos P, Ritter G
Risk factors for shoulder dystocia: the impact of mother's race and ethnicity.
The purpose of this observational study was to examine shoulder dystocia risk factors by race and ethnicity using a 19,236 sample of pregnant women who presented for labor and delivery. Results found that, for White non-Hispanic mothers, the strongest risk factors were delivering past 40 weeks' gestation and use of epidural anesthesia during delivery. Among Black non-Hispanic mothers, the risk factors with the greatest impact were use of epidural and having gestational diabetes and controlling the condition with insulin. Additionally, among Hispanic mothers, having Spanish as the primary language increased shoulder dystocia likelihood compared to those who did not cite it as their primary language. This study provides evidence that risk factors for a labor and delivery condition can vary significantly across racial and ethnic subgroups.
Citation: Hefele JG, Santos P, Ritter G . Risk factors for shoulder dystocia: the impact of mother's race and ethnicity. J Racial Ethn Health Disparities 2018 Apr;5(2):333-41. doi: 10.1007/s40615-017-0374-9..
Keywords: Adverse Events, Labor and Delivery, Injuries and Wounds, Newborns/Infants, Pregnancy, Risk
Santos P, Hefele JG, Ritter G
Population-based risk factors for shoulder dystocia.
This retrospective observational study examined population-based risk factors for infant shoulder dystocia during labor. Five hospitals in 5 states were used and over 19,000 births evaluated between April 2011 and July 2013. An increased risk for dystocia was found for women who were prescribed insulin, indicating gestational diabetes. However this was not true of women with gestational diabetes who were not prescribed insulin. Other risk factors included being Black, Hispanic, covered by Medicaid or no insurance, infant gestational age of 41 weeks or greater, and chronic diabetes.
Citation: Santos P, Hefele JG, Ritter G . Population-based risk factors for shoulder dystocia. J Obstet Gynecol Neonatal Nurs 2018 Jan;47(1):32-42. doi: 10.1016/j.jogn.2017.11.011..
Keywords: Labor and Delivery, Newborns/Infants, Risk, Pregnancy, Injuries and Wounds, Adverse Events
Bommarito KM, Gross GA, Willers DM
The effect of clinical chorioamnionitis on cesarean delivery in the United States.
This study examined the association of clinical chorioamnionitis on cesarean delivery in a national sample of hospital discharges. It found that women with clinical chorioamnionitis were more likely to have cesarean delivery than those without clinical chorioamnionitis. The risk of cesarean delivery varied significantly by hospital location, teaching status, and U.S. region.
Citation: Bommarito KM, Gross GA, Willers DM . The effect of clinical chorioamnionitis on cesarean delivery in the United States. Health Serv Res 2016 Oct;51(5):1879-95. doi: 10.1111/1475-6773.12447.
Keywords: Healthcare Cost and Utilization Project (HCUP), Labor and Delivery, Pregnancy, Risk, Women
Cavazos-Rehg PA, Krauss MJ, Spitznagel EL
Maternal age and risk of labor and delivery complications.
The researchers examined associations between maternal age and prevalence of maternal morbidity during complications of labor and delivery. Using HCUP data, they found that complications with the highest odds among women 11-18 years of age included preterm delivery, chorioamnionitis, endometritis, and mild preeclampsia. Pregnant women 15-19 years old had greater odds for severe preeclampsia, eclampsia, postpartum hemorrhage, poor fetal growth, and fetal distress. Pregnant women 35 and older had greater odds for preterm delivery, hypertension, superimposed preeclampsia, severe preeclampsia, and decreased risk for chorioamnionitis. Women over 40 had increased odds for mild preeclampsia, fetal distress, and poor fetal growth.
Citation: Cavazos-Rehg PA, Krauss MJ, Spitznagel EL . Maternal age and risk of labor and delivery complications. Matern Child Health J 2015 Jun;19(6):1202-11. doi: 10.1007/s10995-014-1624-7.
Keywords: Adverse Events, Healthcare Cost and Utilization Project (HCUP), Labor and Delivery, Pregnancy, Risk
Santos P, Ritter GA, Hefele JL
Decreasing intrapartum malpractice: targeting the most injurious neonatal adverse events.
The researchers conducted a case study of a risk reduction labor and delivery model at 5 demonstration sites. After 27 months post implementation, reporting of unintended events increased significantly (43 vs 84 per 1000 births), while high-risk malpractice events decreased significantly (14 vs 7 per 1000 births).
Citation: Santos P, Ritter GA, Hefele JL . Decreasing intrapartum malpractice: targeting the most injurious neonatal adverse events. J Healthc Risk Manag 2015;34(4):20-7. doi: 10.1002/jhrm.21168..
Keywords: Labor and Delivery, Patient Safety, Risk, Medical Liability, Medical Errors
Witt WP, Wisk LE, Cheng ER
Determinants of cesarean delivery in the US: a lifecourse approach.
The researchers sought to determine whether the effects of preconception stressful life events (PSLEs) on birth weight differed by neighborhood disadvantage. They found that the risk of having very low birthweight infants among women with PSLEs, women with chronic conditions, or minority women was strongest among those living in disadvantaged neighborhoods, which suggests exacerbation of risk within disadvantaged environments.
AHRQ-funded; HS000083; HS000063.
Citation: Witt WP, Wisk LE, Cheng ER . Determinants of cesarean delivery in the US: a lifecourse approach. Matern Child Health J 2015 Jan;19(1):84-93. doi: 10.1007/s10995-014-1498-8..
Keywords: Labor and Delivery, Maternal Care, Pregnancy, Risk, Social Determinants of Health