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OBJECTIVE: We sought to determine the differences in pregnancy outcomes in patients with pre-existing major depressive disorder compared to unaffected women. STUDY DESIGN: A retrospective cohort study comparing the rate of neonatal outcomes among singleton, non-anomalous births in California to women with or without the diagnosis of depression between 2007 and 2011. Neonatal outcomes of interest included preterm delivery (divided into <37, <34 and <32 weeks gestational age), respiratory distress syndrome (RDS), neonatal jaundice, neonatal hypoglycemia, neonatal seizures, and neonatal death (NND). Multivariate regression analyses and chi-square tests were employed for statistical comparisons and a p-value of less than 0.05 was used to indicate statistical significance. RESULTS: Of the 2,214,533 births in California, 18,775 (0.85%) women were diagnosed with depression. Depression was significantly associated with an increased risk of neonatal morbidity and mortality, including preterm delivery at <37, <34, and <32 weeks gestational age (

OBJECTIVE: Fetal fraction (FF) of cell-free DNA (cfDNA) detected in maternal blood is primarily derived from placental cells undergoing apoptosis and necrosis. It has been suggested that concentrations of fetal cfDNA may be a biomarker of trophoblast well-being. We hypothesized that FF is a biomarker of placental function and fetal growth. The objective of this study was to determine the relationship between FF and fetal growth. STUDY DESIGN: A retrospective cohort study was conducted of 197 consecutive singleton pregnancies undergoing fetal cfDNA testing. Fetal growth was defined as birth weight adjusted for gestational age and birth weight percentile for gestational age. The following potential covariates were accounted for: FF, gestational age at FF measurement and at delivery, race and ethnicity, sex of the fetus, maternal BMI. The association between FF and fetal growth was evaluated using stepwise regression to identify factors associated with fetal growth. Multivariable fractional polynomial regression was used to evaluate the linearity of the association, and multivariable regression to evaluate the strength of the association. RESULTS: Fetal DNA was analyzed at median gestational age of 21.4 (IQR [19.5-26.4]) weeks. FF constituted a median of 12.7 % (IQR [9.2-17.0]) of the total cfDNA. Birth weight was significantly associated with FF, BMI, and gestational age at delivery, while percentile of growth was significantly associated with FF and gestational age at delivery. The relationships between birth weight and FF, adjusted for maternal BMI and gestational age at delivery, and between fetal growth percentile and FF, adjusted for gestational age at delivery, were inverse and linear. Each percent increase in FF was associated with decrease of birth weight of 12 g (adj. mean [95% CI]: 12.2 [2.3-22.1], p¼0.016) and decrease of fetal growth of 0.9 percentile (adj. mean [95% CI]: 0.9% [0.3%-1.5%], p¼0.006). CONCLUSION: A linear association, independent of other risk factors, between FF and fetal growth suggests that it could provide a potential tool for early prediction of fetal growth abnormalities.

INTRODUCTION: We sought to determine the differences in pregnancy outcomes seen in women with diagnosed appendicitis when compared to women who do not have this diagnosis. METHODS: A retrospective cohort study of 1,853,219 women in California with singleton, vertex, non-anomalous, term gestations was performed to assess the prevalence of maternal and neonatal outcomes in women with appendicitis during pregnancy as compared to unaffected women. Maternal outcomes included chorioamnionitis, placental abruption, cesarean delivery, post-partum hemorrhage, and maternal sepsis. Neonatal outcomes included preterm delivery (divided into <37, <34, and <32 weeks gestational age), intrauterine fetal demise (IUFD), respiratory distress syndrome (RDS), and neonatal death. Multivariate regression analyses and chi-square tests were employed for statistical comparisons. RESULTS: Women with appendicitis had an increased risk of adverse outcomes in pregnancy. Appendicitis was associated with a statistically significant increase in cesarean delivery (odds ratio [OR], 7.37; 95% confidence interval [CI], 4.58-11.84), preterm delivery prior to 37 weeks (OR, 11.92; CI, 7.85-18.09), and blood transfusion (OR 20.56, CI, 10.86-38.89). It was also associated with several statistically significant adverse neonatal outcomes, including intrauterine death (OR, 4.16 (CI, .56-30.88), respiratory distress syndrome (OR, 14.78; CI, 7.89-27.64), and neonatal death (OR 19.29, CI (5.70-65.19). CONCLUSION: Women with appendicitis in pregnancy are at higher risk of complications than all-comers, with a statistically significant rates of both preterm delivery, cesarean delivery, and neonatal death. Whether this increased risk was due to confounding factors, impact of surgical treatment, or disease pathophysiology, and how these risks can be mitigated through health care practice advancements deserves further consideration.

INTRODUCTION: We sought to determine the differences in pregnancy outcomes among white, black, Hispanic, Asian/Pacific Islander, Native American women with bipolar disorder. METHODS: A retrospective cohort of 3,344 women with bipolar disorder and singleton, non-anomalous gestations was used to examine maternal and neonatal outcomes, assessed according to race. Maternal outcomes included gestational diabetes (GDM), chorioamnionitis, postpartum hemorrhage (PPH), and preeclampsia/eclampsia (abbreviated “Any PET”). Neonatal outcomes included preterm birth (divided into <37, <34 and <32 weeks gestational age), respiratory distress syndrome (RDS), and jaundice. Multivariate regression analyses and chi-square tests were employed for statistical comparisons and a p-value of less than 0.05 was used to indicate statistical significance. RESULTS: Compared to white women, and after controlling for confounders, Asian/Pacific Islander women were more likely to develop GDM, and chorioamnionitis, and trended towards higher rates of PPH. Additionally, black women trended towards higher rates of PET. Compared to neonates of white women, neonates of black women were more likely to be delivered preterm before 37, 34, and 32 weeks gestational age, and had higher rates of RDS. Additionally, Asian/Pacific Islander neonates trended towards higher rates of jaundice. CONCLUSION: Pregnancies of non-white women with bipolar disorder are associated with higher rates of obstetric and neonatal complications than pregnancies of white women, with specific complications and rates varying across races. This data may suggest disparities exist in management of pregnant women with bipolar disorder across different races.