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Estrada P, Tipton L, Chong R, Towner D, Yamasato K. Associations between the Safe Prevention of Primary Cesarean Delivery Care Consensus and Maternal/Neonatal Outcomes. Am J Perinatol 2024; 41:e1084-e1089. [PMID: 36649731 DOI: 10.1055/s-0042-1760387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVE This study aimed to compare cesarean delivery (CD) rates and maternal/neonatal outcomes before and after the 2014 ACOG/SMFM Obstetric Care Consensus for Safe Prevention of Primary CD. STUDY DESIGN This retrospective study compared unscheduled CD rates and outcomes of singleton, cephalic, term pregnancies at a tertiary-care teaching maternity hospital. Births 5 years before (March 2009-February 2014) and after (June 2014-May 2019) release of the consensus were included. Chi-square and t-test were used to compare outcomes and logistic regression to adjust for confounders. RESULTS In this study, 44,001 pregnancies were included, 20,887 before and 23,114 after the consensus. Unscheduled CD rates increased after the consensus (12.9 vs. 14.3%, p < 0.001); however, there was no difference after adjustment (adjusted odds ratio [aOR], 0.97; 95% confidence interval [CI], 0.91-1.03). Vaginal birth after cesarean (VBAC) deliveries increased among multiparas (4.8 vs. 7.2%, p < 0.001), which remained significant after adjustment (aOR, 1.51; 95% CI, 1.37-1.66). Postpartum hemorrhage, blood transfusion, and chorioamnionitis were modestly increased, while third-degree perineal lacerations decreased. Uterine rupture and neonatal outcomes were unchanged after adjustment. CONCLUSION At our tertiary-care maternity hospital, the Safe Prevention of Primary CD Care Consensus was not associated with a change in unscheduled CD, though VBAC deliveries increased. We did not demonstrate improved neonatal outcomes and showed increased maternal morbidity that warrants further study. KEY POINTS · Consensus did not change unscheduled cesarean rates.. · Consensus associated with increased hemorrhage.. · Institutional outcomes can assist implementing changes..
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Affiliation(s)
- Pamela Estrada
- Department of Obstetrics, Gynecology and Women's Health, University of Hawaii John A. Burns School of Medicine, Honolulu, Hawaii
| | - Laura Tipton
- School of Natural Sciences and Mathematics, Data Science, Analytics, and Visualization, Chaminade University of Honolulu, Honolulu, Hawaii
| | - Rylan Chong
- School of Natural Sciences and Mathematics, Data Science, Analytics, and Visualization, Chaminade University of Honolulu, Honolulu, Hawaii
| | - Dena Towner
- Department of Obstetrics, Gynecology and Women's Health, University of Hawaii John A. Burns School of Medicine, Honolulu, Hawaii
| | - Kelly Yamasato
- Department of Obstetrics, Gynecology and Women's Health, University of Hawaii John A. Burns School of Medicine, Honolulu, Hawaii
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Francis EC, Powe CE, Lowe WL, White SL, Scholtens DM, Yang J, Zhu Y, Zhang C, Hivert MF, Kwak SH, Sweeting A. Refining the diagnosis of gestational diabetes mellitus: a systematic review and meta-analysis. COMMUNICATIONS MEDICINE 2023; 3:185. [PMID: 38110524 PMCID: PMC10728189 DOI: 10.1038/s43856-023-00393-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 10/25/2023] [Indexed: 12/20/2023] Open
Abstract
BACKGROUND Perinatal outcomes vary for women with gestational diabetes mellitus (GDM). The precise factors beyond glycemic status that may refine GDM diagnosis remain unclear. We conducted a systematic review and meta-analysis of potential precision markers for GDM. METHODS Systematic literature searches were performed in PubMed and EMBASE from inception to March 2022 for studies comparing perinatal outcomes among women with GDM. We searched for precision markers in the following categories: maternal anthropometrics, clinical/sociocultural factors, non-glycemic biochemical markers, genetics/genomics or other -omics, and fetal biometry. We conducted post-hoc meta-analyses of a subset of studies with data on the association of maternal body mass index (BMI, kg/m2) with offspring macrosomia or large-for-gestational age (LGA). RESULTS A total of 5905 titles/abstracts were screened, 775 full-texts reviewed, and 137 studies synthesized. Maternal anthropometrics were the most frequent risk marker. Meta-analysis demonstrated that women with GDM and overweight/obesity vs. GDM with normal range BMI are at higher risk of offspring macrosomia (13 studies [n = 28,763]; odds ratio [OR] 2.65; 95% Confidence Interval [CI] 1.91, 3.68), and LGA (10 studies [n = 20,070]; OR 2.23; 95% CI 2.00, 2.49). Lipids and insulin resistance/secretion indices were the most studied non-glycemic biochemical markers, with increased triglycerides and insulin resistance generally associated with greater risk of offspring macrosomia or LGA. Studies evaluating other markers had inconsistent findings as to whether they could be used as precision markers. CONCLUSIONS Maternal overweight/obesity is associated with greater risk of offspring macrosomia or LGA in women with GDM. Pregnancy insulin resistance or hypertriglyceridemia may be useful in GDM risk stratification. Future studies examining non-glycemic biochemical, genetic, other -omic, or sociocultural precision markers among women with GDM are warranted.
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Affiliation(s)
- Ellen C Francis
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, NJ, USA.
| | - Camille E Powe
- Diabetes Unit, Massachusetts General Hospital, Boston, MA, USA
| | - William L Lowe
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Sara L White
- Department of Women and Children's Health, King's College London, London, UK
| | - Denise M Scholtens
- Department of Preventive Medicine, Division of Biostatistics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Jiaxi Yang
- Global Center for Asian Women's Health (GloW), Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Department of Obstetrics and Gynecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Bia-Echo Asia Centre for Reproductive Longevity & Equality (ACRLE), Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Yeyi Zhu
- Kaiser Permanente Northern California Division of Research, Oakland, CA, USA
| | - Cuilin Zhang
- Global Center for Asian Women's Health (GloW), Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Department of Obstetrics and Gynecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Bia-Echo Asia Centre for Reproductive Longevity & Equality (ACRLE), Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Marie-France Hivert
- Diabetes Unit, Massachusetts General Hospital, Boston, MA, USA
- Department of Population Medicine, Harvard Medical School, Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | - Soo Heon Kwak
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Arianne Sweeting
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
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Zeng Q, Tan B, Han F, Huang X, Huang J, Wei Y, Guo R. Association of solute carrier family 30 A8 zinc transporter gene variations with gestational diabetes mellitus risk in a Chinese population. Front Endocrinol (Lausanne) 2023; 14:1159714. [PMID: 37324267 PMCID: PMC10266221 DOI: 10.3389/fendo.2023.1159714] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 05/12/2023] [Indexed: 06/17/2023] Open
Abstract
Background The solute carrier family 30 A8 zinc transporter (SLC30A8) plays a crucial role in insulin secretion. This study aimed to investigate the impact of SLC30A8 gene polymorphisms on gestational diabetes mellitus (GDM). Methods The research objective was to select 500 patients with GDM and 502 control subjects. Rs13266634 and rs2466293 were genotyped using the SNPscan™ genotyping assay. Statistical tests, such as the chi-square test, t-test, logistic regression, ANOVA, and meta-analysis, were conducted to determine the differences in genotypes, alleles, and their associations with GDM risk. Results Statistically significant differences were observed in age, pregestational BMI, SBP, DBP, and parity between individuals with GDM and healthy subjects (P < 0.05). After adjusting for these factors, rs2466293 remained significantly associated with an increased risk of GDM in overall subjects (GG+AG vs. AA: OR = 1.310; 95% CI: 1.005-1.707; P = 0.046, GG vs. AA: OR = 1.523; 95% CI: 1.010-2.298; P = 0.045 and G vs. A: OR = 1.249; 95% CI: 1.029-1.516; P = 0.024). Rs13266634 was still found to be significantly associated with a decreased risk of GDM in individuals aged ≥ 30 years (TT vs. CT+CC: OR = 0.615; 95% CI: 0.392-0.966; P = 0.035, TT vs. CC: OR = 0.503; 95% CI: 0.294-0.861; P = 0.012 and T vs. C: OR =0.723; 95% CI: 0.557-0.937; P = 0.014). Additionally, the haplotype CG was found to be associated with a higher risk of GDM (P < 0.05). Furthermore, pregnant women with the CC or CT genotype of rs13266634 exhibited significantly higher mean blood glucose levels than those with the TT genotype (P < 0.05). Our findings were further validated by the results of a meta-analysis. Conclusion The SLC30A8 rs2466293 polymorphism was found to be associated with an increased risk of GDM, while rs13266634 was associated with a decreased risk of GDM in individuals aged ≥ 30 years. These findings provide a theoretical basis for GDM testing.
