Rice refines analysis of MRI contrast agents

Engineers dig deep to detail magnetic mechanism of gadolinium-based agents

Peer-Reviewed Publication

RICE UNIVERSITY

 

IMAGE: SIMULATIONS BY RICE UNIVERSITY ENGINEERS HAVE REVEALED DETAILS ABOUT THE MOLECULAR INTERACTIONS BETWEEN GADOLINIUM CONTRAST AGENTS USED IN MRI SCANS AND THEIR LIQUID ENVIRONMENT. IN THIS MODEL, GREEN GADOLINIUM IS SURROUNDED BY BLUE CHELATE IONS, THEMSELVES SURROUNDED BY WATER (GRAY OXYGEN AND RED HYDROGEN ATOMS). view more 

CREDIT: THIAGO PINHEIRO DOS SANTOS/RICE UNIVERSITY

HOUSTON – (Nov. 17, 2022) – You can keep your best guesses. Engineers at Rice University’s George R. Brown School of Engineering are starting to understand exactly what goes on when doctors pump contrast agents into your body for an MRI scan. 

In a new study that could lead to better scans, a Rice-led team digs deeper via molecular simulations that, unlike earlier models, make absolutely no assumptions about the basic mechanisms at play when gadolinium agents are used to highlight soft tissues. 

The study led by Rice chemical and biomolecular engineer Philip Singer, former associate research professor Dilip Asthagiri, now of Oak Ridge National Laboratory, and graduate student Thiago Pinheiro dos Santos appears in Physical Chemistry Chemical Physics.

It employs the sophisticated models first developed at Rice for oil and gas studies to conclusively analyze how hydrogen nuclei at body temperatures “relax” under nuclear magnetic resonance (NMR), the technology used by magnetic resonance imaging, aka MRI.

Doctors use MRI to “see” the state of soft tissues, including the brain, in a patient by inducing magnetic moments in the hydrogen nuclei of water molecules to align with the magnetic field, a process that can be manipulated when gadolinium agents are in the vicinity. The device detects bright spots when the aligned nuclei relax back to thermal equilibrium following an excitation. The faster they relax, the brighter the contrast.

Gadolinium molecules are naturally paramagnetic and sensitive to magnetic excitation. Because they’re toxic, they are usually chelated when part of a contrast agent. “A chelate basically hugs the gadolinium and protects your body from directly interacting with the metal,” Pinheiro dos Santos said. “We’re asking, exactly how do these molecules behave?”

Though gadolinium-based contrast agents are injected by the ton into patients each year, how they work on a molecular level has never been fully understood. 

“Going back 40 years, in the NMR field people assumed liquid water is just a collection of marbles moving about, and the dipoles in the marbles randomly reorient,” Asthagiri said. 

But such assumptions are limiting, he said. “What Thiago does with his explicit simulation is show how the water network evolves in time,” Asthagiri said. “These are complicated, computationally intensive calculations.”

The Rice simulations make use of highly refined, polarizable force fields to study the phenomenon in detail, and that required intensive GPU-accelerated computing. 

The team validated its molecular dynamics approach with experimental data by co-author Steven Greenbaum, a professor of physics at Hunter College in the City University of New York, whose lab specializes in NMR measurements of ionic and molecular transport processes in condensed matter.

The simulations revealed distinct differences in how the inner and outer shells of water molecules around gadolinium respond to thermal excitation. “The inner shell is the group of eight or nine water molecules around gadolinium,” Pinheiro dos Santos said. “They’re strongly attached to the gadolinium and they stay there for a long time, a few nanoseconds. The outer shell encompasses all of the remaining water molecules.” 

The researchers found that while the structure of the inner shell does not change between 41 and 98.6 degrees Fahrenheit, its dynamics are very susceptible to thermal effects. They also discovered that temperature greatly affects the self-diffusivity of molecules in the gadolinium-water simulations in a way that affects outer-shell relaxation. 

“Overall, these discoveries open a new way to elucidate how contrast agents respond at human body conditions during an MRI scan,” Singer said. “By better understanding this, one can develop new, safer and more sensitive contrast agents, as well as use simulations to enhance the interpretation of MRI data.”

He said future studies will examine chelated gadolinium complexes in fluids that are more representative of cellular interiors. 

