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Newman RB, Stevens DR, Hunt KJ, Grobman WA, Owen J, Sciscione A, Wapner RJ, Skupski D, Chien EK, Wing DA, Ranzini AC, Porto M, Grantz KL. Fetal Growth Biometry as Predictors of Shoulder Dystocia in a Low-Risk Obstetrical Population. Am J Perinatol 2024; 41:891-901. [PMID: 35240706 PMCID: PMC9627645 DOI: 10.1055/a-1787-6991] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVE This study aimed to evaluate fetal biometrics as predictors of shoulder dystocia (SD) in a low-risk obstetrical population. STUDY DESIGN Participants were enrolled as part of a U.S.-based prospective cohort study of fetal growth in low-risk singleton gestations (n = 2,802). Eligible women had liveborn singletons ≥2,500 g delivered vaginally. Sociodemographic, anthropometric, and pregnancy outcome data were abstracted by research staff. The diagnosis of SD was based on the recorded clinical impression of the delivering physician. Simple logistic regression models were used to examine associations between fetal biometrics and SD. Fetal biometric cut points, selected by Youden's J and clinical determination, were identified to optimize predictive capability. A final model for SD prediction was constructed using backward selection. Our dataset was randomly divided into training (60%) and test (40%) datasets for model building and internal validation. RESULTS A total of 1,691 women (98.7%) had an uncomplicated vaginal delivery, while 23 (1.3%) experienced SD. There were no differences in sociodemographic or maternal anthropometrics between groups. Epidural anesthesia use was significantly more common (100 vs. 82.4%; p = 0.03) among women who experienced SD compared with those who did not. Amniotic fluid maximal vertical pocket was also significantly greater among SD cases (5.8 ± 1.7 vs. 5.1 ± 1.5 cm; odds ratio = 1.32 [95% confidence interval: 1.03,1.69]). Several fetal biometric measures were significantly associated with SD when dichotomized based on clinically selected cut-off points. A final prediction model was internally valid with an area under the curve of 0.90 (95% confidence interval: 0.81, 0.99). At a model probability of 1%, sensitivity (71.4%), specificity (77.5%), positive (3.5%), and negative predictive values (99.6%) did not indicate the ability of the model to predict SD in a clinically meaningful way. CONCLUSION Other than epidural anesthesia use, neither sociodemographic nor maternal anthropometrics were significantly associated with SD in this low-risk population. Both individually and in combination, fetal biometrics had limited ability to predict SD and lack clinical usefulness. KEY POINTS · SD unpredictable in low-risk women.. · Fetal biometry does not reliably predict SD.. · Epidural use associated with increased SD risk.. · SD prediction models clinically inefficient..
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Affiliation(s)
- Roger B. Newman
- Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston, South Carolina
| | - Danielle R. Stevens
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina
| | - Kelly J. Hunt
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina
| | - William A. Grobman
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - John Owen
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Anthony Sciscione
- Department of Obstetrics and Gynecology, Christiana Health Care Center, Wilmington, Delaware
| | - Ronald J. Wapner
- Department of Obstetrics and Gynecology, Columbia University Medical Center, New York, New York
| | - Daniel Skupski
- Department of Obstetrics and Gynecology, New York Presbyterian Queens, Flushing, New York
| | - Edward K. Chien
- Department of Obstetrics and Gynecology, Case Western Reserve University, Metro Health Medical Center, Cleveland, Ohio
| | - Deborah A. Wing
- Department of Obstetrics and Gynecology, University of California, Irvine; Orange, California
- Department of Obstetrics and Gynecology, Fountain Valley Regional Hospital and Medical Center, Fountain Valley, California
| | - Angela C. Ranzini
- Department of Obstetrics and Gynecology, Case Western Reserve University, Metro Health Medical Center, Cleveland, Ohio
- Department of Obstetrics and Gynecology, Saint Peter’s University Hospital, New Brunswick, New Jersey
| | - Manuel Porto
- Department of Obstetrics and Gynecology, University of California, Irvine; Orange, California
| | - Katherine L. Grantz
- Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
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Yisahak SF, Hinkle SN, Mumford SL, Grantz KL, Zhang C, Newman RB, Grobman WA, Albert PS, Sciscione A, Wing DA, Owen J, Chien EK, Buck Louis GM, Grewal J. Nutritional Intake in Dichorionic Twin Pregnancies: A Descriptive Analysis of a Multisite United States Cohort. Matern Child Health J 2024; 28:206-213. [PMID: 37934328 DOI: 10.1007/s10995-023-03802-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/17/2023] [Indexed: 11/08/2023]
Abstract
INTRODUCTION Twin gestations have greater nutritional demands than singleton gestations, yet dietary intakes of women with twin gestations have not been well described. METHODS In a prospective, multi-site US study of 148 women with dichorionic twin gestations (2012-2013), we examined longitudinal changes in diet across pregnancy. Women completed a food frequency questionnaire during each trimester of pregnancy. We examined changes in means of total energy and energy-adjusted dietary components using linear mixed effects models. RESULTS Mean energy intake (95% CI) across the three trimesters was 2010 kcal/day (1846, 2175), 2177 kcal/day (2005, 2349), 2253 kcal/day (2056, 2450), respectively (P = 0.01), whereas the Healthy Eating Index-2010 was 63.9 (62.1, 65.6), 64.5 (62.6, 66.3), 63.2 (61.1, 65.3), respectively (P = 0.53). DISCUSSION Women with twin gestations moderately increased total energy as pregnancy progressed, though dietary composition and quality remained unchanged. These findings highlight aspects of nutritional intake that may need to be improved among women carrying twins.
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Affiliation(s)
- Samrawit F Yisahak
- Division of Population Health Research, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
| | - Stefanie N Hinkle
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Sunni L Mumford
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Katherine L Grantz
- Division of Population Health Research, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
| | - Cuilin Zhang
- Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- NUS Bia-Echo Asia Centre for Reproductive Longevity and Equality, National University of Singapore, Singapore, Singapore
| | - Roger B Newman
- Division of Maternal-Fetal Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - William A Grobman
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Paul S Albert
- Biostatistics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, MD, USA
| | | | - Deborah A Wing
- University of California, Irvine and Long Beach Memorial Medical Center, Long Beach, CA, USA
| | - John Owen
- University of Alabama at Birmingham, Birmingham, AL, USA
| | - Edward K Chien
- Women and Infants Hospital of Rhode Island, Providence, RI, USA
| | | | - Jagteshwar Grewal
- Division of Population Health Research, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA.
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Tita ATN, McGee PL, Reddy UM, Bloom SL, Varner MW, Ramin SM, Caritis SN, Peaceman AM, Sorokin Y, Sciscione A, Carpenter MW, Mercer BM, Thorp JM, Malone FD, Buhimschi C. Fetal Tachycardia in the Setting of Maternal Intrapartum Fever and Perinatal Morbidity. Am J Perinatol 2024; 41:160-166. [PMID: 34670321 PMCID: PMC9018887 DOI: 10.1055/a-1675-0901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE The fetal consequences of intrapartum fetal tachycardia with maternal fever or clinical chorioamnionitis are not well studied. We evaluated the association between perinatal morbidity and fetal tachycardia in the setting of intrapartum fever. STUDY DESIGN Secondary analysis of a multicenter randomized control trial that enrolled 5,341 healthy laboring nulliparous women ≥36 weeks' gestation. Women with intrapartum fever ≥ 38.0°C (including those meeting criteria for clinical chorioamnionitis) after randomization were included in this analysis. Isolated fetal tachycardia was defined as fetal heart rate (FHR) ≥160 beats per minute for at least 10 minutes in the absence of other FHR abnormalities. FHR abnormalities other than tachycardia were excluded from the analysis. The primary outcome was a perinatal composite (5-minute Apgar's score ≤3, intubation, chest compressions, or mortality). Secondary outcomes included low arterial cord pH (pH < 7.20), base deficit ≥12, and cesarean delivery. RESULTS A total of 986 (18.5%) of women in the trial developed intrapartum fever, and 728 (13.7%) met criteria to be analyzed; of these, 728 women 336 (46.2%) had maternal-fetal medicine (MFM) reviewer-defined fetal tachycardia, and 349 of the 550 (63.5%) women during the final hour of labor had validated software (PeriCALM) defined fetal tachycardia. After adjusting for confounders, isolated fetal tachycardia was not associated with a significant difference in the composite perinatal outcome (adjusted odds ratio [aOR] = 3.15 [0.82-12.03]) compared with absence of tachycardia. Fetal tachycardia was associated with higher odds of arterial cord pH <7.2, aOR = 1.48 (1.01-2.17) and of infants with a base deficit ≥ 12, aOR = 2.42 (1.02-5.77), but no significant difference in the odds of cesarean delivery, aOR = 1.33 (0.97-1.82). CONCLUSION Fetal tachycardia in the setting of intrapartum fever or chorioamnionitis is associated with significantly increased fetal acidemia defined as a pH <7.2 and base excess ≥12 but not with a composite perinatal morbidity. KEY POINTS · The perinatal outcomes associated with fetal tachycardia in the setting of maternal fever are undefined.. · Fetal tachycardia was not significantly associated with perinatal morbidity although the sample size was limited.. · Fetal tachycardia was associated with an arterial cord pH <7.2 and base deficit of 12 or greater..