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Affiliation(s)
- Qiaoli Zeng
- Department of Internal Medicine, Shunde Women and Children’s Hospital (Maternity and Child Healthcare Hospital of Shunde Foshan), Guangdong Medical University, Foshan, Guangdong, China
- Key Laboratory of Research in Maternal and Child Medicine and Birth Defects, Guangdong Medical University, Foshan, Guangdong, China
- Maternal and Child Research Institute, Shunde Women and Children’s Hospital (Maternity and Child Healthcare Hospital of Shunde Foshan), Guangdong Medical University, Foshan, Guangdong, China
| | - Bing Tan
- Department of Internal Medicine, Shunde Women and Children’s Hospital (Maternity and Child Healthcare Hospital of Shunde Foshan), Guangdong Medical University, Foshan, Guangdong, China
- Key Laboratory of Research in Maternal and Child Medicine and Birth Defects, Guangdong Medical University, Foshan, Guangdong, China
- Department of Endocrinology, Second Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Fengqiong Han
- Department of Obstetric, Shunde Women and Children’s Hospital (Maternity and Child Healthcare Hospital of Shunde Foshan), Guangdong Medical University, Foshan, Guangdong, China
| | - Xiujuan Huang
- Department of Children’s Health, Shunde Women and Children’s Hospital (Maternity and Child Healthcare Hospital of Shunde Foshan), Guangdong Medical University, Foshan, Guangdong, China
| | - Jinzhi Huang
- Department of Gynaecology, Shunde Women and Children’s Hospital (Maternity and Child Healthcare Hospital of Shunde Foshan), Guangdong Medical University, Foshan, Guangdong, China
| | - Yue Wei
- Department of Ultrasound, Shunde Women and Children’s Hospital (Maternity and Child Healthcare Hospital of Shunde Foshan), Guangdong Medical University, Foshan, Guangdong, China
| | - Runmin Guo
- Department of Internal Medicine, Shunde Women and Children’s Hospital (Maternity and Child Healthcare Hospital of Shunde Foshan), Guangdong Medical University, Foshan, Guangdong, China
- Key Laboratory of Research in Maternal and Child Medicine and Birth Defects, Guangdong Medical University, Foshan, Guangdong, China
- Maternal and Child Research Institute, Shunde Women and Children’s Hospital (Maternity and Child Healthcare Hospital of Shunde Foshan), Guangdong Medical University, Foshan, Guangdong, China
- Department of Endocrinology, Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong, China
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Chen YH, Chen WY, Chang CY, Cho CY, Tang YH, Yeh CC, Yang YH, Tsao PC, Lee YS. Association between maternal factors and fetal macrosomia in full-term singleton births. J Chin Med Assoc 2023; 86:324-329. [PMID: 36728402 DOI: 10.1097/jcma.0000000000000871] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Macrosomia, defined as a birth weight of ≥4000 g, is associated with a high risk of birth injury. Fetal growth is highly correlated with maternal conditions, and several maternal factors are associated with neonatal birth size. The current study aimed to assess maternal factors related to fetal macrosomia in a Taiwanese population. METHODS The medical records of pregnant mothers and their newborns were retrospectively reviewed. All singleton pregnancies delivered at and after 37 weeks of gestation were included in the analysis. Maternal and neonatal conditions were evaluated according to different birth weights. RESULTS A total of 4262 infants were enrolled in our study. The mean birth weight was 3156 ± 383 g, including 77 (1.8%) cases with birth weight ≥4000 g, and 154 (3.6%) infants with birth weight <2500 g. The mean maternal body weight before delivery was 67.6 ± 10.0 kg. The mean 6-month gestational weight gain (6mGWG) was 12.3 ± 4.2 kg, and the mean maternal body mass index (BMI) was 26.2 ± 3.6 kg/m 2 . The maternal weight, height, and 6mGWG, gestational age, and placental weight were significantly positively correlated with neonatal birth weight. The odds ratios of macrosomia were 3.1 in neonates born to mothers with a 6mGWG of ≥15 kg, 6.3 in those born to mothers with gestational diabetes mellitus, and 4.1 in those born to mothers with a BMI of ≥30 kg/m 2 . Newborn macrosomia was associated with adverse events in pregnant mothers and newborn infants. CONCLUSION Gestational diabetes mellitus, 6mGWG, and maternal BMI are significantly correlated with neonatal macrosomia in full-term singleton births. Further, neonatal macrosomia is an important cause of maternal and neonatal morbidity. Hence, pregnant women should undergo maternal counseling for weight management before and during pregnancy, and the appropriate delivery method should be identified to prevent perinatal adverse events.
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Affiliation(s)
- Yu-Hsuan Chen
- Department of Pediatrics, Children's Medical Center, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Pediatrics, Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Wei-Yu Chen
- Department of Pediatrics, Children's Medical Center, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Pediatrics, Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Institute of Emergency and Critical Care Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Chia-Yuan Chang
- Department of Pediatrics, Children's Medical Center, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Pediatrics, Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Ching-Yi Cho
- Department of Pediatrics, Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Department of Pediatrics, Hsinchu Branch, National Taiwan University Hospital, Hsinchu, Taiwan, ROC
| | - Yi-Hsuan Tang
- Department of Pediatrics, Children's Medical Center, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Pediatrics, Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Institute of Emergency and Critical Care Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Chang-Ching Yeh
- Department of Pediatrics, Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Yi-Hsin Yang
- Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Pei-Chen Tsao
- Department of Pediatrics, Children's Medical Center, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Pediatrics, Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Institute of Emergency and Critical Care Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Yu-Sheng Lee
- Department of Pediatrics, Children's Medical Center, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Pediatrics, Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Institute of Emergency and Critical Care Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
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Stotz SA, Soon R, Moore KR, Charron-Prochownik D, Fischl A, Spencer K, Mau MK. A Qualitative Study on Preventing Gestational Diabetes in Native Hawaiian and Pacific Islander Adolescent Females: Perspectives from an Expert Panel of Health Care Providers. HAWAI'I JOURNAL OF HEALTH & SOCIAL WELFARE 2023; 82:10-15. [PMID: 36685779 PMCID: PMC9850826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
The authors examined perspectives of health care providers (HCPs) who serve Native Hawaiian and Pacific Islander (NH/PI) adolescents to inform the adaption of an existing American Indian and Alaska Native-specific gestational diabetes mellitus (GDM) risk reduction and preconception counseling program entitled Stopping GDM, for NH/PI adolescents. Hawai'i-based HCPs (n=14) who care for NH/PI adolescent females volunteered for this expert panel focus group study. These HCP participants served as an expert panel specific to their experiences in providing primary care and reproductive health care/family planning, and their perspectives regarding GDM risk reduction for NH adolescents. Several key themes emerged from these expert panel focus groups: (1) importance of multi-generational family involvement and support; (2) need to address the social determinants of health; (3) strengths-based strategies and recommendations to engage adolescents in a preconception counseling and GDM risk-reduction education program. Findings will inform the adaptation of Stopping GDM into a more holistic, multi-level, strengths-based, culturally tailored GDM risk reduction intervention that fosters empowerment and builds on the resilience of NH/PI communities.
