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Article ; Online: Hepatic encephalopathy precipitated by preeclampsia in the setting of cirrhosis: A case report.

Fang, Mary E / Peoples, Nicholas A / Goulding, Alison N / Tolcher, Mary C

2024 Volume 41, Page(s) e00587

Abstract: Preeclampsia and decompensated chronic liver disease are known triggers of acute hepatic dysfunction in pregnancy, rarely including hepatic encephalopathy. Differentiating the driver of acute hepatic dysfunction in patients with concomitant preeclampsia ... ...

Abstract	Preeclampsia and decompensated chronic liver disease are known triggers of acute hepatic dysfunction in pregnancy, rarely including hepatic encephalopathy. Differentiating the driver of acute hepatic dysfunction in patients with concomitant preeclampsia and preexisting liver disease presents a diagnostic challenge with important management implications. A 42-year-old woman, gravida 3 para 0201, at 24 1/7 weeks of gestation presented with hepatic encephalopathy, transaminitis, and hyperbilirubinemia in the setting of cirrhosis and severe new-onset preeclampsia. The preeclampsia was thought to be the leading etiology of hepatic encephalopathy, prompting emergent Cesarean delivery at 24 2/7 weeks. Hepatic encephalopathy, blood pressure, and laboratory derangements improved promptly post-delivery. Preeclampsia can trigger acute hepatic dysfunction, including hepatic encephalopathy, in the setting of previously compensated preexisting liver disease. Recognizing this association has important implications for management and treatment.
Language	English
Publishing date	2024-02-06
Publishing country	Netherlands
Document type	Case Reports
ZDB-ID	2800286-6
ISSN	2214-9112 ; 2214-9112
ISSN (online)	2214-9112
ISSN	2214-9112
DOI	10.1016/j.crwh.2024.e00587
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Article ; Online: Antiretroviral Therapy in Pregnancy: A 2023 Review of the Literature.

Goulding, Alison N / Meeks, Kasey / Shay, Lena / Casey, Sarah / Applegarth, Colton / McKinney, Jennifer

Current HIV/AIDS reports

2024 Volume 21, Issue 1, Page(s) 1–10

Abstract: Purpose of review: Selection of antiretroviral therapy during pregnancy must consider maternal physiology and resulting pharmacokinetic changes in pregnancy, resistance and efficacy profiles, tolerability and frequency of adverse effects, teratogenicity, ...

Abstract	Purpose of review: Selection of antiretroviral therapy during pregnancy must consider maternal physiology and resulting pharmacokinetic changes in pregnancy, resistance and efficacy profiles, tolerability and frequency of adverse effects, teratogenicity, and maternal, neonatal, and pregnancy outcomes. The objective of this review is to summarize the underlying data that informs the current clinical perinatal guidelines in the USA. Recent findings: Data now supports the use of dolutegravir at all stages of pregnancy with no significant increase in neural tube defects. Safety and pharmacokinetic data on newer antiretroviral medications in pregnancy continue to lag behind the general population. While there are multiple safety and tolerability concerns with older regimens, there are now multiple options of regimens that are highly efficacious and have good safety data in pregnancy. Most pregnant patients who are virally suppressed on a well-tolerated regimen are able to safely continue those medications during pregnancy.
MeSH term(s)	Pregnancy ; Female ; Infant, Newborn ; Humans ; HIV Infections/drug therapy ; Pregnancy Complications, Infectious/drug therapy ; Anti-Retroviral Agents/therapeutic use ; Anti-HIV Agents/therapeutic use
Chemical Substances	Anti-Retroviral Agents ; Anti-HIV Agents
Language	English
Publishing date	2024-01-26
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	2151206-1
ISSN	1548-3576 ; 1548-3568
ISSN (online)	1548-3576
ISSN	1548-3568
DOI	10.1007/s11904-024-00688-y
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Article ; Online: Human Papillomavirus and Adverse Pregnancy Outcomes: An Opportunity for Prevention?

