Diabetic retinopathy (DR) is the most feared ocular manifestation of diabetes. DR is characterized by progressive retinal damage that may eventually result in blindness. Clinically, this blindness is caused by progressive damage to the retinal microvasculature, which leads to ischemia, retinal swelling, and neovascularization. Retinopathy is associated with both type 1 and type 2 diabetes, with DR being the leading cause of new onset blindness in United States adults. Despite this strong association with diabetes, it must be noted that the development of retinopathy lesions is multifactorial and may occur in individuals without an established history of diabetes. Metabolic syndrome is a multifactorial condition of central obesity, hypertriglyceridemia, dyslipidemia, hypertension, fasting hyperglycemia, and insulin resistance. Although several studies examined the individual components observed in the metabolic syndrome in relation to the development of DR, there is conflicting data as to the association of the metabolic syndrome with the development of retinopathy lesions in non-diabetic subjects. This review will summarize the current literature on the evidence of the metabolic syndrome on retinopathy in subjects with and without an established history of diabetes. This review will also discuss some of the mechanisms through which metabolic syndrome can contribute to the development of retinopathy.

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OBJECTIVE:We sought to examine the cost effectiveness and outcomes associated with universal vasa previa screening during pregnancy. STUDY DESIGN: A cost-effectiveness model using TreeAge Pro 2020 software was designed to compare outcomes and costs in women who received universal vasa previa screening versus women who received no vasa previa screening during pregnancy. We used a theoretical cohort of 3,945,000, the approximate number of live births each year in the U.S. Outcomes included stillbirth, intrapartum death, neonatal death, and cerebral palsy, in addition to cost and quality-adjusted life years (QALYs) for both the woman and the neonate. Probabilities were derived from the literature, and a costeffectiveness threshold was set at $100,000/QALY. Sensitivity analyses were performed to determine the robustness of baseline assumptions. RESULTS: In our theoretical cohort, universal vasa previa screening was a cost-effective strategy. Universal screening for vasa previa resulted in 1,499 fewer cases of missed vasa previa (Table 1). Universal screening for vasa previa resulted in fewer intrapartum deaths and cases of cerebral palsy. Universal screening for vasa previa resulted in increased effectiveness and increased costs with an incremental cost-effectiveness ratio of $82,272/QALY. This was below the willingness-to-pay threshold of $100,000/QALY, making universal screening cost effective. Sensitivity analysis demonstrated that universal vasa previa screening was cost effective as long as the sensitivity of transvaginal ultrasound for detecting vasa previa was greater than 81% (Figure 1). CONCLUSION: Universal vasa previa screening during pregnancy is a cost-effective strategy and decreases the risk of adverse neonatal outcomes.

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OBJECTIVE: Male sex is associated with the development of severe neonatal opioid withdrawal syndrome (NOWS) in opioid exposed pregnancies. Placental efflux transporters, P-glycoprotein (P-gp) and breast cancer resistance protein (BCRP), are critical for transfer of drugs from the placenta to maternal circulation. Aromatase is responsible for metabolizing Methadone and Buprenorphine in the human placenta. We sought to determine whether sex differences exist in placental aromatase and efflux transporter density within the apical syncytiotrophoblast. STUDY DESIGN: This was a retrospective cohort study from 2014-2019 at a single tertiary site. Pregnant women ! age 18 with nonanomalous fetuses on maintenance Methadone or Buprenorphine with gestational age !33 weeks were included. De-paraffinized placental sections, including the apical syncytiotrophoblast membrane, were labeled with monoclonal antibodies for aromatase, P-gp and BCRP. Placentas were scored for presence and intensity of staining using the Allred scoring schema. Severe NOWS requiring opioid treatment was defined by 3 consecutive Finnegan scores !8 or the sum of 3 consecutive Finnegan scores !24 within 72 hours of birth. Data was analyzed using descriptive, parametric and nonparametric statistics. A p-value of <0.05 was considered significant. RESULTS: There were 110 opioid exposed neonates included in this analysis with a mean gestational age of 37 weeks. Of the 46% (51/110) of infants with severe NOWS, 69% (35/51) were Methadone exposed and 31% (16/ 51) were Buprenorphine exposed (p ¼0.01). There were significantly more males in the group with severe NOWS (non-severe 24 (41%) vs severe 34 (67%), p<0.01). There were no differences in median placental Allred scores for aromatase, P-gp or BCRP between groups (p>0.05). Aromatase and placental efflux transporters had weak, but significant correlation (rho¼0.22). P-gp and BCRP exhibited strong correlation (rho¼0.59). CONCLUSION: Male infants within our cohort were significantly more likely to develop severe NOWS. We found no sex differences in aromatase, P-gp and BCRP within apical syncytiotrophoblasts.

Objective: We compared differences in perinatal outcomes among rural and non-rural women, stratified by maternal race/ethnicity. We also examined differences between majority minority rural counties with majority white rural counties. Study Design: We conducted a retrospective cohort study with 2015 national vital statistics birth certificate data. Maternal county of residence was identified and counties with <50,000 people were designated rural. We compared adverse perinatal outcomes between rural and non-rural residents, stratified by race/ethnicity. Adverse perinatal outcomes included primary term cesarean, preterm birth (PTB) <37 weeks and <32 weeks, NICU admissions, infant death, small for gestational age, and Apgar score at 5min <7 and <3. Majority minority rural counties were defined as counties having <50% white women. We compared perinatal outcomes among this cohort to those of women from majority white rural counties. Bivariate analysis and multivariable logistic regression were performed. Results: Within the entire cohort, rural residents were more likely to be younger (age >/= 35 10.1% vs 16.8%; p <0.001), Medicaid beneficiaries (50.3% vs 44.1%; p<0.001) and uninsured (6.6% vs 4.2%; p<0.001), and less likely to be married (57.4% vs 60.20%; p<0.001). Rural residence was associated with Apgar score <7 (adjusted odds ratio [aOR] 2.04; 95% confidence interval [CI] 1.64-2.54) and <3 (aOR 1.90; 95% CI 1.04-3.48) among Asian women. Rural residence was also associated with PTB <37 weeks among Black (aOR 1.09; 95% CI 1.06-1.13) and Asian women (aOR 1.16; 95% CI 1.03-1.31). When compared to majority white rural county of residence, majority minority rural county of residence was associated with the adverse perinatal outcomes studied. Conclusion: We observed increased rates of adverse perinatal outcomes among rural women. These trends persisted in majority minority rural. Additional study is needed to find actionable targets for improving outcomes for rural women.