Background COVID-19 may be associated with adverse maternal and neonatal outcomes in pregnancy, but there is little controlled data to quantify the magnitude of these risks or to characterize the epidemiology and risk factors. Objective To quantify the associations of COVID-19 with adverse maternal and neonatal outcomes in pregnancy and to characterize the epidemiology and risk factors. Methods We performed a matched case-control study of pregnant patients with confirmed COVID-19 (cases) who delivered between 16 and 41 weeks’ gestation from March 11-June 11, 2020. Uninfected pregnant women (controls) were matched to COVID-19 cases on a 2:1 ratio based on delivery date. Maternal demographic characteristics, COVID-19 symptoms, laboratory evaluations, obstetrical and neonatal outcomes, and clinical management were chart abstracted. The primary outcomes included (i) a composite of adverse maternal outcome, defined as preeclampsia, venous thromboembolism, antepartum admission, maternal intensive care unit admission, need for mechanical ventilation, supplemental oxygen, or maternal death; and (ii) a composite of adverse neonatal outcome, defined as respiratory distress syndrome, intraventricular hemorrhage, necrotizing enterocolitis, five-minute Apgar score <5, persistent category 2 fetal heart rate tracing despite intrauterine resuscitation, or neonatal death. In order to quantify the associations between exposure to mild and severe/critical COVID-19 and adverse maternal and neonatal outcomes, unadjusted and adjusted analyses were performed using conditional logistic regression (to account for matching), with matched-pair odds ratio (OR) and 95% confidence interval (CI) based on 1000 bias-corrected bootstrap resampling as the effect measure. Associations were adjusted for potential confounders. Results 61 confirmed COVID-19 cases were enrolled during the study period (mild disease: n=54, 88.5%; severe disease: n=6, 9.8%; and critical disease: n=1, 1.6%). The odds of adverse composite maternal outcome were 3.4 times higher among cases compared to controls (18.0% versus 8.2%, adjusted OR 3.4, 95% CI 1.2-13.4). The odds of adverse composite neonatal outcome were 1.7 times higher in the case group compared to the control group (18.0% versus 13.9%, adjusted OR 1.7, 95% CI 0.8-4.8). Stratified analyses by disease severity indicated that the morbidity associated with COVID-19 in pregnancy was largely driven by the severe/critical disease phenotype. Major risk factors for associated morbidity were Black and Hispanic race, advanced maternal age, medical comorbidities, and antepartum admissions related to COVID-19. Conclusions COVID-19 during pregnancy is associated with increased risk for adverse maternal and neonatal outcomes, an association that is primarily driven by morbidity associated with severe/critical COVID-19. Black and Hispanic race, obesity, advanced maternal age, medical comorbiditi...

E valuative bibliometrics is a field of quantitative science that uses methodologies like citation analysis to evaluate research performance. 1 Citation analysis utilizes citation data to quantify the impact of research as a reflection of the number of references that an article receives over time. An article that is highly cited has been critically read, deemed of value, and used to promote and defend research. This type of bibliometric analysis is especially important in the modern context with the existence of predatory journals and variations in the peer review process. 2 Using citation analysis and other quantitative methodologies, bibliometrics can identify the most impactful papers in a journal's history. Published bibliometric studies have evaluated frequently cited papers in obstetrics and gynecology and other fields of medicine. 3e5 These studies provide insight into the important topics of each field and highlight the contributions of individual researchers and institutions. These studies can also focus on individual journals, identifying some of the most influential papers in a journal's history. 6 The Journal has published scientific articles for close to 150 years. During this time, the Journal published landmark papers that shaped the scope and practice of obstetrician-gynecologists. 3,7 In its current form, the Journal's influence extends across continents, reaching more than 43,000 readers in print and online each year. 8 The Journal is now one of the most impactful obstetrics and gynecology journals, ranked second to Human Reproduction Update and is the top-ranked publisher of original research in the field. 7 To date, there has not been a bibliometric study of top-cited papers in the Journal. On the 150th anniversary of the Journal, we performed this study to identify the top-cited papers from the Journal and to see how characteristics of these publications changed over time. We hypothesized that the present analysis would identify a representative list of the Journal's most influential papers while also providing insight into the Journal's history and illuminating its impact on the field of obstetrics and gynecology. Materials and Methods We performed a bibliometric study looking at the top-cited articles in the Journal. We used Web of Science (of Thomas Reuters) and Scopus to identify the 100 most frequently cited articles in each database.

