1
|
Haga M, Nishimura E, Oshima A, Miyahara N, Oka S, Motojima Y, Saito K, Itoh K, Kanai M, Kabe K, Era S, Yabe S, Kikuchi A, Namba F. Prolonged oligohydramnios and the adverse composite outcome of death or severe neurodevelopmental impairment at 3 years of age in infants born at 22-29 gestational weeks. Early Hum Dev 2024; 197:106100. [PMID: 39180798 DOI: 10.1016/j.earlhumdev.2024.106100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2024] [Revised: 08/14/2024] [Accepted: 08/14/2024] [Indexed: 08/27/2024]
Abstract
OBJECTIVE To investigate the association between prolonged oligohydramnios and a composite outcome of death or severe neurodevelopmental impairment (NDI) at 3 years of age. METHODS This single-center retrospective cohort study enrolled infants born at 22-29 weeks of gestational age without major congenital anomalies. The patients were classified into three groups depending on the existence and duration of oligohydramnios: no/non-prolonged oligohydramnios (no or 0-7 days of oligohydramnios), prolonged oligohydramnios (8-14 days), and very prolonged oligohydramnios (> 14 days). The primary outcome was a composite of death or severe NDI, which was defined as severe cerebral palsy, developmental delay, severe visual impairment, or deafness at age 3. RESULTS Out of the 843 patients, 784 (93 %), 30 (3.6 %), and 29 (3.4 %) were classified into the no/non-prolonged, prolonged, and very prolonged oligohydramnios groups, respectively. After excluding patients lost to follow-up, the adverse composite outcome at 3 years of age was observed in 194/662 (29 %), 7/26 (27 %), and 8/23 (35 %) in the corresponding groups. The composite outcome showed no significant trend with the duration of oligohydramnios (P = 0.70). In a logistic regression model controlling the known predictors of gestational age, birth weight, small-for-gestational-age, male sex, multiple pregnancy, hypertensive disorders of pregnancy, antenatal corticosteroids, and the number of family-social risk factors, the duration of oligohydramnios was not independently associated with the composite outcome; odds ratio 1.3 (95 % confidence interval, 0.78-2.0). CONCLUSION Prolonged oligohydramnios was not associated with the composite outcome of death or severe NDI at 3 years of age.
Collapse
Affiliation(s)
- Mitsuhiro Haga
- Department of Pediatrics, Saitama Medical Center, Saitama Medical University, Kawagoe, Saitama, Japan.
| | - Eri Nishimura
- Department of Pediatrics, Saitama Medical Center, Saitama Medical University, Kawagoe, Saitama, Japan
| | - Ayumi Oshima
- Department of Pediatrics, Saitama Medical Center, Saitama Medical University, Kawagoe, Saitama, Japan
| | - Naoyuki Miyahara
- Department of Pediatrics, Saitama Medical Center, Saitama Medical University, Kawagoe, Saitama, Japan
| | - Shuntaro Oka
- Department of Pediatrics, Saitama Medical Center, Saitama Medical University, Kawagoe, Saitama, Japan; Institute for children with profound intellectual and multiple disability "Karugamo-no-ie", Kawagoe, Saitama, Japan
| | - Yukiko Motojima
- Department of Pediatrics, Saitama Medical Center, Saitama Medical University, Kawagoe, Saitama, Japan; Department of Pediatrics, Saitama Medical University Hospital, Moroyama, Saitama, Japan
| | - Kana Saito
- Department of Pediatrics, Saitama Medical Center, Saitama Medical University, Kawagoe, Saitama, Japan; Department of Pediatrics, Tokai University School of Medicine, Isehara, Kanagawa, Japan
| | - Kanako Itoh
- Department of Pediatrics, Saitama Medical Center, Saitama Medical University, Kawagoe, Saitama, Japan
| | - Masayo Kanai
- Department of Pediatrics, Saitama Medical Center, Saitama Medical University, Kawagoe, Saitama, Japan
| | - Kazuhiko Kabe
- Department of Pediatrics, Saitama Medical Center, Saitama Medical University, Kawagoe, Saitama, Japan
| | - Sumiko Era
- Department of Obstetrics and Gynecology, Saitama Medical Center, Saitama Medical University, Kawagoe, Saitama, Japan
| | - Shinichiro Yabe
- Department of Obstetrics and Gynecology, Saitama Medical Center, Saitama Medical University, Kawagoe, Saitama, Japan
| | - Akihiko Kikuchi
- Department of Obstetrics and Gynecology, Saitama Medical Center, Saitama Medical University, Kawagoe, Saitama, Japan
| | - Fumihiko Namba
- Department of Pediatrics, Saitama Medical Center, Saitama Medical University, Kawagoe, Saitama, Japan
| |
Collapse
|
2
|
Mu Y, Huang J, Yang J, Zuo H, Monami M, Cristina do Vale Moreira N, Hussain A. Ethnic differences in the effects of lifestyle interventions on adverse pregnancy outcomes among women with gestational diabetes mellitus: A systematic review and meta-analysis. Diabetes Res Clin Pract 2024; 217:111875. [PMID: 39349252 DOI: 10.1016/j.diabres.2024.111875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2024] [Revised: 09/24/2024] [Accepted: 09/26/2024] [Indexed: 10/02/2024]
Abstract
AIMS Lifestyle interventions are widely used among women with gestational diabetes mellitus (GDM). This study aimed to assess the ethnic disparities in the effectiveness of lifestyle interventions on reducing adverse pregnancy outcomes, particularly macrosomia and neonatal hypoglycemia among women with GDM. METHODS We systematically searched the PubMed/MEDLINE, Web of Science, and Cochrane Library databases from January 1, 2000, up to March 31, 2024, to identify randomized controlled trials (RCTs) examining the effects of lifestyle interventions in GDM patients. Subgroup analysis was performed to investigate heterogeneity across different ethnic groups (including Asians, Whites/Caucasians, Hispanics/ Latinos, and Unknown ethnicity). The random effects model was used to calculate the relative risk (RR) and 95% confidence interval (CI). RESULTS After applying inclusion and exclusion criteria, twenty-one studies comprising 4567 participants were included. Lifestyle interventions significantly reduced the incidence of macrosomia ((RR = 0.54; 95 % CI: 0.42-0.70, P < 0.001), with consistent effects observed across racial groups. Conversely, lifestyle interventions were associated with a significant reduction in the risk of neonatal hypoglycemia only among Asians (RR = 0.56; 95 % CI: 0.38-0.84, P = 0.004), while no significant effects were observed in Whites/Caucasians or Hispanics/Latinos (all P > 0.05). Sensitivity analyses confirmed the robustness of the findings. CONCLUSIONS Regardless of ethnic background, this study emphasizes the significant benefits of lifestyle interventions in reducing the risk of macrosomia among women with GDM. However, lifestyle interventions seem to reduce the risk of neonatal hypoglycemia only among Asians, which warrants further studies.