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Affiliation(s)
- Alan T. N. Tita
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Paula L. McGee
- George Washington University Biostatistics Center, Washington, Dist. of Columbia
| | - Uma M. Reddy
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland
| | - Steven L. Bloom
- University of Texas Southwestern Medical Center, Dallas, Texas
| | | | - Susan M. Ramin
- The University of Texas Health Science Center at Houston-Children’s Memorial Herman Hospital Houston, Texas
| | | | | | | | | | | | - Brian M. Mercer
- MetroHealth Medical Center- Case Western Reserve University, Cleveland, Ohio
| | - John M. Thorp
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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Bank TC, Macones G, Sciscione A. The "30-minute rule" for expedited delivery: fact or fiction? Am J Obstet Gynecol 2023; 228:S1110-S1116. [PMID: 36934051 DOI: 10.1016/j.ajog.2022.06.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 06/12/2022] [Accepted: 06/13/2022] [Indexed: 03/18/2023]
Abstract
Initially developed from hospital feasibility data from the 1980s, the "30-minute rule" has perpetuated the belief that the decision-to-incision time in an emergency cesarean delivery should be <30 minutes to preserve favorable neonatal outcomes. Through a review of the history, available data on delivery timing and associated outcomes, and consideration of feasibility across several hospital systems, the use and applicability of this "rule" are explored, and its reconsideration is called for. Moreover, we have advocated for balanced consideration of maternal safety with rapidity of delivery, encouraged process-based approaches, and proposed standardization of terminology regarding delivery urgency. Furthermore, a standardized 4-tier classification system for delivery urgency, from class I, for a perceived threat to maternal or fetal life, to class IV, a scheduled delivery, and a call for further research with a standardized structure to facilitate comparison have been proposed.
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Affiliation(s)
| | - George Macones
- Department of Obstetrics and Gynecology, The University of Texas at Austin, Austin, TX
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Vafai Y, Yeung EH, Sundaram R, Smarr MM, Gerlanc N, Grobman WA, Skupski D, Chien EK, Hinkle SN, Newman RB, Wing DA, Ranzini AC, Sciscione A, Grewal J, Zhang C, Grantz KL. Prenatal medication use in a prospective pregnancy cohort by pre-pregnancy obesity status. J Matern Fetal Neonatal Med 2022; 35:5799-5806. [PMID: 33706661 PMCID: PMC8802334 DOI: 10.1080/14767058.2021.1893296] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 02/12/2021] [Accepted: 02/17/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND The association between obesity (body mass index (BMI) ≥ 30 kg/m2) and pattern of medication use during pregnancy in the United States is not well-studied. Higher pre-pregnancy BMI may be associated with increases or decreases in medication use across pregnancy as symptoms (e.g. reflux) or comorbidities (e.g. gestational diabetes) requiring treatment that may be associated with higher BMI could also change with advancing gestation. OBJECTIVES To determine whether prenatal medication use, by the number and types of medications, varies by pre-pregnancy obesity status. METHODS In a secondary data analysis of a racially/ethnically diverse prospective cohort of pregnant women with low risk for fetal abnormalities enrolled in the first trimester of pregnancy and followed to delivery (singleton, 12 United States clinical sites), free text medication data were obtained at enrollment and up to five follow-up visits and abstracted from medical records at delivery. RESULTS In 436 women with obesity and 1750 women without obesity (pre-pregnancy BMI, 19-29.9 kg/m2), more than 70% of pregnant women (77% of women with and 73% of women without obesity) reported taking at least one medication during pregnancy, respectively (adjusted risk ratio (aRR)=1.10, 95% confidence interval (CI)=1.01, 1.20), with 81% reporting two and 69% reporting three or more. A total of 17 classes of medications were identified. Among medication classes consumed by at least 5% of all women, the only class that differed between women with and without obesity was hormones and synthetic substitutes (including steroids, progesterone, diabetes, and thyroid medications) in which women with obesity took more medications (11 vs. 5%, aRR = 1.9, 95% CI = 1.38, 2.61) compared to women without obesity. Within this class, a higher percentage of women with obesity took diabetes medications (2.3 vs. 0.7%) and progesterone (3.4 vs. 1.3%) than their non-obese counterparts. Similar percentages of women with and without obesity reported consuming medications in the remaining medication classes including central nervous system agents (50 and 46%), gastrointestinal drugs (43 and 40%), anti-infective agents (23 and 21%), antihistamines (20 and 17%), autonomic drugs (10 and 9%), and respiratory tract agents (7 and 6%), respectively (p > 0.05 for all adjusted comparisons). There were no differences in medication use by obesity status across gestation. Since the study exclusion criteria limited the non-obese group to women without thyroid disease, in a sensitivity analysis we excluded all women who reported thyroid medication intake and still a higher proportion of women with obesity took the hormones and synthetic substitutes class compared to women without obesity. CONCLUSION Our findings suggest that pre-pregnancy obesity in otherwise healthy women is associated with a higher use of only selected medications (such as diabetes medications and progesterone) during pregnancy, while the intake of other more common medication types such as analgesics, antibiotics, and antacids does not vary by pre-pregnancy obesity status. As medication safety information for prenatal consumption is insufficient for many medications, these findings highlight the need for a more in-depth examination of factors associated with prenatal medication use.
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Affiliation(s)
- Yassaman Vafai
- Epidemiology Branch, Division of Intramural Population
Health Research, Eunice Kennedy Shriver National Institute of Child
Health and Human Development, National Institutes of Health, Bethesda, MD, USA
| | - Edwina H. Yeung
- Epidemiology Branch, Division of Intramural Population
Health Research, Eunice Kennedy Shriver National Institute of Child
Health and Human Development, National Institutes of Health, Bethesda, MD, USA
| | - Rajeshwari Sundaram
- Biostatistics and Bioinformatics Branch, Division of
Intramural Population Health Research, Eunice Kennedy Shriver
National Institute of Child Health and Human Development, National Institutes of
Health, Bethesda, MD, USA
| | - Melissa M. Smarr
- Gangarosa Department of Environmental Health, Rollins
School of Public Health, Emory University, Atlanta, GA, USA
| | | | | | | | - Edward K. Chien
- Women and Infants Hospital of Rhode Island, Providence, RI,
USA
- Cleveland Clinic, Case Western Reserve University,
Cleveland, OH, USA
| | - Stefanie N. Hinkle
- Epidemiology Branch, Division of Intramural Population
Health Research, Eunice Kennedy Shriver National Institute of Child
Health and Human Development, National Institutes of Health, Bethesda, MD, USA
| | - Roger B. Newman
- Department of Obstetrics and Gynecology, Medical University
of South Carolina, Charleston, SC, USA
| | - Deborah A. Wing
- School of Medicine, University of California, Irvine, CA,
USA
- Fountain Valley Regional Hospital and Medical Center,
Fountain Valley, CA, USA
| | - Angela C. Ranzini
- Cleveland Clinic, Case Western Reserve University,
Cleveland, OH, USA
- Saint Peter’s University Hospital, New Brunswick,
NJ, USA
| | | | - Jagteshwar Grewal
- Epidemiology Branch, Division of Intramural Population
Health Research, Eunice Kennedy Shriver National Institute of Child
Health and Human Development, National Institutes of Health, Bethesda, MD, USA
| | - Cuilin Zhang
- Epidemiology Branch, Division of Intramural Population
Health Research, Eunice Kennedy Shriver National Institute of Child
Health and Human Development, National Institutes of Health, Bethesda, MD, USA
| | - Katherine L. Grantz
- Epidemiology Branch, Division of Intramural Population
Health Research, Eunice Kennedy Shriver National Institute of Child
Health and Human Development, National Institutes of Health, Bethesda, MD, USA
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Grantz KL, Grewal J, Kim S, Grobman WA, Newman RB, Owen J, Sciscione A, Skupski D, Chien EK, Wing DA, Wapner RJ, Ranzini AC, Nageotte MP, Craigo S, Hinkle SN, D'Alton ME, He D, Tekola-Ayele F, Hediger ML, Buck Louis GM, Zhang C, Albert PS. Unified standard for fetal growth velocity: the Eunice Kennedy Shriver National Institute of Child Health and Human Development Fetal Growth Studies. Am J Obstet Gynecol 2022; 227:916-922.e1. [PMID: 35926648 PMCID: PMC9729377 DOI: 10.1016/j.ajog.2022.07.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 07/26/2022] [Indexed: 01/27/2023]
Affiliation(s)
- Katherine L Grantz
- Division of Population Health Research, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD.