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Affiliation(s)
- Sarah A. Stotz
- Centers for American Indian and Alaska Native Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO (SAS, KRM)
| | - Reni Soon
- John A. Burns School of Medicine, University of Hawai‘i, Honolulu, HI (RS, KS, MM)
| | - Kelly R. Moore
- Centers for American Indian and Alaska Native Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO (SAS, KRM)
| | - Denise Charron-Prochownik
- Department of Health Promotion and Development, School of Nursing, University of Pittsburgh, Pittsburgh, PA (AF, DC-P)
| | - Andrea Fischl
- Department of Health Promotion and Development, School of Nursing, University of Pittsburgh, Pittsburgh, PA (AF, DC-P)
| | - Kim Spencer
- John A. Burns School of Medicine, University of Hawai‘i, Honolulu, HI (RS, KS, MM)
| | - Marjorie K.L.M. Mau
- John A. Burns School of Medicine, University of Hawai‘i, Honolulu, HI (RS, KS, MM)
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Dłuski DF, Ruszała M, Rudziński G, Pożarowska K, Brzuszkiewicz K, Leszczyńska-Gorzelak B. Evolution of Gestational Diabetes Mellitus across Continents in 21st Century. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15804. [PMID: 36497880 PMCID: PMC9738915 DOI: 10.3390/ijerph192315804] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 11/07/2022] [Accepted: 11/22/2022] [Indexed: 06/17/2023]
Abstract
Over the last few decades, several definitions of gestational diabetes mellitus (GDM) have been described. There is currently not enough research to show which way is the best to diagnose GDM. Opinions differ in terms of the optimal screening and diagnostic measures, in part due to the differences in the population risks, the cost-effectiveness considerations, and the lack of an evidence base to support large national screening programs. The basic method for identifying the disease is the measurement of glucose plasma levels which may be determined when fasting, two hours after a meal, or simply at any random time. The currently increasing incidence of diabetes in the whole population, the altering demographics and the presence of lifestyle changes still require better methods of screening for hyperglycemia, especially during pregnancy. The main aim of this review is to focus on the prevalence and modifications to the screening criteria for GDM across all continents in the 21st century. We would like to show the differences in the above issues and correlate them with the geographical situation. Looking at the history of diabetes, we are sure that more than one evolution in GDM diagnosis will occur, due to the development of medicine, appearance of modern technologies, and the dynamic continuation of research.
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Affiliation(s)
- Dominik Franciszek Dłuski
- Chair and Department of Obstetrics and Perinatology, Medical University of Lublin, 20-954 Lublin, Poland
| | - Monika Ruszała
- Chair and Department of Obstetrics and Perinatology, Medical University of Lublin, 20-954 Lublin, Poland
| | - Gracjan Rudziński
- Faculty of Medicine, Medical University of Lublin, 20-059 Lublin, Poland
| | - Kinga Pożarowska
- Faculty of Medicine, Medical University of Lublin, 20-059 Lublin, Poland
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Kawamura MY, Mau MK, Soon R, Yamasato K. A Scoping Review on Gestational Diabetes in Hawai'i: A "Window of Opportunity" to Address Intergenerational Risk for Type 2 Diabetes Mellitus. HAWAI'I JOURNAL OF HEALTH & SOCIAL WELFARE 2022; 81:58-70. [PMID: 35261986 PMCID: PMC8899083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
The health of women over the entire span of their reproductive years is crucial - beginning in adolescence and extending through the postpartum period. This paper provides a scoping review of the relevant literature on risk factors for gestational diabetes mellitus (GDM) and progression from GDM to type 2 diabetes mellitus (T2DM), particularly among women of Native Hawaiian and Pacific Islander (NHPI) and Asian racial/ethnic backgrounds in Hawai'i, using the PubMed database (July 2010 to July 2020). NHPI and Asian populations have a greater likelihood of developing GDM compared to their White counterparts. Risk factors such as advanced maternal age, high maternal body mass index, and lack of education about GDM have varying levels of impact on GDM diagnosis between ethnic populations. Mothers who have a history of GDM are also at higher risk of developing T2DM. Common risk factors include greater increase in postpartum body mass index and use of diabetes medications during pregnancy. However, few studies investigate the progression from GDM to T2DM in Hawai'i's Asian and NHPI populations, and no studies present upstream preconception care programs to prevent an initial GDM diagnosis among Hawai'i's women. Thus, updated reports are necessary for optimal early interventions to prevent the onset of GDM and break the intergenerational cycle of increased susceptibility to T2DM and GDM in both mother and child. Further attention to the development of culturally sensitive interventions may reduce disparities in GDM and improve the health for all affected by this condition.
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Affiliation(s)
- Megan Y. Kawamura
- Department of Native Hawaiian Health Summer 2020 Research Intern, John A. Burns School of Medicine, University of Hawai‘i at Manoa, Honolulu, HI
| | - Marjorie K. Mau
- Department of Native Hawaiian Health, John A. Burns School of Medicine, University of Hawai‘i at Manoa, Honolulu, HI
| | - Reni Soon
- Department of Obstetrics, Gynecology and Women’s Health, John A. Burns School of Medicine, University of Hawai‘i at Manoa, Honolulu, HI
| | - Kelly Yamasato
- Department of Obstetrics, Gynecology and Women’s Health, John A. Burns School of Medicine, University of Hawai‘i at Manoa, Honolulu, HI
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Suss R, Mahoney M, Arslanian KJ, Nyhan K, Hawley NL. Pregnancy health and perinatal outcomes among Pacific Islander women in the United States and US Affiliated Pacific Islands: Protocol for a scoping review. PLoS One 2022; 17:e0262010. [PMID: 35041684 PMCID: PMC8765672 DOI: 10.1371/journal.pone.0262010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 12/15/2021] [Indexed: 11/18/2022] Open
Abstract
This scoping review examines the literature on pregnancy and perinatal outcomes among Pacific Islander women in the United States (U.S.) and U.S.-affiliated Pacific Islands. Our aim was to identify research that disaggregated Pacific Islanders from other population groups. We conducted a systematic search of MEDLINE (Ovid), Embase (Ovid), CINAHL (EBSCO), and PsycINFO (Ovid) databases and a hand-search of grey literature. Forty-eight articles published between January 2010 and June 2020 were included. The majority of studies were conducted in Hawaii and utilized clinical record data. Infant outcomes were more commonly reported than maternal outcomes. We highlighted several limitations of the existing literature that included aggregation of Pacific Islanders with Asian American and other ethnic groups; limited comparison between Pacific Islander sub-groups; inadequate definitions of the nationality and ethnic composition of Pacific Islander groups; a lack of hypothesis-driven primary data collection and clinical trials; and underrepresentation of Pacific Islanders in population-based studies. Researchers should address these limitations to improve pregnancy and perinatal outcomes among Pacific Islanders, who comprise the second fastest growing ethnic minority in the U.S.
