Brenna L Hughes

Respiratory syncytial virus is a leading cause of lower respiratory tract illness globally in children aged <5 years. Each year, approximately 58,000 hospitalizations in the United States are attributed to respiratory syncytial virus. Infants aged ≤6 months experience the most severe morbidity and mortality. Until recently, prevention with the monoclonal antibody, palivizumab, was only offered to infants with high-risk conditions, and treatment primarily consisted of supportive care. Currently, 2 products are approved for the prevention of respiratory syncytial virus in infants. These include the Pfizer bivalent recombinant respiratory syncytial virus prefusion F protein subunit vaccine, administered seasonally to the pregnant person between 32 0/7 and 36 6/7 weeks of gestation, and the monoclonal antibody, nirsevimab, administered to infants aged up to 8 months entering their first respiratory syncytial virus season. With few …

HighlightsAll vaccinated individuals had neutralizing antibodies to SARS-CoV-2 wild type.Most vaccinated individuals had neutralizing antibodies to SARS-CoV-2 Delta variant.Neutralizing antibodies present in both maternal and neonatal blood at delivery.COVID-19 vaccination provides maternal protection and passive neonatal immunity.The Delta pandemic wave saw increased maternal morbidity and mortality compared to prior viral strains. COVID-19 vaccination in pregnancy elicits detectable levels of neutralizing antibodies to SARS-CoV-2 wild type and SARS-CoV-2 Delta variants in both maternal and neonatal samples at delivery. Our results demonstrate the effectiveness of vaccination which confers an immunological response against newer, and potentially more dangerous, viral variants.

Objective To improve timely and equitable access to postpartum blood pressure (BP) monitoring in individuals with hypertensive disorders of pregnancy (HDP).Methods A quality improvement initiative was implemented at a large academic medical centre in the USA for postpartum individuals with HDP. The primary aim was to increase completed BP checks within 7 days of hospital discharge from 40% to 70% in people with HDP in 6 months. Secondary aims included improving rates of scheduled visits, completed visits within 3 days for severe HDP and unattended visits. The balancing measure was readmission rate. Statistical process control charts were used, and data were stratified by race and ethnicity. Direct feedback from birthing individuals was obtained through phone interviews with a focus on black birthing people after a racial disparity was noted in unattended visits.Results Statistically significant …

OBJECTIVE:To characterize breastfeeding behaviors and identify factors associated with breastfeeding initiation among people with hepatitis C virus (HCV) infection.METHODS:

BackgroundVenous thromboembolism accounts for approximately 9% of pregnancy-related deaths in the United States. National guidelines recommend postpartum risk stratification and pharmacologic prophylaxis in at-risk individuals. Knowledge on modern rates of postpartum pharmacologic thromboprophylaxis and its associated risks is limited.ObjectiveThis study aimed to describe the rate of, and factors associated with, initiation of postpartum pharmacologic prophylaxis for venous thromboembolism, and to assess associated adverse outcomes.Study DesignThis was a secondary analysis of a multicenter cohort of individuals delivering on randomly selected days at 17 US hospitals (2019–2020). Medical records were reviewed by trained and certified personnel. Those with an antepartum diagnosis of venous thromboembolism, receiving antepartum anticoagulation, or known SARS-CoV-2 infection were …

STUDY DESIGN: In this quasi-experimental study, GANC was introduced to 104 facilities across Nasarawa in 2021-2022. Providers were trained on GANC, including malaria in pregnancy prevention, directly observed SP therapy, and tracking IPTp uptake. Baseline and endline data on IPTp coverage were collected from facility records. RESULTS: Project data reported 43,328 women enrolled in GANC, which is 70% of total ANC1 clients. The number of ANC clients who received at least one dose of IPTp increased 46% from 29,813 (baseline) to 43,601 (endline). Coverage of at least three doses of IPTp increased from 8,149 (baseline) to 26,792 (endline)(229%)(p< 0.001).CONCLUSION: This study is the first to provide evidence that introduction of GANC may facilitate increased uptake of IPTp at scale outside a trial context. Given recognized global challenges in improving IPTp coverage and the known negative …

BACKGROUNDData regarding the microbiome of the gestational membranes are emerging and conflicting. Shifts in the microbial communities in the setting of labor, rupture of membranes, and intraamniotic infection are yet to be understood.OBJECTIVEThis study aimed to characterize the microbiome of the gestational membranes of women in labor or with ruptured membranes, including those with and without intraamniotic infection.STUDY DESIGNWomen with a singleton pregnancy at ≥28 weeks’ gestation undergoing unscheduled cesarean delivery in the setting of labor or rupture of membranes were included. Demographic and clinical variables were collected. We defined suspected intraamniotic infection by standard clinical criteria; placentae and gestational membranes were also reviewed for histologic evidence of infection. Sterile swabs were collected from membranes at the time of delivery. Bacteria …

ObjectiveTo describe postpartum scenarios requiring uterine exploration and/or instrumentation, review data on antibiotic prophylaxis, and delineate antibiotic recommendations for each scenario.

