Scholars@Duke
Sarahn M Wheeler

Sarahn M Wheeler

Associate Professor of Obstetrics and Gynecology
Obstetrics and Gynecology, Maternal Fetal Medicine
sarahn.wheeler@duke.edu
DUMC 3967, Durham, NC 27710
2608 Erwin Road, Durham, NC 27710

Scholarly Works - Journal articles

Counseling Preferences of Expectant Parents With a Fetal Neurologic Diagnosis: A Scoping Review of the Literature.

Journal article J Child Neurol · August 2026 Diagnosis and management of fetal neurologic conditions is evolving rapidly. This scoping review aims to synthesize existing literature characterizing parental preferences for fetal neurologic counseling. A literature search and screening of MEDLINE, Embas ... Full text Link to item Cite

The Impact of a Protocol on Equitable Labor and Delivery Substance Use Screening: A Retrospective Cohort Study.

Journal article Am J Perinatol · July 2026 OBJECTIVE: The Society for Maternal-Fetal Medicine (SMFM), the American College of Obstetricians and Gynecologists (ACOG), and the American Society of Addiction Medicine (ASAM) jointly recommend universal substance use screening in pregnancy with a validat ... Full text Link to item Cite

The association between postpartum aspirin use and NT-proBNP levels as a marker for maternal cardiac health: a randomized controlled trial.

Journal article Am J Obstet Gynecol · May 2026 BACKGROUND: During pregnancy, administration of low-dose aspirin 81 mg (LDA) has been demonstrated to decrease the incidence of preeclampsia in at-risk individuals. However, the role of continuation of LDA in the postpartum period and its association with ... Full text Link to item Cite

The impact of an obstetric substance use screening and biologic testing protocol on neonatal drug testing.

Journal article J Perinatol · April 2026 OBJECTIVE: Substance use during pregnancy may affect fetal development and have implications for newborn, childhood, and life-long health. While standardized maternal screening protocols may reduce testing disparities, there are limited data describing the ... Full text Link to item Cite

Spontaneous preterm birth following unintended hysterotomy extension during second-stage labor cesarean delivery.

Journal article Pregnancy (Hoboken) · March 2026 BACKGROUND: Unintended hysterotomy extensions occur frequently during second-stage cesarean delivery and may result in uterine and cervical tissue trauma. The impact of these extensions on adverse outcomes in subsequent pregnancies, including spontaneous p ... Full text Link to item Cite

Communicating neurological prognosis in the prenatal period: a narrative review and practice guidelines.

Journal article Pediatr Res · November 2025 Clinicians may face an array of challenges in conducting fetal neurological consultations including prognostic uncertainty, a lack of training in fetal counseling, and limited opportunity to build rapport with families. In this setting, it is critical to e ... Full text Link to item Cite

Indomethacin and Cefazolin for Physical Exam-Indicated Cerclage to Improve Latency: A Protocol Validation Study.

Journal article Am J Perinatol · August 2025 A single-center randomized trial showed improved latency with use of indomethacin and cefazolin (I/C) during and following exam-indicated cerclage (EIC). The same center recently published a pre/post comparison demonstrating similar results. This research ... Full text Link to item Cite

Moving the ACR's Reproductive Health Guidelines Into Practice: A Quantitative and Qualitative Assessment of a Novel Reproductive Rheumatology ECHO.

Journal article J Clin Rheumatol · August 1, 2025 BACKGROUND: Project ECHO (Extension for Community Healthcare Outcomes) links experts with community providers through video teleconferences that include both didactics and case discussions. We piloted the first ECHO with a specific focus on reproductive rh ... Full text Link to item Cite

Neonatal Outcomes at 2 Years following Expectant Management of Previable Premature Prelabor Rupture of Membranes at a Single Center.