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Affiliation(s)
- Rachel Suss
- Yale College, Yale University, New Haven, CT, United States of America
| | - Madison Mahoney
- Yale College, Yale University, New Haven, CT, United States of America
| | - Kendall J. Arslanian
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, United States of America
| | - Kate Nyhan
- Harvey Cushing/John Hay Whitney Medical Library, Yale University, New Haven, CT, United States of America
| | - Nicola L. Hawley
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, United States of America
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Benny P, Ahn HJ, Burlingame J, Lee MJ, Miller C, Chen J, Urschitz J. Genetic risk factors associated with gestational diabetes in a multi-ethnic population. PLoS One 2021; 16:e0261137. [PMID: 34928995 PMCID: PMC8687569 DOI: 10.1371/journal.pone.0261137] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 11/24/2021] [Indexed: 11/19/2022] Open
Abstract
AIMS Genome-wide association studies have shown an increased risk of type-2-diabetes (T2DM) in patients who carry single nucleotide polymorphisms in several genes. We investigated whether the same gene loci confer a risk for gestational diabetes mellitus (GDM) in women from Hawaii, and in particular, Pacific Islander and Filipino populations. METHODS Blood was collected from 291 women with GDM and 734 matched non-diabetic controls (Pacific Islanders: 71 GDM, 197 non-diabetic controls; Filipinos: 162 GDM, 395 controls; Japanese: 58 GDM, 142 controls). Maternal DNA was used to genotype and show allele frequencies of 25 different SNPs mapped to 18 different loci. RESULTS After adjusting for age, BMI, parity and gravidity by multivariable logistic regression, several SNPs showed significant associations with GDM and were ethnicity specific. In particular, SNPs rs1113132 (EXT2), rs1111875 (HHEX), rs2237892 (KCNQ1), rs2237895 (KCNQ1), rs10830963 (MTNR1B) and rs13266634 (SLC30A8) showed significant associations with GDM in Filipinos. For Japanese, SNPs rs4402960 (IGFBP2) and rs2237892 (KCNQ1) were significantly associated with GDM. For Pacific Islanders, SNPs rs10830963 (MTNR1B) and rs13266634 (SLC30A8) showed significant associations with GDM. Individually, none of the SNPs showed a consistent association with GDM across all three investigated ethnicities. CONCLUSION Several SNPs associated with T2DM are found to confer increased risk for GDM in a multiethnic cohort in Hawaii.
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Affiliation(s)
- Paula Benny
- Department of Obstetrics, Gynecology, and Women’s Health, John A. Burns School of Medicine, University of Hawaii, Honolulu, HI, United States of America
| | - Hyeong Jun Ahn
- Department of Quantitative Health Sciences, John A. Burns School of Medicine, University of Hawaii, Honolulu, HI, United States of America
| | - Janet Burlingame
- Department of Obstetrics, Gynecology, and Women’s Health, John A. Burns School of Medicine, University of Hawaii, Honolulu, HI, United States of America
| | - Men-Jean Lee
- Department of Obstetrics, Gynecology, and Women’s Health, John A. Burns School of Medicine, University of Hawaii, Honolulu, HI, United States of America
| | - Corrie Miller
- Department of Obstetrics, Gynecology, and Women’s Health, John A. Burns School of Medicine, University of Hawaii, Honolulu, HI, United States of America
| | - John Chen
- Department of Quantitative Health Sciences, John A. Burns School of Medicine, University of Hawaii, Honolulu, HI, United States of America
| | - Johann Urschitz
- Department of Anatomy, Biochemistry and Physiology, John A. Burns School of Medicine, University of Hawaii, Honolulu, HI, United States of America
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Ni M, Zhang Q, Zhao J, Shen Q, Yao D, Wang T, Liu Z. Relationship between maternal vitamin D status in the first trimester of pregnancy and maternal and neonatal outcomes: a retrospective single center study. BMC Pediatr 2021; 21:330. [PMID: 34325665 PMCID: PMC8320191 DOI: 10.1186/s12887-021-02730-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 05/17/2021] [Indexed: 12/28/2022] Open
Abstract
Background This study aimed to investigate the relationship between maternal serum vitamin D status in the first trimester of pregnancy and maternal as well as neonatal outcomes, considered the prevalence of vitamin D deficiency (serum 25(OH)D < 50 nmol/L) around the world, especially in the pregnant women. Methods From January 2015 to December 2016, in this cross-sectional retrospective study, we enrolled women receiving regular prenatal examinations and giving birth in the International Peace Maternity and Child Health Hospital. Cases confirmed as multiple pregnancy, incomplete medical records, and vitamin D level recorded after 13 weeks of gestation were excluded. A total of 23,394 mother-infant pairs were included ultimately. Obstetric and neonatal information were extracted from the database. Maternal serum vitamin D concentration was measured by chemiluminescence microparticle immunoassay. Logistic regression analysis (unadjusted and adjusted models) was used to analyze the association between vitamin D and maternal and neonatal outcomes. Results The average 25(OH) D concentration was 43.20 ± 0.10 nmol/L; 67.09% of patients were vitamin D deficient(25(OH) D < 50.00 nmol/L), 29.84% were vitamin D insufficient (50 nmol/L ≤ 25(OH)D < 75 nmol/L), 3.07% were sufficient (25(OH)D ≥ 75 nmol/L). The maternal 25(OH)D levels varied with age, pre-pregnancy BMI, season when blood sample was collected, number of previous-pregnancy. Notably, newborns delivered by women with deficient vitamin D status had a higher incidence rate of admission to NICU (Deficiency: 12.20% vs Insufficiency: 10.90% vs Sufficiency: 11.70%, Pbonferroni = .002) and a longer stay (deficiency: 6.2 ± 4.1 days vs insufficiency: 5.9 ± 3.1 days vs sufficiency: 5.1 ± 2.1 days, Pbonferroni = .010). Moreover, maternal vitamin D deficiency was a dependent risk factor for admission to NICU (unadjusted OR = 1.35, 95% CI,1.05–1.74 Pbonferroni = .022; adjusted OR = 1.31, 95% CI,1.010–1.687 Pbonferroni = .042). Conclusions Maternal vitamin D deficiency (25(OH) D < 50 nmol/L) was prevalent in eastern coastal China. The incidence rate of GDM as well as preeclampsia was higher in vitamin D insufficient group while vitamin D deficiency group was liable to intrauterine infection when compared with the other two groups. Most importantly, low vitamin D status in the first trimester of pregnancy was a dependent risk factor for admission to NICU. More well-designed perspective researches are necessary to clarify the role of vitamin D in the early stage of pregnancy.
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Affiliation(s)
- Meng Ni
- International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, 910# Hengshan Road, Shanghai, 20030, China.,International Peace Maternity and Child Health Hospital of China Welfare Institution, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.,Shanghai Key Laboratory of Embryo Original Disease, Shanghai, China
| | - Qianqian Zhang
- International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, 910# Hengshan Road, Shanghai, 20030, China.,International Peace Maternity and Child Health Hospital of China Welfare Institution, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.,Shanghai Key Laboratory of Embryo Original Disease, Shanghai, China
| | - Jiuru Zhao
- International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, 910# Hengshan Road, Shanghai, 20030, China.,International Peace Maternity and Child Health Hospital of China Welfare Institution, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.,Shanghai Key Laboratory of Embryo Original Disease, Shanghai, China
| | - Qianwen Shen
- International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, 910# Hengshan Road, Shanghai, 20030, China.,International Peace Maternity and Child Health Hospital of China Welfare Institution, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.,Shanghai Key Laboratory of Embryo Original Disease, Shanghai, China
| | - Dongting Yao
- International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, 910# Hengshan Road, Shanghai, 20030, China.,International Peace Maternity and Child Health Hospital of China Welfare Institution, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.,Shanghai Key Laboratory of Embryo Original Disease, Shanghai, China
| | - Tao Wang
- International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, 910# Hengshan Road, Shanghai, 20030, China.,International Peace Maternity and Child Health Hospital of China Welfare Institution, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.,Shanghai Key Laboratory of Embryo Original Disease, Shanghai, China
| | - Zhiwei Liu
- International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, 910# Hengshan Road, Shanghai, 20030, China. .,International Peace Maternity and Child Health Hospital of China Welfare Institution, School of Medicine, Shanghai Jiao Tong University, Shanghai, China. .,Shanghai Key Laboratory of Embryo Original Disease, Shanghai, China.
