IMPORTANCE Published data suggest that there are increased hospitalizations, placental abnormalities, and rare neonatal transmission among pregnant women with coronavirus disease 2019 (COVID-19). OBJECTIVES To evaluate adverse outcomes associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in pregnancy and to describe clinical management, disease progression, hospital admission, placental abnormalities, and neonatal outcomes. DESIGN, SETTING, AND PARTICIPANTS This observational cohort study of maternal and neonatal outcomes among delivered women with and without SARS-CoV-2 during pregnancy was conducted from March 18 through August 22, 2020, at Parkland Health and Hospital System (Dallas, Texas), a high-volume prenatal clinic system and public maternity hospital with widespread access to SARS-CoV-2 testing in outpatient, emergency department, and inpatient settings. Women were included if they were tested for SARS-CoV-2 during pregnancy and delivered. For placental analysis, the pathologist was blinded to illness severity. EXPOSURES SARS-CoV-2 infection during pregnancy. MAIN OUTCOMES AND MEASURES The primary outcome was a composite of preterm birth, preeclampsia with severe features, or cesarean delivery for abnormal fetal heart rate among women delivered after 20 weeks of gestation. Maternal illness severity, neonatal infection, and placental abnormalities were described.

Context Barbershop-based hypertension (HTN) outreach programs for black men are becoming increasingly common, but whether they are an effective approach for improving HTN control remains uncertain. Objective To evaluate whether a continuous high blood pressure (BP) monitoring and referral program conducted by barbers will motivate male patrons with elevated BP to pursue physician follow-up, leading to improved HTN control. Design, Setting, and Participants Cluster randomized trial (Barber-Assisted Reduction in Blood Pressure in Ethnic Residents [BARBER-1]) of HTN control among black male patrons of 17 black-owned barbershops in Dallas County, Texas (March 2006-December 2008). Intervention Black male patrons of participating barbershops underwent 10-week baseline BP screening. Study sites were then randomized to a comparison group (8 shops, 77 hypertensives/shop) that received standard BP pamphlets or an intervention group (9 shops, 75 hypertensives/shop) in which barbers continually offered BP checks with haircuts and promoted physician follow-up with gender-specific peer-based health messaging. After 10 months, follow-up data were obtained. Primary Outcome Measure Change in HTN control rate for each barbershop. Results The HTN control rate increased more in intervention-arm barbershops than in comparison-arm barbershops (absolute group difference, 8.8%; 95% confidence interval [CI], 0.8 to 16.9%; P=0.036); the intervention effect persisted after adjustment for covariates (P=0.031). A marginal intervention effect was found for systolic BP change (absolute group difference: −2.5 mmHg; 95% CI, −5.3 to 0.3 mmHg; P=0.08). Conclusion The effect of BP screening on HTN control among black male barbershop patrons was improved when barbers were enabled to become health educators, monitor BP, and promote physician referral. Further research is warranted. Trial registration clinicalTrials.gov Identifier NCT00325533

Pregnant women with severe or critical coronavirus disease 2019 (COVID-19) infection are at increased risk for preterm birth and pregnancy loss. In studies of hospitalized pregnant women with COVID-19, which have included between 240 and 427 infected women, the risk for preterm delivery (both iatrogenic and spontaneous) has ranged from 10% to 25%, with rates as high as 60% among women with critical illness. 1 The primary risk to a pregnancy appears to be from maternal illness. In addition, pregnant women may be at higher risk for severe illness and death caused by COVID-19 compared with nonpregnant women. In an analysis of national surveillance data that included pregnancy status of 409 462 women with symptomatic COVID-19 illness through October 3, 2020, the adjusted risk ratio in pregnant women (vs those of similar age and not pregnant) was 3.0 for intensive care unit admission, 2.9 for mechanical ventilation, and 1.7 for death. 2 Thus, preventing critical COVID-19 infection is important for both mother and fetus.It is now clear that early neonatal COVID-19 infections are rare, but whether maternal immune response to infection protects the fetus remains unknown. Despite reports of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) IgG detected in newborns with negative IgM and negative results on polymerase chain reaction, SARS-CoV-2-specific antibodies appear to be inefficiently transferred across the placenta following third-trimester maternal infection compared with antibody transfer following infection with influenza or pertussis. 3 Nevertheless, changes in SARS-CoV-2specific antibody glycosylation patterns and placental selectivity for these antibodies may compensate for suboptimal protection and could be an important lesson for vaccine development. Furthermore, the gestational age of de novo maternal antibody production influences the level of SARS-CoV-2-specific antibody that is detected in cord blood specimens, implying there may be an ideal time for maternal vaccination prior to delivery to optimize protection of the fetus.Vaccination during pregnancy is common to prevent maternal and infant morbidity from other infectious diseases. Vaccination is specifically recommended to prevent both influenza and pertussis. The clinical data on safety and efficacy of influenza vaccination are abundant. In a randomized trial of 3693 pregnant women in Nepal, influenza immunization was associated with a relative reduction in maternal febrile influenzalike illness by 19% and relative reductions of low birth weight by 15% and infant influenza disease by 30%. 4 These benefits were demonstrated following maternal immunization in either early or late gestation.Likewise, following early studies that demonstrated rapid decay of maternal pertussis antibody passively transferred to the neonate, a study that included 74 504 mother-infant pairs demonstrated an 85% rela-VIEWPOINT