Journal article Am J Perinatol · April 2025 Previable premature prelabor rupture of membranes (pPPROM) can lead to significant maternal and neonatal morbidity and mortality. Limited literature exists describing long-term outcomes in neonates surviving pPPROM. Our study describes 2-year survival and ... Full text Link to item Cite

Vaginal progesterone for prevention of preterm birth in women with a history of preterm birth regardless of cervical length: an argument against use.

Journal article Am J Obstet Gynecol MFM · March 2025 Preterm birth, defined as birth before 37 weeks of gestation, has a significant public health effect as the most frequent cause of neonatal-related death and the second most frequent cause of infant-related death at the age of <5 years. Given the unclear a ... Full text Link to item Cite

Second Trimester Kidney Function and Adverse Pregnancy Outcomes among Patients with Lupus.

Journal article Kidney360 · February 14, 2025 KEY POINTS: In our combined cohort, second trimester kidney function was associated with adverse outcomes for patients with lupus. Measurement of kidney function during pregnancy may have potential benefit, especially among patients without kidney disease. ... Full text Link to item Cite

Predictors of Vaginal Delivery among Patients Admitted with Severe Preeclampsia.

Journal article Am J Perinatol · January 2025 OBJECTIVE: This study aimed to assess the rates of vaginal delivery (VD) and the predictors of VD in a cohort of patients with early (<34 weeks) preeclampsia with severe features (Early Severe PreEClampsia [ESPEC]). STUDY DESIGN: We conducted a retrospecti ... Full text Link to item Cite

Racial, Ethnic, and Color-Based Discrimination and Pre-Pregnancy Risk Factors for Preeclampsia Among Nulliparous Patients.

Journal article Health Equity · 2025 INTRODUCTION: Obesity and chronic hypertension are well-known risk factors for maternal morbidity and mortality. Evidence suggests racism contributes to the development of these chronic conditions. METHODS: We conducted a secondary analysis of the Nullipar ... Full text Link to item Cite

Untrustworthiness, ineffective communication, and discrimination: The real issues behind lower utilization of labor epidural analgesia by Black Americans.

Journal article Nurs Outlook · 2025 BACKGROUND: Non-Hispanic Black pregnant individuals utilize up to 50% less labor epidural analgesia compared to non-Hispanic White individuals. PURPOSE: This Outlook and Perspectives aims to evaluate the factors contributing to racial differences in the ut ... Full text Link to item Cite

Community-engaged implementation of a safety bundle for pregnancy-related severe hypertension in the outpatient setting: protocol for a type 3 hybrid study with a multiple baseline design.

Journal article BMC Health Serv Res · September 30, 2024 BACKGROUND: Hypertensive disorders of pregnancy are among the leading causes of maternal mortality and morbidity in the U.S., with rates highest among birthing people who are Black, rural residents, and/or have low-income. Severe hypertension, in particula ... Full text Link to item Cite

Longitudinal Management of Cardiovascular Risk Factors Among Postpartum Women.

Journal article J Womens Health (Larchmt) · July 2024 Background: Pregnancy-related cardiovascular (CV) conditions, including hypertensive disorders of pregnancy (HDP) and gestational diabetes (GDM), are associated with increased long-term CV risk. Methods: This retrospective cohort study defined the prevalen ... Full text Link to item Cite

Preterm Birth Rates and Racial Disparities during the COVID-19 Pandemic at a Single Institution in the Southeastern United States.

Journal article Am J Perinatol · May 2024 OBJECTIVE: The COVID pandemic has been associated with varied effects on preterm birth (PTB). We sought to compare rates of PTB during the pre- and post vaccination COVID periods with pre-pandemic PTB rates, stratified by race and ethnicity. STUDY DESIGN: ... Full text Link to item Cite

Factors Associated with Guideline Concordant Clinician Counseling about Low-Dose Aspirin to Prevent Preeclampsia in Nulliparous Patients.