We evaluated the contributions of maternal age, year of death (period), and year of birth (cohort) on trends in hypertension-related maternal deaths in the United States. We undertook a sequential time series analysis of 155 710 441 live births and 3287 hypertension-related maternal deaths in the United States, 1979 to 2018. Trends in pregnancy-related mortality rate (maternal mortality rate [MMR]) due to chronic hypertension, gestational hypertension, and preeclampsia/eclampsia, were examined. MMR was defined as death during pregnancy or within 42 days postpartum due to hypertension. Trends in overall and race-specific hypertension-related MMR based on age, period, and birth cohort were evaluated based on weighted Poisson models. Trends were also adjusted for secular changes in obesity rates and corrected for potential death misclassification. During the 40-year period, the overall hypertension-related MMR was 2.1 per 100 000 live births, with MMR being almost 4-fold higher among Black compared with White women (5.4 [n=1396] versus 1.4 [n=1747] per 100 000 live births). Advancing age was associated with a sharp increase in MMR at ≥15 years among Black women and at ≥25 years among White women. Birth cohort was also associated with increasing MMR. Preeclampsia/eclampsia-related MMR declined annually by 2.6% (95% CI, 2.2–2.9), but chronic hypertension–related MMR increased annually by 9.2% (95% CI, 7.9–10.6). The decline in MMR was attenuated when adjusted for increasing obesity rates. The temporal burden of hypertension-related MMR in the United States has increased substantially for chronic hypertension–associated MMR and decreased for preeclampsia/eclampsia-associated MMR. Nevertheless, deaths from hypertension continue to contribute substantially to maternal deaths.

Placental abruption and cardiovascular disease (CVD) have common etiologic underpinnings and there is accumulating evidence that abruption may be associated with future CVD. We estimate associations between abruption and coronary heart disease (CHD) and stroke. The meta-analysis was based on the random-effects risk ratio (RR) and 95% confidence interval (CI) as the effect measure. We conducted a bias analysis to account for abruption misclassification, selection bias and unmeasured confounding. We included 11 cohort studies comprised of 6,325,152 pregnancies, 69,759 abruptions and 49,265 CHD and stroke cases (1967 to 2016). Risks of the combined CVD morbidity-mortality among abruption and non-abruption groups were 16.7 and 9.3 per 1000 births, respectively (RR 1.76, 95% CI: 1.24, 2.50; I2=94%; τ2=0.22). Women who suffered abruption were at 2.65-fold (95% CI: 1.55, 4.54; I2=85%; τ2=0.36) higher risk for deaths related to CHD/stroke than non-fatal CHD/stroke complications (RR 1.32, 95% CI: 0.91, 1.92; I2=93%; τ2=0.15). Abruption was associated with higher mortality from CHD (RR 2.64, 95% CI: 1.57, 4.44; I2=76%; τ2=0.31) than stroke (RR 1.70, 95% CI: 1.19, 2.42; I2=40%; τ2=0.05). Corrections for the aforementioned biases increased these estimates. Women with pregnancies complicated by placental abruption may benefit from postpartum screening or therapeutic interventions to help mitigate CVD risks.

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Background: Universal testing for coronavirus disease (COVID-19) on labor and delivery identifies asymptomatic patients. Whether or not these patients are at increased risk for adverse outcomes and go on to develop clinically significant disease is uncertain. Objective: To assess the prevalence of asymptomatic COVID-19 among pregnant patients admitted for delivery and to determine if these patients become symptomatic or require hospital readmission after discharge. Methods: We performed a multicenter prospective cohort study of pregnant patients between 20 0/7 and 41 6/7 weeks gestation who were found to have COVID-19 based on universal screening on delivery admission at four medical centers in New Jersey (exposed group). The unexposed group comprised of patients who tested negative for COVID-19 were identified from the primary study site. The primary outcomes were the asymptomatic positive COVID-19 rate and the development of symptoms in the asymptomatic positive patients and hospital readmission in the two weeks following discharge. We compared the frequency distribution of risk factors and outcomes in relation to COVID-19 status, with COVID-19 positive patients across all centers and COVID-19 negative patients at the primary site. Associations for categorical risk factors with respect to COVID-19 status were expressed as relative risks (RR) with 95% confidence intervals (CI). Results : Between 10 April 2020 to 15 June 2020, there were 218 COVID-19 positive patients from the four sites and 413 COVID-19 negative patients from the primary site. The majority (188 [83.2%]) of COVID-19 positive patients were asymptomatic. Compared to negative controls, these asymptomatic patients were not at increased risk for obstetric complications that may increase the risk for COVID-19, including gestational diabetes (8.2% versus 11.4%, RR 0.72, 95% CI 0.24-2.01) and gestational hypertension (6.1% versus 7.0%, RR 0.88, 95% CI 0.29-2.67). Postpartum follow-up via telephone surveys revealed that these patients remained asymptomatic and had low rates of family contacts acquiring the disease, but their adherence with social distancing guidelines waned during the two weeks postpartum. Review of inpatient and emergency department records revealed low rates of hospital readmission. Conclusions : The majority of pregnant patients who screened positive for COVID-19 are asymptomatic and do not go on to develop clinically significant infection after delivery. Routine surveillance of these patients after hospital discharge appears sufficient.

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