Jay D Iams

A statewide initiative to reduce inappropriate scheduled births at 36(0/7)-38(6/7) weeks' gestation.

OBJECTIVEnWe sought to reduce scheduled births between 36(0/7)-38(6/7) weeks that lack appropriate medical indication.nnnSTUDY DESIGNnTwenty Ohio maternity hospitals collected baseline data for 60 days and then selected locally appropriate Institute for Healthcare Improvement Breakthrough Series interventions to reduce the incidence of scheduled births. Deidentified birth data were analyzed centrally. Rates of scheduled births without a documented indication, birth certificate data, and implementation issues were shared regularly among sites.nnnRESULTSnThe rate of scheduled births between 36(0/7)-38(6/7) weeks without a documented medical indication declined from 25% to <5% (P < .05) in participating hospitals. Birth certificate data showed inductions without an indication declined from a mean of 13% to 8% (P < .0027). Dating criteria were documented in 99% of charts.nnnCONCLUSIONnA statewide quality collaborative was associated with fewer scheduled births lacking a documented medical indication.

Why the United States preterm birth rate is declining

The preterm birth rate in the United States declined to 11.4% in 2013, the lowest level since 1997. Although the United States has one of the highest preterm birth rates in the developed world, we are improving this outcome and therefore improving the lives of thousands of infants. Demographic changes that may be responsible include a reduced teenage birth rate and fewer higher-order multiple births. Additionally, a public policy shift to prevent nonmedically indicated births at <39 weeks gestation and smoking bans in several states have been associated with the reduced rate of preterm births. Last, interventions such as 17 hydroxyprogesterone caproate, vaginal progesterone, and the use of cerclage in selected populations probably are contributing to the reduction in preterm deliveries. However, a large portion of these births could still be prevented with greater access and implementation of our current interventions, the reduction of modifiable risk factors for preterm birth, and expanded reporting of outcomes and risk factors to facilitate research for both prevention and treatment.

Serum Proinflammatory Cytokine Responses to Influenza Virus Vaccine among Women during Pregnancy versus Non-Pregnancy

This study aimed to comprehensively describe inflammatory responses to trivalent influenza virus vaccine (TIV) among pregnant women and determine whether responses differ compared to non‐pregnancy.

Self-Rated Health among Pregnant Women: Associations with Objective Health Indicators, Psychological Functioning, and Serum Inflammatory Markers

BackgroundBiobehavioral correlates of self-rated health in pregnancy are largely unknown.PurposeThe goals of this study were to examine, in pregnant women, associations of self-rated health with (1) demographics, objective health status, health behaviors, and psychological factors, and (2) serum inflammatory markers.MethodsIn the second trimester of pregnancy, 101 women provided a blood sample, completed measures of psychosocial stress, health status, and health behaviors, and received a comprehensive periodontal examination.ResultsThe following independently predicted poorer self-rated health: (1) greater psychological stress, (2) greater objective health diagnoses, (3) higher body mass index, and (4) past smoking (versus never smoking). Poorer self-rated health was associated with higher serum interleukin-1β (pu2009=u20090.02) and marginally higher macrophage migration inhibitory factor (pu2009=u20090.06). These relationships were not fully accounted for by behavioral/psychological factors.ConclusionsThis study provides novel data regarding factors influencing subjective ratings of health and the association of self-rated health with serum inflammatory markers in pregnant women.

Using a State Birth Registry as a Quality Improvement Tool

Background Birth registry data are universally collected, generating large administrative datasets. However, these data are typically not used for quality improvement (QI) initiatives in perinatal medicine because the quality and timeliness of the information is uncertain. Objective We sought to identify and address causes of inaccuracy in recording birth registry information so that birth registry data could support statewide obstetrical quality initiatives in Ohio. Study Design The Ohio Perinatal Quality Collaborative and the Ohio Department of Health Vital Statistics used QI techniques in 15 medium‐sized maternity hospitals to identify and remove systemic sources of inaccuracy in birth registry data. The primary outcome was the rate of scheduled deliveries without medical indication between 370/7 and 386/7 weeks at participating hospitals from birth registry data. Results Inaccurate birth registry data most commonly resulted from limited communication between clinical and medical record staff. The rate of scheduled births between 370/7 and 386/7 weeks’ gestation without a documented medical indication as recorded in the birth registry declined by 35%. Conclusion A QI initiative aimed at increasing the accuracy of birth registry information demonstrated the utility of these data for surveillance of perinatal outcomes and has led to ongoing efforts to support birth registrars in submitting accurate data.

Dissemination of a quality improvement intervention to reduce early term elective deliveries and improve birth registry accuracy at scale in Ohio

Methods Participating hospitals were exposed to an 8-month QI intervention to reduce non-medically indicated scheduled deliveries <39 weeks and reflect those improvements in accurate state vital statistics data. The intervention was implemented using a step-wedge design with hospitals divided into three balanced waves. Effectiveness was assessed using interrupted time-series analysis. Interviews with a sample of participants and project call recordings were analyzed using qualitative methods to understand implementation.