Journal article Am J Perinatol · May 2024 OBJECTIVE: The primary aim of this study was to examine the United States Preventative Services Task Force (USPSTF) guidelines concordant low-dose aspirin (LDA) counseling and factors associated with counseling in nulliparous birthing individuals. STUDY DE ... Full text Link to item Cite

Obstetric Racial Disparities in the Era of the ARRIVE (A Randomized Trial of Induction Versus Expectant Management) Trial and the Coronavirus Disease 2019 (COVID-19) Pandemic.

Journal article Obstet Gynecol · May 1, 2024 OBJECTIVE: To evaluate the influence of the ARRIVE (A Randomized Trial of Induction Versus Expectant Management) trial and the coronavirus disease 2019 (COVID-19) pandemic on racial and ethnic differences in labor induction, pregnancy-associated hypertensi ... Full text Link to item Cite

Prenatal Vaccination Patterns among Birthing Individuals with History of Preterm Birth in the Pre- and Post-COVID Era.

Journal article Am J Perinatol · April 2024 OBJECTIVE: This study aims to explore vaccination acceptance among individuals with a history of preterm birth between March and June during the pre-COVID (2019), early-COVID (2020), and late-COVID (2021) periods. STUDY DESIGN: This is a cross-sectional, r ... Full text Link to item Cite

Maternal chronic hypertension in women veterans.

Journal article Health Serv Res · April 2024 OBJECTIVE: To describe the prevalence of maternal chronic hypertension (MCH), assess how frequently blood pressure is controlled before pregnancy among those with MCH, and explore management practices for antihypertensive medications (AHM) during the pre-p ... Full text Open Access Link to item Cite

Attitudes Toward Pregnancy and Their Impact on Timing of Prenatal Care Initiation after Prior Spontaneous Preterm Delivery: A Qualitative Descriptive Study.

Journal article Womens Health Rep (New Rochelle) · 2024 INTRODUCTION: Timely presentation to prenatal care (PNC) is especially important for patients with a history of spontaneous preterm birth (sPTB). Our objective was to identify factors that pregnant individuals with prior sPTB perceived affected the timing ... Full text Link to item Cite

CenteringPregnancy: A Review of Implementation and Outcomes.

Journal article Obstet Gynecol Surv · August 2023 IMPORTANCE: CenteringPregnancy (CP) is a model for group prenatal care associated with improved perinatal outcomes for preterm birth and low birthweight, increased rates of breastfeeding, and higher rates of patient and clinician satisfaction. OBJECTIVE: T ... Full text Link to item Cite

Transvaginal Ovarian Cyst Drainage in Third Trimester to Facilitate Vaginal Delivery.

Journal article AJP Rep · July 2023 Adnexal masses in the third trimester of pregnancy may obstruct the pelvic outlet precluding labor induction and vaginal delivery. Expectant versus surgical management of adnexal cysts in pregnancy must carefully weigh maternal-fetal benefits and risks. Si ... Full text Link to item Cite

Maternal Cardiovascular Morbidity Events Following Preeclampsia: A Retrospective Cohort Study.

Journal article Anesth Analg · April 1, 2023 BACKGROUND: Patients with preeclampsia are at high risk for long-term cardiovascular events, yet the short-term, acute cardiovascular complications that follow preeclampsia are understudied. The objective of this study was to compare the short-term, acute ... Full text Link to item Cite

Accuracy Is Anti-Racism.

Journal article Obstet Gynecol · March 1, 2023 Full text Link to item Cite

Doula Care: A Review of Outcomes and Impact on Birth Experience.

Journal article Obstet Gynecol Surv · February 2023 IMPORTANCE: Doulas are trained professionals that provide comprehensive support during the perinatal period. Doula-supported care is associated with improved maternal and infant outcomes including decreased preterm birth, increased breastfeeding initiation ... Full text Link to item Cite

For better care we need better data: towards a national obstetrics registry.