Goulding, Alison N / Rahangdale, Lisa

Journal of women's health (2002)

2019 Volume 28, Issue 5, Page(s) 565–567

MeSH term(s)	Female ; Humans ; Infant, Newborn ; Papillomaviridae ; Papillomavirus Infections ; Pregnancy ; Retrospective Studies ; Vaccination
Language	English
Publishing date	2019-02-06
Publishing country	United States
Document type	Journal Article ; Comment
ZDB-ID	1139774-3
ISSN	1931-843X ; 1059-7115 ; 1540-9996
ISSN (online)	1931-843X
ISSN	1059-7115 ; 1540-9996
DOI	10.1089/jwh.2018.7602
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Article ; Online: Crucial nuances in understanding (mis)associations between the neonatal microbiome and Cesarean delivery.

Sassin, Alexa M / Johnson, Grace J / Goulding, Alison N / Aagaard, Kjersti M

Trends in molecular medicine

2022 Volume 28, Issue 10, Page(s) 806–822

Abstract: As rates of Cesarean delivery and common non-communicable disorders (NCDs), such as obesity, metabolic disease, and atopy/asthma, have concomitantly increased in recent decades, investigators have attempted to discern a causal link. One line of research ... ...

Abstract	As rates of Cesarean delivery and common non-communicable disorders (NCDs), such as obesity, metabolic disease, and atopy/asthma, have concomitantly increased in recent decades, investigators have attempted to discern a causal link. One line of research has led to a hypothesis that Cesarean birth disrupts the presumed normal process of colonization of the neonatal microbiome with vaginal microbes, yielding NCDs later in life. However, a direct link between a disrupted microbiota transfer at time of delivery and acute and/or chronic illness in infants born via Cesarean has not been causally established. Microbiota seeding from maternal vaginal or stool sources has been preliminarily evaluated as an intervention designed to compensate for the lack of (or limited) exposure to such sources among Cesarean-delivered neonates. However, to date, clinical trials have yet to show a clear health benefit with neonatal 'vaginal seeding' practices. Until the long-term effects of these microbiome alterations can be fully determined, it is paramount to conduct parallel meaningful and mechanistic-minded interrogations of the impact of clinically modifiable maternal, nutritional, or environmental exposure on the functional microbiome over the duration of pregnancy and lactation to determine their role in the mitigation of childhood and adult NCDs.
MeSH term(s)	Adult ; Cesarean Section/adverse effects ; Feces ; Female ; Humans ; Infant ; Infant, Newborn ; Microbiota ; Obesity ; Pregnancy ; Vagina
Language	English
Publishing date	2022-09-06
Publishing country	England
Document type	Journal Article ; Review ; Research Support, N.I.H., Extramural
ZDB-ID	2036490-8
ISSN	1471-499X ; 1471-4914
ISSN (online)	1471-499X
ISSN	1471-4914
DOI	10.1016/j.molmed.2022.07.005
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Article ; Online: A Pregnant Patient Presents with Leakage of Vaginal Fluid in the Second Trimester.

Goulding, Alison N / McKinney, Jennifer R / Crabtree Sokol, Diana / Beasley, Anitra D

NEJM evidence

2022 Volume 2, Issue 1, Page(s) EVIDmr2200281

Abstract: Leakage of Vaginal Fluid in the Second TrimesterA pregnant 43-year-old woman presented with leakage of vaginal fluid at 15 weeks of gestation. How do you approach the evaluation, and what is on your differential diagnosis? ...

Abstract	Leakage of Vaginal Fluid in the Second TrimesterA pregnant 43-year-old woman presented with leakage of vaginal fluid at 15 weeks of gestation. How do you approach the evaluation, and what is on your differential diagnosis?
MeSH term(s)	Pregnancy ; Female ; Humans ; Adult ; Pregnancy Trimester, Second
Language	English
Publishing date	2022-12-27
Publishing country	United States
Document type	Case Reports ; Journal Article
ISSN	2766-5526
ISSN (online)	2766-5526
DOI	10.1056/EVIDmr2200281
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Article ; Online: A Retrospective Review of Social Deprivation Index and Maternal Outcomes with Placenta Accreta Spectrum from a Single Referral Center.