| | - Jagteshwar Grewal
- Division of Population Health Research, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD
| | - Sungduk Kim
- Biostatistics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD
| | | | - Roger B Newman
- Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston, SC
| | - John Owen
- University of Alabama at Birmingham, Birmingham, AL
| | - Anthony Sciscione
- Department of Obstetrics and Gynecology, ChristianaCare Health System, Newark, DE
| | | | - Edward K Chien
- Women and Infants Hospital of Rhode Island, Providence, RI; Cleveland Clinic, Cleveland, OH
| | - Deborah A Wing
- University of California, Irvine, Orange, CA; Fountain Valley Regional Hospital and Medical Center, Fountain Valley, CA
| | | | - Angela C Ranzini
- Saint Peter's University Hospital, New Brunswick, NJ; The MetroHealth System, Cleveland, OH
| | - Michael P Nageotte
- Miller Children's and Women's Hospital Long Beach/Long Beach Memorial Medical Center, Long Beach, CA
| | - Sabrina Craigo
- Department of Obstetrics and Gynecology, Tufts Medical Center, Boston, MA
| | - Stefanie N Hinkle
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | | | - Dian He
- Division of Population Health Research, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD; The Prospective Group, Inc, Fairfax, VA
| | - Fasil Tekola-Ayele
- Division of Population Health Research, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD
| | - Mary L Hediger
- Division of Population Health Research, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD
| | | | - Cuilin Zhang
- Division of Population Health Research, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD; Bia-Echo Asia Centre for Reproductive Longevity & Equality, Yong Loo Lin School of Medicine, National University of Singapore, Queenstown, Singapore; Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Queenstown, Singapore
| | - Paul S Albert
- Biostatistics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD
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7
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Grantz KL, Grewal J, Kim S, Grobman WA, Newman RB, Owen J, Sciscione A, Skupski D, Chien EK, Wing DA, Wapner RJ, Ranzini AC, Nageotte MP, Craigo S, Hinkle SN, D’Alton ME, He D, Tekola-Ayele F, Hediger ML, Buck Louis GM, Zhang C, Albert PS. Unified standard for fetal growth: the Eunice Kennedy Shriver National Institute of Child Health and Human Development Fetal Growth Studies. Am J Obstet Gynecol 2022; 226:576-587.e2. [PMID: 34906542 DOI: 10.1016/j.ajog.2021.12.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 12/03/2021] [Accepted: 12/06/2021] [Indexed: 11/25/2022]
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Vafai Y, Yeung EH, Sundaram R, Smarr MM, Gerlanc N, Grobman WA, Skupski D, Chien EK, Hinkle SN, Newman RB, Wing DA, Ranzini AC, Sciscione A, Grewal J, Zhang C, Grantz KL. Racial/Ethnic Differences in Prenatal Supplement and Medication Use in Low-Risk Pregnant Women. Am J Perinatol 2022; 39:623-632. [PMID: 33032328 PMCID: PMC8802333 DOI: 10.1055/s-0040-1717097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE This study aimed to describe the overall quantity and type of supplements and medications used during pregnancy in a low-risk cohort and to examine any racial/ethnic differences in intake. STUDY DESIGN We used data from 2,164 racially/ethnically diverse, nonobese, and low-risk pregnant women participating without pre-pregnancy chronic conditions in a prospective cohort study at 12 sites across the United States. Medication data were self-reported as free text in enrollment, follow-up visit questionnaires, and abstracted from medical records at delivery. Supplements and medications data were mapped to their active ingredients and categorized into corresponding classes using the Slone Drug Dictionary. The total number and classes of supplements and medications consumed during pregnancy were calculated. Modified Poisson regression models were used to estimate the racial/ethnic differences in supplements and medications intake. All models were adjusted for maternal sociodemographic factors and study site. RESULTS 98% of women took at least one supplement during pregnancy, with prenatal vitamins/multivitamins being most common. While only 31% reported taking no medications during pregnancy, 23% took one, 18% took two, and 28% took three or more. The percentage of women taking at least one medication during pregnancy was highest among non-Hispanic white women and lowest among Asians (84 vs. 55%, p < 0.001). All racial/ethnic groups reported taking the same top four medication classes including central nervous system agents, gastrointestinal drugs, anti-infective agents, and antihistamines. Compared with non-Hispanic white women, Hispanic (adjusted relative risk [aRR]: 0.84, 95% confidence interval [CI]: 0.71-0.98), and Asian women (aRR: 0.83, 95% CI: 0.70-0.98) were less likely to take central nervous system agents, as well as gastrointestinal drugs (Hispanics aRR: 0.79, 95% CI: 0.66-0.94; Asians aRR = 0.75, 95% CI: 0.63-0.90), and antihistamines (Hispanics aRR: 0.65, 95% CI: 0.47-0.92). CONCLUSION Supplement intake was nearly universal. Medication use was also common among this low-risk pregnancy cohort and differed by race/ethnicity. GOV IDENTIFIER NCT00912132. KEY POINTS · In women without chronic conditions, medication use is common.. · Racial/ethnic differences exist in prenatal medications use.. · Almost all women use supplements during pregnancy..
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Affiliation(s)
- Yassaman Vafai
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
| | - Edwina H. Yeung
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
| | - Rajeshwari Sundaram
- Biostatistics and Bioinformatics Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
| | - Melissa M. Smarr
- Population Health Branch, Division of Extramural Research and Training, National Institute of Environmental Health Sciences, Durham, North Carolina
| | - Nicole Gerlanc
- Prospective Group Inc, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
| | | | | | - Edward K. Chien
- Women and Infants Hospital, Providence, Rhode Island,Case Western Reserve University, MetroHealth Medical Center, Cleveland, Ohio
| | - Stefanie N. Hinkle
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
| | - Roger B. Newman
- Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston, South Carolina
| | - Deborah A. Wing
- University of California, Irvine, Orange, California,Fountain Valley Regional Hospital and Medical Center, Fountain Valley, California
| | | | - Anthony Sciscione
- Department of Obstetrics and Gynecology, Christiana Care Health System, Wilmington, Delaware
| | - Jagteshwar Grewal
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
| | - Cuilin Zhang
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
| | - Katherine L. Grantz
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
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Bank TC, Sciscione A. Intrapartum antibiotic administration and associated neonatal inflammation. Am J Obstet Gynecol 2022; 226:285-286. [PMID: 34582797 DOI: 10.1016/j.ajog.2021.09.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 09/22/2021] [Indexed: 11/25/2022]
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Bank TC, Nuss E, Subedi K, Hoffman MK, Sciscione A. Outcomes associated with antibiotic administration for isolated maternal fever in labor. Am J Obstet Gynecol 2022; 226:255.e1-255.e7. [PMID: 34363779 PMCID: PMC8810660 DOI: 10.1016/j.ajog.2021.07.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 07/10/2021] [Accepted: 07/29/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND The American College of Obstetricians and Gynecologists currently recommends that antibiotic treatment should be considered for women with isolated maternal fevers during labor. However, there is little known about the maternal and neonatal impact of antibiotic treatment in this scenario. OBJECTIVE We sought to assess the outcomes in women with a nonsustained, isolated maternal fever treated with antibiotics and compare it with expectant management. STUDY DESIGN This was a retrospective cohort study of laboring women with a singleton gestation at term and a single temperature of between 38.0°C and 38.9°C without other evidence of infection (leukocytosis >15,000/mm3, fetal tachycardia, malodorous amniotic fluid, suspected alternate source of infection) at a tertiary teaching hospital. A contemporaneously maintained, validated obstetrical database was used to identify women for our cohort. Women with rheumatologic or renal disease, nongestational diabetes, preterm labor, placental abruption, vaginal bleeding, HIV, malpresentation, and fetal anomalies were excluded. The primary outcome was a postpartum fever above 38.0°C. Secondary maternal outcomes were treatment for postpartum endometritis, uterine atony, postpartum hemorrhage, admission to the intensive care unit, and postpartum length of stay. Secondary neonatal outcomes were neonatal intensive care unit admission, 5-minute Apgar score of <7, 5-minute Apgar score of <4, neonatal intensive care unit length of stay, and neonatal antibiotic administration. The results were compared using univariable and multivariable analyses. RESULTS From January 1, 2015, to December 31, 2018, 359 women were identified; 85 received antibiotics and 274 did not. The baseline characteristics were similar between the groups, except for gestational age at the time of delivery (39.2 weeks vs 39.5 weeks for the antibiotic and no antibiotic groups, respectively; P=.02). The incidence in postpartum fever showed a downward trend in the antibiotic group (10.59% for the antibiotic group vs 18.98% for the no antibiotic group; P=.07). Significantly fewer women in the antibiotic group were treated for postpartum endometritis (3.53% vs 11.31%; P=.03). Neonatal intensive care unit admission and neonatal antibiotic administration rates were higher in the antibiotic group (41.18% vs 17.88%; P<.001 and 36.47% vs 12.41%; P<.001, respectively). The incidence of 5-minute Apgar score of <7 was higher in the antibiotic group (8.25% vs 2.19%; P=.016). After controlling for age, gestational age, body mass index, group B streptococci status, delivery method, parity, administration of epidural, and receipt of acetaminophen, the odds for postpartum fever were reduced by a factor of 0.42 (95% confidence interval, 0.18-0.99) among women who received antibiotics when compared with those who did not receive antibiotics. Outcome results are presented in Table 2. CONCLUSION Although there was a lower rate of treatment for endometritis among women who received antibiotics for a single isolated maternal fever, there was a higher rate of neonatal intensive care unit admissions and 5-minute Apgar score of <7. This indicates that there likely is maternal benefit associated with antibiotic use, however, there are concerns about the neonatal risk.
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Affiliation(s)
| | - Emily Nuss
- Department of Obstetrics and Gynecology, ChristianaCare, Newark, DE
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Gomez Slagle HB, Fonge YN, Sciscione A, Hoffman M. Predictive Factors Associated With Unplanned Cesarean Delivery Following Combined Foley Catheter-Misoprostol Labor Induction At Term. Am J Obstet Gynecol 2022. [DOI: 10.1016/j.ajog.2021.11.698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Tita AT, Chen C, Grantz K, Grobman WA, Sciscione A, Skupski D, Palomares K, Vena JE, Newman R. Neurodevelopmental outcomes of children born small-for-gestation and large-for-gestation compared with appropriate-for-gestation. Am J Obstet Gynecol 2022. [DOI: 10.1016/j.ajog.2021.11.129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Gomez Slagle HB, Fonge YN, Sciscione A, Hoffman M. Vaginal Group B Streptococcal Colonization Not Associated With Chorioamnionitis In Laboring Patients. Am J Obstet Gynecol 2022. [DOI: 10.1016/j.ajog.2021.11.1265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Abstract
OBJECTIVE Despite lack of evidence to support efficacy, activity restriction is one of the most commonly prescribed interventions used for the prevention of preterm birth. We have a departmental policy against the use of activity restriction but many practitioners still prescribe it in an effort to prevent preterm birth. We sought to evaluate the rate and compliance of women who are prescribed activity restriction during pregnancy to prevent preterm birth. STUDY DESIGN This was a single-site retrospective questionnaire study at a tertiary care, academic affiliated medical center. Women with a history of preterm delivery or short cervix were included. Once patients were identified, each patient was contacted and administered a questionnaire. We assessed the rates of activity restriction prescription and compliance. Secondary outcomes included details regarding activity restriction and treatment in pregnancy. Continuous variables were compared with t-test and categorical variables with Chi-square test. The value p < 0.05 was considered significant. RESULTS Among the 52 women who responded to the questionnaire, 18 reported being placed on activity restriction by a physician, with 1 self-prescribing activity restriction, giving a rate of our primary outcome of 19 of 52 (36.5%). All women reported compliance with prescribed activity restriction (100%). Gestational age at delivery was not different in women placed on activity restriction. CONCLUSION This questionnaire suggests that approximately one in three high-risk women were placed on activity restriction during their pregnancy despite a departmental policy against its use. The 100% compliance rate in patients placed on activity restriction is a strong reminder of the impact prescribing patterns of physicians can have on patients. KEY POINTS · One in three women are placed on activity restriction in pregnancy.. · Women are compliant with prescribed activity restriction.. · Activity restriction does not reduce rates of preterm birth..