Journal article Am J Obstet Gynecol MFM · January 2023 Unacceptably high rates of severe maternal morbidity and mortality in the United States and stark racial disparities in outcomes are generating efforts to improve both research capacity and quality improvement in obstetrical care. Comprehensive, high-quali ... Full text Link to item Cite

"You start feeling comfortable, you just start sharing:" A qualitative study of patient distress screening in Black and White patients with endometrial cancer.

Journal article Gynecol Oncol · January 2023 OBJECTIVES: Black patients with endometrial cancer are less likely to express distress and receive referrals for support services compared to White patients. We aim to characterize patient perceptions of the National Comprehensive Cancer Network Distress T ... Full text Link to item Cite

The risk for recurrent preterm birth after prior preterm birth complicated by major fetal anomaly.

Journal article J Matern Fetal Neonatal Med · December 2022 Major fetal anomalies (MFA) are a known risk factor for preterm birth (PTB), though the etiology of this is not well-studied, making counseling of these patients difficult. Thus, we sought to describe the rate of recurrent PTB in a second-observed pregnanc ... Full text Link to item Cite

EngagINg the COmmunity to Reduce Preterm birth via Adherence To an Individualized Prematurity Prevention Plan (INCORPorATe IP3): intervention development and future pilot study design.

Journal article J Matern Fetal Neonatal Med · December 2022 OBJECTIVE: Non-Hispanic Black birthing individuals are at increased risk of preterm birth compared to other racial and ethnic groups. In our clinical setting, we offer a tailored package of recommendations to reduce the risk of preterm birth known as an in ... Full text Open Access Link to item Cite

Symptomatic versus asymptomatic COVID-19: does it impact placental vasculopathy?

Journal article J Matern Fetal Neonatal Med · December 2022 This study sought to assess the impact of COVID-19 on placental vasculature in the context of maternal symptomatology - comparing asymptomatic to symptomatic pregnant patients - and disease severity - comparing pregnant patients with mild, moderate, severe ... Full text Link to item Cite

Health inequities start early in life, even before birth: Why race-specific fetal and neonatal growth references disadvantage Black infants.

Journal article Semin Perinatol · December 2022 Clinicians and researchers use published standards to assess and classify the size and growth of the fetus and newborn infant. Fetal growth is slower on average in Black fetuses as compared with White fetuses, and existing standards differ in whether they ... Full text Link to item Cite

Group B Streptococcus and Pregnancy: Critical Concepts and Management Nuances.

Journal article Obstet Gynecol Surv · December 2022 IMPORTANCE: Group B Streptococcus (GBS) is a common pathogen with an effective treatment. However, it remains a significant cause of neonatal sepsis, morbidity, and mortality. The screening and management of this infection are some of the first concepts le ... Full text Link to item Cite

Sickle cell disease and the incidence and etiology of preterm birth.

Journal article Am J Obstet Gynecol MFM · November 2022 BACKGROUND: Medically indicated delivery can be defined as delivery owing to intervention for maternal or fetal well-being-most commonly because of preeclampsia or nonreassuring fetal status. Among the general population of the United States, approximately ... Full text Link to item Cite

Racial and ethnic representation in 17-hydroxyprogesterone caproate preterm birth prevention studies: a systematic review.

Journal article J Perinat Med · September 27, 2022 OBJECTIVES: The US preterm birth rate varies dramatically by race and ethnicity yet the racial and ethnic representation within studies evaluating 17-hydroxprogesterone caproate (17-P) for preterm birth prevention is unknown. The objectives of our study we ... Full text Link to item Cite

Society for Maternal-Fetal Medicine Special Statement: Race in maternal-fetal medicine research- Dispelling myths and taking an accurate, antiracist approach

Journal article American Journal of Obstetrics and Gynecology · April 1, 2022 Profound inequities in maternal and infant outcomes based on race exist, and the maternal-fetal medicine community has an important role in eliminating these disparities. Accurately employing race and ethnicity as social constructs within research that gui ... Full text Cite

Estimated Prevalence of Risk Factors for Preeclampsia Among Individuals Giving Birth in the US in 2019.