Goulding, Alison N / Fox, Karin A / Reed, Christina C / Salmanian, Bahram / Shamshirsaz, Alireza A / Aagaard, Kjersti M

American journal of perinatology

2023 Volume 40, Issue 13, Page(s) 1383–1389

Abstract: Objective: Little is known about how community characteristics influence placenta accreta spectrum (PAS) outcomes. Our objective was to evaluate whether adverse maternal outcomes among pregnant people (gravidae) with PAS delivering at a single referral ... ...

Abstract	Objective: Little is known about how community characteristics influence placenta accreta spectrum (PAS) outcomes. Our objective was to evaluate whether adverse maternal outcomes among pregnant people (gravidae) with PAS delivering at a single referral center differ by community-level measures of social deprivation. Study design: We conducted a retrospective cohort study of singleton gravidae with histopathology confirmed PAS delivering from January 2011 to June 2021 at a referral center. Data abstraction collected relevant patient information, including resident zip code, which was linked to Social Deprivation Index (SDI) score (a measure of area-level social deprivation). SDI scores were divided into quartiles for analysis. Primary outcome was a composite of maternal adverse outcomes. Bivariate analyses and multivariable logistic regression were performed. Results: Among our cohort ( Conclusion: Within a cohort of gravidae with PAS delivered at a single referral center, we found that those living in more socially deprived communities were more likely to receive transfusion of ≥4 red blood cell units, but other maternal adverse outcomes did not differ. Our findings highlight the importance of considering how characteristics of the surrounding community can impact PAS outcomes and may assist with risk stratification and resource deployment. Key points: · Little is known about how community characteristics influence PAS outcomes.. · In a referral center, transfusion was more common in gravidae living in socially deprived areas.. · Future research should consider how community characteristics can impact PAS outcomes..
MeSH term(s)	Pregnancy ; Female ; Humans ; Retrospective Studies ; Placenta Accreta/epidemiology ; Placenta Accreta/surgery ; Blood Transfusion ; Social Deprivation ; Family
Language	English
Publishing date	2023-09-18
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-0043-1770162
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Article: A Retrospective Review of Social Deprivation Index and Maternal Outcomes with Placenta Accreta Spectrum from a Single Referral Center

Goulding, Alison N. / Fox, Karin A. / Reed, Christina C. / Salmanian, Bahram / Shamshirsaz, Alireza A. / Aagaard, Kjersti M.