Co-authors of the paper are Rice alumnus Arjun Valiya Parambathu, now a postdoctoral researcher at the University of Delaware; Carla Fraenza and Casey Walsh of Hunter College; and Walter Chapman, the William W. Akers Professor of Chemical and Biomolecular Engineering at Rice. 

The Robert A. Welch Foundation (C-1241), the Ken Kennedy Institute, the Rice University Creative Ventures Fund and the Rice University Consortium on Processes in Porous Media supported the research. Research at Oak Ridge National Laboratory is supported under contract DE-AC05-00OR22725 from the U.S. Department of Energy to UT-Battelle LLC.

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Read the abstract at https://pubs.rsc.org/en/content/articlelanding/2022/cp/d2cp04390d.

This news release can be found online at https://news.rice.edu/news/2022/rice-refines-analysis-mri-contrast-agents.

Follow Rice News and Media Relations via Twitter @RiceUNews.

Video:

https://youtu.be/4WyjIXdKdPs

Video produced by Thiago Pinheiro dos Santos 

Images for download:

https://news-network.rice.edu/news/files/2022/11/1124_NMR-1-web.jpg

Simulations by Rice University engineers have revealed details about the molecular interactions between gadolinium contrast agents used in MRI scans and their liquid environment. In this model, green gadolinium is surrounded by blue chelate ions, themselves surrounded by water (gray oxygen and red hydrogen atoms). (Credit: Thiago Pinheiro dos Santos/Rice University)

https://news-network.rice.edu/news/files/2022/11/1124_NMR-2-web.jpg

Simulations by Rice University engineers revealed details about the magnetic interactions between gadolinium contrast agents used in MRI scans and their environment. From left: Philip Singer, Walter Chapman and Dilip Asthagiri. (Credit: Jeff Fitlow/Rice University)

https://news-network.rice.edu/news/files/2022/11/1124_NMR-3-web.jpg

Rice University graduate student Thiago Pinheiro dos Santos is lead author of a study that adds detail to models of gadolinium-based contrast agents used in MRI. (Credit: Rice University)

Related materials:

Modern simulations could improve MRIs: https://news2.rice.edu/2021/09/20/modern-simulations-could-improve-mris/

Chapman Research Group: https://www.ruf.rice.edu/~saft/

Chemical and Biomolecular Engineering: https://chbe.rice.edu

George R. Brown School of Engineering: https://engineering.rice.edu

Located on a 300-acre forested campus in Houston, Rice University is consistently ranked among the nation’s top 20 universities by U.S. News & World Report. Rice has highly respected schools of Architecture, Business, Continuing Studies, Engineering, Humanities, Music, Natural Sciences and Social Sciences and is home to the Baker Institute for Public Policy. With 4,240 undergraduates and 3,972 graduate students, Rice’s undergraduate student-to-faculty ratio is just under 6-to-1. Its residential college system builds close-knit communities and lifelong friendships, just one reason why Rice is ranked No. 1 for lots of race/class interaction and No. 1 for quality of life by the Princeton Review. Rice is also rated as a best value among private universities by Kiplinger’s Personal Finance.

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JOURNAL

Physical Chemistry Chemical Physics

DOI

10.1039/D2CP04390D 

METHOD OF RESEARCH

Computational simulation/modeling

SUBJECT OF RESEARCH

Not applicable

ARTICLE TITLE

Thermal and concentration effects on 1H NMR relaxation of Gd3+-aqua using MD simulations and measurements

ARTICLE PUBLICATION DATE

8-Nov-2022

Plants use their epigenetic memories to adapt to climate change, scientists say

Peer-Reviewed Publication

CELL PRESS

Animals can adapt quickly to survive adverse environmental conditions. Evidence is mounting to show that plants can, too. A paper publishing in the journal Trends in Plant Science on November 17 details how plants are rapidly adapting to the adverse effects of climate change, and how they are passing down these adaptations to their offspring.

“One day I thought how the living style and experience of a person can affect his or her gametes transmitting molecular marks of their life into their children,” says Federico Martinelli, a plant geneticist at the University of Florence. “Immediately I thought that even more epigenetic marks must be transmitted in plants, being that plants are sessile organisms that are subjected to many more environmental stresses than animals during their life.”

Plants are facing more environmental stressors than ever. For example, climate change is making winters shorter and less severe in many locations, and plants are responding. “Many plants require a minimum period of cold in order to set up their environmental clock to define their flowering time,” says Martinelli. “As cold seasons shorten, plants have adapted to require less period of cold to delay flowering. These mechanisms allow plants to avoid flowering in periods where they have less chances to reproduce.”