Journal article JAMA Netw Open · January 4, 2022 IMPORTANCE: Low-dose aspirin (LDA) is one of the few evidence-based interventions for preventing preeclampsia, which is a leading cause of maternal or fetal morbidity and mortality. Current guidelines recommend LDA based on the presence of risk factors for ... Full text Link to item Cite

A Qualitative Study Documenting Black Birthing Individuals' Perspectives on the Disproportionate Rate of Preterm Birth in the Black Community.

Journal article Womens Health Rep (New Rochelle) · 2022 BACKGROUND: Compared with all other racial and ethnic groups, the rate of preterm birth (PTB) is 50% higher among non-Hispanic Blacks (NHB). There are limited published data focused on the etiology of the racial disparity in PTB from the perspective of Bla ... Full text Link to item Cite

Improving Clinician's Knowledge and Comfort with Prenatal and Postpartum Employment Laws: A Pilot Intervention.

Journal article Womens Health Rep (New Rochelle) · 2022 BACKGROUND: It is common for pregnant people in the United States to continue to work throughout their pregnancy. Pregnant people may need leave time or other accommodations to continue working safely. It is imperative that obstetric providers are knowledg ... Full text Link to item Cite

Clinical and economic evaluation of a proteomic biomarker preterm birth risk predictor: cost-effectiveness modeling of prenatal interventions applied to predicted higher-risk pregnancies within a large and diverse cohort.

Journal article J Med Econ · 2022 OBJECTIVES: Preterm birth occurs in more than 10% of U.S. births and is the leading cause of U.S. neonatal deaths, with estimated annual costs exceeding $25 billion USD. Using real-world data, we modeled the potential clinical and economic utility of a pre ... Full text Link to item Cite

IMPaCT: A Pilot Randomized Trial of an Intervention to Reduce Preterm Birth Among Non-Hispanic Black Patients at High Risk.

Journal article Health Equity · 2022 INTRODUCTION: Preterm birth is a major cause of neonatal morbidity and mortality rate. Non-Hispanic black patients disproportionately experience preterm birth and nonadherence to evidence-based preventive measures. Interventions tailored to non-Hispanic bl ... Full text Open Access Link to item Cite

Pregnancy vs. paycheck: a qualitative study of patient's experience with employment during pregnancy at high risk for preterm birth.

Journal article BMC Pregnancy Childbirth · September 25, 2020 BACKGROUND: Pregnant women with a history of preterm birth are at risk for recurrence, often requiring frequent prenatal visits for close monitoring and/or preventive therapies. Employment demands can limit uptake and adherence to recommended monitoring an ... Full text Link to item Cite

Performance of a proteomic preterm delivery predictor in a large independent prospective cohort.

Journal article Am J Obstet Gynecol MFM · August 2020 BACKGROUND: Preterm birth remains a common and devastating complication of pregnancy. There remains a need for effective and accurate screening methods for preterm birth. Using a proteomic approach, we previously discovered and validated (Proteomic Assessm ... Full text Link to item Cite

OB/GYN Providers' Knowledge of Racial and Ethnic Reproductive Health Disparities.

Journal article J Natl Med Assoc · June 2020 OBJECTIVE: This study explores OB/GYN providers' knowledge about published health and healthcare disparities in women's reproductive health. METHOD: We collected demographic and health disparities knowledge information from OB/GYN providers who were member ... Full text Link to item Cite

Factors Associated with Utilization of 17-Hydroxyprogesterone Caproate for the Prevention of Recurrent Preterm Birth.

Journal article American journal of perinatology · February 2020 ObjectiveWeekly 17-hydroxyprogesterone caproate (17OHP-C) from 16 to 36 weeks' gestation reduces the risk of recurrent spontaneous preterm birth (sPTB). Limited data suggest poor adherence to published guidelines. This study aimed to identify fact ... Full text Cite

Beyond the Window: Patient Characteristics and Geographic Locations Associated with Late Prenatal Care in Women Eligible for 17-P Preterm Birth Prevention.

