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Article ; Online: Biomarkers and the Risk of Preeclampsia.

Emeruwa, Ukachi N / Gyamfi-Bannerman, Cynthia / Laurent, Louise C

2023 Volume 329, Issue 7, Page(s) 539–541

MeSH term(s)	Pregnancy ; Female ; Humans ; Pre-Eclampsia ; Biomarkers ; Risk Factors
Chemical Substances	Biomarkers
Language	English
Publishing date	2023-02-19
Publishing country	United States
Document type	Editorial ; Comment
ZDB-ID	2958-0
ISSN	1538-3598 ; 0254-9077 ; 0002-9955 ; 0098-7484
ISSN (online)	1538-3598
ISSN	0254-9077 ; 0002-9955 ; 0098-7484
DOI	10.1001/jama.2022.24906
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Article ; Online: Health Care Disparities in the COVID-19 Pandemic in the United States: A Focus on Obstetrics.

Emeruwa, Ukachi N / Gyamfi-Bannerman, Cynthia / Miller, Russell S

Clinical obstetrics and gynecology

2022 Volume 65, Issue 1, Page(s) 123–133

Abstract: The influence of social determinants of health on disease dynamics and outcomes has become increasingly clear, making them a prime target of investigation and mitigation efforts. The obstetric population is uniquely positioned to provide insight into the ...

Abstract	The influence of social determinants of health on disease dynamics and outcomes has become increasingly clear, making them a prime target of investigation and mitigation efforts. The obstetric population is uniquely positioned to provide insight into the health inequities exacerbated by the coronavirus disease 2019 pandemic given their susceptibility to infectious disease morbidity and frequent interactions with the health care system, which provide opportunities for ascertainment of disease incidence and severity. This review summarizes the data on disparities identified in the US obstetric population during the coronavirus disease 2019 pandemic as they relate to race and ethnicity, built environment, insurance status, language, and immigration status.
MeSH term(s)	COVID-19 ; Female ; Health Inequities ; Healthcare Disparities ; Humans ; Obstetrics ; Pandemics ; Pregnancy ; SARS-CoV-2 ; United States/epidemiology
Language	English
Publishing date	2022-01-18
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	391207-3
ISSN	1532-5520 ; 0009-9201
ISSN (online)	1532-5520
ISSN	0009-9201
DOI	10.1097/GRF.0000000000000665
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Article ; Online: Optimal Obstetric Management for Women with Diabetes: the Benefits and Costs of Fetal Surveillance.

Emeruwa, Ukachi N / Zera, Chloe

Current diabetes reports

2018 Volume 18, Issue 10, Page(s) 96

Abstract: Purpose of review: To elaborate on the risks and benefits associated with antenatal fetal surveillance for stillbirth prevention in women with diabetes.: Recent findings: Women with pregestational diabetes have a 3- to 5-fold increased odds of ... ...

Abstract	Purpose of review: To elaborate on the risks and benefits associated with antenatal fetal surveillance for stillbirth prevention in women with diabetes. Recent findings: Women with pregestational diabetes have a 3- to 5-fold increased odds of stillbirth compared to women without diabetes. The stillbirth risk in women with gestational diabetes (GDM) is more controversial; while recent data suggest the odds for stillbirth are approximately 50% higher in women with GDM at term (37 weeks and beyond) than in those without GDM, it is unclear if this risk is seen in women with optimal glycemic control. Current professional society guidelines are broad with respect to fetal testing strategies and delivery timing in women with diabetes. The data supporting strategies to reduce the risk of stillbirth in women with diabetes are limited. Antepartum fetal surveillance should be performed to reduce stillbirth rates; however, the optimal test, frequency of testing, and delivery timing are not yet clear. Future studies of obstetric management for women with diabetes should consider not just individual but also system level costs and benefits associated with antenatal surveillance.
MeSH term(s)	Cost-Benefit Analysis ; Diabetes, Gestational/economics ; Diabetes, Gestational/therapy ; Female ; Fetus/physiology ; Humans ; Obstetrics ; Pregnancy ; Risk Factors ; Stillbirth/epidemiology
Language	English
Publishing date	2018-09-07
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	2065167-3
ISSN	1539-0829 ; 1534-4827
ISSN (online)	1539-0829
ISSN	1534-4827
DOI	10.1007/s11892-018-1058-5
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Article ; Online: Advances in Management for Preterm Fetuses at Risk of Delivery.