Because plants don’t have neural networks, their memory is based entirely on cellular, molecular, and biochemical networks. These networks make up what the researchers term somatic memory. “These mechanisms allow plants to recognize the occurrence of a previous environmental condition and to react more promptly in presence of the same consequential condition,” says Martinelli.

These somatic memories can then be passed to the plants’ progeny via epigenetics. “We have highlighted key genes, proteins, and small oligonucleotides, which previous studies have shown play a key role in the memory of abiotic stresses such as drought, salinity, cold, heat, and heavy metals and pathogen attacks,” says Martinelli. “In this peer-reviewed opinion piece, we provide several examples that demonstrate the existence of molecular mechanisms modulating plant memory to environmental stresses and affecting the adaptation of offspring to these stresses.”

Going forward, Martinelli and his colleagues hope to understand even more about the genes that are being passed down. “We are particularly interested in decoding the epigenetic alphabet underlying all the modifications of the genetic material caused by the environment, without changes in DNA sequence,” he says. “This is especially important when we consider the rapid climate change we observe today that every living organism, including plants, needs to quickly adapt to in order to survive.”

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Trends in Plant Science, Gallusci et al.: “Deep inside the epigenetic memories of stressed plants” https://www.cell.com/trends/plant-science/fulltext/S1360-1385(22)00266-7

Trends in Plant Science (@TrendsPlantSci), published by Cell Press, is a monthly review journal that features broad coverage of basic plant science, from molecular biology to ecology. Aimed at researchers, students, and teachers, its articles are authoritative and written by both leaders in the field and rising stars. Visit http://www.cell.com/trends/plant-science. To receive Cell Press media alerts, please contact press@cell.com.

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JOURNAL

Trends in Plant Science

DOI

10.1016/j.tplants.2022.09.004 

METHOD OF RESEARCH

Commentary/editorial

SUBJECT OF RESEARCH

Not applicable

ARTICLE TITLE

Deep inside the epigenetic memories of stressed plants

ARTICLE PUBLICATION DATE

17-Nov-2022

Social bees travel greater distances for food than their solitary counterparts, study finds

Peer-Reviewed Publication

UNIVERSITY OF BRISTOL

 

IMAGE: HONEYBEE WITH POLLEN ON SUNFLOWER view more 

CREDIT: FRANCISCA SEGERS

Social bees such as honeybees and bumblebees have larger foraging ranges, according to researchers at the University of Bristol.

The findings, published today in Current Biology, show that social bees venture further for pollen and nectar. This has implications for predicting pollination services and for creating effective conservation strategies for bees and plants.

Social bees travel bigger distances as a result of several traits which include body size, colony size, communication and flower constancy.

Larger bees like the bumblebee have greater foraging ranges. They have bigger wings and can fly faster so it's easier for them to cover more ground.

Bees from greater colonies will experience more competition from their sisters if they stay close to the nest so they need to travel further to avoid congestion.

Many social bees have evolved different kinds of communication methods. This allows foragers that have found a highly rewarding flower species to tell their sisters about their discovery. As a result, more bees will have a preference for the same kind of flowers.

Furthermore social bees tend to visit one type of flower during a foraging trip. Flower constancy means that bees ignore viable alternative options as they focus only on a subset of all available flowers, forcing them to travel further to find their favoured flower.

As bees, and especially social bees, are amongst the most important pollinators, while also being under threat, the findings have implications for their protection and the conservation of endangered plants which they pollinate.

Lead author Dr Christoph Grueter, from Bristol’s School of Biological Sciences explained: “Our findings suggest that solitary bees might be most affected by human-caused habitat loss and fragmentation because they will struggle more to find suitable food sources at greater distances.

“Social bees might be particularly important for the protection of endangered plant species that exist only in isolated patches. Since many social bee species can be kept in hives, we could use our understanding of their foraging ranges in targeted ways to aid the pollination of plants in remote areas.”

Dr Grueter and Lucy Hayes carried out the study during lockdown using coding to build a simulation model in combination with published literature to find the existing data on bee foraging ranges of 90 bee species.  They also developed an agent-based model to test how social, dietary, and environmental factors affect foraging ranges. Now he plans to study and confirm the findings in the bees’ natural environment and look at which bees are most and least affected by habitat loss and fragmentation.