Collapse
Affiliation(s)
- Yingjun Mu
- School of Public Health, Suzhou Medical College of Soochow University, Suzhou, China
| | - Junyao Huang
- School of Public Health, Suzhou Medical College of Soochow University, Suzhou, China
| | - Jie Yang
- School of Public Health, Suzhou Medical College of Soochow University, Suzhou, China
| | - Hui Zuo
- School of Public Health, Suzhou Medical College of Soochow University, Suzhou, China; Jiangsu Key Laboratory of Preventive and Translational Medicine for Major Chronic Non-Communicable Diseases, Suzhou Medical College of Soochow University, Suzhou, China; MOE Key Laboratory of Geriatric Diseases and Immunology, Suzhou Medical College of Soochow University, Suzhou, China.
| | - Matteo Monami
- Unit of Diabetology and Metabolic Diseases, Careggi Teaching Hospital, Florence, Italy
| | | | - Akhtar Hussain
- Faculty of Health Sciences, NORD University, Bodø, Norway; Faculty of Medicine, Federal University of Ceará (FAMED-UFC), Brazil; International Diabetes Federation, 166 Chaussee de La Hulpe B-1170, Brussels, Belgium
| |
Collapse
|
3
|
Haga M, Kanai M, Ishiguro A, Nishimura E, Minamitani Y, Iwatani A, Nishiguchi R, Miyahara N, Oka S, Sasaki A, Motojima Y, Saito K, Itoh K, Era S, Yabe S, Kikuchi A, Fuji M, Matsumoto M, Namba F, Sobajima H, Tamura M, Kabe K. Changes in In-Hospital Survival and Long-Term Neurodevelopmental Outcomes of Extremely Preterm Infants: A Retrospective Study of a Japanese Tertiary Center. J Pediatr 2023; 255:166-174.e4. [PMID: 36462685 DOI: 10.1016/j.jpeds.2022.11.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 11/15/2022] [Accepted: 11/28/2022] [Indexed: 12/02/2022]
Abstract
OBJECTIVES The objective of this study was to elucidate whether the survival and long-term neurodevelopmental outcomes of extremely preterm infants have improved in a Japanese tertiary center with an active treatment policy for infants born at 22-23 weeks of gestation. STUDY DESIGN This single-centered retrospective cohort study enrolled extremely preterm infants treated at Saitama Medical Center, Saitama Medical University, from 2003 to 2014. Patients with major congenital abnormalities were excluded. Primary outcomes were in-hospital survival and severe neurodevelopmental impairment (NDI) at 6 years of age, which was defined as having severe cerebral palsy, severe cognitive impairment, severe visual impairment, or deafness. We assessed the changes in primary outcomes between the first (period 1; 2003-2008) and the second half (period 2; 2009-2014) of the study period and evaluated the association between birth-year and primary outcomes using multivariate logistic regression models. RESULTS Of the 403 eligible patients, 340 (84%) survived to discharge. Among 248 patients available at 6 years of age, 43 (14%) were classified as having severe NDI. Between the 2 periods, in-hospital survival improved from 155 of 198 (78%) to 185 of 205 (90%), but severe NDI increased from 11 of 108 (10%) to 32 of 140 (23%). In multivariate logistic regression models adjusted for gestational age, birthweight, sex, singleton birth, and antenatal corticosteroids, the aOR (95% CI) of birth-year for in-hospital survival and severe NDI was 1.2 (1.1-1.3) and 1.1 (1.0-1.3), respectively. CONCLUSION Mortality among extremely preterm infants has improved over the past 12 years; nevertheless, no significant improvement was observed in the long-term neurodevelopmental outcomes.
Collapse
Affiliation(s)
- Mitsuhiro Haga
- Division of Neonatal Medicine, Center for Maternal, Fetal and Neonatal Medicine, Saitama Medical Center, Saitama Medical University, Kawagoe, Saitama, Japan
| | - Masayo Kanai
- Division of Neonatal Medicine, Center for Maternal, Fetal and Neonatal Medicine, Saitama Medical Center, Saitama Medical University, Kawagoe, Saitama, Japan.
| | - Akio Ishiguro
- Division of Neonatal Medicine, Center for Maternal, Fetal and Neonatal Medicine, Saitama Medical Center, Saitama Medical University, Kawagoe, Saitama, Japan
| | - Eri Nishimura
- Division of Neonatal Medicine, Center for Maternal, Fetal and Neonatal Medicine, Saitama Medical Center, Saitama Medical University, Kawagoe, Saitama, Japan
| | - Yohei Minamitani
- Division of Neonatal Medicine, Center for Maternal, Fetal and Neonatal Medicine, Saitama Medical Center, Saitama Medical University, Kawagoe, Saitama, Japan
| | - Ayaka Iwatani
- Division of Neonatal Medicine, Center for Maternal, Fetal and Neonatal Medicine, Saitama Medical Center, Saitama Medical University, Kawagoe, Saitama, Japan
| | - Ryo Nishiguchi
- Division of Neonatal Medicine, Center for Maternal, Fetal and Neonatal Medicine, Saitama Medical Center, Saitama Medical University, Kawagoe, Saitama, Japan
| | - Naoyuki Miyahara
- Division of Neonatal Medicine, Center for Maternal, Fetal and Neonatal Medicine, Saitama Medical Center, Saitama Medical University, Kawagoe, Saitama, Japan
| | - Shuntaro Oka
- Division of Neonatal Medicine, Center for Maternal, Fetal and Neonatal Medicine, Saitama Medical Center, Saitama Medical University, Kawagoe, Saitama, Japan
| | - Ayumi Sasaki
- Division of Neonatal Medicine, Center for Maternal, Fetal and Neonatal Medicine, Saitama Medical Center, Saitama Medical University, Kawagoe, Saitama, Japan
| | - Yukiko Motojima
- Division of Neonatal Medicine, Center for Maternal, Fetal and Neonatal Medicine, Saitama Medical Center, Saitama Medical University, Kawagoe, Saitama, Japan
| | - Kana Saito
- Division of Neonatal Medicine, Center for Maternal, Fetal and Neonatal Medicine, Saitama Medical Center, Saitama Medical University, Kawagoe, Saitama, Japan
| | - Kanako Itoh
- Division of Neonatal Medicine, Center for Maternal, Fetal and Neonatal Medicine, Saitama Medical Center, Saitama Medical University, Kawagoe, Saitama, Japan
| | - Sumiko Era
- Division of Maternal and Fetal Medicine, Center for Maternal, Fetal and Neonatal Medicine, Saitama Medical Center, Saitama Medical University, Kawagoe, Saitama, Japan