Journal article J Racial Ethn Health Disparities · June 2019 INTRODUCTION: To reduce the risk of recurrence, women with a history of spontaneous preterm birth (PTB) are recommended to receive 17-hydroxyprogesterone caproate (17-P) injections starting by the 20th week of pregnancy. In women eligible for 17-P, we aime ... Full text Link to item Cite

Improving Uptake and Adherence to 17-Hydroxyprogesterone Caproate in Non-Hispanic Black Women: A Mixed Methods Study of Potential Interventions from the Patient Perspective.

Journal article Biores Open Access · 2019 Women with a history of a preterm birth (PTB) are at high risk for recurrence. Weekly 17-hydroxyprogestrone caproate (17-P) injections can reduce the risk of recurrence in women with prior spontaneous PTB. PTB occurs disproportionately in non-Hispanic blac ... Full text Link to item Cite

Psychosocial Stress and Preterm Birth: The Impact of Parity and Race.

Journal article Matern Child Health J · October 2018 Objectives Studies examining risk factors for preterm birth (PTB) such as psychosocial stress are often focused on women with a history of PTB; however, most preterm babies are born to women with no history of preterm birth. Our objective was to determine ... Full text Link to item Cite

Pregnant Women's Knowledge and Beliefs about the Safety and Outcomes of Delivery at Various Gestational Ages.

Journal article AJP Rep · January 2018 Objectives  Despite the morbidity associated with late preterm and early-term births, there is limited data on pregnant women's perception of neonatal risk based on gestational age (GA). Therefore, our objective was to determine pregnant women's perception ... Full text Open Access Link to item Cite

The relationship of cervical microbiota diversity with race and disparities in preterm birth.

Journal article J Neonatal Perinatal Med · 2018 OBJECTIVE: Pregnant non-Hispanic blacks (NHB) have increased vaginal microbiome diversity compared to non-Hispanic whites (NHW) which may contribute to increased preterm birth. Cervical microbiome diversity is poorly characterized in pregnancy, therefore o ... Full text Link to item Cite

Racial and Ethnic Disparities in Health and Health Care.

Journal article Obstet Gynecol Clin North Am · March 2017 A health disparity is defined as an increased burden of an adverse health outcome or health determinant within a specific subset of the population. There are well-documented racial and ethnic disparities throughout health care at the patient, provider, and ... Full text Link to item Cite

Maternal Effects of Respiratory Syncytial Virus Infection during Pregnancy.

Journal article Emerg Infect Dis · November 2015 Given the illness and deaths caused by respiratory syncytial virus (RSV) infection during the first year of life, preventing infant RSV infections through maternal vaccination is intriguing. However, little is known about the extent and maternal effects of ... Full text Open Access Link to item Cite

Neonatal pertussis, cocooning and maternal immunization.

Journal article Expert Rev Vaccines · September 2014 The rising incidence of whooping cough, a highly contagious infection caused by Bordetella pertussis, is particularly significant for young infants who have the highest risk for morbidity and mortality. The pertussis resurgence has led to a shift in primar ... Full text Link to item Cite

Gynecologic and surgical complications in type IV Ehlers-Danlos syndrome.

Journal article Obstet Gynecol · February 2014 BACKGROUND: Although type IV Ehlers-Danlos syndrome is a rare condition, it is critical that physicians be aware of this disease because it presents unique management challenges. CASE: We present a young woman who was admitted with a pelvic abscess after h ... Full text Link to item Cite

Evaluation of upper airway obstruction--an ENT perspective.

Journal article Pulm Pharmacol Ther · 2008 Upper airway obstruction is a common clinical problem. Nasal obstruction can be the result of nasal anatomy, mucosal swelling, or acquired blockage. The anatomy of the upper airway differs from the lower because of the presence of erectile tissue in the no ... Full text Link to item Cite