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Affiliation(s)
- Ghamar Bitar
- Department of Obstetrics and Gynecology, Christiana Care Health System, Newark, Delaware
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Gomez Slagle HB, Fonge YN, Caplan R, Sciscione A, Hoffman M. Early versus Expectant Artificial Rupture of Membranes Following Foley Catheter Ripening: A Randomized Controlled Trial. Am J Obstet Gynecol 2022. [DOI: 10.1016/j.ajog.2021.11.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Tita AT, Grantz K, Grobman WA, Sciscione A, Skupski D, Palomares K, Vena JE, Newman R, for ECHO National Fetal Growth Study Consortium. Childhood Neurodevelopmental outcomes of hypertensive disorders of pregnancy. Am J Obstet Gynecol 2022. [DOI: 10.1016/j.ajog.2021.11.848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Ouidir M, Tekola-Ayele F, Canty T, Grantz KL, Sciscione A, Tong D, Jones RR, Sundaram R, Williams A, Stevens D, Mendola P. Acute ambient air pollution exposure and placental Doppler results in the NICHD fetal growth studies - Singleton cohort. Environ Res 2021; 202:111728. [PMID: 34297937 PMCID: PMC8578287 DOI: 10.1016/j.envres.2021.111728] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 06/21/2021] [Accepted: 07/16/2021] [Indexed: 05/29/2023]
Abstract
BACKGROUND Increased placental vascular resistance is a proposed mechanism by which air pollution exposure during pregnancy lowers birth weight and increases pregnancy-induced hypertensive disorders. OBJECTIVE To examine the impact of acute air pollution exposure during pregnancy on uterine and umbilical artery Doppler indicators of placental vascular resistance. METHODS After a first ultrasound to confirm gestational age, 2562 pregnant women recruited in 12 clinics throughout the United States underwent up to five standardized ultrasounds with Doppler measurements. Exposures to 11 air pollutants were estimated for the hour of ultrasound and each of the 2 h prior to ultrasound at the clinics using the National Air Quality Forecast Capability reanalysis products. We used mixed logistic regression to study the longitudinal odds ratio (OR) of any, uni- or bi-lateral systolic and diastolic uterine artery notching compared to no notching and the longitudinal OR of abnormal end diastolic flow of the umbilical artery compared to forward flow. Uterine and umbilical artery resistance indexes were studied using linear mixed models. RESULTS Each inter-quartile range (IQR) increase of particulate matter < 2.5 μm, nitrate, ammonium, primary organic matter (POM) and nitrogen dioxide during the hour of ultrasound was associated with a decreased risk of unilateral systolic notch and with increased resistance index of the left uterine artery. For the umbilical artery, each IQR increase in ozone was associated with decreased resistance index (b: -0.26, 95 % CI: -0.52, -0.01) and with a decreased risk of abnormal end diastolic flow (OR: 0.36, 95 % CI: 0.14, 0.94); while each IQR increase of elemental carbon and POM was associated with increased risk of abnormal end diastolic flow (OR: 1.47, 95 % CI: 1.02, 2.13 and OR: 1.67, 95 % CI: 1.17, 2.39, respectively). DISCUSSION Our results suggest acute air pollution exposure may influence placental vascular resistance.
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Affiliation(s)
- Marion Ouidir
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, USA
| | - Fasil Tekola-Ayele
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, USA
| | - Timothy Canty
- Department of Atmospheric and Oceanic Science, University of Maryland, College Park, MD, USA
| | - Katherine L Grantz
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, USA
| | - Anthony Sciscione
- Department of Obstetrics and Gynecology, Christiana Care Health System, Newark, DE, USA
| | - Daniel Tong
- Center for Spatial Science and Systems, George Mason University, Fairfax, VA, USA
| | - Rena R Jones
- Occupational and Environmental Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
| | - Rajeshwari Sundaram
- Biostatistics and Bioinformatics Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, USA
| | - Andrew Williams
- University of North Dakota, School of Medicine & Health Sciences, Grand Forks, ND, USA
| | - Danielle Stevens
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, USA
| | - Pauline Mendola
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, USA; Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY, USA.
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Gomez HB, Hoffman M, Caplan R, Sciscione A. 114 Early versus delayed amniotomy following combination foley catheter-misoprostol for term labor induction. Am J Obstet Gynecol 2021. [DOI: 10.1016/j.ajog.2020.12.136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Gomez HB, Hoffman M, Caplan R, Sciscione A. 830 Risk of chorioamnionitis following intrauterine pressure catheter placement in laboring patients. Am J Obstet Gynecol 2021. [DOI: 10.1016/j.ajog.2020.12.853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Gomez HB, Hoffman M, Caplan R, Fawcett M, Sciscione A. 177 Incremental risk of chorioamnionitis associated with cervical examination. Am J Obstet Gynecol 2021. [DOI: 10.1016/j.ajog.2020.12.199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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21
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Gomez HB, Hoffman M, Caplan R, Young MH, Ruhstaller K, Sciscione A. 48 Buccal Versus Vaginal Misoprostol Combined with a Foley Catheter (BEGIN Trial): A Randomized Controlled Trial. Am J Obstet Gynecol 2021. [DOI: 10.1016/j.ajog.2020.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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22
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Christensen A, Hersh AR, Hermesch A, Sciscione A, Caughey AB. 1075 Outpatient cervical ripening with foley catheter in low-risk women: a cost-effectiveness analysis. Am J Obstet Gynecol 2021. [DOI: 10.1016/j.ajog.2020.12.1100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Gomez HB, Weerasooriya N, Ingraham C, Delvadia D, Sciscione A. 282 A novel approach to teaching B-lynch suture: a multi-center validation of a uterus model. Am J Obstet Gynecol 2021. [DOI: 10.1016/j.ajog.2020.12.304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Pierce-Williams R, Lesser H, Saccone G, Harper LM, Kuper S, Sciscione A, Ehsanipoor R, Berghella V. 1141 Outpatient balloon cervical ripening. Am J Obstet Gynecol 2021. [DOI: 10.1016/j.ajog.2020.12.1165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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25
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Gomez HB, Hoffman M, Caplan R, Fawcett M, Sciscione A. 255 Chorioamnionitis rates in private versus resident-managed labor in term pregnancies. Am J Obstet Gynecol 2021. [DOI: 10.1016/j.ajog.2020.12.277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Hinkle SN, Zhang C, Grantz KL, Sciscione A, Wing DA, Grobman WA, Newman RB, D'Alton ME, Skupski D, Nageotte MP, Ranzini AC, Owen J, Chein EK, Craigo S, Yisahak SF, Liu A, Albert PS, Louis GMB, Grewal J. Nutrition during Pregnancy: Findings from the National Institute of Child Health and Human Development (NICHD) Fetal Growth Studies-Singleton Cohort. Curr Dev Nutr 2021; 5:nzaa182. [PMID: 33553996 PMCID: PMC7846139 DOI: 10.1093/cdn/nzaa182] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 12/17/2020] [Accepted: 12/18/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Accumulating evidence indicates that maternal diets are important for optimizing maternal and offspring health. Existing research lacks comprehensive profiles of maternal diets throughout pregnancy, especially in a racially/ethnically diverse obstetrical population. OBJECTIVE The aim was to characterize diets in a longitudinal US pregnancy cohort by trimester, race/ethnicity, and prepregnancy BMI. METHODS Data were obtained from pregnant women in the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Fetal Growth Studies-Singleton cohort (2009-2013). A food-frequency questionnaire (FFQ) at 8-13 wk of gestation assessed periconception and first-trimester diet (n = 1615). Automated, self-administered, 24-h dietary recalls targeted at 16-22, 24-29, 30-33, and 34-37 wk of gestation assessed second- and third-trimester diets (n = 1817 women/6791 recalls). The Healthy Eating Index-2010 (HEI-2010) assessed diet quality (i.e., adherence to US Dietary Guidelines). Variations in weighted energy-adjusted means for foods and nutrients were examined by trimester, self-identified race/ethnicity, and self-reported prepregnancy BMI. RESULTS Mean (95% CI) HEI-2010 was 65.9 (64.9, 67.0) during periconception to the first trimester assessed with an FFQ and 51.6 (50.8, 52.4) and 51.5 (50.7, 52.3) during the second trimester and third trimester, respectively, assessed using 24-h recalls. No significant differences were observed between the second and third trimester in macronutrients, micronutrients, foods, or HEI-2010 components (P ≥ 0.05). Periconception to first-trimester HEI-2010 was highest among Asian/Pacific Islander [67.2 (65.9, 68.6)] and lowest among non-Hispanic Black [58.7 (57.5, 60.0)] women and highest among women with normal weight [67.2 (66.1, 68.4)] and lowest among women with obesity [63.5 (62.1, 64.9)]. Similar rankings were observed in the second/third trimesters. CONCLUSIONS Most pregnant women in this cohort reported dietary intakes that, on average, did not meet US Dietary Guidelines for nonpregnant individuals. Also, diet differed across race/ethnic groups and by prepregnancy BMI, with the lowest overall dietary quality in all trimesters among non-Hispanic Black women and women with obesity. No meaningful changes in dietary intake were observed between the second and third trimesters.