Emeruwa, Ukachi N / Krenitsky, Nicole M / Sheen, Jean-Ju

Clinics in perinatology

2020 Volume 47, Issue 4, Page(s) 685–703

Abstract: Preterm birth accounts for only 11% of live births but contributes to up to 75% of neonatal mortality and more than half of long-term morbidity. Targeted interventions to reduce the most common causes of perinatal morbidity and mortality include ... ...

Abstract	Preterm birth accounts for only 11% of live births but contributes to up to 75% of neonatal mortality and more than half of long-term morbidity. Targeted interventions to reduce the most common causes of perinatal morbidity and mortality include intrapartum group B Streptococcus prophylaxis, magnesium sulfate for fetal neuroprotection, antenatal corticosteroids for fetal lung maturity, latency antibiotics for preterm premature rupture of membranes, and tocolysis to allow corticosteroid administration and transfer to a tertiary care center. This article reviews the evidence for interventions to improve outcomes for fetuses at risk for preterm delivery at different gestational ages.
MeSH term(s)	Anti-Bacterial Agents/therapeutic use ; Anticonvulsants/therapeutic use ; Betamethasone/therapeutic use ; Dexamethasone/therapeutic use ; Female ; Fetal Membranes, Premature Rupture/therapy ; Fetal Organ Maturity ; Fetal Viability ; Glucocorticoids/therapeutic use ; Humans ; Indomethacin/therapeutic use ; Magnesium Sulfate/therapeutic use ; Neonatal Sepsis/prevention & control ; Neuroprotective Agents/therapeutic use ; Nifedipine/therapeutic use ; Pregnancy ; Premature Birth/therapy ; Streptococcal Infections/prevention & control ; Streptococcus agalactiae ; Tocolysis ; Tocolytic Agents/therapeutic use
Chemical Substances	Anti-Bacterial Agents ; Anticonvulsants ; Glucocorticoids ; Neuroprotective Agents ; Tocolytic Agents ; Magnesium Sulfate (7487-88-9) ; Dexamethasone (7S5I7G3JQL) ; Betamethasone (9842X06Q6M) ; Nifedipine (I9ZF7L6G2L) ; Indomethacin (XXE1CET956)
Language	English
Publishing date	2020-11-05
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	193116-7
ISSN	1557-9840 ; 0095-5108
ISSN (online)	1557-9840
ISSN	0095-5108
DOI	10.1016/j.clp.2020.08.006
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Article ; Online: SARS-CoV-2 and hypertensive disease in pregnancy.

Madden, Nigel / Emeruwa, Ukachi N / Polin, Melanie / Bejerano, Shai / Gyamfi-Bannerman, Cynthia / Booker, Whitney A

American journal of obstetrics & gynecology MFM

2021 Volume 4, Issue 1, Page(s) 100496

MeSH term(s)	COVID-19 ; Female ; Humans ; Hypertension ; Infectious Disease Transmission, Vertical ; Pregnancy ; Pregnancy Complications, Infectious/diagnosis ; Pregnancy Complications, Infectious/epidemiology ; SARS-CoV-2
Language	English
Publishing date	2021-09-25
Publishing country	United States
Document type	Letter ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
ISSN	2589-9333
ISSN (online)	2589-9333
DOI	10.1016/j.ajogmf.2021.100496
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Article ; Online: Lasix for the prevention of de novo postpartum hypertension: A randomized placebo-controlled trial (LAPP Trial).

Emeruwa, Ukachi N / Azad, Hooman / Ona, Samsiya / Bejerano, Shai / Alnafisee, Sarah / Emont, Jordan / Mathew, Sharon / Batlle, Michelle / Arnold, Denice / Ukoha, Erinma P / Laurent, Louise C / Jacobs, Marni / Aubey, Janice J / Miller, Russell S / Gyamfi-Bannerman, Cynthia

American journal of obstetrics and gynecology

2024

Abstract: ... for whom secondary outcomes were assessed, 10% (n=8) developed dnPPHTN and 9% (n=7) were initiated ...