| | - Shinichiro Yabe
- Division of Maternal and Fetal Medicine, Center for Maternal, Fetal and Neonatal Medicine, Saitama Medical Center, Saitama Medical University, Kawagoe, Saitama, Japan
| | - Akihiko Kikuchi
- Division of Maternal and Fetal Medicine, Center for Maternal, Fetal and Neonatal Medicine, Saitama Medical Center, Saitama Medical University, Kawagoe, Saitama, Japan
| | - Miharu Fuji
- Center for Maternal, Fetal and Neonatal Medicine, Saitama Medical Center, Saitama Medical University, Kawagoe, Saitama, Japan
| | - Mizue Matsumoto
- Center for Maternal, Fetal and Neonatal Medicine, Saitama Medical Center, Saitama Medical University, Kawagoe, Saitama, Japan
| | - Fumihiko Namba
- Department of Pediatrics, Saitama Medical Center, Saitama Medical University, Kawagoe, Saitama, Japan
| | - Hisanori Sobajima
- Department of Pediatrics, Saitama Medical Center, Saitama Medical University, Kawagoe, Saitama, Japan
| | - Masanori Tamura
- Department of Pediatrics, Saitama Medical Center, Saitama Medical University, Kawagoe, Saitama, Japan
| | - Kazuhiko Kabe
- Division of Neonatal Medicine, Center for Maternal, Fetal and Neonatal Medicine, Saitama Medical Center, Saitama Medical University, Kawagoe, Saitama, Japan
| |
Collapse
|
4
|
Tehrani FR, Naz MSG, Bidhendi-Yarandi R, Behboudi-Gandevani S. Effect of Different Types of Diagnostic Criteria for Gestational Diabetes Mellitus on Adverse Neonatal Outcomes: A Systematic Review, Meta-Analysis, and Meta-Regression. Diabetes Metab J 2022; 46:605-619. [PMID: 35255550 PMCID: PMC9353558 DOI: 10.4093/dmj.2021.0178] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Accepted: 10/02/2021] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Evidence supporting various diagnostic criteria for diagnose gestational diabetes mellitus (GDM) are consensus-based, needs for additional evidence related to outcomes. Therefore, the aim of this systematic-review and meta-analysis was to assess the impact of different GDM diagnostic-criteria on the risk of adverse-neonatal-outcomes. METHODS Electronic databases including Scopus, PubMed, and Web of Sciences were searched to retrieve English original, population-based studies with the universal GDM screening approach, up to January-2020. GDM diagnostic criteria were classified in seven groups and International Association of the Diabetes and Pregnancy Study Groups (IADPSG) was considered as reference one. We used the Mantel-Haenszel method to calculate the pooled odds of events. The possibility of publication bias was examined by Begg's test. RESULTS A total of 55 population-based studies consisting of 1,604,391 pregnant women with GDM and 7,770,855 non-GDM counterparts were included. Results showed that in all diagnostic-criteria subgroups, the risk of adverse neonatal outcomes including macrosomia, hyperbilirubinemia, respiratory distress syndrome, neonatal hypoglycemia, neonatal intensive care unit admission, preterm birth, and birth-trauma were significantly higher than the non-GDM counterparts were significantly higher than non-GDM counterparts. Meta-regression analysis revealed that the magnitude of neonatal risks in all diagnostic-criteria subgroups are similar. CONCLUSION Our results showed that the risk of adverse-neonatal-outcome increased among women with GDM, but the magnitude of risk was not different among those women who were diagnosed through more or less intensive strategies. These findings may help health-care-providers and policy-makers to select the most cost-effective approach for the screening of GDM among pregnant women.
Collapse
Affiliation(s)
- Fahimeh Ramezani Tehrani
- Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran,
Iran
| | - Marzieh Saei Ghare Naz
- Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran,
Iran
| | - Razieh Bidhendi-Yarandi
- Department of Biostatistics, University of Social Welfare and Rehabilitation Sciences, Tehran,
Iran
| | | |
Collapse
|
5
|
Ramezani Tehrani F, Naz MSG, Yarandi RB, Behboudi-Gandevani S. The Impact of Diagnostic Criteria for Gestational Diabetes Mellitus on Adverse Maternal Outcomes: A Systematic Review and Meta-Analysis. J Clin Med 2021; 10:jcm10040666. [PMID: 33572314 PMCID: PMC7916110 DOI: 10.3390/jcm10040666] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 02/01/2021] [Accepted: 02/03/2021] [Indexed: 12/13/2022] Open
Abstract
This systematic review and meta-analysis aimed to examine the impact of different gestational-diabetes (GDM) diagnostic-criteria on the risk of adverse-maternal-outcomes. The search process encompassed PubMed (Medline), Scopus, and Web of Science databases to retrieve original, population-based studies with the universal GDM screening approach, published in English language and with a focus on adverse-maternal-outcomes up to January 2020. According to GDM diagnostic criteria, the studies were classified into seven groups. A total of 49 population-based studies consisting of 1409018 pregnant women with GDM and 7,667,546 non-GDM counterparts were selected for data analysis and knowledge synthesis. Accordingly, the risk of adverse-maternal-outcomes including primary-cesarean, induction of labor, maternal-hemorrhage, and pregnancy-related-hypertension, overall, regardless of GDM diagnostic-criteria and in all diagnostic-criteria subgroups were significantly higher than non-GDM counterparts. However, in meta-regression, the increased risk was not influenced by the GDM diagnostic-classification and the magnitude of the risks among patients, using the IADPSG criteria-classification as the most strict-criteria, was similar to other criteria. In conclusion, a reduction in the diagnostic-threshold increased the prevalence of GDM, but the risk of adverse-maternal-outcome was not different among those women who were diagnosed through more or less intensive strategies. Our review findings can empower health-care-providers to select the most cost-effective approach for the screening of GDM among pregnant women.