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Affiliation(s)
- Stefanie N Hinkle
- Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, NIH, Bethesda, MD, USA
| | - Cuilin Zhang
- Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, NIH, Bethesda, MD, USA
| | - Katherine L Grantz
- Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, NIH, Bethesda, MD, USA
| | - Anthony Sciscione
- Department of Obstetrics and Gynecology, Christiana Care Health System, Newark, DE, USA
| | - Deborah A Wing
- Korn Ferry, Los Angeles, CA, USA
- Division of Maternal-Fetal Medicine, University of California, Irvine, CA, USA
| | - William A Grobman
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Roger B Newman
- Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston, SC, USA
| | - Mary E D'Alton
- Department of Obstetrics and Gynecology, Columbia University Medical Center, New York, NY, USA
| | - Daniel Skupski
- Department of Obstetrics and Gynecology, New York Hospital Queens, Queens, NY, USA
| | - Michael P Nageotte
- Department of Obstetrics and Gynecology, Miller Children's Hospital/Long Beach Memorial Medical Center, Long Beach, CA, USA
| | - Angela C Ranzini
- Division of Maternal and Fetal Medicine, Department of Obstetrics and Gynecology, St Peter's University Hospital, New Brunswick, NJ, USA
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, MetroHealth Medical Center/Case Western Reserve University, Cleveland, OH, USA
| | - John Owen
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology University of Alabama, Birmingham, School of Medicine, Birmingham, AL, USA
| | - Edward K Chein
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Women and Infants Hospital of Rhode Island, Providence, RI, USA
| | - Sabrina Craigo
- Department of Obstetrics and Gynecology, Tufts Medical Center, Boston, MA, USA
| | - Samrawit F Yisahak
- Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, NIH, Bethesda, MD, USA
| | - Aiyi Liu
- Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, NIH, Bethesda, MD, USA
| | - Paul S Albert
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, Bethesda, MD, USA
| | - Germaine M Buck Louis
- Dean's Office, College of Health and Human Services, George Mason University, Fairfax, VA, USA
| | - Jagteshwar Grewal
- Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, NIH, Bethesda, MD, USA
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Commodore S, Ferguson PL, Neelon B, Newman R, Grobman W, Tita A, Pearce J, Bloom MS, Svendsen E, Roberts J, Skupski D, Sciscione A, Palomares K, Miller R, Wapner R, Vena JE, Hunt KJ. Reported Neighborhood Traffic and the Odds of Asthma/Asthma-Like Symptoms: A Cross-Sectional Analysis of a Multi-Racial Cohort of Children. Int J Environ Res Public Health 2020; 18:E243. [PMID: 33396261 PMCID: PMC7794885 DOI: 10.3390/ijerph18010243] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 12/11/2020] [Accepted: 12/25/2020] [Indexed: 11/16/2022]
Abstract
Asthma in children poses a significant clinical and public health burden. We examined the association between reported neighborhood traffic (a proxy for traffic-related air pollution) and asthma among 855 multi-racial children aged 4-8 years old who participated in the Environmental Influences on Child Health Outcomes (ECHO) cohort. We hypothesized that high neighborhood traffic density would be associated with the prevalence of asthma. Asthma/asthma-like symptoms (defined as current and/or past physician diagnosed asthma, past wheezing, or nighttime cough or wheezing in the past 12 months) was assessed by parental report. The relationship between neighborhood traffic and asthma/asthma-like symptoms was assessed using logistic regression. The prevalence of asthma/asthma-like symptoms among study participants was 23%, and 15% had high neighborhood traffic. Children with significant neighborhood traffic had a higher odds of having asthma/asthma-like symptoms than children without neighborhood traffic [adjusted OR = 2.01 (95% CI: 1.12, 3.62)] after controlling for child's race-ethnicity, age, sex, maternal education, family history of asthma, play equipment in the home environment, public parks, obesity and prescribed asthma medication. Further characterization of neighborhood traffic is needed since many children live near high traffic zones and significant racial/ethnic disparities exist.
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Affiliation(s)
- Sarah Commodore
- Department of Environmental and Occupational Health, Indiana University, Bloomington, IN 47405, USA
| | - Pamela L. Ferguson
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC 29425, USA; (P.L.F.); (B.N.); (J.P.); (E.S.); (J.E.V.); (K.J.H.)
| | - Brian Neelon
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC 29425, USA; (P.L.F.); (B.N.); (J.P.); (E.S.); (J.E.V.); (K.J.H.)
| | - Roger Newman
- Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston, SC 29425, USA;
| | - William Grobman
- Department of Obstetrics and Gynecology, Northwestern University, Chicago, IL 60611, USA;
| | - Alan Tita
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL 35233, USA;
| | - John Pearce
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC 29425, USA; (P.L.F.); (B.N.); (J.P.); (E.S.); (J.E.V.); (K.J.H.)
| | - Michael S. Bloom
- Department of Global and Community Health, George Mason University, Fairfax, VA 22030, USA;
| | - Erik Svendsen
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC 29425, USA; (P.L.F.); (B.N.); (J.P.); (E.S.); (J.E.V.); (K.J.H.)
| | - James Roberts
- Department of Pediatrics, Medical University of South Carolina, Charleston, SC 29425, USA;
| | - Daniel Skupski
- Department of Obstetrics and Gynecology, New York-Presbyterian Queens Hospital, Queens, NY 11365, USA;
- Department of Obstetrics and Gynecology, Weill Cornell Graduate School of Medical Sciences, Cornell University, New York, NY 10021, USA
| | - Anthony Sciscione
- Department of Obstetrics and Gynecology, Christiana Care Health System, Wilmington, DE 19899, USA;
| | - Kristy Palomares
- Department of Obstetrics and Gynecology, Saint Peter’s University Hospital, New Brunswick, NJ 08901, USA;
| | - Rachel Miller
- Department of Medicine, Division of Clinical Immunology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA;
| | - Ronald Wapner
- Columbia University Irving Medical Center, Department of Obstetrics and Gynecology, Columbia University, New York, NY 10032, USA;
| | - John E. Vena
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC 29425, USA; (P.L.F.); (B.N.); (J.P.); (E.S.); (J.E.V.); (K.J.H.)
| | - Kelly J. Hunt
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC 29425, USA; (P.L.F.); (B.N.); (J.P.); (E.S.); (J.E.V.); (K.J.H.)
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Waters T, McNulty J, Wylie B, Sciscione A, Iriye B, Iriye B. Society for Maternal-Fetal Medicine Special Statement: Society for Maternal-Fetal Medicine's conflict of interest policy. Am J Obstet Gynecol 2020; 223:B47-B57.e3. [PMID: 32971012 DOI: 10.1016/j.ajog.2020.09.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
A vital mission of the Society for Maternal-Fetal Medicine is to provide independent, objective, scientifically based information and recommendations for providers, patients, and payors of high-risk pregnancy care. To ensure that these recommendations are free from bias, special interest, or the perception of either, a publicly transparent process for disclosing relevant financial and nonfinancial interests (disclosures of interest) and management of potential conflicts of interest are essential. Educational and research presentations also require proper disclosure to allow attendees to properly assess information presented at the Society for Maternal-Fetal Medicine events. The Society for Maternal-Fetal Medicine established a task force to review the current Society for Maternal-Fetal Medicine policies and procedures as they pertain to disclosure of interest and conflict of interest. To establish current best practices in disclosure of interest and conflict of interest definitions, reporting, and conflict of interest mitigation, members of the task force reviewed external literature, including policies of other medical organizations. The Society for Maternal-Fetal Medicine is committed to a continuous process of improvement in the approach to these issues and will revise this policy as indicated.
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Lauder J, Sciscione A, Biggio J, Osmundson S, Osmundson S. Society for Maternal-Fetal Medicine Consult Series #50: The role of activity restriction in obstetric management: (Replaces Consult Number 33, August 2014). Am J Obstet Gynecol 2020; 223:B2-B10. [PMID: 32360110 DOI: 10.1016/j.ajog.2020.04.031] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Despite current recommendations against its use, activity restriction remains a common intervention used to prevent preterm birth in multiple clinical settings. Hypertensive disorders of pregnancy, preterm premature rupture of membranes, multiple gestations, vaginal bleeding, short cervical length, placenta previa, and fetal growth restriction are also common reasons for antepartum hospital admission and frequently lead to a recommendation for activity restriction. However, numerous reports have shown that activity restriction does not prevent adverse obstetrical outcomes but does confer significant physical and psychosocial risks. This consult reviews the current literature on activity restriction and examines the evidence regarding its use in obstetrical management. The recommendations by the Society for Maternal-Fetal Medicine are as follows: (1) we recommend against the routine use of any type of activity restriction in pregnant women at risk of preterm birth based on preterm labor symptoms, arrested preterm labor, or shortened cervix (GRADE 1B); (2) we recommend against the use of routine inpatient hospitalization and activity restriction for the prevention of preterm birth in women with multiple gestations (GRADE 1A); and (3) given the lack of data definitively demonstrating that activity restriction improves perinatal outcome in pregnancies complicated by fetal growth restriction, preterm premature rupture of membranes, or hypertensive diseases of pregnancy, coupled with evidence of adverse effects of activity restriction, we suggest that activity restriction not be prescribed for the treatment of pregnancies complicated by fetal growth restriction, preterm premature rupture of membranes, or hypertensive disease (GRADE 2B).
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Affiliation(s)
| | | | | | | | - Sarah Osmundson
- Society for Maternal-Fetal Medicine, 409 12 St. SW, Washington, DC 20024, USA.