Abstract	Background: Birthing people with de novo postpartum hypertensive disorders remain among the highest risk for severe maternal morbidity. Randomized controlled trials demonstrate a benefit to oral loop-diuretics in decreasing postpartum hypertensive morbidity in patients with an antenatal diagnosis of preeclampsia. It is not known whether this same therapy benefits patients at risk for new-onset postpartum hypertension OBJECTIVE: To evaluate whether oral furosemide can reduce risk for de novo postpartum hypertension (dnPPHTN) among high-risk birthing people by reducing post-delivery blood pressure. Study design: From October 2021 to April 2022, we conducted a randomized triple-masked placebo-controlled clinical trial of individuals at high risk for dnPPHTN at a single university-based tertiary care medical center. A total of 82 postpartum patients with no antenatal diagnosis of chronic hypertension or a hypertensive disorder of pregnancy who were at high-risk for the development of dnPPHTN based on a pre-specified risk factor algorithm were enrolled after childbirth. The participants were randomly assigned in a 1:1 ratio to a five-day course of oral furosemide 20 mg daily or identical-appearing placebo starting within eight hours of delivery. Participants were followed for 6 weeks postpartum using Bluetooth-enabled remote blood pressure monitoring and electronic surveys. The primary outcome was the difference in mean arterial pressure (MAP) averaged over the 24 hours prior to discharge or the 24 hours prior to antihypertensive therapy initiation. The study was powered to detect a 5 mmHg difference in mean MAP (standard deviation 6.4 mmHg) with 90% power at an alpha of 0.05, requiring a sample size of 41 per group. Secondary outcomes included the rate of dnPPHTN, readmission data, other measures of hypertensive and maternal morbidity, breastfeeding data, and drug-related neonatal outcomes. Results: The primary outcome was assessed in 80 of the 82 participants. Baseline characteristics were similar between groups. There was no significant difference in mean MAP 24 hours prior to discharge (or antihypertensive initiation) in the furosemide group (88.9 ± 7.4 mmHg) compared to the placebo group (86.8 ± 7.1 mmHg; absolute difference 2.1 mmHg, 95% CI -1.2 to 5.3). Of the 79 participants for whom secondary outcomes were assessed, 10% (n=8) developed dnPPHTN and 9% (n=7) were initiated on antihypertensive therapy. Rates were not significantly different between groups. Conclusions: De novo postpartum hypertension is a common phenomenon among at-risk patients, warranting close monitoring for severe hypertension and other maternal morbidity. There is insufficient evidence to suggest that furosemide reduces mean MAP in the 24 hours prior to discharge from the delivery hospitalization (or antihypertensive medication initiation) compared to placebo.
Language	English
Publishing date	2024-04-17
Publishing country	United States
Document type	Journal Article
ZDB-ID	80016-8
ISSN	1097-6868 ; 0002-9378
ISSN (online)	1097-6868
ISSN	0002-9378
DOI	10.1016/j.ajog.2024.04.016
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Article ; Online: Race and neonatal respiratory morbidity in the late preterm period.

Andrikopoulou, Maria / Emeruwa, Ukachi N / Ludwig, Elizabeth / Overton, Eve / Gyamfi-Bannerman, Cynthia

American journal of obstetrics & gynecology MFM

2021 Volume 3, Issue 5, Page(s) 100408

Abstract: ... 26.9% (n=627) were Black/African American, 57.1% (n=1333) White, 3.56% (n=83) Asian, and 12.36% (n ...