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11
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Estrada P, Ahn HJ, Harvey SA. Racial/Ethnic Disparities in Intensive Care Admissions in a Pregnant and Postpartum Population, Hawai'i, 2012-2017. Public Health Rep 2021; 137:711-720. [PMID: 34096822 DOI: 10.1177/00333549211021146] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE Maternal morbidity and mortality is a global concern despite advances in medical care and technology and improved economic resources of nations worldwide. The primary objective of our study was to describe racial/ethnic disparities in severe maternal morbidity by using admission to an intensive care unit (ICU) as a marker. The secondary objective was to evaluate associations between patient characteristics, including obstetric outcomes, and severe maternal morbidity. METHODS This retrospective cohort study used a large inpatient database to identify pregnancy and postpartum hospitalizations in Hawai'i from January 2012 through September 2017. We evaluated associations between sociodemographic and clinical characteristics and race/ethnicity by using χ2 tests. We used multivariable logistic regression to assess associations between race/ethnicity and ICU admission. We used a post hoc analysis to assess associations between ICU admission and obstetric outcomes by race/ethnicity. RESULTS After adjustment, we found a significantly higher ICU admission rate among Asian (adjusted odds ratio [aOR] = 1.30; 95% CI, 1.04-1.62; P = .02), Filipino (aOR = 1.45; 95% CI, 1.17-1.79; P < .001), and Native Hawaiian/Other Pacific Islander (aOR = 1.39; 95% CI, 1.15-1.68; P < .001) women compared with non-Hispanic White women. Multiple clinical characteristics and outcomes were associated with ICU admission, such as preexisting chronic conditions and pregnancy-induced hypertensive disorders. CONCLUSION We found that severe maternal morbidity represented by ICU admission is higher among Asian, Filipino, and Native Hawaiian/Other Pacific Islander women than among non-Hispanic White women in Hawai'i. Our findings reemphasize the need for health care providers to be vigilant in caring for members of racial/ethnic minority groups and managing their comorbidities.
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Affiliation(s)
- Pamela Estrada
- 3939 Department of Obstetrics, Gynecology, and Women's Health, University of Hawai'i John A. Burns School of Medicine, Honolulu, HI, USA
| | - Hyeong Jun Ahn
- Department of Quantitative Health Sciences, University of Hawai'i John A. Burns School of Medicine, Honolulu, HI, USA
| | - Scott A Harvey
- 3939 Department of Obstetrics, Gynecology, and Women's Health, University of Hawai'i John A. Burns School of Medicine, Honolulu, HI, USA
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12
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Adugna DG, Enyew EF, Jemberie MT. Prevalence and Associated Factors of Macrosomia Among Newborns Delivered in University of Gondar Comprehensive Specialized Hospital, Gondar, Ethiopia: An Institution-Based Cross-Sectional Study. PEDIATRIC HEALTH MEDICINE AND THERAPEUTICS 2020; 11:495-503. [PMID: 33364874 PMCID: PMC7751438 DOI: 10.2147/phmt.s289218] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 12/10/2020] [Indexed: 11/23/2022]
Abstract
Background Macrosomia is defined as a birth weight of newborns ≥4000 grams irrespective of gestational age. It is becoming a burning public health issue in most developing countries and contributes to maternal and newborn complications. Though macrosomia has been increasing in Ethiopia, evidence about its magnitude and associated factors is limited yet. Therefore, this study aimed to assess the prevalence and associated factors of macrosomia among newborns delivered at the University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia. Methods An institution-based cross-sectional study was carried out from February 23rd to April 23rd, 2020. A total of 491 mothers and their newborns were included in the study. The data were collected by interviewing the mothers and reviewing their charts using a structured questionnaire. The outcome variable was newborn birth weight. Data were entered using Epi-data version 4.6 and analyzed using STATA version 14 software. Bivariable and multivariable binary logistic regression were used to identify the factors associated with macrosomia. Results The prevalence of macrosomia was 7.54%. Gestational age ≥40 weeks (adjusted odds ratio (AOR) = 4.1 (95% CI = 1.7-9.7)), diabetes mellitus (AOR=5.5 (95% CI = 1.2-25)), previous history of macrosomia (AOR = 3.7 (95% CI = 1.4-10)), and male sex (AOR = 3.4 (95% CI = 1.3-8.7)) were significantly associated with macrosomia. Conclusion In the current study, the prevalence of macrosomia was relatively high. The study revealed that maternal diabetes mellitus, higher gestational age, history of macrosomia, and male newborns were the predictors of macrosomia. Thus, obstetric caregivers should give attention to early detection and management of mothers with diabetes mellitus, history of macrosomia, and gestational age of ≥40 weeks during pregnancy to prevent macrosomia and its complications.
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Affiliation(s)
- Dagnew Getnet Adugna
- Department of Human Anatomy, School of Medicine, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Engidaw Fentahun Enyew
- Department of Human Anatomy, School of Medicine, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Molla Taye Jemberie
- Department of Human Anatomy, School of Medicine, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
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13
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Sahhaf Ebrahimi F, Homayouni Rad A, Mosen M, Abbasalizadeh F, Tabrizi A, Khalili L. Effect of L. acidophilus and B. lactis on blood glucose in women with gestational diabetes mellitus: a randomized placebo-controlled trial. Diabetol Metab Syndr 2019; 11:75. [PMID: 31485272 PMCID: PMC6714347 DOI: 10.1186/s13098-019-0471-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 08/23/2019] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Gestational diabetes mellitus (GDM) is a complication of pregnancy that can be associated with neonatal complications and adverse pregnancy outcomes. Recently, probiotic use has been proposed for better control of glucose in GDM patients. The aim of this study was to evaluate the effect of probiotic yoghurt compare with ordinary yoghurt on GDM women. METHODS In this double-blind placebo-controlled clinical trial, 84 pregnant women with GDM were randomly assigned into two groups of 42 recipients who underwent 300 g/day of probiotic yoghurt or placebo for 8 weeks. Blood glucose, HbA1c, and the outcome of pregnancy were compared between the two groups after the intervention. RESULTS According to the findings of present trial no significant differences were observed in general characteristics between the two groups (p > 0.05). Both fasting and post prandial blood glucose as well as the level of HbA1c were decreased significantly in probiotic group (p < 0.05), although these changes are not statistically significant in the placebo group. The between group differences was significant after the 2 month intervention (p < 0.05). Neonates born of probiotic group mothers, have significantly lower weight and fewer macrosome neonates were born in this group compared with control group (p < 0.05). However, no difference was observed in other values of outcome. CONCLUSIONS Our study revealed that better control of blood glucose can be achieved by consumption of probiotic yoghurt in patients whose pregnancy is complicated by GDM, compared with placebo. Also incidence of macrosomia may be decreased by this regimen.