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Bitar G, Sciscione A, Fonge Y. Activity Rest Prescription and Compliance in Women With Short Cervix [03K]. Obstet Gynecol 2020. [DOI: 10.1097/01.aog.0000664408.05657.31] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Li M, Hinkle SN, Grantz KL, Kim S, Grewal J, Grobman WA, Skupski DW, Newman RB, Chien EK, Sciscione A, Zork N, Wing DA, Nageotte M, Tekola-Ayele F, Louis GMB, Albert PS, Zhang C. Glycaemic status during pregnancy and longitudinal measures of fetal growth in a multi-racial US population: a prospective cohort study. Lancet Diabetes Endocrinol 2020; 8:292-300. [PMID: 32135135 PMCID: PMC7676113 DOI: 10.1016/s2213-8587(20)30024-3] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 01/15/2020] [Accepted: 01/20/2020] [Indexed: 12/26/2022]
Abstract
BACKGROUND The timepoint at which fetal growth begins to differ by maternal glycaemic status is not well understood. To address this lack of data, we examined gestational diabetes, impaired glucose tolerance, and early pregnancy glucose concentrations in relation to fetal growth trajectories. METHODS This cohort study included 2458 pregnant women from the NICHD Fetal Growth Studies-Singletons study, which took place between 2009 and 2013. Women were recruited from 12 clinical centres in the USA. Women aged 18-40 years without major chronic conditions when entering pregnancy were included and those with records of neither glucose screening test or glucose tolerance test were excluded from the study. Women were enrolled at gestational weeks 8-13 and randomly assigned to four ultrasonogram schedules (Group A; weeks 16, 24, 30, 34; Group B: weeks 18, 26, 31, 35, 39; Group C: weeks 20, 28, 32, 36; Group D: weeks 22, 29, 33, 37, 41) to capture weekly fetal growth. Gestational diabetes, impaired glucose tolerance, and normal glucose tolerance were defined by medical record review. Glucose was measured in a subsample of women at weeks 10-14. We modelled fetal growth trajectories using linear mixed models with cubic splines. This study is registered with ClinicalTrials.gov, NCT00912132. FINDINGS Of the 2458 women included in this study, 107 (4·4%) had gestational diabetes, 118 (4·8%) had impaired glucose tolerance, and 2020 (82·2%) had NGT. 213 women were excluded from the main analysis. The cohort with gestational diabetes was associated with a larger estimated fetal weight that started at week 20 and was significant at week 28-40 (at week 37: 3061 g [95% CI 2967-3164] for women with gestational diabetes vs 2943 g [2924-2962] for women with normal glucose tolerance, adjusted p=0·02). In addition, glucose levels at weeks 10-14 were positively associated with estimated fetal weight starting at week 23 and the association became significant at week 27 (at week 37: 3073 g [2983-3167] in the highest tertile vs 2853 g [2755-2955] in the lowest tertile, adjusted p=0·0009. INTERPRETATION Gestational diabetes was associated with a larger fetal size that started at week 20 and became significant at gestational week 28. Efforts to mitigate gestational diabetes-related fetal overgrowth should start before 24-28 gestational weeks, when gestational diabetes is typically screened for in the USA. FUNDING National Institutes of Health.
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Affiliation(s)
- Mengying Li
- Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
| | - Stefanie N Hinkle
- Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
| | - Katherine L Grantz
- Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
| | - Sungduk Kim
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Jagteshwar Grewal
- Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
| | - William A Grobman
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Daniel W Skupski
- Department of Obstetrics and Gynecology, New York-Presbyterian Hospital Queens, Flushing, NY, USA
| | - Roger B Newman
- Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston, SC, USA
| | - Edward K Chien
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Women and Infants Hospital of Rhode Island, Providence, RI, USA
| | | | - Noelia Zork
- Department of Obstetrics and Gynecology, Columbia University Medical Center, New York, NY, USA
| | - Deborah A Wing
- Division of Maternal-Fetal Medicine, Department of Obstetrics-Gynecology, University of California School of Medicine, Irvine, CA, USA; Fountain Valley Regional Hospital and Medical Center, Fountain Valley, CA, USA
| | | | - Fasil Tekola-Ayele
- Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
| | | | - Paul S Albert
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Cuilin Zhang
- Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA.
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Gilstrop Thompson M, Corsetti S, Jain V, Ruhstaller K, Sciscione A. Accuracy of Routine Prenatal Genetic Screening in Patients Referred for Genetic Counseling. Am J Perinatol 2020; 37:271-276. [PMID: 30795016 DOI: 10.1055/s-0039-1678533] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVE The American College of Obstetricians and Gynecologists (ACOG) guidelines recommend routine prenatal screening for genetic diseases that could affect the pregnancy. We sought to determine the rate of missed genetic information in the general obstetrician's routine prenatal genetic screening process. STUDY DESIGN This is a sequential case series of women referred for genetic counseling between March and August of 2015. Once identified, all women completed a personalized genetic history/exposure intake form (GHEF) created by our certified genetic counselors, followed by an in-person genetic counseling session with pedigree generation. The corresponding prenatal record was reviewed for genetic history obtained by the referring provider, most often utilizing the standardized ACOG prenatal intake form's genetic and family history sections. This information was then compared with that discovered in the GHEF and through the in-person genetic counseling session. Missed genetic information was defined as information discovered on the GHEF or during the in-person genetic counseling session which was not noted on the prenatal genetic screening document from the obstetric provider. Missing genetic information that lead to a change in clinical care, either through additional laboratory screening tests, fetal imaging or prenatal diagnostic testing through chorionic villus sampling, or amniocentesis was considered significant. We also assessed the study population as to maternal race, parity, and referral source. Statistical significance was assessed using Chi-squared testing with p < 0.05 identifying significance. RESULTS A total of 299 patients underwent genetic counseling. Of them, 57.5% patients were referred from private providers, 28.1% from academic faculty practice, and 14.4% from a federally funded clinic. Missed genetic information was discovered in 171/299 (57.2%) of patients in the genetic counseling process. Of these 171 patients, 28.7% were identified via the GHEF and 52.6% during the in-person genetic counseling session. Of the 171 patients who had new genetic information discovered, 73 (42.7%) findings were significant. There was no statistical difference in patient race or referring office setting in the occurrence of new information found. CONCLUSION In our population, genetic history obtained in the general obstetrician's office, regardless of practice type, missed genetic information in over half of cases with approximately 40% of that information leading to a subsequent change in clinical care. Developing a genetic intake form similar to our pregenetic counseling form, or modification/clarification of the "Family History and Genetic Screening" section within the standardized ACOG prenatal genetic history form, used at most practices in our region may decrease missed genetic information in the general obstetrician's office.
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Affiliation(s)
| | - Stephanie Corsetti
- Department of Obstetrics and Gynecology, Christiana Care Health System, Newark, Delaware
| | - Vanita Jain
- Department of Obstetrics and Gynecology, Christiana Care Health System, Newark, Delaware
| | - Kelly Ruhstaller
- Department of Obstetrics and Gynecology, Christiana Care Health System, Newark, Delaware
| | - Anthony Sciscione
- Department of Obstetrics and Gynecology, Christiana Care Health System, Newark, Delaware
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Gomez HB, Shlossman P, Matthew H, Caplan R, Sciscione A. 76: A novel text-based app for the diagnosis of type 2 diabetes in the postpartum period. Am J Obstet Gynecol 2020. [DOI: 10.1016/j.ajog.2019.11.092] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Bank TC, Nuss E, Antoline M, Subedi K, Sciscione A. 455: Antibiotic administration for a single isolated maternal fever in labor: who benefits? Am J Obstet Gynecol 2020. [DOI: 10.1016/j.ajog.2019.11.471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Schoen CN, Keefe KW, Berghella V, Sciscione A, Pettker CM. Blown out of proportion? Induction Foley balloon ruptures associated with overinflation. Am J Obstet Gynecol MFM 2019; 1:100026. [PMID: 33345790 DOI: 10.1016/j.ajogmf.2019.06.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 05/13/2019] [Accepted: 06/13/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Larger volume Foley catheters are occasionally used for labor induction. In some instances the balloon is overinflated to obtain this volume. Neither the risk or rate of rupture are known for this practice. OBJECTIVE The purpose of this study was to evaluate the use of overinflated Foley catheter balloons and the rate of rupture in prospective trials and to describe rupture events in our institutions. STUDY DESIGN Clinical trials and prospective cohorts were identified through a search of MEDLINE from 2000 through May 1, 2017; prospective studies were examined for the use of overinflated Foley catheters. Reports of overinflated balloons were then reviewed in detail to determine if rupture occurred and to record any reported maternal, neonatal, or gynecologic outcomes. Internal reports to the Obstetric Safety Report System were used to describe the local cases at our institutions. RESULTS We reviewed 296 abstracts. Seventeen prospective cohorts or randomized trials used larger balloon volumes (≥50 mL), of which 12 abstracts confirmed routine overinflation of the balloon. Within these studies, 19 patients who underwent cervical ripening with overinflated Foley catheters experienced balloon rupture during use. The incidence of rupture in these studies was 0.9%. No adverse maternal or fetal effects were noted. Internal safety reporting yielded an additional case. One gynecologic case was identified internally. The patient had an overinflated Foley catheter balloon used to tamponade excessive uterine bleeding after uterine evacuation. Balloon rupture was noted, and hysteroscopy was needed to remove fragments of the balloon. CONCLUSION Overinflation of Foley catheter balloons in obstetric and gynecologic applications may cause rupture. Because of possible underreporting, the extent of complications that may result from balloon rupture is unknown.
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Affiliation(s)
- Corina N Schoen
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Massachusetts-Baystate, Springfield, MA.
| | - Kimberly W Keefe
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, New Haven, CT
| | - Vincenzo Berghella
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA
| | - Anthony Sciscione
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Christiana Care Health Systems, Newark, DE
| | - Christian M Pettker
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, New Haven, CT
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Li M, Hinkle S, Kim S, Grantz K, Grewal J, Grobman W, Skupski D, Newman R, Chien E, Sciscione A, Zork N, Wing D, Tekola-Ayele F, Louis GB, Albert P, Zhang C. Gestational Diabetes and Longitudinal Ultrasonographic Measures of Fetal Growth in the NICHD Fetal Growth Studies-Singletons (P11-133-19). Curr Dev Nutr 2019. [DOI: 10.1093/cdn/nzz048.p11-133-19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Objectives
Gestational diabetes (GDM) is associated with increased risk for large-for-gestational-age birth. Yet, longitudinal fetal growth trajectories in women with GDM and the timing of alterations related to GDM is not well understood, particularly in early pregnancy. This study aims to investigate these critical data gaps.