He added: “Since there will be a big international push for reforestation and rewilding, this will help us understand how reforestation and rewilding projects might affect and be affected by different pollinator groups.

“Their social lifestyle means that bee colonies collect food over a much larger area than solitary bees. This helps us to plan effective conservation strategies to help both bees and the plants they pollinate.”

Paper:

‘Sociality is a key driver of foraging ranges in bees’ by Christoph Grueter and Lucy Hayes in Current Biology.

Honeybee with transponder

CREDIT

Christoph Grueter

CAPTION

Stingless bee (Melipona quadrifasciata) collecting nectar

CREDIT

Christoph Grueter

METHOD OF RESEARCH

Computational simulation/modeling

SUBJECT OF RESEARCH

Animals

ARTICLE TITLE

Sociality is a key driver of foraging ranges in bees

Environment: Feeding pets dry food reduces their environmental impact

Peer-Reviewed Publication

SCIENTIFIC REPORTS

Cat and dog owners could significantly reduce the environmental impact of their pets’ diets by feeding them dry food (consisting of kibble or biscuits) rather than wet food with higher water content, suggests a study of Brazilian pets published in Scientific Reports. The findings highlight how pet owners can feed their animals more sustainably while still providing them with sufficient nutrients and calories.

The population of pet cats and dogs is growing worldwide. Currently, the USA is estimated to have 76.8 million dogs and 58.4 million cats, while Brazil has 52.2 million dogs and China has 53.1 million cats. However, the environmental impact of pet diets is unclear.

Marcio Brunetto and colleagues evaluated the environmental impacts – including greenhouse gas emissions, land use, and water usage – of 618 diets for dogs and 320 diets for cats in Brazil. The authors investigated commercial wet diets and dry diets found on the websites of three major Brazilian pet food retailers. These were also compared to homemade diets – either food produced by companies, or food cooked by owners at home using recipes provided by companies. Additionally, the authors assessed the nutritional and calorific make-up of the different diets.

For all variables, wet diets for cats and dogs had the greatest environmental impact, particularly compared to dry diets. Homemade diets tended to have intermediary environmental impacts, although water usage in homemade cat diets was similar to dry diets. The authors estimate that a ten-kilogram dog consuming on average 534 calories per day would be responsible for 828.37 kilograms of CO2 per year when fed a dry diet compared to 6,541 kilograms of CO2 per year for a wet diet – an almost seven-fold increase (689%).

Dry diets provided the highest amount of energy per gram, while wet diets and homemade diets provided higher amounts of protein. In wet diets, almost twice as much energy was provided by animal ingredients compared to dry diets (45.42% versus 89.27%), which may contribute to their greater environmental impact. 

These results highlight the extensive environmental impacts of pet foods, the need to make them more sustainable and an indication of how this may be achieved.

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JOURNAL

Scientific Reports

DOI

10.1038/s41598-022-22631-0 

ARTICLE TITLE

Environmental impact of diets for dogs and cats

ARTICLE PUBLICATION DATE

17-Nov-2022

Association of Residential Racial and Economic Segregation With Cancer Mortality in the US

Lu Zhang, PhD¹; Rui Gong, PhD²; Lu Shi, PhD¹; et alMing Wen, PhD³; Xiaoqian Sun, PhD⁴; K. Robin Yabroff, PhD⁵; Xuesong Han, PhD⁵

Author Affiliations Article Information

JAMA Oncol. Published online November 17, 2022. doi:10.1001/jamaoncol.2022.5382

 Brief Report

November 17, 2022

Key Points

Question  Is residential racial and economic segregation, measured by the Index of Concentration at the Extremes, associated with cancer mortality at the county level in the US?

Findings  In this ecological study of 3110 US counties, age-adjusted mortality rates were statistically significantly higher for the most deprived counties for all cancers combined and for 12 of 13 selected cancer sites compared with the most privileged counties, with the largest magnitude occurring with lung and bronchus cancer.

Meaning  This study’s findings suggest that residential racial and economic segregation may be associated with higher cancer mortality at the county level in the US.

Abstract

Importance  Residential segregation is a structural risk factor for poor cancer outcomes. Previous research examining the association of residential segregation with cancer outcomes was limited by older data, restricted geographic areas, and few cancer sites. To guide targeted interventions, a comprehensive evaluation of the association between segregation and cancer outcomes is needed.