American Journal of Perinatology

2023 Volume 40, Issue 13, Page(s) 1383–1389

Abstract	Objective: Little is known about how community characteristics influence placenta accreta spectrum (PAS) outcomes. Our objective was to evaluate whether adverse maternal outcomes among pregnant people (gravidae) with PAS delivering at a single referral center differ by community-level measures of social deprivation. Study Design: We conducted a retrospective cohort study of singleton gravidae with histopathology confirmed PAS delivering from January 2011 to June 2021 at a referral center. Data abstraction collected relevant patient information, including resident zip code, which was linked to Social Deprivation Index (SDI) score (a measure of area-level social deprivation). SDI scores were divided into quartiles for analysis. Primary outcome was a composite of maternal adverse outcomes. Bivariate analyses and multivariable logistic regression were performed. Results: Among our cohort ( n = 264), those in the lowest (least deprived) SDI quartile were older, had lower body mass index, and were more likely to identify as non-Hispanic white. Composite maternal adverse outcome occurred in 81 (30.7%), and did not differ significantly by SDI quartile. Intraoperative transfusion of ≥4 red blood cell units occurred more often among those living in deprived areas (31.2% in the highest [most deprived] vs. 22.7% in the lowest [least deprived] SDI quartile, p = 0.04). No other outcomes differed by SDI quartile. In multivariable logistic regression, a quartile increase in SDI was associated with 32% increased odds of transfusion of ≥4 red blood cell units (adjusted odds ratio: 1.32, 95% confidence interval: 1.01–1.75). Conclusion: Within a cohort of gravidae with PAS delivered at a single referral center, we found that those living in more socially deprived communities were more likely to receive transfusion of ≥4 red blood cell units, but other maternal adverse outcomes did not differ. Our findings highlight the importance of considering how characteristics of the surrounding community can impact PAS outcomes and may assist with risk stratification and resource deployment. Key Points: Little is known about how community characteristics influence PAS outcomes. In a referral center, transfusion was more common in gravidae living in socially deprived areas. Future research should consider how community characteristics can impact PAS outcomes.
Keywords	placenta accreta spectrum ; social determinants of health ; Social Deprivation Index ; neighborhood vulnerability
Language	English
Publishing date	2023-09-18
Publisher	Thieme Medical Publishers, Inc.
Publishing place	Stuttgart ; New York
Document type	Article
ZDB-ID	605671-4
ISSN	1098-8785 ; 0735-1631
ISSN (online)	1098-8785
ISSN	0735-1631
DOI	10.1055/s-0043-1770162
Database	Thieme publisher's database

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Article ; Online: Contraception and Breastfeeding at 4 Months Postpartum Among Women Intending to Breastfeed.

Goulding, Alison N / Wouk, Kathryn / Stuebe, Alison M

Breastfeeding medicine : the official journal of the Academy of Breastfeeding Medicine

2017 Volume 13, Issue 1, Page(s) 75–80

Abstract: Objective: To estimate the association between postpartum contraception and breastfeeding among women intending to breastfeed.: Methods: We analyzed data from the Infant Feeding Practices Study II, a prospective cohort study of U.S. mothers (2005- ... ...

Abstract	Objective: To estimate the association between postpartum contraception and breastfeeding among women intending to breastfeed. Methods: We analyzed data from the Infant Feeding Practices Study II, a prospective cohort study of U.S. mothers (2005-2007). Among 1,349 women with prenatal intention to breastfeed at least 4 months who reported contraception use 3 months postpartum, we used multivariable logistic regression to estimate odds and predicted probabilities of breastfeeding by contraceptive category. We considered prenatal breastfeeding intention, age, race, education, income, marital status, region, depressive symptoms, parity, and timing of return to work as potential confounders, using standard statistical methods to determine model covariates. Results: At 3 months postpartum, contraception was reported as follows: 720 (53%) nonhormonal contraceptives (NHCs), 256 (19%) combined hormonal contraceptives (CHCs), 217 (16%) progestin-only pills (POPs), 92 (7%) intrauterine devices, and 64 (5%) depot medroxyprogesterone acetate. Compared with NHCs, adjusted odds ratio (aOR) for any breastfeeding at 4 months postpartum among women using POPs was 3.15 (95% confidence interval [CI] 1.42-7.02), and for women using CHCs aOR was 0.17 (95% CI 0.10-0.29). For women using NHCs, predicted probability of any breastfeeding at 4 months postpartum was 90% (95% CI 85-94); it was 97% (95% CI 92-99) among those using POPs and 61% (95% CI 46-74) among those using CHCs. Conclusion: In a cohort of women intending to breastfeed at least 4 months, women using POPs were most likely, and women using CHCs were least likely, to achieve their breastfeeding intentions.
MeSH term(s)	Adolescent ; Adult ; Breast Feeding/psychology ; Breast Feeding/statistics & numerical data ; Contraception/methods ; Contraception/utilization ; Female ; Humans ; Intention ; Logistic Models ; Multivariate Analysis ; Postpartum Period ; Prospective Studies ; Return to Work/statistics & numerical data ; United States/epidemiology ; Young Adult
Language	English
Publishing date	2017-11-01
Publishing country	United States
Document type	Journal Article
ZDB-ID	2234680-6
ISSN	1556-8342 ; 1556-8253
ISSN (online)	1556-8342
ISSN	1556-8253
DOI	10.1089/bfm.2017.0064
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Article ; Online: Provider Counseling and Women's Family Planning Decisions in the Postpartum Period.