Collapse
Affiliation(s)
- Fahimeh Ramezani Tehrani
- Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran 1985717413, Iran; (F.R.T.); (M.S.G.N.); (R.B.Y.)
| | - Marzieh Saei Ghare Naz
- Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran 1985717413, Iran; (F.R.T.); (M.S.G.N.); (R.B.Y.)
| | - Razieh Bidhendi Yarandi
- Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran 1985717413, Iran; (F.R.T.); (M.S.G.N.); (R.B.Y.)
| | - Samira Behboudi-Gandevani
- Faculty of Nursing and Health Sciences, Nord University, 8049 Bodø, Norway
- Correspondence: ; Tel.: +47-75517670
| |
Collapse
|
6
|
Soliman A, Salama H, Al Rifai H, De Sanctis V, Al-Obaidly S, Al Qubasi M, Olukade T. The effect of different forms of dysglycemia during pregnancy on maternal and fetal outcomes in treated women and comparison with large cohort studies. ACTA BIO-MEDICA : ATENEI PARMENSIS 2018; 89:11-21. [PMID: 30049927 DOI: 10.23750/abm.v89is4.7356] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Indexed: 12/11/2022]
Abstract
AIMS OF THE STUDY We describe the impact of different forms of dysglycemia on maternal and neonatal health. This research is a part of the PEARL-Peristat Maternal and newborn registry, funded by Qatar National Research Fund (QNRF) Doha, Qatar. METHODS A population-based retrospective data analysis of 12,255 women with singleton pregnancies screened during the year 2016-2017, of which 3,027 women were identified with gestation diabetes mellitus (GDM) during pregnancy and 233 were diabetic before pregnancy. Data on maternal outcome was collected from the PEARL-Peristat Maternal and newborn registry. RESULTS The prevalence of GDM and diabetes mellitus (DM) was 24.7 % and 1.9%, respectively. 55% of DM, 38% of GDM and 25.6% of controls were obese (p<0.001). 71% of pregnant women with DM and 57.8% of those with GDM were older than 30 years versus 44.2% of controls. Pregnant women with DM or GDM had higher prevalence of hypertension versus normal controls (9.9%, 5.5% and 3.5%, respectively; p<0.001). Among women with vaginal deliveries, the proportion of women with induction of labor was significantly higher in the DM and GDM compared to control subjects (33.9%, 26.5% and 12.4%, respectively; p<0.001). The number of women who underwent Cesarean section was significantly higher in the DM and GDM groups versus normal controls (51.9%, 36.8%, and 28.5%, respectively; p<0.001). Preterm delivery was significantly higher in women with DM and GDM (13.7% and 9%, respectively versus normal women (6.4%); p<0.001). Babies of DM and GDM had significantly higher occurrence of respiratory distress (RDS) or transient tachypnea (TTS): 9% and 5.8 % versus normal controls (4.8%). Macrosomia was more prevalent in babies of DM (6.4%) and GDM (6.8%) compared to controls (5%) (p: <0.001). Significant hypoglycemic episodes occurred more frequently in babies of DM and GDM women (11.2% and 3%, respectively) versus controls (0.6%) (p: <0.001. Infants of DM and GDM mothers required more treatments of phototherapy (9.4% and 8.9%, respectively) versus those born to normal women (7.2%) (p: 0.006). The prevalence of congenital anomalies and neonatal death did not differ between the groups. CONCLUSIONS Despite the improvement in the prenatal diagnosis and management of dysglycemia, there is still a higher prevalence of prematurity, macrosomia, and hypoglycemia in infants of mothers with DM and GDM. Measurements to reduce obesity and control dysglycemia in women during the childbearing period are highly required to prevent the still higher morbidity during pregnancy.
Collapse
Affiliation(s)
- Ashraf Soliman
- Departments of Pediatrics and Neonatology, Hamad Medical Center, Doha, Qatar.
| | | | | | | | | | | | | |
Collapse
|
7
|
Early Mortality and Morbidity in Infants with Birth Weight of 500 Grams or Less in Japan. J Pediatr 2017; 190:112-117.e3. [PMID: 28746032 DOI: 10.1016/j.jpeds.2017.05.017] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Revised: 04/17/2017] [Accepted: 05/03/2017] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To assess the short-term prognosis of Japanese infants with a birth weight (BW) of ≤500 g. STUDY DESIGN Demographic and clinical data were reviewed for 1473 live born infants with a BW ≤500 g at gestational age ≥22 weeks who were treated in the 204 affiliated hospitals of the Neonatal Research Network of Japan between 2003 and 2012. RESULTS Survival to hospital discharge occurred in 811 of 1473 infants (55%; 95% CI 53%-58%). The survival rates of BW ≤300 g, 301-400 g, and 401-500 g were 18% (95% CI 10%-31%), 41% (95% CI 36%-47%), and 60% (95% CI 57%-63%), respectively. In a multivariable Cox proportional hazards analysis, antenatal corticosteroid use (adjusted hazard ratio: 0.68; 95% CI 0.58-0.81; P < .01), cesarean delivery (0.69; 95% CI 0.56-0.85; P < .01), advanced gestational age per week (0.94; 95% CI 0.89-0.99; P = .02), BW per 100-g increase (0.55; 95% CI 0.49-0.64; P < .01), Apgar score ≥4 at 5 minutes (0.51; 95% CI 0.43-0.61; P < .01), and no major congenital abnormalities (0.38; 95% CI 0.29-0.51; P < .01) were associated with survival to discharge. Despite the improved survival rate over the 10-year study period (from 40% in 2003 [95% CI 30%-51%] to 68% in 2012 [95% CI 61%-75%]), at least 1 severe morbidity was present in 81%-89% of the survivors. CONCLUSIONS Improvements in perinatal-neonatal medicine have improved the survival, but not the rate of major morbidities, of infants with a BW ≤500 g in Japan.
Collapse
|
8
|
Risk assessment for neonatal RDS/TTN using gestational age and the amniotic lamellar body count in twin pregnancies. Clin Chim Acta 2015; 451:301-4. [PMID: 26477481 DOI: 10.1016/j.cca.2015.10.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Revised: 10/14/2015] [Accepted: 10/14/2015] [Indexed: 12/21/2022]
Abstract
BACKGROUND The amniotic lamellar body count (LBC) is useful for predicting respiratory distress syndrome (RDS) and transient tachypnea of the newborn (TTN) in twin pregnancies. However, the risk of neonatal respiratory complications varies with gestational age (GA). We herein created a model to predict the risk for RDS and TTN using GA and the LBC in twin pregnancies. METHODS Six hundred thirty-two amniotic fluid samples, comprising 169 dichorionic twin (DCT) and 147 monochorionic twin (MCT) gestations, were obtained at Cesarean section. The samples were analyzed immediately without centrifugation. A logistic regression model including the LBC and GA was used to develop the prediction model for RDS/TTN. RESULTS There were 101 neonates (16.0%) with RDS/TTN. The GA and LBC were significant independent factors affecting RDS/TTN. According to the logistic regression model, we determined the probability of RDS/TTN given the values of GA and the LBC. The overall diagnostic accuracy for predicting neonatal RDS/TTN using GA and the LBC was higher than the use of the LBC alone. CONCLUSIONS GA-specific LBC cutoffs for the risk assessment of neonatal RDS/TTN have been considered to be more accurate in twin pregnancies. Our findings provide valuable, new information for the management of twin pregnancies.