Abstract	Background: Prematurity is one of the leading causes of perinatal morbidity and mortality. Some studies suggest that respiratory disease may differ by race in early preterm infants. However, the role of race in late preterm neonatal morbidity is not yet established. Objective: The objective of our study was to determine whether neonatal respiratory morbidity differs by race in neonates born late preterm. Study design: This was a secondary analysis of a randomized trial of women at high risk for late preterm delivery (Antenatal Late Preterm Steroids). Our study was limited to women with nonanomalous, singleton gestations, delivering between 34+0 to 36+6 weeks. Women were categorized into 4 groups by race: Black, White, Asian, or other/mixed. The primary outcome was a neonatal composite of treatment in the first 72 hours (continuous positive airway pressure or high-flow nasal cannula >2 hours, oxygen >4 hours, extracorporeal membrane oxygenation or mechanical ventilation) or stillbirth or neonatal death before 72 hours. The secondary outcomes included severe respiratory morbidity (the primary outcome extending continuous positive airway pressure or high-flow nasal cannula to >12 continuous hours and oxygen to at least 24 continuous hours), respiratory distress syndrome, transient tachypnea of the newborn, apnea, neonatal intensive care unit admission, bronchopulmonary dysplasia, and surfactant administration. The primary and secondary outcomes were assessed in the active (steroid) and placebo groups separately. We fit a logistic regression model to adjust for confounders related to respiratory morbidity. Results: Of a total of 2331 included women, 26.9% (n=627) were Black/African American, 57.1% (n=1333) White, 3.56% (n=83) Asian, and 12.36% (n=288) were other/mixed. In the placebo group, the rate of the primary outcome was significantly higher in Whites (18.6%) and Asians (22.8%) compared with the African American/Black group (12.3%) (P=.03). Adjusting for confounders, the primary outcome was not significant between the groups. The primary predictor for respiratory morbidity was a prior pregnancy with neonatal respiratory morbidity. Findings were similar in the steroid group, but severe respiratory morbidity was less common in Black infants compared with White infants (adjusted odds ratio, 0.45; 95% confidence interval, 0.24-0.83). However, a prior pregnancy with neonatal respiratory complications was no longer associated with respiratory morbidity after receipt of betamethasone. Conclusion: Late preterm respiratory morbidity was similar between racial groups. Although a history of pregnancy with previous neonatal respiratory disease is the strongest risk factor for recurrence, this risk factor is mitigated by the receipt of steroids.
MeSH term(s)	Betamethasone ; Female ; Humans ; Infant ; Infant, Newborn ; Infant, Premature ; Morbidity ; Pregnancy ; Premature Birth ; Respiratory Distress Syndrome, Newborn/epidemiology
Chemical Substances	Betamethasone (9842X06Q6M)
Language	English
Publishing date	2021-05-28
Publishing country	United States
Document type	Journal Article ; Randomized Controlled Trial
ISSN	2589-9333
ISSN (online)	2589-9333
DOI	10.1016/j.ajogmf.2021.100408
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Article ; Online: Adverse Outcomes during Postpartum Readmissions after Deliveries Complicated by Hypertensive Disorders of Pregnancy.

Emeruwa, Ukachi N / Gyamfi-Bannerman, Cynthia / Wen, Timothy / Booker, Whitney / Wright, Jason D / Huang, Yongmei / D'Alton, Mary E / Friedman, Alexander M

American journal of perinatology

2021 Volume 39, Issue 7, Page(s) 699–706

Abstract: Objective: This study aimed to characterize risk for postpartum complications based on specific hypertensive diagnosis at delivery.: Study design: This retrospective cohort study used the 2010 to 2014 Nationwide Readmissions Database to identify 60- ... ...

Abstract	Objective: This study aimed to characterize risk for postpartum complications based on specific hypertensive diagnosis at delivery. Study design: This retrospective cohort study used the 2010 to 2014 Nationwide Readmissions Database to identify 60-day postpartum readmissions. Delivery hospitalizations were categorized based on hypertensive diagnoses as follows: (1) preeclampsia with severe features, (2) superimposed preeclampsia, (3) chronic hypertension, (4) preeclampsia without severe features, (5) gestational hypertension, or (6) no hypertensive diagnosis. Risks for 60-day readmission was determined based on hypertensive diagnosis at delivery. The following adverse outcomes during readmissions were analyzed: (1) stroke, (2) pulmonary edema and heart failure, (3) eclampsia, and (4) severe maternal morbidity (SMM). We fit multivariable log-linear regression models to assess the magnitude of association between hypertensive diagnoses at delivery and risks for readmission and associated complications with adjusted risk ratios (aRR) as measures of effect. Results: From 2010 to 2014, 15.7 million estimated delivery hospitalizations were included in the analysis. Overall risk for 60-day postpartum readmission was the highest among women with superimposed preeclampsia (6.6%), followed by preeclampsia with severe features (5.2%), chronic hypertension (4.0%), preeclampsia without severe features (3.9%), gestational hypertension (2.9%), and women without a hypertensive diagnosis (1.5%). In adjusted analyses for pulmonary edema and heart failure as the outcome, risks were the highest for preeclampsia with severe features (aRR = 7.82, 95% confidence interval [CI]: 6.03, 10.14), superimposed preeclampsia (aRR = 8.21, 95% CI: 5.79, 11.63), and preeclampsia without severe features (aRR = 8.87, 95% CI: 7.06, 11.15). In the adjusted model for stroke, risks were similarly highest for these three hypertensive diagnoses. Evaluating risks for SMM during postpartum readmission, chronic hypertension and superimposed preeclampsia were associated with the highest risks. Conclusion: Chronic hypertension was associated with increased risk for a broad range of adverse postpartum outcomes. Risk estimates associated with chronic hypertension with and without superimposed preeclampsia were similar to preeclampsia with severe features for several outcomes. Key points: · Chronic hypertension was associated with increased risk for a broad range of adverse outcomes.. · Close postpartum follow-up is required if hypertension is present at delivery.. · The majority of readmissions occurred within 10 days after delivery hospitalization discharge..
MeSH term(s)	Female ; Heart Failure/epidemiology ; Humans ; Hypertension, Pregnancy-Induced/epidemiology ; Patient Readmission ; Postpartum Period ; Pre-Eclampsia/epidemiology ; Pregnancy ; Pulmonary Edema/epidemiology ; Retrospective Studies ; Stroke
Language	English
Publishing date	2021-11-12
Publishing country	United States
Document type	Journal Article
ZDB-ID	605671-4
ISSN	1098-8785 ; 0735-1631
ISSN (online)	1098-8785
ISSN	0735-1631
DOI	10.1055/s-0041-1739429
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Article ; Online: Associations Between Built Environment, Neighborhood Socioeconomic Status, and SARS-CoV-2 Infection Among Pregnant Women in New York City.