Objective  To examine the association of residential racial and economic segregation with cancer mortality at the US county level for all cancers combined and for the 13 cancer types that represent the top 10 causes of cancer deaths in males or females.

Design, Setting, and Participants  This ecological study used county-level sociodemographic data from the 2015-2019 American Community Survey linked with 2015-2019 county-level mortality data. Data analysis was performed from September 2021 to April 2022.

Exposures  Residential racial and economic segregation measured by the Index of Concentration at the Extremes (ICE) and categorized into quintiles 1 (most deprived) through 5 (most privileged).

Main Outcomes and Measures  Age-adjusted cancer mortality was the outcome. Multilevel linear mixed modeling was used to calculate the adjusted mortality rate ratio (aRR).

Results  A total of 3110 counties were included. The age-adjusted mortality rates of all cancers combined were 179.8, 177.3, 167.6, 159.6, and 146.1 per 100 000 population (P < .001 for trend) for the 5 ICE categories (most deprived to least deprived), respectively. Compared with the least deprived counties, aRRs for all cancers combined were 1.22 (95% CI, 1.20-1.24) for the most deprived counties, followed by 1.17 (95% CI, 1.15-1.19), 1.10 (95% CI, 1.09-1.12), and 1.06 (95% CI, 1.04-1.08) for the other 3 quintiles, respectively (P < .001 for trend). Segregation was associated with increased mortality from 12 of 13 selected cancer sites, in which aRRs ranged from 1.06 (95% CI, 1.02-1.09) for brain and other nervous system cancer to 1.49 (95% CI, 1.43-1.54) for lung and bronchus cancer.

Conclusions and Relevance  The findings of this ecological study suggest that residential racial and economic segregation is associated with higher cancer mortality at the county level, highlighting opportunities for geographically targeted cancer prevention and control efforts.

READ OR DOWNLOAD

Ray-finned fish survived mass extinction event

Peer-Reviewed Publication

UNIVERSITY OF BIRMINGHAM

 

IMAGE: PALAEONEIROS CLACKORUM SKULL AND SHOULDER GIRDLE view more 

CREDIT: MUSEUM OF COMPARATIVE ZOOLOGY, HARVARD UNIVERSITY; © PRESIDENT AND FELLOWS OF HARVARD COLLEGE

Ray-finned fish, now the most diverse group of backboned animals, were not as hard hit by a mass extinction event 360 million years ago as scientists previously thought.

The extinction event that ended the Devonian period corresponds to a major change in the kinds of fishes populating ancient seas and lakes. Ray-finned fishes, the staple of the aquarium and dinner table, were uncommon before this major crisis, and their success had been linked to new opportunities in the aftermath of the extinction.

After the extinction, in a period called the Carboniferous, the once rare ray-fins make up a sizeable percentage of fish species. These new Carboniferous fishes also show features indicating more diverse diets and styles of swimming.

A new study in Nature Ecology and Evolution, however, suggests that this shift might not have been as stark as a literal reading of the fossil record suggests. What at first seems like a sudden explosion of diversity instead appears to have had a long—but previously undetected—fuse.

In the study, the researchers investigated a tiny fossil specimen from the Late Devonian period, around 370 million years ago. The fossil, named Palaeoneiros clackorum, was found in the US state of Pennsylvania over a century ago. It had previously received little attention because of its size: at only 55 mm long it was too small to study via conventional means.

However, using CT scanning technology, the team was able to peer inside the fossil’s tiny skull and discover features that showed where Palaeoneiros fit in the family tree of fishes. To their surprise, it showed specific internal details not found in Devonian ray-fins, but instead typical of younger species from the Carboniferous.

This would mean the ray-finned fish started to diversify much earlier during the Devonian period, accumulating small but important changes to the internal structure of the head. These occurred before the outwardly obvious changes appearing during the Carboniferous including new kinds of teeth and highly specialized bodies shaped like everything from eels to angelfish.

Lead researcher Dr Sam Giles said: “These findings overturn previous assumptions about species diversification around the boundary of the Devonian and Carboniferous periods. It shows a much more complex picture in which, rather than just a handful of survivors, we can see hints of extensive diversification and survival from one period into the other.”

These results suggest that further investigation of other neglected fossils might provide more clues about how ray-finned fishes responded to the extinction at the end of the Devonian. Dr Giles and her colleagues look to apply a similar approach to other specimens they have identified, with the goal of better understanding this critical time period. “The fossil record provides us with a remarkable opportunity to see how biology responds to major environmental crises,” Dr Giles said. “And I think we’re getting closer to figuring out how—or if—this spectacularly diverse group’s rise relates to one of the most catastrophic extinctions in Earth’s history.”