Methods
The NICHD Fetal Growth Studies–Singleton Cohort enrolled women at 8w0d to 13w6d gestation from 12 U.S. clinical centers and randomized them among four ultrasonology schedules for longitudinal fetal measurement. Fetal biparietal diameter, head circumference (HC), abdominal circumference (AC), femurs length and humerus length were measured. Estimated fetal weight (EFW) was calculated using the Hadlock formula. GDM was defined using the Carpenter-Coustan Criteria, impaired glucose tolerance (IGT) was defined as 2-hour plasma glucose in the 75 g or 100 g oral glucose tolerance test (OGTT) 140–199 mg/dL, and normal glucose tolerance (NGT) was defined by no elevated values on either the OGTT or 50 g glucose challenge test. The fetal growth trajectories were modeled using linear mixed models with cubic spline adjusting for race, age, parity, pre-pregnancy BMI and infant sex.
Results
One hundred and seven women developed GDM, 118 developed IGT, and 2,020 had NGT. Most fetal growth measures were larger at 10–12 weeks and became smaller at 14–16 weeks in GDM than NGT group. At 28 weeks, AC and EFW became larger in GDM group, and the differences persisted through 40 weeks (at 40 weeks: AC: 368 vs. 355 mm, P = 0.03; EFW: 3866 vs. 3558 g, P = 0.003). The HC to AC ratio was smaller in GDM group 19–36 weeks. The associations were modified by the family history of diabetes (p-interaction < 0.001), such that GDM-related early pregnancy growth alterations were only seen in women with a family history of diabetes, whereas GDM-related late pregnancy overgrowth was only seen in those without. IGT group also had larger EFW and smaller HC to AC ratio than the NGT group at late third trimester.
Conclusions
GDM-related fetal growth alterations appeared to start as early as 10 weeks of gestation. Fetal overgrowth related to GDM was solely driven by AC and started at 28 weeks of gestation, suggesting current GDM diagnosis and treatment timing may be too late to normalize fetal growth.
Funding Sources
Eunice Kennedy Shriver National Institute of Child Health and Human Development.
Supporting Tables, Images and/or Graphs
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Ananth CV, Jablonski K, Myatt L, Roberts JM, Tita ATN, Leveno KJ, Reddy UM, Varner MW, Thorp JM, Mercer BM, Peaceman AM, Ramin SM, Carpenter MW, Samuels P, Sciscione A, Tolosa JE, Saade G, Sorokin Y. Risk of Ischemic Placental Disease in Relation to Family History of Preeclampsia. Am J Perinatol 2019; 36:624-631. [PMID: 30282103 PMCID: PMC6447463 DOI: 10.1055/s-0038-1672177] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
OBJECTIVE To assess the risk of ischemic placental disease (IPD) including preeclampsia, small for gestational age (SGA), and abruption, in relation to preeclampsia in maternal grandmother, mother, and sister(s). STUDY DESIGN We performed a secondary analysis of data from a randomized trial of vitamins C and E for preeclampsia prevention. Data on family history of preeclampsia were based on recall by the proband. The associations between family history of preeclampsia and the odds of IPD were evaluated from alternating logistic regressions. RESULTS Of the 9,686 women who delivered nonmalformed, singleton live births, 17.1% had IPD. Probands provided data on preeclampsia in 55.5% (n = 5,374) on all three family members, 26.5% (n = 2,562) in mother and sister(s) only, and 11.6% (n = 1,125) in sister(s) only. The pairwise odds ratio (pOR) of IPD was 1.16 (95% confidence interval [CI]: 1.00-1.36) if one or more of the female relatives had preeclampsia. The pORs of preeclampsia were 1.54 (95% CI: 1.12-2.13) and 1.35 (95% CI: 1.03-1.77) if the proband's mother or sister(s) had a preeclamptic pregnancy, respectively, but no associations were seen for SGA infant or abruption. CONCLUSION This study suggests that IPD may share a predisposition with preeclampsia, suggesting a familial inheritance.
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Affiliation(s)
- Cande V Ananth
- Department of Obstetrics and Gynecology, Vagelos College of Physicians and Surgeons, Joseph L. Mailman School of Public Health, Columbia University, New York, New York
- Department of Health Policy and Management, Joseph L. Mailman School of Public Health, Columbia University, New York, New York
| | - Kathleen Jablonski
- Department of Obstetrics and Gynecology, Biostatistics Center, The George Washington University, Washington, District of Columbia
| | - Leslie Myatt
- Department of Obstetrics and Gynecology, University of Cincinnati, Cincinnati, Ohio
| | - James M Roberts
- Department of Obstetrics and Gynecology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Alan T N Tita
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Kenneth J Leveno
- Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, Texas
| | | | - Michael W Varner
- Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, Utah
| | - John M Thorp
- Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Brian M Mercer
- Department of Obstetrics and Gynecology, MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio
| | - Alan M Peaceman
- Department of Obstetrics and Gynecology, Northwestern University, Chicago, Illinois
| | - Susan M Ramin
- Department of Obstetrics and Gynecology, Children's Memorial Hermann Hospital, The University of Texas Health Science Center at Houston, Houston, Texas
| | - Marshall W Carpenter
- Department of Obstetrics and Gynecology, Brown University, Providence, Rhode Island
| | - Philip Samuels
- Department of Obstetrics and Gynecology, The Ohio State University, Columbus, Ohio
| | - Anthony Sciscione
- Department of Obstetrics and Gynecology, Drexel University, Philadelphia, Pennsylvania
| | - Jorge E Tolosa
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, Oregon
| | - George Saade
- Department of Obstetrics and Gynecology, The University of Texas Medical Branch, Galveston, Texas
| | - Yoram Sorokin
- Department of Obstetrics and Gynecology, Wayne State University, Detroit, Michigan
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Grewal J, Grantz KL, Zhang C, Sciscione A, Wing DA, Grobman WA, Newman RB, Wapner R, D'Alton ME, Skupski D, Nageotte MP, Ranzini AC, Owen J, Chien EK, Craigo S, Albert PS, Kim S, Hediger ML, Buck Louis GM. Cohort Profile: NICHD Fetal Growth Studies-Singletons and Twins. Int J Epidemiol 2019; 47:25-25l. [PMID: 29025016 DOI: 10.1093/ije/dyx161] [Citation(s) in RCA: 104] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/27/2017] [Indexed: 11/14/2022] Open
Affiliation(s)
- Jagteshwar Grewal
- Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD
| | - Katherine L Grantz
- Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD
| | - Cuilin Zhang
- Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD
| | - Anthony Sciscione
- Department of Obstetrics and Gynecology, Christiana Care Health System, Newark, DE
| | - Deborah A Wing
- Division of Maternal-Fetal Medicine, Department of Obstetrics-Gynecology, School of Medicine, University of California, Irvine, CA
- Fountain Valley Regional Hospital and Medical Center, Fountain Valley, CA
| | - William A Grobman
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Roger B Newman
- Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston, SC
| | - Ronald Wapner
- Department of Obstetrics and Gynecology, Columbia University Medical Center, New York, NY
| | - Mary E D'Alton
- Department of Obstetrics and Gynecology, Columbia University Medical Center, New York, NY
| | - Daniel Skupski
- Department of Obstetrics and Gynecology, New York Hospital Queens, Queens, NY
| | - Michael P Nageotte
- Department of Obstetrics and Gynecology, Miller Children's Hospital/Long Beach Memorial Medical Center, Long Beach, CA
| | - Angela C Ranzini
- Division of Maternal and Fetal Medicine, Department of Obstetrics and Gynecology, St Peter's University Hospital, New Brunswick, NJ
| | - John Owen
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, School of Medicine, University of Alabama, Birmingham, AL
| | - Edward K Chien
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Women and Infants Hospital of Rhode Island, Providence, RI
| | - Sabrina Craigo
- Department of Obstetrics and Gynecology, Tufts Medical Center, Boston, MA
| | - Paul S Albert
- Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD
| | - Sungduk Kim
- Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD
| | - Mary L Hediger
- Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD
| | - Germaine M Buck Louis
- Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD
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Randis TM, Rice MM, Myatt L, Tita ATN, Leveno KJ, Reddy UM, Varner MW, Thorp JM, Mercer BM, Dinsmoor MJ, Ramin SM, Carpenter MW, Samuels P, Sciscione A, Tolosa JE, Saade G, Sorokin Y. Incidence of early-onset sepsis in infants born to women with clinical chorioamnionitis. J Perinat Med 2018; 46:926-933. [PMID: 29791315 PMCID: PMC6177287 DOI: 10.1515/jpm-2017-0192] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Accepted: 03/06/2018] [Indexed: 01/19/2023]
Abstract
Objective To determine the frequency of sepsis and other adverse neonatal outcomes in women with a clinical diagnosis of chorioamnionitis. Methods We performed a secondary analysis of a multi-center placebo-controlled trial of vitamins C/E to prevent preeclampsia in low risk nulliparous women. Clinical chorioamnionitis was defined as either the "clinical diagnosis" of chorioamnionitis or antibiotic administration during labor because of an elevated temperature or uterine tenderness in the absence of another cause. Early-onset neonatal sepsis was categorized as "suspected" or "confirmed" based on a clinical diagnosis with negative or positive blood, urine or cerebral spinal fluid cultures, respectively, within 72 h of birth. Adjusted odds ratios (ORs) and 95% confidence intervals (CIs) were estimated by logistic regression. Results Data from 9391 mother-infant pairs were analyzed. The frequency of chorioamnionitis was 10.3%. Overall, 6.6% of the neonates were diagnosed with confirmed (0.2%) or suspected (6.4%) early-onset sepsis. Only 0.7% of infants born in the setting of chorioamnionitis had culture-proven early-onset sepsis versus 0.1% if chorioamnionitis was not present. Clinical chorioamnionitis was associated with both suspected [OR 4.01 (3.16-5.08)] and confirmed [OR 4.93 (1.65-14.74)] early-onset neonatal sepsis, a need for resuscitation within the first 30 min after birth [OR 2.10 (1.70-2.61)], respiratory distress [OR 3.14 (2.16-4.56)], 1 min Apgar score of ≤3 [OR 2.69 (2.01-3.60)] and 4-7 [OR 1.71 (1.43-2.04)] and 5 min Apgar score of 4-7 [OR 1.67 (1.17-2.37)] (vs. 8-10). Conclusion Clinical chorioamnionitis is common and is associated with neonatal morbidities. However, the vast majority of exposed infants (99.3%) do not have confirmed early-onset sepsis.