Emeruwa, Ukachi N / Ona, Samsiya / Shaman, Jeffrey L / Turitz, Amy / Wright, Jason D / Gyamfi-Bannerman, Cynthia / Melamed, Alexander

JAMA

2020 Volume 324, Issue 4, Page(s) 390–392

MeSH term(s)	Adult ; Betacoronavirus ; Built Environment/classification ; Built Environment/economics ; COVID-19 ; Coronavirus Infections/epidemiology ; Coronavirus Infections/transmission ; Cross-Sectional Studies ; Crowding ; Female ; Humans ; Income ; Logistic Models ; New York City/epidemiology ; Pandemics ; Pneumonia, Viral/epidemiology ; Pneumonia, Viral/transmission ; Population Density ; Pregnancy ; Pregnancy Complications, Infectious/epidemiology ; Residence Characteristics/classification ; SARS-CoV-2 ; Social Class ; Unemployment/statistics & numerical data
Keywords	covid19
Language	English
Publishing date	2020-06-18
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
ZDB-ID	2958-0
ISSN	1538-3598 ; 0254-9077 ; 0002-9955 ; 0098-7484
ISSN (online)	1538-3598
ISSN	0254-9077 ; 0002-9955 ; 0098-7484
DOI	10.1001/jama.2020.11370
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Article ; Online: Adding to the Denominator: A Case Report of Neuraxial Anesthesia for Cesarean Delivery in the Setting of Hemolysis, Elevated Liver Enzyme, Low Platelet, Thrombocytopenia, and Pulmonary Hypertension.

Meng, Marie-Louise / Bernstein, Kyra / Hussey, Patrick / Emeruwa, Ukachi N / Mourad, Mirella / Haythe, Jennifer / Landau, Ruth

A&A practice

2020 Volume 14, Issue 5, Page(s) 144–148

Abstract: The acceptable platelet count for the safe provision of neuraxial anesthesia in obstetric patients is unknown. Comorbidities may sway a provider to perform neuraxial anesthesia, despite thrombocytopenia, as the putative risk of spinal-epidural hematoma ... ...

Abstract	The acceptable platelet count for the safe provision of neuraxial anesthesia in obstetric patients is unknown. Comorbidities may sway a provider to perform neuraxial anesthesia, despite thrombocytopenia, as the putative risk of spinal-epidural hematoma may not outweigh the risks associated with general anesthesia. The case of a 22-year-old nulliparous woman undergoing a cesarean delivery with a new diagnosis of pulmonary hypertension and right heart failure, compounded with thrombocytopenia and possible Hemolysis, Elevated Liver Enzyme, and Low Platelet (HELLP) syndrome, is presented. Risks and benefits of general versus neuraxial anesthesia in this specific setting are reviewed.
MeSH term(s)	Anesthesia, Obstetrical/adverse effects ; Cesarean Section/methods ; Female ; HELLP Syndrome/diagnosis ; Heart Failure/diagnosis ; Hemolysis ; Humans ; Hypertension, Pulmonary/diagnosis ; Pregnancy ; Pregnancy Complications/diagnosis ; Thrombocytopenia/diagnosis ; Young Adult
Language	English
Publishing date	2020-01-23
Publishing country	United States
Document type	Case Reports ; Journal Article
ISSN	2575-3126
ISSN (online)	2575-3126
DOI	10.1213/XAA.0000000000001168
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