Lindsey Carr

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Technology platforms continue to make their way into obstetrical care.

Researchers from the Edith Wolfson Medical Center in Holon, Israel, found that a smartphone-based daily feedback and counseling platform between postpartum women and a multidisciplinary lactation-support team increased lactation rates 3 months postpartum.

With a specifically developed app, a multidisciplinary team consisting of obstetricians, neonatologists, nurses, lactation counselors, and a psychologist provided counseling to assist and counsel postpartum women in maintaining lactation. For the study, researchers recruited 197 women at day 1 postpartum who planned to breastfeed. Women were randomized to either the control group, who received routine lactation counseling and support, or the app group, who received additional daily detailed counseling and feedback on lactation from the team via the app.

The primary outcome was partial or full lactation at 3 months. With 100 women in the control group and 97 in the app group, the app group demonstrated higher rates of lactation at 3 months postpartum (81.4% vs. 69.0%, p=0.04) as well as lactation 6 weeks postpartum (96.9% vs. 82.0%, p<0.001), compared to the control group. Patients in the app group reported excellent satisfaction from the app use and from their postnatal care.

In a personal note, Dr. Miremberg adds, "We believe our study adds to the growing data of the use of telemedicine in obstetric care. In light of the COVID-19 pandemic, the importance of telemedicine is even more emphasized. Mothers who face the difficulties of breastfeeding and the emotional "roller-coaster" of the postpartum period should be able to use easy and accessible technology to receive professional support from their caregivers."

Miremberg is a 6th-year resident in the Department of Obstetrics and Gynecology at the Edith Wolfson Center in Holon, Israel and is affiliated with Tel Aviv University in Tel Aviv, Israel.

Articles

This article is on based on information presented at the Society for Maternal-Fetal Medicine’s 2021 Virtual Annual Meeting, which will be held from Jan. 25 to Jan. 30.  

Smartphone-based counseling and postpartum lactation

A study presented at SMFM’s 2021 Virtual Annual Meeting found that prenatal maternal mental distress is associated with impaired amygdala growth in newborns and impacts cognitive and motor skills in infants at 18 months.

Researchers from Children’s National Hospital in Washington, DC investigated whether prenatal maternal stress, anxiety and depression were associated with postnatal brain growth and infant neurodevelopmental outcomes at 18 months.

Of 116 women, 96 completed mental distress measures twice at different gestational ages (32.0±4.5, 23-40 gestational weeks). 101 newborns underwent postnatal MRI (41.9±1.9, 38-47 gestational weeks); and 87 infants completed neurodevelopmental testing at 18 months.

Evaluations of prenatal maternal stress, anxiety, and depression used the Perceived Stress Scale, Spielberger State-Trait Anxiety Inventory, and Edinburgh Postnatal Depression Scale, respectively.

Neonates were scanned on a 3T MRI scanner with an 8-channel hi-res brain array receive-only coil. Neonatal brain MR images were segmented into cortical grey matter, white matter, deep grey matter, cerebellum, brainstem, left and right hippocampus and amygdala via Draw-EM pipeline. Infant neurodevelopment was evaluated via Bayley Scales of Infant and Toddler Development III at 18 months.

They found that prenatal maternal anxiety was associated with a smaller left and right amygdala in newborns, and lower cognitive scores in infants at 18 months. Prenatal maternal stress was also associated with decreased cognitive and motor scores at 18 months.

Prenatal maternal distress impairs newborn amygdala growth

There is transfer of SARS-CoV-2-specific antibodies from mothers to newborns, according to new research presented at SMFM’s 2021 Virtual Annual Meeting.

Previous studies have found that patients infected with SARS-CoV-2 develop high titers of IgG antibodies targeting the Spike (S) protein within the few weeks of infection. Researchers from the Herold Lab at Albert Einstein College of Medicine and Montefiore Medical Center in The Bronx, NY conducted a study to assess and quantify the transfer of these specific IgG antibodies from mothers to infants.

The study included 42 dyads (pregnant patients and their newborns) who were diagnosed with SARS-CoV-2 by PCR assay on nasopharyngeal swabs. Blood was collected from pregnant mothers during admission for delivery and cord blood samples at time of delivery.

Of the 42 women, 16 (38.1%) were diagnosed with SARS-CoV-2 at least 7 days before delivery, and 26 (61.9%) were diagnosed less than 7 days before delivery. All samples were assayed via Multiplex assay for anti-Spike IgM and IgG. Results showed that the anti-Spike IgG were higher in pregnant women who had been diagnosed 7 days or more before delivery when compared to those diagnosed for less than 7 days before delivery, but the concentration of IgM antibodies between both groups was similar. 

The IgG antibodies were actively transported across placenta as evidenced by the findings of similar concentration of IgG specific anti-Spike antibodies in the mothers’ and cord blood in those diagnosed >7 days before delivery, but the cord blood levels were lower in those who had been diagnosed within 7 days. 

In addition, the neutralizing activity of the antibodies, an important defense against infection, was significantly lower in the pregnant women who had been diagnosed <7 days before delivery and was significantly lower in the cord blood in both groups; suggesting a time sensitive production of this subset of Spike-specific antibodies. 

According to their research, transfer and production of the SARS-CoV-2-specific antibodies seems to be dependent on timing of infection. Patients infected with SARS-CoV-2 for a longer period of time before delivery, transfer more antibodies and, specifically, more neutralizing antibodies, to their newborns.

Placental transfer of SARS-CoV-2 specific antibodies from mothers to newborns

This article is on based on information presented at the Society for Maternal-Fetal Medicine’s 2021 Virtual Annual Meeting, which will be held from Jan. 25 to Jan. 30.

The Florida Pregnancy Associated Mortality Review (PAMR) Committee conducted its review of all pregnancy-related deaths (PRD) from 2009 to 2018. Established in 1996, its goal is to identify opportunities for prevention and make recommendations for care.

Washington Hill, MD, presented the findings at SMFM’s 2021 Virtual Annual Meeting on Friday.

The committee found that 408 pregnancy-related deaths occurred in Florida for 2,191,578 live births between 2009 and 2018. Among non-Hispanic Black women, the rate of pregnancy-related deaths decreased by 37% (p=0.002). The rate among Hispanic women also decreased by 42% (p=0.04).

From 2009 to 2018, six causes of death accounted for 77% of Florida’s pregnancy-related deaths: hemorrhage, infection, hypertensive disorders, cardiomyopathy, cardiovascular and thrombotic embolism.

According to the review, significant risk factors associated with pregnancy-related deaths were cesarean delivery (RR 3.3), age of 35 or older (RR 2.7), obesity (RR 2.6), no prenatal care during the first trimester (RR 2.4), being a non-Hispanic Black woman (RR 2.5), and having an education of high school or less (RR 1.4).

“The trend towards a reduced FLORIDA PRMR from 2009 through 2018 is distinct from national data over this time and may reflect combined activities of Florida PAMR, ACOG District XII, other professional organizations, and the grass roots efforts of FPQC,” said Hill.

Florida’s Pregnancy Related Mortality Ratio (PRMR) shows a significant decrease in pregnancy-related mortality rates among Hispanic and non-Hispanic Black women, according to a study presented at SMFM’s 2021 Virtual Annual Meeting. 

Lindsey Carr

Articles

Smartphone-based counseling and postpartum lactation

Prenatal maternal distress impairs newborn amygdala growth

Placental transfer of SARS-CoV-2 specific antibodies from mothers to newborns

Pregnancy-related deaths: 2009-2018