Collapse
|
9
|
Tsuda H, Kotani T, Sumigama S, Mano Y, Kawabata I, Takahashi Y, Iwagaki S, Hirakawa A, Kikkawa F. Amniotic lamellar body count: predicting and distinguishing neonatal respiratory complications in twin pregnancies. Clin Chim Acta 2015; 441:75-8. [DOI: 10.1016/j.cca.2014.12.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Revised: 11/17/2014] [Accepted: 12/15/2014] [Indexed: 11/29/2022]
|
10
|
Ipekci SH, Kebapcilar AG, Yilmaz SA, Ilhan TT, Pekin AT, Abusoglu S, Unlu A, Annagur A, Celik C. Serum levels of neopterin in gestational diabetes mellitus: the relationship with Apgar scores. Arch Gynecol Obstet 2015; 292:103-9. [DOI: 10.1007/s00404-015-3615-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2014] [Accepted: 01/05/2015] [Indexed: 12/25/2022]
|
11
|
Nallaperumal S, Bhavadharini B, Mahalakshmi MM, Maheswari K, Jalaja R, Moses A, Anjana RM, Deepa M, Ranjani H, Mohan V. Comparison of the world health organization and the International association of diabetes and pregnancy study groups criteria in diagnosing gestational diabetes mellitus in South Indians. Indian J Endocrinol Metab 2013; 17:906-9. [PMID: 24083175 PMCID: PMC3784877 DOI: 10.4103/2230-8210.117241] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
AIM We aimed to compare the International Association of Diabetes and Pregnancy Study Groups (IADPSG) and the World Health Organization (WHO) criteria to diagnose gestational diabetes mellitus (GDM) in Chennai, India. MATERIALS AND METHODS We reviewed the retrospective data of 1351 pregnant women who underwent screening for GDM at four selected diabetes centers at Chennai (three private and one government). All women underwent an oral glucose tolerance test using 75g glucose load and fasting, 1-h, and 2-h samples were collected. The IADPSG and WHO criteria were compared for diagnosis of GDM. RESULTS A total of 839 women had GDM by either the IADPSG or the WHO criteria, of whom the IADPSG criteria identified 699 and the WHO criteria also identified 699 women as having GDM. However, only 599/839 women (66.6%) were identified by both criteria. Thus, 140/839 women (16.7%) were missed by both the IADPSG and the WHO criteria. 687/699 (98.2%) of the women with GDM were identified by the WHO criteria. In contrast, each value of IADPSG criteria i.e., fasting, 1 h, and 2 h identified only 12.5%, 14%, and 22%, respectively. CONCLUSIONS A single WHO cut-point of 2 h > 140 mg/dl appears to be suitable for large-scale screening for GDM in India and other developing countries.
Collapse
Affiliation(s)
- Sivagnanam Nallaperumal
- Department of Diabetology, Swamy Diabetes and Prashanthi Infertility Research Center, Chennai, India
| | - Balaji Bhavadharini
- Department of Epidemiology, Madras Diabetes Research Foundation, and Dr. Mohan's Diabetes Specialties Centre, Chennai, India
| | - Manni Mohanraj Mahalakshmi
- Department of Epidemiology, Madras Diabetes Research Foundation, and Dr. Mohan's Diabetes Specialties Centre, Chennai, India
| | - Kumar Maheswari
- Department of Epidemiology, Madras Diabetes Research Foundation, and Dr. Mohan's Diabetes Specialties Centre, Chennai, India
| | - Ramesh Jalaja
- Department of Diabetology, Geetika Diabetes Center, Chennai, India
| | - Anand Moses
- Department of Diabetology, Madras Medical College and Government General Hospital, Institute of Diabetology, Chennai, India
| | - Ranjit Mohan Anjana
- Department of Diabetology, Madras Diabetes Research Foundation, and Dr. Mohan's Diabetes Specialties Centre, Chennai, India
| | - Mohan Deepa
- Department of Epidemiology, Madras Diabetes Research Foundation, and Dr. Mohan's Diabetes Specialties Centre, Chennai, India
| | - Harish Ranjani
- Department of Translational Research and Diabetology, Geetika Diabetes Center, Chennai, India
| | - Viswanathan Mohan
- Department of Diabetology, Madras Diabetes Research Foundation, and Dr. Mohan's Diabetes Specialties Centre, Chennai, India
| |
Collapse
|
12
|
Uppal P, Holland AJA, Bajuk B, Abdel-Latif M, Jaffe A, Hilder L, Lui K, Oei JL. The association between maternal country of birth and neonatal intensive care unit outcomes. Early Hum Dev 2013; 89:607-14. [PMID: 23567194 DOI: 10.1016/j.earlhumdev.2013.03.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2012] [Revised: 03/06/2013] [Accepted: 03/12/2013] [Indexed: 02/07/2023]
Abstract
BACKGROUND Immigration is increasingly common worldwide and its impact on neonatal intensive care unit outcomes is uncertain. AIMS To determine the outcomes of children of immigrant mothers admitted to NICUs in New South Wales (NSW), Australia, between 2000 and 2006. STUDY DESIGN Record linkage study of routinely collected state-based health databases. SUBJECTS Infants of Australian-born (9813, 81.9%) and overseas born mothers (2166, 18.1%). OUTCOME MEASURES NICU and childhood outcomes to a maximum 5 years of age. RESULTS Immigrant mothers came from 122 countries, 897 (44%) from high income regions. Australian born mothers were more likely to be teenaged (Odds Ratio, 95% confidence interval: 3.07, 2.21-4.26), use drugs (3.55, 2.49-5.06) and suffer an antepartum hemorrhage (1.29, 1.14-1.48). They were less likely to have gestational diabetes (0.45, 0.38-0.54), fetal distress (0.75, 0.66-0.85) and intrauterine growth restriction (0.80, 0.67-0.93). Their infants were more likely to be admitted to the NICU for prematurity but less likely to have low 5 min Apgar scores (0.81, 0.69-0.93) or a congenital abnormality (0.79, 0.70-0.90). Infants of Middle-Eastern mothers had the lowest hospital survival rate (88.5%). Children of immigrant Asian mothers were least likely to be rehospitalized after NICU discharge (1.66, 1.27-2.17). CONCLUSIONS NICU outcomes are affected by maternal country of birth even within the same ethnic group. Further study regarding the impact of paternal race and immigration status and duration of residency will provide data for the changing cultural environment of global perinatal care.
