Rose, Sherrill

Objective To evaluate maternal risk factors associated with chronic villitis of unknown etiology (VUE) and to describe cooccurring placental pathologies. Study Design A retrospective case–control study was conducted using placental pathology records from deliveries ≥ 20 weeks between 2010 and 2018. Cases were placentas with documented chronic villitis without infectious cause, hereafter called VUE. Controls were placentas without this diagnosis, matched to the cases 2:1. Maternal and neonatal demographic and clinical data were collected. Descriptive statistics are reported with Fisher's exact test or a chi-squared test, as appropriate, and multivariable conditional logistic regression was conducted. Results Our study included 352 cases with VUE and 657 controls. A diagnosis of gestational diabetes (p = 0.03) and gestational hypertension (p = 0.06) was 1.5 times more likely to occur in those with a VUE diagnosis. A trend was also seen for chronic hypertension (odds ratio [OR] = 1.7, p = 0.07) and preeclampsia (OR = 1.5, p = 0.09) compared with controls. Placentas with VUE, specifically high-grade VUE, were more likely to be small for gestational age (p = 0.01), and to be diagnosed with other placental findings including lymphoplasmacytic or chronic deciduitis (p < 0.01), maternal (p < 0.01) and fetal vascular malperfusion (p = 0.02), and chorionitis (acute or chronic; p < 0.01). Conclusion Gestational diabetes and hypertension were associated with a diagnosis of VUE, and overall, VUE placentas have more abnormal placental findings compared with control. Understanding VUE risk factors may facilitate prenatal care strategies and counseling to achieve the best outcomes for pregnant patients and their neonates. Key Points

Importance Approximately 10% to 16% of women meet diagnostic criteria for depression during pregnancy. Untreated maternal depression is associated with adverse pregnancy outcomes including premature birth, low birth weight, and fetal growth restriction. Objective The aim of this study is to review the current safety data on electroconvulsive therapy (ECT) in pregnancy and provide guidance to clinicians on the role of ECT in pregnancy and the special considerations for its use in our population. Evidence Acquisition We reviewed 4 meta-analyses on the use of ECT in pregnancy as well as the source material (case series, etc) for these meta-analyses. We reviewed the official position statements on ECT in pregnancy from obstetric and psychiatric governing bodies as well as clinical best practice information from practitioners of ECT in pregnancy. Results Electroconvulsive therapy may be underutilized due to stigma and lack of access for these women. Rates of ECT use in pregnancy are difficult to determine. There are physiologic differences in pregnancy that merit additional attention during ECT, including increased risk of aspiration, concern for aortocaval compression, and the possibility of fetal heart rate changes associated with prolonged seizure activity. Serious adverse outcomes associated with ECT use in pregnancy are rare. Conclusions and Relevance Electroconvulsive therapy is a highly effective and safe treatment modality for unipolar depression, bipolar disorder, schizophrenia, and other psychiatric illnesses. Electroconvulsive therapy treatment in pregnancy requires a multidisciplinary team approach with obstetrics, maternal-fetal medicine, psychiatry, and anesthesiology, but is overall felt to be safe and effective. Target Audience Obstetricians and gynecologist, family medicine physicians. Learning Objectives After completing this activity, the learner should be better able to assess the current evidence and best practices regarding ECT use in pregnant patients; describe risks, benefits, and contraindications to ECT use in pregnant patients; and explain the potential for practice gaps in the utilization of ECT in pregnancy.

Objective: A retrospective cohort study was performed to evaluate whether birthweight was less among infants of women taking amphetamine–dextroamphetamine during pregnancy at our academic institution. Method: We identified mother–infant pairs with documented exposure to amphetamine–dextroamphetamine in pregnancy from 2005 through 2015. Patients were matched 2:1 with unexposed controls. Charts were reviewed for known causes of intrauterine growth restriction. Analysis of birthweight used generalized estimating equation blocking on matching. Medical histories were analyzed with χ 2 test or Fisher’s exact test. Results: We identified 53 exposed mother–infant pairs. The difference in mean birthweight of infants exposed to amphetamine–dextroamphetamine versus those not exposed was 26.9 g, which is not significant (95% confidence interval [CI] = [−141, 195 g]; p = .75). A significant difference was noted for exposed versus unexposed mothers for comorbid psychiatric illness and history of substance abuse ( p < .001). Conclusion: With a limited sample size, our study suggests no significant difference in birthweight.

INTRODUCTION: Increasing numbers of pregnant women are being treated for ADHD. The safety of ADHD medications in pregnancy have not been well studied, although studies suggest that methylphenidate use may lower birthweight compare to unexposed newborns. Our primary outcome was to evaluate if birthweight was lower among infants of women utilizing Adderall in our academic institution. METHODS: Maternal and infant pairs exposed to Adderall between January 2005 and December 2015 was identified in EMR based on active medication list during pregnancy. Patients were matched 2:1 with unexposed controls of similar age, gestational age at delivery, parity, infant sex and date of delivery. All charts were reviewed for known causes of IUGR or low birthweight. Statistical analysis of infant birthweight was done using generalized estimating equation blocking on matching. Medical histories were analyzed using Chi-Square test or Fishers exact test as appropriate. RESULTS: We identified 53 exposed pairs. The difference in mean birthweight for exposed vs unexposed infants was 26.9g which is not statistically or clinically significant (95% CI, P-value: (-141, 195), 0.75). A statistically significant difference was noted for exposed vs unexposed mothers for comorbid psychiatric illness and history of substance abuse (p = <0.0001). CONCLUSION: As Adderall use increases among childbearing women, understanding the risk to infants is crucial. With a limited sample size, our study suggests no significant difference in birthweight, which is a concern for women requiring medication in pregnancy. Women using Adderall may have higher rates of comorbid psychiatric disorders and substance use and may benefit from early screening.