Randomized Trial of Hyperimmune Globulin for Congenital CMV Infection - 2-Year Outcomes Randomized Trial of Hyperimmune Globulin for Congenital CMV Infection - 2-Year Outcomes N Engl J Med. 2023 Nov 9;389(19):1822-1824. doi: 10.1056/NEJMc2308286. Authors Brenna L Hughes 1 , Rebecca G Clifton 2 , Dwight J Rouse 3 , George R Saade 4 , Mara J Dinsmoor 5 , Uma M Reddy 6 , Robert Pass 7 , Donna Allard 3 , Gail Mallett 5 , Cora MacPherson 2 , Ronald Wapner 8 , Torri Metz 9 , William H Goodnight 10 , Alan TN Tita 7 , Maged M Costantine 11 , Geeta K Swamy 12 , Kent D Heyborne 13 , Edward K Chien 14 , Suneet P Chauhan 15 , Yasser Y El-Sayed 16 , Brian M Casey 17 , Samuel Parry 18 , Hyagriv N Simhan 19 , Peter G Napolitano 20 , George A Macones 21 ; Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal–Fetal Medicine Units Network; Eunice …

There are 5,563 obstetrics and gynecology residents currently in training across 298 accredited residency programs in the United States. 1 In 2021, a total of 336 applicants secured a position through the National Resident Matching Program for an obstetrics and gynecology subspecialty fellowship beginning in the summer of 2022. 2 Although some fellows will enter fellowship after some time away from residency, be it for clinical practice, research, or other endeavors, the majority of first-year fellows transition directly from the completion of residency to the start of fellowship training.Recently, the Council on Resident Education in Obstetrics and Gynecology (CREOG) proposed changing the start date of the seven obstetrics and gynecology subspecialty fellowships from July 1 to August 1. CREOG proposed this change as an outgrowth of the Right Resident, Right Program, Ready

ObjectiveData are lacking comparing morbidity and mortality of COVID-19 infection in pregnancy across virus variants. We evaluated disease severity and hospitalization among pregnant individuals across pandemic waves.Study DesignRetrospective analysis of electronic medical records for all individuals with COVID-19 diagnosed during pregnancy who delivered at a single center between 3/2020 and 2/25/2022. Primary outcome was disease severity at diagnosis; secondary outcome was hospitalization for COVID-19. Outcomes were compared across four pandemic waves defined by public data on local peak cases. Diagnoses between pre-specified waves were excluded.Results444 pregnant individuals were diagnosed with COVID-19 during four waves: wildtype 129 (29.1%), alpha 99 (22.3%), delta 60 (13.4%) and omicron 156 (35.1%). Black and Hispanic individuals comprised the majority of cases, with …

Objective The COVID pandemic has been associated with varied effects on preterm birth (PTB). We sought to compare rates of PTB during the pre- and post vaccination COVID periods with pre-pandemic PTB rates, stratified by race and ethnicity. Study Design Retrospective cohort comparing all deliveries over 20 weeks at a single tertiary center during “early” (March 2020–June 2020) versus “late” COVID (March 2021–June 2021), and “late” COVID versus pre-COVID (March to June 2014–2019). PTBs <37, <34, and <28 weeks were compared and stratified by race/ethnicity. Results A total of 16,483 deliveries occurred including 2,068 “early” COVID, 2,115 “late” COVID, and 12,300 pre-COVID. The PTB rate during “late” COVID was lower compared to “early” COVID (12.1 vs. 14.6%, p = 0.02). Rate of PTB <34 was also lower during “late” COVID (4.4 vs. 5.7%, p = 0.05). PTB <28 did not differ. When …

OBJECTIVE: On November 22, 2022, 2 hospitals in Oregon declared crisis standards of care (CSC) in response to the “tripledemic,” or rising rates of influenza, respiratory syncytial virus, and COVID-19.

Objective Hepatitis C virus and intrahepatic cholestasis of pregnancy (ICP) are well-known independent risk factors for adverse outcomes in pregnancy. In addition, it is well-established that there is an association between Hepatitis C and ICP. This study’s objective was to describe the impact of having both Hepatitis C and ICP on maternal and obstetric outcomes compared to patients having either Hepatitis C or ICP. Methods We conducted a retrospective cohort study of the Nationwide Readmissions Database, an all-payor sample of discharges from approximately 60% of US hospitalizations. Deliveries at 24–42+ weeks between 10/2015 and 12/2020 were included. Diagnosis of Hepatitis C and ICP, and outcomes related to severe maternal morbidity were identified using International Classification of Disease-10 codes. Patients were categorized based on Hepatitis C and ICP status. Weighted logistic and negative binomial regression analyses were used to evaluate the association between Hepatitis C and ICP status and outcomes, adjusting for patient and hospital characteristics. The primary outcome was any severe maternal morbidity; secondary outcomes included acute respiratory distress syndrome, acute kidney injury, sepsis, gestational diabetes, cesarean delivery, preterm birth, and hospital length of stay. We modeled interaction terms between ICP and Hepatitis C to assess whether there was a greater or lesser effect from having both conditions on outcomes than we would expect from additive combination of the individual components (i.e., synergy or antagonism). Results A total of 10,040,850 deliveries between 24–42+ weeks …

