This year’s annual meeting of the Society for Maternal-Fetal Medicine (SMFM) will go down in history as one to remember.
Not only was the meeting held on a virtual platform during a pandemic, the science was incredible, as 21 of the 101 orals presented were randomized controlled trials. The meeting focused on health equity and addressing health care disparities, with a special forum on racism and respectful care.
In no particular order, here are some of the highlights from SMFM 2021:
Rebecca Hamm, MD, showed how the ACOG definition of anemia by race, using a lower cutoff for Black women, resulted in a larger proportion of them presenting with anemia at delivery. This prospective cohort study found that Black women had 75% of the odds of presenting to deliver with a hemoglobin level of < 11 g/dL, and that presenting with a hemoglobin level of < 11 was associated with a 3-fold increase in the likelihood of transfusion. The conclusion recommends removing race-based thresholds defining anemia.
This National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network study of pregnant individuals with coronavirus disease 2019 (COVID-19) found that women with severe COVID-19 had worse obstetric outcomes.
Mary Norton, MD, and colleagues analyzed first trimester noninvasive prenatal testing “no call” results and found an association with a higher rate of preterm delivery and preeclampsia as well as an increased risk for aneuploidy.
The BETADOSE study from France tested a lower dose (12mg x 1 dose, rather than 12 mg q 24 hours x 2 doses) of betamethasone for fetal lung maturity. The study found that neonatal survival and complications did not differ by group, however, the rate of respiratory distress syndrome was 3 percentage points higher in the single-dose group.
In this randomized trial from 4 centers in France, investigators found that manual rotation in the early second stage of labor decreased the operative vaginal delivery rate by about 30%. The 5-minute Apgar score was also higher in neonates of participants who were manually rotated.
Investigators analyzed electronic medical records of 50,998 women in the University of North Carolina health system from 2014 to 2020. Each woman’s home address was geocoded and assigned to a Census tract and linked to the Centers for Disease Control and Prevention’s (CDC) publicly available Social Vulnerability Index (SVI). The study found that women who delivered prematurely were more likely to live in an area with a higher overall SVI and higher social vulnerability in each SVI theme. The authors suggested that if individual communities can identify areas of relative weakness where additional support is needed, that may improve pregnancy outcomes.
Sarah Lassey, MD, presented on the timing of Foley Cook catheter removal (6 hours versus 12 hours) for induction with oxytocin. The study found that removal at 6 hours was associated with a shorter time to delivery with no difference in cesarean rates.
Investigators reported placental transfer of the spike protein of SARS-CoV-2 from mothers to their newborns when they sampled cord blood of pregnancies complicated by COVID-19. The group said that the significance of this finding was unclear, as they were doing future studies to look at the functionality of these antibodies.
Investigators asked where communication or linguistic barriers would affect pregnancy outcomes when counseling is an important part of the care, such as with diabetes. They found a higher rate of pregnancy morbidities in individuals with evidence of communication or linguistic barriers, as measured by a predefined scoring system, but these differences were not noted in non-diabetic pregnancies.
Investigators sought to determine whether the association between sleep-disordered breathing (SDB) and preeclampsia could be predicted by measuring angiogenic factors such as angiogenic domain using soluble endoglin, soluble FMS-like tyrosine kinase 1, and placental growth factor. They found that these factors did not correlate with SDB, however, they did find that mean arterial pressure was elevated with an early pregnancy diagnosis of SDB.