Goulding, Alison N / Bauer, Anna E / Muddana, Anitha / Bryant, Amy G / Stuebe, Alison M

Journal of women's health (2002)

2020 Volume 29, Issue 6, Page(s) 847–853

Abstract: Introduction: ...

Abstract	Introduction:
MeSH term(s)	Adult ; Contraception/statistics & numerical data ; Contraception Behavior/statistics & numerical data ; Contraceptive Agents ; Counseling/statistics & numerical data ; Cross-Sectional Studies ; Family Planning Services/statistics & numerical data ; Female ; Health Knowledge, Attitudes, Practice ; Humans ; Long-Acting Reversible Contraception ; Postpartum Period ; Surveys and Questionnaires
Chemical Substances	Contraceptive Agents
Language	English
Publishing date	2020-03-16
Publishing country	United States
Document type	Journal Article
ZDB-ID	1139774-3
ISSN	1931-843X ; 1059-7115 ; 1540-9996
ISSN (online)	1931-843X
ISSN	1059-7115 ; 1540-9996
DOI	10.1089/jwh.2019.7872
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Article ; Online: Maternal, Fetal, and Child Outcomes of Mental Health Treatments in Women: A Meta-Analysis of Pharmacotherapy.

Viswanathan, Meera / Middleton, Jennifer Cook / Stuebe, Alison M / Berkman, Nancy D / Goulding, Alison N / McLaurin-Jiang, Skyler / Dotson, Andrea B / Coker-Schwimmer, Manny / Baker, Claire / Voisin, Christiane E / Bann, Carla / Gaynes, Bradley N

Psychiatric research and clinical practice

2021 Volume 3, Issue 3, Page(s) 123–140

Abstract: Objective: The authors systematically reviewed evidence on pharmacotherapy for perinatal mental health disorders.: Methods: The authors searched for studies of pregnant, postpartum, or reproductive-age women with mental health disorders treated with ... ...

Abstract	Objective: The authors systematically reviewed evidence on pharmacotherapy for perinatal mental health disorders. Methods: The authors searched for studies of pregnant, postpartum, or reproductive-age women with mental health disorders treated with pharmacotherapy in MEDLINE, EMBASE, PsycINFO, the Cochrane Library, and trial registries from database inception through June 5, 2020 and surveilled literature through March 2, 2021. Outcomes included symptoms; functional capacity; quality of life; suicidal events; death; and maternal, fetal, infant, or child adverse events. Results: 164 studies were included. Regarding benefits, brexanolone for third-trimester or postpartum depression onset may be associated with improved depressive symptoms at 30 days when compared with placebo. Sertraline for postpartum depression may be associated with improved response, remission, and depressive symptoms when compared with placebo. Discontinuing mood stabilizers during pregnancy may be associated with increased recurrence of mood episodes for bipolar disorder. Regarding adverse events, most studies were observational and unable to fully account for confounding. Evidence on congenital and cardiac anomalies for treatment compared with no treatment was inconclusive. Brexanolone for depression onset in the third trimester or the postpartum period may be associated with risk of sedation or somnolence, leading to dose interruption or reduction when compared with placebo. Conclusions: Evidence from few studies supports the use of pharmacotherapy for perinatal mental health disorders. Although many studies report on adverse events, they could not rule out underlying disease severity as the cause of the association between exposures and adverse events. Patients and clinicians need to make informed, collaborative decisions on treatment choices.
Language	English
Publishing date	2021-05-04
Publishing country	United States
Document type	Journal Article ; Review
ISSN	2575-5609
ISSN (online)	2575-5609
DOI	10.1176/appi.prcp.20210001
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