OBJECTIVE:To evaluate whether delivering during the early the coronavirus disease 2019 (COVID-19) pandemic was associated with increased risk of maternal death or serious morbidity from common obstetric complications compared with a historical control period.METHODS:

BackgroundSARS-CoV-2 infection during pregnancy is associated with adverse pregnancy outcomes, including fetal death and preterm birth. It is not known whether that risk occurs only during the time of acute infection or whether the risk persists later in pregnancy.ObjectiveThis study aimed to evaluate whether the risk of SARS-CoV-2 infection during pregnancy persists after an acute maternal illness.Study DesignA retrospective cohort study of pregnant patients with and without SARS-CoV-2 infection delivering at 17 hospitals in the United States between March 2020 and December 2020. Patients experiencing a SARS-CoV-2–positive test at or before 28 weeks of gestation with a subsequent delivery hospitalization were compared with those without a positive SAR-CoV-2 test at the same hospitals with randomly selected delivery days during the same period. Deliveries occurring at <20 weeks of gestation in both …

Objective The use of extracorporeal membrane oxygenation (ECMO) therapy has increased in the adult population. Studies from the H1N1 influenza pandemic suggest that ECMO deployment in pregnancy is associated with favorable outcomes. With increasing numbers of pregnant women affected by COVID-19 (coronavirus disease 2019) and potentially requiring this life-saving therapy, we sought to compare comorbidities, costs, and outcomes between pregnancy- and nonpregnancy-associated ECMO therapy among reproductive-aged female patients. Study Design We used the 2013 to 2019 National Readmissions Database. Diagnosis and procedural coding were used to identify ECMO deployment, potential indications, comorbid conditions, and pregnancy outcomes. The primary outcome was in-hospital mortality during the patient's initial ECMO stay. Secondary outcomes included length of stay and …

Importance SARS-CoV-2 infection can result in ongoing, relapsing, or new symptoms or other health effects after the acute phase of infection; termed post-acute sequelae of SARS-CoV-2 infection (PASC), or long COVID. The characteristics, prevalence, trajectory and mechanisms of PASC are ill-defined. The objectives of the Researching COVID to Enhance Recovery (RECOVER) Multi-site Observational Study of PASC in Adults (RECOVER-Adult) are to: (1) characterize PASC prevalence; (2) characterize the symptoms, organ dysfunction, natural history, and distinct phenotypes of PASC; (3) identify demographic, social and clinical risk factors for PASC onset and recovery; and (4) define the biological mechanisms underlying PASC pathogenesis. Methods RECOVER-Adult is a combined prospective/retrospective cohort currently planned to enroll 14,880 adults aged ≥18 years. Eligible participants either must meet WHO criteria for suspected, probable, or confirmed infection; or must have evidence of no prior infection. Recruitment occurs at 86 sites in 33 U.S. states, Washington, DC and Puerto Rico, via facility- and community-based outreach. Participants complete quarterly questionnaires about symptoms, social determinants, vaccination status, and interim SARS-CoV-2 infections. In addition, participants contribute biospecimens and undergo physical and laboratory examinations at approximately 0, 90 and 180 days from infection or negative test date, and yearly thereafter. Some participants undergo additional testing based on specific criteria or random sampling. Patient representatives provide input on all study processes. The primary study …

BACKGROUNDIncreased duration of breastfeeding improves maternal cardiovascular health and may be especially beneficial in high-risk populations, such as those with chronic hypertension. Others have shown that individuals with hypertension are less likely to breastfeed, and there has been limited research aimed at supporting breastfeeding goals in this population. The impact of perinatal blood pressure control on breastfeeding outcomes among people with chronic hypertension is unknown.OBJECTIVEThis study aimed to evaluate whether breastfeeding initiation and short-term duration assessed at the postpartum clinic visit differed according to perinatal blood pressure treatment strategy (targeting blood pressure <140/90 mm Hg vs reserving antihypertensive treatment for blood pressure ≥160/105 mm Hg).STUDY DESIGNWe performed a secondary analysis of the Chronic Hypertension and Pregnancy …

Researching COVID to enhance recovery (RECOVER) pregnancy study protocol: Rationale, objectives, and design (preprint) | medrxiv; 2023. | PREPRINT-MEDRXIV 1 2 3 +A A -A The WHO Covid-19 Research Database is a resource created in response to the Public Health Emergency of International Concern (PHEIC). Its content remains searchable and spans the time period March 2020 to June 2023. Since June 2023, manual updates to the database have been discontinued. 3.Researching COVID to enhance recovery (RECOVER) pregnancy study protocol: Rationale, objec This article is a Preprint Preprints are preliminary research reports that have not been certified by peer review. They should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information. Preprints posted online allow authors to receive rapid feedback and the entire …