Collapse
Affiliation(s)
- Preena Uppal
- Department of Newborn Care, Royal Hospital for Women, Randwick, NSW, Australia
| | | | | | | | | | | | | | | |
Collapse
|
13
|
Risk-based screening for thyroid dysfunction during pregnancy. J Pregnancy 2013; 2013:619718. [PMID: 23606967 PMCID: PMC3625569 DOI: 10.1155/2013/619718] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2013] [Accepted: 02/27/2013] [Indexed: 12/03/2022] Open
Abstract
Objective. We conducted the study to see the incidence of thyroid dysfunction in women with obstetrical high-risk factors. Methods. We retrospectively reviewed medical charts of high-risk pregnant women who had examination for thyroid function during pregnancy. Women were divided according to clinical presentation, symptoms of thyroid disease and those with a personal history of thyroid disease (thyroid disease, n = 32), intrauterine growth restriction (IUGR, n = 115), diabetes mellitus (diabetes, n = 115), hypertension (n = 63), intrauterine fetal death (IUFD, n = 52), and placental abruption (abruption, n = 15). The incidence of thyroid dysfunctions including hyperthyroidism or hypothyroidism was compared. Results. The overall prevalence of thyroid dysfunction was 24.7%. The incidence of thyroid dysfunction in each group was as follows: 31% in thyroid disease, 25% in IUGR, 30% in diabetes, 27% in hypertension, 12% in IUFD, and 7% in abruption. Except IUFD, the incidence was not statistically significant from the group of thyroid disease (thyroid disease versus IUFD, P = 0.03 by χ2 test). Thyroid disease represented for only 10% of all thyroid dysfunctions. Conclusion. Testing of women with a personal history or current symptoms of thyroid disease during pregnancy may be insufficient to detect women with thyroid dysfunction, who will become at high-risk pregnancy.
Collapse
|
14
|
Abstract
BACKGROUND We examined the extent of fetal lung hypoplasia and lung maturation using the amniotic lamellar body count (LBC) in congenital diaphragmatic hernia (CDH). METHODS We obtained 30 amniotic fluid samples from human CDH cases during cesarean section. We assessed LBC, magnetic resonance imaging (MRI), and ultrasound findings for predicting the prognosis of CDH. We collected newborn amniotic fluid and lung tissue at embryonic day (E)21 from normal and nitrofen-induced CDH rats (administered 100 mg orally at E9). Amniotic LBCs in rats were measured using light microscopy. RESULTS In human CDH, LBC was significantly higher in the surviving than in the deceased group (P < 0.01). A significant positive correlation was observed between LBC and percentage of fetal lung volume on MRI (P < 0.001; r = 0.716). In rats, LBC was significantly higher in controls than in CDH rats (P < 0.01) and correlated with fetal lung weight. CONCLUSION We conclude that LBC is useful for predicting lung hypoplasia in human CDH after 35 gestational weeks and in a rat model of nitrofen-induced CDH.
Collapse
|
15
|
Wendland EM, Torloni MR, Falavigna M, Trujillo J, Dode MA, Campos MA, Duncan BB, Schmidt MI. Gestational diabetes and pregnancy outcomes--a systematic review of the World Health Organization (WHO) and the International Association of Diabetes in Pregnancy Study Groups (IADPSG) diagnostic criteria. BMC Pregnancy Childbirth 2012; 12:23. [PMID: 22462760 PMCID: PMC3352245 DOI: 10.1186/1471-2393-12-23] [Citation(s) in RCA: 356] [Impact Index Per Article: 29.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2011] [Accepted: 03/31/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Two criteria based on a 2 h 75 g OGTT are being used for the diagnosis of gestational diabetes (GDM), those recommended over the years by the World Health Organization (WHO), and those recently recommended by the International Association for Diabetes in Pregnancy Study Group (IADPSG), the latter generated in the HAPO study and based on pregnancy outcomes. Our aim is to systematically review the evidence for the associations between GDM (according to these criteria) and adverse outcomes. METHODS We searched relevant studies in MEDLINE, EMBASE, LILACS, the Cochrane Library, CINHAL, WHO-Afro library, IMSEAR, EMCAT, IMEMR and WPRIM. We included cohort studies permitting the evaluation of GDM diagnosed by WHO and or IADPSG criteria against adverse maternal and perinatal outcomes in untreated women. Only studies with universal application of a 75 g OGTT were included. Relative risks (RRs) and their 95% confidence intervals (CI) were obtained for each study. We combined study results using a random-effects model. Inconsistency across studies was defined by an inconsistency index (I2) > 50%. RESULTS Data were extracted from eight studies, totaling 44,829 women. Greater risk of adverse outcomes was observed for both diagnostic criteria. When using the WHO criteria, consistent associations were seen for macrosomia (RR = 1.81; 95%CI 1.47-2.22; p < 0.001); large for gestational age (RR = 1.53; 95%CI 1.39-1.69; p < 0.001); perinatal mortality (RR = 1.55; 95% CI 0.88-2.73; p = 0.13); preeclampsia (RR = 1.69; 95%CI 1.31-2.18; p < 0.001); and cesarean delivery (RR = 1.37;95%CI 1.24-1.51; p < 0.001). Less data were available for the IADPSG criteria, and associations were inconsistent across studies (I2 ≥ 73%). Magnitudes of RRs and their 95%CIs were 1.73 (1.28-2.35; p = 0.001) for large for gestational age; 1.71 (1.38-2.13; p < 0.001) for preeclampsia; and 1.23 (1.01-1.51; p = 0.04) for cesarean delivery. Excluding either the HAPO or the EBDG studies minimally altered these associations, but the RRs seen for the IADPSG criteria were reduced after excluding HAPO. CONCLUSIONS The WHO and the IADPSG criteria for GDM identified women at a small increased risk for adverse pregnancy outcomes. Associations were of similar magnitude for both criteria. However, high inconsistency was seen for those with the IADPSG criteria. Full evaluation of the latter in settings other than HAPO requires additional studies.
Collapse
Affiliation(s)
| | | | | | - Janet Trujillo
- Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | | | | | - Bruce B Duncan
- Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | | |
Collapse
|
16
|
Tsuda H, Takahashi Y, Iwagaki S, Uchida Y, Kawabata I, Hayakawa M, Sumigama S, Hayakawa H, Kotani T, Kikkawa F. Amniotic lamellar body counts can predict the occurrence of respiratory distress syndrome as well as transient tachypnea of the newborn (TTN). J Perinat Med 2011; 39:245-50. [PMID: 21314236 DOI: 10.1515/jpm.2011.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
AIMS The purpose of this study is to predict the occurrence of transient tachypnea of the newborn (TTN) using amniotic lamellar body count (LBC) and compare the LBCs in neonates with TTN with the LBCs in neonates with respiratory distress syndrome (RDS) and controls. METHODS Three hundred and eighty-one amniotic fluid samples were obtained at cesarean section from 27 to 40 weeks of gestation. Samples were analyzed immediately without centrifugation and the number of lamellar bodies was counted. RESULTS The LBC in amniotic fluid ranged from 1,000 to 577,000/μL. An LBC cut-off value of 48,500/μL resulted in 84.7% sensitivity, 76.2% specificity, and 98.1% negative predictive value for predicting TTN. The LBC in neonates with TTN was significantly lower than that in controls (50,000 vs. 122,000; P<0.001) and significantly higher than that in neonates with RDS (50,000 vs. 21,000; P=0.042). CONCLUSIONS We established a cut-off value of LBC for predicting the occurrence of TTN. The LBC in neonates with TTN was significantly lower than that in controls. Amniotic LBC can be a useful marker to predict if neonatal respiratory management is required.