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Affiliation(s)
- Farnaz Sahhaf Ebrahimi
- Obstetrics and Gynecology, Women’s Reproductive Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Aziz Homayouni Rad
- Department of Food Science and Technology, Faculty of Nutrition and Food Sciences, Nutrition Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Metanat Mosen
- Obstetrics and Gynecology, Women’s Reproductive Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Fatemeh Abbasalizadeh
- Obstetrics and Gynecology, Women’s Reproductive Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Aydin Tabrizi
- Pediatric Neurology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Leila Khalili
- Department of Nutrition, Faculty of Nutrition and Food Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
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14
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Ro A, Goldberg RE, Kane JB. Racial and Ethnic Patterning of Low Birth Weight, Normal Birth Weight, and Macrosomia. Prev Med 2019; 118:196-204. [PMID: 30342108 PMCID: PMC6596993 DOI: 10.1016/j.ypmed.2018.10.012] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Revised: 08/02/2018] [Accepted: 10/13/2018] [Indexed: 11/30/2022]
Abstract
Both low birthweight (<2500 g; LBW) and macrosomia (>4000 g) are considered adverse birth outcomes and are associated with later poor health conditions, yet the social determinants of macrosomia are understudied. In this study, we explore patterning of LBW, normal birthweight, and macrosomia by race/ethnicity and nativity. We examined data from all live births between 1999 and 2014 in New Jersey with a non-missing, plausible value of birthweight (n = 1,609,516). We compared the risk for LBW and macrosomia among non-Hispanic White, non-Hispanic Black, Hispanic, and non-Hispanic Asian mothers, and between the US- and native-born. For Hispanics and Asians, we also examined differences by country of origin. The racial/ethnic patterns for macrosomia mirrored those of LBW, suggesting that the factors underlying LBW shift birthweight distributions. For example, non-Hispanic White mothers had the lowest risk for LBW and the highest risk for macrosomia. Nativity patterns differed by subgroup, however, with unique risks for macrosomia among some origin groups, such as foreign-born Cubans. The racial/ethnic and nativity patterns of macrosomia do not completely mirror those of LBW, suggesting some distinct social risk factors for macrosomia. Our findings raise questions about whether and how racial/ethnic and nativity patterning in both low and excess birthweight is retained in later conditions, such as childhood obesity.
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Affiliation(s)
- Annie Ro
- Program in Public Health, University of California, Irvine, 653 E. Peltason Drive, AIRB 2036, Irvine, CA 92617, United States of America.
| | - Rachel E Goldberg
- Department of Sociology, University of California, Irvine, United States of America
| | - Jennifer B Kane
- Department of Sociology, University of California, Irvine, United States of America
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Abstract
PURPOSE OF REVIEW Ethnicity has long been described as a major risk factor for the development of gestational diabetes mellitus (GDM), and it is widely recognised that women from ethnicities other than Europids are at higher risk of developing GDM. There are also described differences between ethnicities in key GDM pregnancy outcomes. This review describes some of the factors that relate to the ethnic disparities in GDM. RECENT FINDINGS The global prevalence of GDM has been steadily increasing and estimated to be 16.2% from the International Diabetes Federation extrapolation. Reported prevalence rates may understate the true prevalence, due to factors of access and attitudes to GDM diagnosis and screening in low resource settings for foreign-born women and indigenous populations. Other factors may relate to genes associated with specific ethnicities, obesity, body composition and gestational weight gain. Various factors such as access to screening, body composition, genetics and gestational weight gain may result in ethnic disparities in the prevalence and outcomes of GDM.
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Affiliation(s)
- Lili Yuen
- School of Medicine, Western Sydney University, Sydney, NSW, Australia.
| | - Vincent W Wong
- Diabetes and Endocrine Service, Liverpool Hospital, Liverpool, NSW, Australia
- University of New South Wales, Liverpool, NSW, Australia
| | - David Simmons
- School of Medicine, Western Sydney University, Sydney, NSW, Australia
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16
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Ju AC, Heyman MB, Garber AK, Wojcicki JM. Maternal Obesity and Risk of Preterm Birth and Low Birthweight in Hawaii PRAMS, 2000–2011. Matern Child Health J 2018; 22:893-902. [DOI: 10.1007/s10995-018-2464-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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17
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Holdt Somer SJ, Sinkey RG, Bryant AS. Epidemiology of racial/ethnic disparities in severe maternal morbidity and mortality. Semin Perinatol 2017; 41:258-265. [PMID: 28888263 DOI: 10.1053/j.semperi.2017.04.001] [Citation(s) in RCA: 78] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The literature abounds with examples of racial/ethnic disparities in both obstetric outcomes and care. Disparities in maternal mortality are well documented with non-Hispanic blacks carrying the burden of the highest maternal mortality rates. Maternal deaths likely represent only the "tip of the iceberg" with respect to pregnancy complications, leading many to explore risk factors and disparities in severe maternal morbidity, a more common precursor to maternal mortality. This review article explores commonly cited indicators of severe maternal morbidity and includes a review of the epidemiological literature supporting or refuting disparities among each indicator.
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Affiliation(s)
- Sarah J Holdt Somer
- Department of Obstetrics and Gynecology, University of South Florida College of Medicine, Tampa, FL
| | - Rachel G Sinkey
- Department of Obstetrics and Gynecology, University of South Florida College of Medicine, Tampa, FL
| | - Allison S Bryant
- Department of Obstetrics and Gynecology, Massachusetts General Hospital, 55 Fruit St, Founders 4, Boston, MA 02114.
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18
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Obesity alters the ovarian glucidic homeostasis disrupting the reproductive outcome of female rats. J Nutr Biochem 2017; 42:194-202. [DOI: 10.1016/j.jnutbio.2017.01.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Revised: 12/16/2016] [Accepted: 01/14/2017] [Indexed: 12/27/2022]
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Karamali M, Dadkhah F, Sadrkhanlou M, Jamilian M, Ahmadi S, Tajabadi-Ebrahimi M, Jafari P, Asemi Z. Effects of probiotic supplementation on glycaemic control and lipid profiles in gestational diabetes: A randomized, double-blind, placebo-controlled trial. DIABETES & METABOLISM 2016; 42:234-41. [DOI: 10.1016/j.diabet.2016.04.009] [Citation(s) in RCA: 94] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Revised: 04/16/2016] [Accepted: 04/22/2016] [Indexed: 12/28/2022]
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A randomized-controlled clinical trial investigating the effect of omega-3 fatty acids and vitamin E co-supplementation on markers of insulin metabolism and lipid profiles in gestational diabetes. J Clin Lipidol 2016; 10:386-93. [DOI: 10.1016/j.jacl.2015.12.017] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Revised: 12/02/2015] [Accepted: 12/21/2015] [Indexed: 01/17/2023]
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21
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Shahgheibi S, Farhadifar F, Pouya B. The effect of vitamin D supplementation on gestational diabetes in high-risk women: Results from a randomized placebo-controlled trial. JOURNAL OF RESEARCH IN MEDICAL SCIENCES 2016; 21:2. [PMID: 27904548 PMCID: PMC5122001 DOI: 10.4103/1735-1995.175148] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/03/2015] [Revised: 10/17/2015] [Accepted: 12/08/2015] [Indexed: 12/03/2022]
Abstract
Background: Vitamin D deficiency is common in pregnancy, leading to increase in the frequency of preeclampsia, cesarean delivery, neonatal bacterial vaginosis, and gestational diabetes. The current study was designed and implemented to investigate the effect of vitamin D during the first and second trimesters of pregnancy in reducing the risk of gestational diabetes mellitus (GDM) in women who are at high risk [history of GDM, birth macrosomia, family history, and high body mass index (BMI)]. Materials and Methods: In a randomized, double-blind, and placebo-controlled trial, 90 pregnant women who had at least one risk factor for GDM were randomized into intervention (46 participants) and control (44 participants) groups. Participants in the intervention group took 5000 units of vitamin D daily and the control group took placebo until the 26th week of pregnancy. Then the glucose challenge test (GCT) and the glucose tolerance test (GTT) were performed to evaluate GDM. Results: Mean ± standard deviation (SD) age was 31.28 ± 6.38 years and 29 ± 6.24 years for the intervention group and the placebo group, respectively, (P > 0.05). In addition, there were no significant differences between two groups in terms of vitamin D levels and GCT (P > 0.05), and the difference was not significant. The incidence of diabetes in the intervention groups was statistically lower than in control group (11.4% vs 34.8; P < 0.01). The results showed that abnormal GCT in the placebo group was statistically higher than in intervention group (35.9% vs 10.9 P < 0.005). Conclusion: The results of the current study showed that the prescription of vitamin D supplementation in the first and second trimesters of pregnancy was effective in reducing GDM and controlling GTT and GTC.