IMPORTANCE Ensuring access to prenatal care services in the US is challenging, and implementation of telehealth options was limited before the COVID-19 pandemic, especially in vulnerable populations, given the regulatory requirements for video visit technology.OBJECTIVE To explore the association of audio-only virtual prenatal care with perinatal outcomes. DESIGN, SETTING, AND PARTICIPANTSThis cohort study compared perinatal outcomes of women who delivered between May 1 and October 31, 2019 (n = 6559), and received in-person prenatal visits only with those who delivered between May 1 and October 31, 2020 (n = 6048), when audioonly virtual visits were integrated into prenatal care during the COVID-19 pandemic, as feasible based on pregnancy complications. Parkland Health and Hospital System in Dallas, Texas, provides care to the vulnerable obstetric population of the county via a high-volume prenatal clinic system and public maternity hospital. All deliveries of infants weighing more than 500 g, whether live or stillborn, were included.EXPOSURES Prenatal care incorporating audio-only prenatal care visits. MAIN OUTCOMES AND MEASURESThe primary outcome was a composite of placental abruption, stillbirth, neonatal intensive care unit admission in a full-term (Ն37 weeks) infant, and umbilical cord blood pH less than 7.0. Visit data, maternal characteristics, and other perinatal outcomes were also examined.

Increasing severity of COVID-19 in pregnancy with Delta (B.1.617.2) variant surge OBJECTIVE:The Delta (B.1.617.2) variant of the SARS-CoV-2 virus became the predominant variant circulating in the United States beginning July 2021. 1 We report the trends of illness severity among obstetrical patients with COVID-19, on a background of Delta variant predominance and describe COVID-19 vaccinations in this cohort at Parkland Hospital-a public county hospital. STUDY DESIGN:We prospectively studied pregnant patients diagnosed with SARS-CoV-2 by nasal or nasopharyngeal swab polymerase chain reaction, in a large prenatal system encompassing a centralized acute care hospital and 10 community-based prenatal clinics, all with an integrated electronic health record. Externally tested patients who received care at Parkland were also included. In mid-May

studies should expand gender identity response options to be more inclusive of nonbinary, genderqueer, and gendernonconforming populations. Limitations to this study include possible response and self-report bias, limited generalizability (only 15 states collected gender identity data), gender identity misclassification, and unmeasured confounders.

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Despite a national plan to eliminate syphilis by 2005, recent trends have reversed previously achieved progress in the United States. After a nadir between 2000 and 2013, rates of primary and secondary syphilis among women and congenital syphilis rose by 172% and 185% between 2014 and 2018, respectively. Screening early in pregnancy, repeat screening in the third trimester and at delivery among women at high risk, adherence to recommended treatment regimens, and prompt reporting of newly diagnosed syphilis cases to local public health authorities are strategies that obstetrician–gynecologists can employ to fight the current epidemic. In this report, clinical manifestations and management of syphilis in pregnancy are reviewed, and both traditional and reverse sequence screening algorithms are reviewed in detail in the context of clinical obstetrics.