Collapse
Affiliation(s)
- Hiroyuki Tsuda
- Department of Obstetrics and Gynecology, Nagoya University School of Medicine, Nagoya, Japan.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
17
|
Tsuda H, Takahashi Y, Iwagaki S, Kawabata I, Hayakawa H, Kotani T, Shibata K, Kikkawa F. Intra-amniotic infection increases amniotic lamellar body count before 34 weeks of gestation. J Matern Fetal Neonatal Med 2011; 23:1230-6. [PMID: 20158396 DOI: 10.3109/14767051003615442] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To examine the lamellar body count (LBC) value in intra-amniotic infection cases and evaluate its association with the incidence of respiratory distress syndrome (RDS). METHODS Three hundred sixty-five amniotic fluid (AF) samples were obtained at caesarean section from 27 to 38 weeks of gestation. LBC and glucose concentrations in AF were measured with no centrifugation. We defined AF glucose concentrations<0.8 mmol/L and positive C-reactive protein (CRP) of the neonates as intra-amniotic infection. RESULTS An LBC cutoff value of 29,500/μL resulted in 94.0% sensitivity, 82.4% specificity, and 99.1% negative predictive value (NPV) for RDS. Neonates with glucose concentrations<0.8 mmol/L in AF and positive CRP had no RDS and significantly higher LBC values than controls before 34 weeks of gestation (17.0 vs. 4.3, p<0.05 and 25.5 vs. 5.0, p<0.05, respectively), but there were no significant differences after 34 weeks of gestation. CONCLUSIONS LBC is an accurate predictor of foetal lung maturity and our LBC cutoff value had a high NPV for predicting RDS. We showed that intra-amniotic infection was associated with significantly higher LBC values than the value in controls before 34 weeks of gestation, which correlated with a low incidence of RDS.
Collapse
Affiliation(s)
- Hiroyuki Tsuda
- Department of Obstetrics and Gynecology, Nagoya University School of Medicine, Nagoya, Japan.
| | | | | | | | | | | | | | | |
Collapse
|
18
|
Clinical characterization and long-term prognosis of neurological development in preterm infants with late-onset circulatory collapse. J Perinatol 2010; 30:751-6. [PMID: 20357811 PMCID: PMC2994595 DOI: 10.1038/jp.2010.41] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To characterize the risk factors for late-onset circulatory collapse (LCC) in preterm infants responsive to corticosteroid therapy and evaluate the long-term neurological prognosis. STUDY DESIGN A retrospective case-control study for preterm infants (≤32 weeks' gestation) admitted to our neonatal intensive care unit from 1994 through 2002. RESULT Sixty-five infants (11%) were diagnosed with LCC. Infants with a shorter gestation and lower birth weight had a higher incidence of LCC. LCC infants had a significantly lower 1-min Apgar score, significantly higher incidence of severe intraventricular hemorrhage, chronic lung disease, and postnatal periventricular leukomalacia, and significantly longer duration of ventilation use, oxygen use, and hospital stay. Somatic growth at 36 weeks' postmenstrual age was poorer in infants with LCC than without LCC (controls). LCC infants were significantly more likely than controls to have cerebral palsy at 3 years. CONCLUSION LCC is associated with poor neurodevelopmental outcomes. Prevention of LCC can lead to improved neurological prognoses.
Collapse
|
19
|
Abstract
OBJECTIVE The purpose of this study was to examine rates and factors associated with recurrence of gestational diabetes mellitus (GDM) among women with a history of GDM. RESEARCH DESIGN AND METHODS We conducted a systematic literature review of articles published between January 1965 and November 2006, in which recurrence rates of GDM among women with a history of GDM were reported. Factors abstracted included recurrence rates, time elapsed between pregnancies, race/ethnicity, diagnostic criteria, and, when available, maternal age, parity, weight or BMI at the initial and subsequent pregnancy, weight gain at the initial or subsequent pregnancy and between pregnancies, insulin use, gestational age at diagnosis, glucose tolerance test levels, baby birth weight and presence of macrosomia, and breast-feeding. RESULTS Of 45 articles identified, 13 studies were eligible for inclusion. After the index pregnancy, recurrence rates varied between 30 and 84%. Lower rates were found in non-Hispanic white (NHW) populations (30-37%), and higher rates were found in minority populations (52-69%). Exceptions to observed racial/ethnic variations in recurrence were found in cohorts that were composed of a significant proportion of both NHW and minority women or that included women who had subsequent pregnancies within 1 year. No other risk factors were consistently associated with recurrence of GDM across studies. The rates of future preexisting diabetes in pregnancy, socioeconomic status, postpartum diabetes screening rates after the index pregnancy, and the average length of time between pregnancies were generally not reported. CONCLUSIONS Recurrence of GDM was common and may vary most significantly by NHW versus minority race/ethnicity.
Collapse
Affiliation(s)
- Catherine Kim
- Department of Medicine, University of Michigan, Ann Arbor, Michigan, USA.
| | | | | |
Collapse
|
20
|
Kusuda S, Fujimura M, Sakuma I, Aotani H, Kabe K, Itani Y, Ichiba H, Matsunami K, Nishida H. Morbidity and mortality of infants with very low birth weight in Japan: center variation. Pediatrics 2006; 118:e1130-8. [PMID: 16950943 DOI: 10.1542/peds.2005-2724] [Citation(s) in RCA: 167] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES The objectives of this study were to describe the characteristics and morbidity of very low birth weight infants, to identify the medical intervention for these infants, and to evaluate the factors affecting the mortality of these infants among the participating hospitals. METHODS A large multicenter neonatal research network that included level III NICUs from throughout Japan was established. A standardized mortality rate was formulated by giving a ratio of the observed deaths and the predicted deaths based on a 100-g birth weight interval mortality. A regression model was used to predict the factors that affect neonatal mortality. RESULTS The network included 37 centers and 2145 infants weighing < or = 1500 g, born or admitted to the centers in 2003. Gestational age and birth weight of studied infants were 28.6 +/- 3.6 gestational weeks (mean +/- SD) and 1025 +/- 302 g, respectively. Overall, 11% of the infants died before being discharged from hospitals (range: 0%-21%). The standardized mortality rate varied among the facilities (range: 0%-30%). No association between the annual number of patients admitted and standardized mortality rate was found. Among all of the very low birth weight infants, 14% were outborn infants, 72% were delivered by cesarean sections, 27% had patent ductus arteriosus, 3% had gastrointestinal perforation, 8% had bacterial sepsis, and 13% had intraventricular hemorrhage. Medical interventions involved were: 41% antenatal corticosteroids, 54% surfactant therapy, 18% postnatal steroids for chronic lung disease, and 29% high-frequency oscillatory ventilation. We found variations in the medical interventions and the clinical outcomes among the centers. CONCLUSIONS The overall survival rate for very low birth weight infants among neonatal centers in Japan was approximately 90%. However, differences in the morbidity and mortality were observed among these centers.