Palaeoneiros clackorum skull and shoulder girdle

CREDIT

Museum of Comparative Zoology, Harvard University; © President and Fellows of Harvard College

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JOURNAL

Nature Ecology & Evolution

DOI

10.1038/s41559-022-01919-4 

METHOD OF RESEARCH

Experimental study

SUBJECT OF RESEARCH

Not applicable

ARTICLE TITLE

'A Late Devonian actinopterygian suggests high lineage survivorship across the end-Devonian mass extinction

ARTICLE PUBLICATION DATE

17-Nov-2022

Pregnant trauma patients with certain injury patterns should be screened for intimate partner violence during their hospital stay

Head injuries, multiple contusions, and other injury patterns can indicate that pregnant women are at risk of intimate partner violence, and should be screened by trauma care professionals, according to a new study

AMERICAN COLLEGE OF SURGEONS

 

VIDEO: A NEW STUDY PUBLISHED IN JACS PROVIDES KEY RECOMMENDATIONS ON WHICH PREGNANT TRAUMA PATIENTS SHOULD BE SCREENED FOR INTIMATE PARTNER VIOLENCE (IPV). view more 

CREDIT: AMERICAN COLLEGE OF SURGEONS

Key takeaways

• Pregnant women are especially vulnerable to intimate partner violence (IPV) and those with certain injury patterns should be screened for IPV early in their hospital stay.
• Pregnant trauma patients with injuries to the head, face, and neck, multiple injuries, and other abrasions are at risk of IPV and should be screened by a medical professional.
• More research is needed to assess the follow-up care of IPV trauma patients and to ensure they receive proper resources and counseling.

CHICAGO: Pregnant trauma patients with certain injury patterns—including multiple injuries, injuries to the head, face, neck, and scalp, and multiple contusions—should be screened for intimate partner violence (IPV), according to study results published in the Journal of the American College of Surgeons (JACS).

The study, “Intimate Partner Violence in Pregnancy: A Nationwide Analysis of Injury Patterns and Risk Factors,” defines specific risk factors for IPV in pregnant patients—and provides key recommendations on which subset of pregnant patients should be screened for IPV.

Lead author Paul Thomas Albini, MD, FACS, an acute care surgeon at Riverside University Health System, Moreno Valley, California, notes that this study was born out of a concern from the staff at his hospital who noticed an uptick in pregnant trauma patients affected by IPV in recent years.

“To the best of my knowledge, there has not been an analysis to show specific risk factors for intimate partner violence in a defined population,” said Dr. Albini, who is also an assistant professor of surgery at Loma Linda University and the University of California, Riverside. “We wanted to study intimate partner violence in pregnant patients as we know that they are particularly vulnerable, and their outcomes are generally poor.”

IPV—which includes forms of physical, emotional, sexual, or psychological abuse—is a significant global health problem, affecting about 1 in 4 women and 1 in 10 men in their lifetime.1 Pregnant patients are especially vulnerable. About 3% to 9% of women experience abuse during pregnancy, and trauma is the leading cause of non-obstetric maternal death, affecting approximately 8% of pregnancies.2,3 Public health experts and the American College of Surgeons (ACS) IPV Task Force have raised the alarm that IPV may be severely underreported, and may have worsened during the COVID-19 pandemic when lockdowns prevented many from seeking help.

Current methods and tools for IPV screening vary per hospital system. Guidelines for trauma center recognition of IPV from the ACS Trauma Quality Programs (TQP) recommend universal IPV screening for trauma patients of all ages seeking health care, noting that IPV is linked to increased self-reported mental illness, substance abuse, and recurrent injuries. In pregnant patients who experience IPV, fetal outcomes can also be impacted, leading to premature birth and low birth weight. Surgeons can play an important role in recognizing IPV in patients by incorporating screening tolls into healthcare assessment protocols.