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Affiliation(s)
- Shole Shahgheibi
- Department of Obstetrics and Gynecology, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Fariba Farhadifar
- Department of Obstetrics and Gynecology, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Bahar Pouya
- Department of Obstetrics and Gynecology, Kurdistan University of Medical Sciences, Sanandaj, Iran
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Ogonowski J, Miazgowski T. Intergenerational transmission of macrosomia in women with gestational diabetes and normal glucose tolerance. Eur J Obstet Gynecol Reprod Biol 2015; 195:113-116. [PMID: 26512436 DOI: 10.1016/j.ejogrb.2015.10.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Revised: 08/04/2015] [Accepted: 10/06/2015] [Indexed: 11/29/2022]
Abstract
OBJECTIVES It has been suggested that neonatal macrosomia may contribute to increased risk of obesity and type 2 diabetes in later life. Much less is known about the association between maternal birth weight (MBW) and offspring birth weight (OBW). This retrospective study evaluated the prevalence of macrosomia in women with treated gestational diabetes mellitus (GDM) and normal glucose tolerance during pregnancy. The study also investigated associations between MBW and OBW. STUDY DESIGN Medical records of 519 pregnant women with treated GDM and 766 women with normal glucose tolerance, referred to the Gestational Diabetes Outpatient Clinic in Szczecin, Poland, were analyzed. The following data were assessed: maternal age, pregravid body weight, height, gestational weight gain, prior GDM, prior macrosomia, MBW and OBW. Birth weight was classified as small for gestational age (SGA), appropriate for gestational age (AGA), large for gestational age (LGA) and macrosomia (≥4000g). OBW was obtained from birth certificates, and MBW was obtained from birth certificates or self-report. RESULTS The overall prevalence of macrosomia was 8.1%, and was comparable in subgroups of women with and without GDM (7.7% and 8.4%, respectively; p=0.905). The frequencies of SGA, AGA and LGA did not differ between study groups. A positive correlation was found between MBW and OBW in women with treated GDM (r=0.211, p<0.001) and in women with normal glucose tolerance (r=0.220, p<0.001). Regardless of glucose tolerance status during pregnancy, the greatest proportion of macrosomic babies were born to mothers who were themselves born macrosomic (26.5% in mothers with GDM and 20.0% in mothers with normal glucose tolerance; p=0.631). On logistic regression, MBW was found to be a robust predictor of macrosomia in offspring [odds ratio (OR) 1.64, 95% confidence interval (CI) 1.15-2.36 in women with treated GDM; OR 1.35, 95% CI 1.07-1.76 in women with normal glucose tolerance). Other independent predictors of fetal macrosomia were gestational weight gain, prior macrosomia and pregravid body mass index (BMI). CONCLUSIONS MBW, prior macrosomia, pregravid BMI and gestational weight gain were predictors of macrosomia in offspring, but GDM was not. High MBW seems to contribute to intergenerational transmission of macrosomia.
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Affiliation(s)
- J Ogonowski
- Outpatient Clinic for Diabetic Pregnant Women, Provincial Hospital, Szczecin, Poland; Department of Civilization Diseases, Pomeranian Medical University, Szczecin, Poland
| | - T Miazgowski
- Department of Hypertension and Internal Medicine, Pomeranian Medical University, Szczecin, Poland.
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Asemi Z, Jamilian M, Mesdaghinia E, Esmaillzadeh A. Effects of selenium supplementation on glucose homeostasis, inflammation, and oxidative stress in gestational diabetes: Randomized, double-blind, placebo-controlled trial. Nutrition 2015; 31:1235-42. [PMID: 26250486 DOI: 10.1016/j.nut.2015.04.014] [Citation(s) in RCA: 87] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Revised: 03/08/2015] [Accepted: 04/21/2015] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To our knowledge, no reports are available indicating the effects of selenium supplementation on metabolic parameters, inflammatory factors, and oxidative stress in gestational diabetes mellitus (GDM). The aim of this study was to assess the effects of selenium supplementation on metabolic status in pregnant women with GDM who were not on oral hypoglycemic agents. METHODS This randomized, double-blind, placebo-controlled clinical trial was performed with 70 women with GDM. Patients were randomly assigned to receive either 200 μg selenium supplements as tablet (n = 35) or placebo (n = 35) for 6 wk from weeks 24 to 28 of gestation. Fasting plasma samples were taken at study baseline and after 6 wk of intervention to quantify related variables. RESULTS Selenium supplementation, compared with placebo, resulted in a significant reduction in fasting plasma glucose (-10.5 ± 11.9 versus +4.5 ± 12.9 mg/dL; P < 0.001), serum insulin levels (-1.98 ± 11.25 versus +5.26 ± 9.33 μIU/mL; P = 0.005), homeostasis model of assessment (HOMA)-insulin resistance (-0.84 ± 2.76 versus +1.47 ± 2.46; P < 0.001) and a significant increase in quantitative insulin sensitivity check index (+0.008 ± 0.03 versus -0.01 ± 0.01; P = 0.009). Additionally, a significant decrease in serum high-sensitivity C-reactive protein (hs-CRP) levels (-791.8 ± 2271.8 versus +500.5 ± 2563.3 ng/mL; P = 0.02) was seen after the administration of selenium supplements compared with placebo. Additionally, we observed a significant elevation in plasma glutathione (+52.14 ± 58.31 versus -39.93 ± 153.52 μmol/L; P = 0.002) and a significant reduction in plasma malondialdehyde levels (-0.01 ± 0.36 versus +0.67 ± 1.90 μmol/L; P = 0.04) after consumption of selenium supplements compared with placebo. We did not find any significant effect of taking selenium supplements on HOMA β-cell function, lipid profiles, plasma nitric oxide, or total antioxidant capacity concentrations. CONCLUSION Selenium supplementation in pregnant women with GDM demonstrated beneficial effects on glucose metabolism, hs-CRP levels, and biomarkers of oxidative stress.
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Affiliation(s)
- Zatollah Asemi
- Research Center for Biochemistry and Nutrition in Metabolic Diseases, Kashan University of Medical Sciences, Kashan, I.R. Iran
| | - Mehri Jamilian
- Department of Gynecology and Obstetrics, School of Medicine, Arak University of Medical Sciences, Arak, Iran
| | - Elaheh Mesdaghinia
- Department of Gynecology and Obstetrics, School of Medicine, Kashan University of Medical Sciences, Kashan, I.R. Iran
| | - Ahmad Esmaillzadeh
- Food Security Research Center, Isfahan University of Medical Sciences, Isfahan, Iran; Department of Community Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran.
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Lin TC, Mu CF, Hsu CY. Risk factors for gestational diabetes mellitus: ethnic disparities. Aust J Rural Health 2015; 23:176-80. [PMID: 25614928 DOI: 10.1111/ajr.12151] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/12/2014] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE Gestational diabetes mellitus (GDM) increases the risk of poor maternal and infant health outcomes; therefore, the objective of this study was to compare the ethnic disparities and identify the risk factors for GDM. DESIGN We performed a cross-sectional analysis using patient records from a hospital located in the Puli area of Central Taiwan. SETTING A teaching hospital located in a rural mountainous area of Central Taiwan. PARTICIPANTS Between 2002 and 2012, the hospital admitted 154 patients (107 non-aborigines, 30 aborigines, and 17 non-Taiwanese) who exhibited glucose intolerance during their pregnancy. MAIN OUTCOME MEASURES GDM was confirmed using the oral-glucose-tolerance-test administered in dose of either 100 g or 75 g. The incidence and risk factors for GDM in the aboriginal and non-aboriginal women was compared. RESULTS We excluded the patients who had overt diabetes or were non-Taiwanese. Thus, 132 patients (28 aboriginal and 104 non-aboriginal women; mean age 30 years) were enrolled in the final study. A total of 51 patients (15 aboriginal, 36 non-aboriginal women) had GDM, which was more prevalent among the aboriginal mothers (53.6% versus 34.6%). The risk factors for GDM among the aboriginal women were persistent glycosuria and prior macrosomia. CONCLUSION The Taiwanese aboriginal women exhibited higher incidence of GDM; thus, we recommend that early screening and health education for pregnant aboriginal women be provided.