Collapse
Affiliation(s)
- Satoshi Kusuda
- Department of Neonatology, Maternal and Perinatal Center, Tokyo Women's Medical University, 8-1 Kawadacho, Shinjuku, Tokyo, 162-8666 Japan.
| | | | | | | | | | | | | | | | | |
Collapse
|
21
|
Nohira T, Kim S, Nakai H, Okabe K, Nohira T, Yoneyama K. Recurrence of gestational diabetes mellitus: rates and risk factors from initial GDM and one abnormal GTT value. Diabetes Res Clin Pract 2006; 71:75-81. [PMID: 16005100 DOI: 10.1016/j.diabres.2005.05.011] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2004] [Revised: 03/03/2005] [Accepted: 05/09/2005] [Indexed: 11/21/2022]
Abstract
The recurrence rate of GDM among women in Japan who had GDM or one abnormal value on 75 g oral glucose tolerance test (OAV) during an initial pregnancy is unclear. We therefore sought to determine the recurrence rate and risk factors of recurrent GDM by evaluating 32 patients with GDM and 37 with OAV in their index pregnancies. Medical records and chemical data were compared between patients with and without GDM in their subsequent pregnancies. The recurrence rate from index GDM and OAV were 65.6% and 40.5%. Age, BMI before pregnancy, an increased weight gain between pregnancies and a short interval between pregnancies were risk factors for recurrence from the initial GDM. An increased weight gain between pregnancies and a short interval between pregnancies were risk factors of development to GDM from the initial OAV. We concluded that the control of weight gain and interval between pregnancies could be important to reduce GDM recurrence.
Collapse
Affiliation(s)
- Tomoyoshi Nohira
- Department of Obstetrics and Gynecology, Hachioji Medical Center of Tokyo Medical University, Tate-machi 1163, Hachioji-si, Tokyo 193-0998, Japan.
| | | | | | | | | | | |
Collapse
|
22
|
Stone CA, McLachlan KA, Halliday JL, Wein P, Tippett C. Gestational diabetes in Victoria in 1996: incidence, risk factors and outcomes. Med J Aust 2002; 177:486-91. [PMID: 12405890 DOI: 10.5694/j.1326-5377.2002.tb04916.x] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2001] [Accepted: 07/04/2002] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To describe the epidemiology of gestational diabetes mellitus (GDM) in Victoria. STUDY DESIGN Population study of all women having singleton births in Victoria in 1996. METHODS Probabilistic record linkage of routinely collected data and capture-recapture techniques to provide an estimate of the incidence of GDM. MAIN OUTCOME MEASURES Risk factors for and the adverse outcomes associated with GDM compared with the non-diabetic population by univariate and multivariate analysis. RESULTS The estimated incidence of GDM was 3.6% (95% confidence interval [CI], 3.60%-3.64%). GDM is associated with women who are older, Aboriginal, non-Australian born, or who give birth in a larger hospital. The adverse outcomes associated with GDM pregnancies were hypertension/pre-eclampsia (adjusted odds ratio [OR], 1.6; 95% CI, 1.4-1.9), hyaline membrane disease (1.6; 1.2-2.2), neonatal jaundice (1.4; 1.2-1.7) and macrosomia (2.0; 1.8-2.3). Interventions during childbirth were also associated with GDM - for example, induction of labour (3.0; 2.7-3.4) and caesarean section (1.7; 1.6-1.9). CONCLUSION Women with GDM had increased rates of hypertension, pre-eclampsia, induced labour, and interventional delivery. Their offspring had a higher risk of macrosomia, neonatal jaundice and hyaline membrane disease.
Collapse
Affiliation(s)
- Christine A Stone
- Prevention and National Health Priorities, Public Health Division, Department of Human Services, 17th Floor, 120 Spencer Street, Melbourne, VIC 3001, Australia.
| | | | | | | | | |
Collapse
|
23
|
Gokcel A, Bagis T, Killicadag EB, Tarim E, Guvener N. Comparison of the criteria forgestational diabetes mellitus by NDDG and Carpenter and Coustan, and the outcomes of pregnancy. J Endocrinol Invest 2002; 25:357-61. [PMID: 12030608 DOI: 10.1007/bf03344018] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
This is a retrospective study to compare the criteria for diagnosis of gestational diabetes mellitus (GDM) by the National Diabetes Data Group (NDDG), and Carpenter and Coustan criteria, and to study the outcome of GDM when diagnosed by the more sensitive criteria. Six hundred and sixty-two pregnant women were included in this study from the medical records between September 1998 and April 2001. GDM was positive in 6.50% of patients according to Carpenter and Coustan and in 4.08% of patients according to NDDG criteria. Women with GDM were older, had higher fasting and glucose challenge test (GCT) glucose levels, and fetal weight than the normal women. Hypoglycemia was observed only in one infant. Regarding pre-term delivery and pre-eclampsia, there was no significant difference between the groups. Age, delivery week and fetal weight of patients who had caesarian delivery were significantly higher than spontaneous vaginal delivery. Prevalence of macrosomia in GDM group was higher than in the normal group. There was a significant correlation between the macrosomia and number of positive blood glucose values during OGTT. In multivariate analyses, fasting, GCT and second hour OGTT blood glucose levels, mean parity, and delivery week were independent risk factors for fetal weight. Carpenter and Coustan criteria is more sensitive than the NDDG criteria and women with GDM had a higher frequency of macrosomia and the frequency of macrosomia increases by the number of positive blood glucose levels during OGTT. Tight glycemic control might decrease the prevalence of caesarian delivery, pre-eclampsia, pre-term delivery and hypoglycemia of the infant.
Collapse
Affiliation(s)
- A Gokcel
- Endocrinology and Metabolism Division, Baskent University, Adana, Turkey.
| | | | | | | | | |
Collapse
|