Study details

Using the Nationwide Emergency Department Sample (NEDS) database—part of the Healthcare Cost and Utilization Project (HCUP)—the researchers identified pregnant adult women patients (18-44 years old) who visited emergency room (ER) departments with traumatic injuries between 2010-2014. Based on injury code, the authors first compared pregnant IPV patients with pregnant trauma (non-IPV) patients and completed a secondary analysis comparing pregnant IPV patients with non-pregnant IPV patients. In both comparisons, the researchers noted demographics, injury mechanisms, and National Trauma Data Standard injury diagnoses of the patients. They then used statistical analyses to identify risk factors and the outcomes of pregnant IPV patients. In total, they analyzed data from 556 pregnant IPV patients, 73,970 non-IPV pregnant trauma patients, and 56,543 non-pregnant IPV patients.

Key findings

• Risk factors in pregnant trauma patients that may point toward IPV include multiple injuries, head injuries, face, neck, and scalp injuries, as well as contusions and abrasions.
• Pregnant IPV patients were more likely to experience abdominal injuries, firearm violence, and abrasions/friction burns compared with non-pregnant IPV patients.
• Due to the vulnerability of both the mother and fetus, pregnant IPV patients may benefit from increased monitoring during their hospital stay.
• Most pregnant and non-pregnant IPV patients were treated and released from the ER, with no significant difference in mortality and hospital admissions between the two groups.
• Pregnant women with multiple injuries and those who had experienced firearm violence were more likely to be admitted to the hospital.
• Pregnant IPV patients were younger, and more often had Medicaid insurance or self-pay coverage than private/HMO insurance, though income distribution was not significantly different between the groups.
• The authors concluded that trauma systems should consider improving screening methods and offer counseling and prevention measures in the ER, where most patient care will occur before discharge.

Helping stop the cycle of violence

The study was retrospective and included a relatively small sample size of pregnant women with reported IPV, so it may not capture granular data on suspected IPV cases and other larger demographic data on IPV patterns, Dr. Albini noted. But the study points to several important risk factors to recognize patterns of IPV injury more closely.

“I think we have identified certain risk factors that should prompt screening for intimate partner violence. Using these risk factors to guide screening can happen anywhere, not just at our institution,” he said. “I think that would be very helpful and may address an underlying problem for a proportion of patients.”

He also hopes the study illuminates more of the complexities of screening for IPV—and many of the unanswered questions that still need to be investigated. There are validated tools for IPV screening, but many hospital staff may lack guidance on who to screen, and how to provide appropriate counseling or follow-up care.

“This study was eye-opening in so many ways on the more research that needs to be done,” Dr. Albini said. “We need to prevent the cycle of violence from happening again.”

Study coauthors are Bishoy Zakhary, MPH, Sara B. Edwards, MD, MS, FACS, Raul Coimbra, MD, PhD, FACS, and Megan L. Brenner, MD, MS, FACS.

Dr. Brenner is a member of the Prytime Medical Inc. Clinical Advisory Board. Dr. Coimbra is editor-in-chief of the Journal of Trauma and Acute Care Surgery. The authors report no other disclosures.

Citation: Albini PT, Zakhary B, Edwards SB, et al. Intimate Partner Violence in Pregnancy, A Nationwide Analysis of Injury Patterns and Risk Factors. Journal of the American College of Surgeons. DOI:10.1097/XCS.0000000000000421

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1. Evans ML, Lindauer M, and Farrell ME. A pandemic within a pandemic—Intimate partner violence during Covid-19. N Engl J Med 2020: 383(24), 2302-2304.

2. Alhusen JL, Ray E, Sharps P, and Bullock L. Intimate partner violence during pregnancy: maternal and neonatal outcomes. J Womens Health 2015: 24(1), 100-106.

3. Brown S, Mozurkewich E. Trauma during pregnancy. Obstet Gynecol Clin North Am 2013: 40(1), 47-57.

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About the American College of Surgeons

The American College of Surgeons is a scientific and educational organization of surgeons that was founded in 1913 to raise the standards of surgical practice and improve the quality of care for all surgical patients. The College is dedicated to the ethical and competent practice of surgery. Its achievements have significantly influenced the course of scientific surgery in America and have established it as an influential advocate for all surgical patients. The College has more than 84,000 members and is the largest organization of surgeons in the world.

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JOURNAL

Journal of the American College of Surgeons

DOI

10.1097/XCS.0000000000000421 

METHOD OF RESEARCH

Data/statistical analysis

SUBJECT OF RESEARCH

People

ARTICLE TITLE

Intimate Partner Violence in Pregnancy: A Nationwide Analysis of Injury Patterns and Risk Factors

ARTICLE PUBLICATION DATE

17-Nov-2022