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Affiliation(s)
- Tzu-Chi Lin
- Department of Obstetrics and Gynecology, Changhua Christian Hospital, Changhua, Taiwan
| | - Chia-Fen Mu
- Department of Family Medicine, Puli Christian Hospital, Puli, Taiwan
| | - Chao-Yu Hsu
- Department of Family Medicine, Puli Christian Hospital, Puli, Taiwan.,Department of Medical Education and Research, Puli Christian Hospital, Puli, Taiwan.,National Chi Nan University, Puli, Taiwan.,Central Taiwan University of Science and Technology, Taichung, Taiwan.,National Taichung University of Science and Technology, Taichung, Taiwan.,Chaoyang University of Technology, Taichung, Taiwan.,National Chin-Yi University of Technology, Taichung, Taiwan.,Feng Chia University, Taichung, Taiwan
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Asemi Z, Karamali M, Esmaillzadeh A. Effects of calcium-vitamin D co-supplementation on glycaemic control, inflammation and oxidative stress in gestational diabetes: a randomised placebo-controlled trial. Diabetologia 2014; 57:1798-806. [PMID: 24962666 DOI: 10.1007/s00125-014-3293-x] [Citation(s) in RCA: 99] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2014] [Accepted: 05/19/2014] [Indexed: 02/07/2023]
Abstract
AIMS/HYPOTHESIS This study was designed to assess the effects of calcium and vitamin D supplementation on the metabolic status of pregnant women with gestational diabetes mellitus (GDM). METHODS This randomised placebo-controlled trial was performed at maternity clinics affiliated to Kashan University of Medical Sciences, Kashan, Iran. Participants were 56 women with GDM at 24-28 weeks' gestation (18 to 40 years of age). Subjects were randomly assigned to receive calcium plus vitamin D supplements or placebo. All study participants were blinded to group assignment. Individuals in the calcium-vitamin D group (n = 28) received 1,000 mg calcium per day and a 50,000 U vitamin D3 pearl twice during the study (at study baseline and on day 21 of the intervention), and those in the placebo group (n = 28) received two placebos at the mentioned times. Fasting blood samples were taken at study baseline and after 6 weeks of intervention. RESULTS The study was completed by 51 participants (calcium-vitamin D n = 25, placebo n = 26). However, as the analysis was based on an intention-to-treat approach, all 56 women with GDM (28 in each group) were included in the final analysis. After the administration of calcium plus vitamin D supplements, we observed a significant reduction in fasting plasma glucose (-0.89 ± 0.69 vs +0.26 ± 0.92 mmol/l, p < 0.001), serum insulin levels (-13.55 ± 35.25 vs +9.17 ± 38.50 pmol/l, p = 0.02) and HOMA-IR (-0.91 ± 1.18 vs +0.63 ± 2.01, p = 0.001) and a significant increase in QUICKI (+0.02 ± 0.03 vs -0.002 ± 0.02, p = 0.003) compared with placebo. In addition, a significant reduction in serum LDL-cholesterol (-0.23 ± 0.79 vs +0.26 ± 0.74 mmol/l, p = 0.02) and total cholesterol: HDL-cholesterol ratio (-0.49 ± 1.09 vs +0.18 ± 0.37, p = 0.003) and a significant elevation in HDL-cholesterol levels (+0.15 ± 0.25 vs -0.02 ± 0.24 mmol/l, p = 0.01) was seen after intervention in the calcium-vitamin D group compared with placebo. In addition, calcium plus vitamin D supplementation resulted in a significant increase in GSH (+51.14 ± 131.64 vs -47.27 ± 203.63 μmol/l, p = 0.03) and prevented a rise in MDA levels (+0.06 ± 0.66 vs +0.93 ± 2.00 μmol/l, p = 0.03) compared with placebo. CONCLUSIONS/INTERPRETATION Calcium plus vitamin D supplementation in women with GDM had beneficial effects on their metabolic profile. TRIAL REGISTRATION www.irct.ir IRCT201311205623N11. FUNDING The study was supported by a grant (no. 92110) from Kashan University of Medical Sciences.
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Affiliation(s)
- Zatollah Asemi
- Research Center for Biochemistry and Nutrition in Metabolic Diseases, Kashan University of Medical Sciences, Kashan, I. R., Iran
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Sentell T, Chang A, Cheng Y, Miyamura J. Maternal quality and safety outcomes for Asians and Pacific Islanders in Hawai'i: an observational study from five years of statewide data. BMC Pregnancy Childbirth 2014; 14:298. [PMID: 25174436 PMCID: PMC4158120 DOI: 10.1186/1471-2393-14-298] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2014] [Accepted: 08/27/2014] [Indexed: 11/14/2022] Open
Abstract
Background Empirical evidence regarding maternal quality and safety outcomes across heterogeneous Asian and Pacific Islanders subgroups in the United States is limited, despite the importance of this topic to health disparities research and quality improvement efforts. Methods Detailed discharge data from all Hawai‘i childbirth hospitalizations (n = 75,725) from 2008 to 2012 were considered. Validated measures of maternal quality and safety were compared in descriptive and multivariable models across seven racial/ethnic groups: Filipino, Native Hawaiian, other Pacific Islander (e.g., Samoan, Tongan, Micronesian), Japanese, Chinese, white, and other race/ethnicity. Multivariable models adjusted for age group, payer, rural vs. urban hospital location, multiple gestation, and high-risk pregnancy. Results Compared to whites, Japanese, Filipinos, and Other Pacific Islanders had significantly higher overall delivery complication rates while Native Hawaiians had significantly lower rates. Native Hawaiians also had significantly lower rates of obstetric trauma in vaginal delivery with and without instruments compared to whites (Rate Ratio (RR):0.66; 95% CI:0.50-0.87 and RR:0.62; 95% CI:0.52-0.74, respectively). Japanese and Chinese had significantly higher rates of obstetric trauma for vaginal deliveries without instruments (RR:1.52; 95% CI:1.27-1.81 and RR:1.95;95% CI:1.53-2.48, respectively) compared to whites, and Chinese also had significantly higher rates of birth trauma in vaginal delivery with instrument (RR 1.42; 95% CI:1.06-1.91). Filipinos and Other Pacific Islanders had significantly higher rates of Cesarean deliveries compared to whites (RR:1.15; 95% CI:1.11-1.20 and RR:1.16; 95% CI:1.10-1.22, respectively). Other Pacific Islanders also had significantly higher rates of vaginal births after Cesarean (VBAC) deliveries compared to whites (RR: 1.28; 95% CI:1.08-1.51) and Japanese had significantly lower rates of uncomplicated VBACs (RR:0.77; 95% CI:0.63-0.94). Conclusions Significant variation was seen for Asian and Pacific Islander subgroups across maternal quality and safety outcomes. Notably, high rates of obstetric trauma were seen among Chinese and Japanese vaginal deliveries. Filipinos and other Pacific Islanders had high rates of Cesarean deliveries. Native Hawaiians had better quality and safety outcomes than whites on several quality and safety measures, including obstetric trauma during vaginal delivery. Other Pacific Islanders had high rates of VBACs, while Japanese had lower rates. This information can help guide clinical practice, research, and quality improvement efforts.
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Affiliation(s)
- Tetine Sentell
- Office of Public Health Studies, University of Hawai'i at Mānoa, 1960 East-West Road, Biomed T102, Honolulu, HI 96822, USA.
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