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Affiliation(s)
- Tara M. Randis
- Department of Pediatrics, Columbia University, New York, NewYork
| | | | - Leslie Myatt
- Department of Obstetrics and Gynecology, University of Cincinnati, Cincinnati, Ohio
| | - Alan T. N. Tita
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Kenneth J. Leveno
- Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Uma M. Reddy
- Pregnancy and Perinatology Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland
| | - Michael W. Varner
- Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, Utah
| | - John M. Thorp
- Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Brian M. Mercer
- Department of Obstetrics and Gynecology, Case Western Reserve University-MetroHealth Medical Center, Cleveland, Ohio
| | - Mara J Dinsmoor
- Department of Obstetrics and Gynecology, Northwestern University, Chicago, Illinois
| | - Susan M. Ramin
- Department of Obstetrics and Gynecology, University of Texas Health Science Center at Houston, Houston, Texas
| | | | - Philip Samuels
- Department of Obstetrics and Gynecology, The Ohio State University, Columbus, Ohio
| | - Anthony Sciscione
- Department of Obstetrics and Gynecology, Drexel University, Philadelphia, Pennsylvania
| | - Jorge E. Tolosa
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, Oregon
| | - George Saade
- Department of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston, Texas
| | - Yoram Sorokin
- Department of Obstetrics and Gynecology, Wayne State University, Detroit, Michigan
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Tita AT, Doherty L, Roberts JM, Myatt L, Leveno KJ, Varner MW, Wapner RJ, Thorp JM, Mercer BM, Peaceman A, Ramin SM, Carpenter MW, Iams J, Sciscione A, Harper M, Tolosa JE, Saade GR, Sorokin Y. Adverse Maternal and Neonatal Outcomes in Indicated Compared with Spontaneous Preterm Birth in Healthy Nulliparas: A Secondary Analysis of a Randomized Trial. Am J Perinatol 2018; 35:624-631. [PMID: 29190847 PMCID: PMC5948166 DOI: 10.1055/s-0037-1608787] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To compare the risks of adverse maternal and neonatal outcomes associated with spontaneous (SPTB) versus indicated preterm births (IPTB). METHODS A secondary analysis of a multicenter trial of vitamin C and E supplementation in healthy low-risk nulliparous women. Outcomes were compared between women with SPTB (due to spontaneous membrane rupture or labor) and those with IPTB (due to medical or obstetric complications). A primary maternal composite outcome included: death, pulmonary edema, blood transfusion, adult respiratory distress syndrome (RDS), cerebrovascular accident, acute tubular necrosis, disseminated intravascular coagulopathy, or liver rupture. A neonatal composite outcome included: neonatal death, RDS, grades III or IV intraventricular hemorrhage (IVH), sepsis, necrotizing enterocolitis (NEC), or retinopathy of prematurity. RESULTS Of 9,867 women, 10.4% (N = 1,038) were PTBs; 32.7% (n = 340) IPTBs and 67.3% (n = 698) SPTBs. Compared with SPTB, the composite maternal outcome was more frequent in IPTB-4.4% versus 0.9% (adjusted odds ratio [aOR], 4.0; 95% confidence interval [CI], 1.4-11.8), as were blood transfusion and prolonged hospital stay (3.2 and 3.7 times, respectively). The frequency of composite neonatal outcome was higher in IPTBs (aOR, 1.8; 95% CI, 1.1-3.0), as were RDS (1.7 times), small for gestational age (SGA) < 5th percentile (7.9 times), and neonatal intensive care unit (NICU) admission (1.8 times). CONCLUSION Adverse maternal and neonatal outcomes were significantly more likely with IPTB than with SPTB.
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Affiliation(s)
- Alan T Tita
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Lindsay Doherty
- The Biostatistics Center, The George Washington University, Washington, District of Columbia
| | - Jim M Roberts
- Department of Obstetrics and Gynecology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Leslie Myatt
- Department of Obstetrics and Gynecology, University of Cincinnati, Cincinnati, Ohio
| | - Kenneth J Leveno
- Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Michael W Varner
- Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, Utah
| | - Ronald J Wapner
- Department of Obstetrics and Gynecology, Columbia University, New York, New York
| | - John M Thorp
- Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Brian M Mercer
- Department of Obstetrics and Gynecology, Case Western Reserve University-MetroHealth Medical Center, Cleveland, Ohio
| | - Alan Peaceman
- Department of Obstetrics and Gynecology, Northwestern University, Chicago, Illinois
| | - Susan M Ramin
- Department of Obstetrics and Gynecology, University of Texas Health Science Center at Houston-Children's Memorial Hermann Hospital, Houston, Texas
| | - Marshall W Carpenter
- Department of Obstetrics and Gynecology, Brown University, Providence, Rhode Island
| | - Jay Iams
- Department of Obstetrics and Gynecology, The Ohio State University, Columbus, Ohio
| | - Anthony Sciscione
- Department of Obstetrics and Gynecology, Drexel University, Philadelphia, Pennsylvania
| | - Margaret Harper
- Department of Obstetrics and Gynecology, Wake Forest University Health Sciences, Winston-Salem, North Carolina
| | - Jorge E Tolosa
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, Oregon
| | - George R Saade
- Department of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston, Texas
| | - Yoram Sorokin
- Department of Obstetrics and Gynecology, Wayne State University, Detroit, Michigan
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Sciscione A, Hughes F, Francis A, O'keeffe D, Ruhstaller K. 646: Physician burnout among members of the SMFM. Am J Obstet Gynecol 2018. [DOI: 10.1016/j.ajog.2017.11.175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Lauder JR, Ruhstaller K, Jain V, Sciscione A. 885: Demographic and Clinical Factors Associated with the Proper Administration of Late Preterm Steroids. Am J Obstet Gynecol 2018. [DOI: 10.1016/j.ajog.2017.11.422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Schoen C, Grant G, Berghella V, St. Marie P, Hoffmann M, Sciscione A. 372: Intracervical foley catheter with and without oxytocin for labor induction for women with Bishop score ≤3. Am J Obstet Gynecol 2018. [DOI: 10.1016/j.ajog.2017.10.308] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Anastasio HB, Ward A, Berghella V, St. Marie P, Hoffman MK, Sciscione A, Schoen C. 407: Association between timing of rupture of membranes and length of labor induction: Secondary analysis of a randomized controlled trial. Am J Obstet Gynecol 2018. [DOI: 10.1016/j.ajog.2017.10.343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Zhang C, Hediger ML, Albert PS, Grewal J, Sciscione A, Grobman WA, Wing DA, Newman RB, Wapner R, D’Alton ME, Skupski D, Nageotte MP, Ranzini AC, Owen J, Chien EK, Craigo S, Kim S, Grantz KL, Louis GMB. Association of Maternal Obesity With Longitudinal Ultrasonographic Measures of Fetal Growth: Findings From the NICHD Fetal Growth Studies-Singletons. JAMA Pediatr 2018; 172:24-31. [PMID: 29131898 PMCID: PMC5808867 DOI: 10.1001/jamapediatrics.2017.3785] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Despite the increasing prevalence of pregravid obesity, systematic evaluation of the association of maternal obesity with fetal growth trajectories is lacking. OBJECTIVE To characterize differences in fetal growth trajectories between obese and nonobese pregnant women, and to identify the timing of any observed differences. DESIGN, SETTING, AND PARTICIPANTS The Eunice Kennedy Shriver National Institute of Child Health and Human Development Fetal Growth Studies-Singletons study enrolled cohorts of pregnant women at 12 US health care institutions. Obese women (with prepregnancy body mass index > 30) and nonobese women (prepregnancy body mass indexes, 19-29.9) without major chronic diseases were recruited between 8 weeks and 0 days' gestation and 13 weeks and 6 days' gestation. A mixed longitudinal randomization scheme randomized participants into 1 of 4 schedules for 2-dimensional and 3-dimensional ultrasonograms to capture weekly fetal growth data throughout the remainder of their pregnancies. MAIN OUTCOMES AND MEASURES On each ultrasonogram, fetal humerus length, femur length, biparietal diameter, head circumference, and abdominal circumference were measured. Fetal growth curves were estimated using linear mixed models with cubic splines. Median differences in the fetal measures at each gestational week of the obese and nonobese participants were examined using the likelihood ratio and Wald tests after adjustment for maternal characteristics. RESULTS The study enrolled 468 obese and 2334 nonobese women between 8 weeks and 0 days' gestation and 13 weeks and 6 days' gestation. After a priori exclusion criteria, 443 obese and 2320 nonobese women composed the final cohort. Commencing at 21 weeks' gestation, femur length and humerus length were significantly longer for fetuses of obese woman than those of nonobese women. Differences persisted in obese and nonobese groups through 38 weeks' gestation (median femur length, 71.0 vs 70.2 mm; P = .01; median humerus length, 62.2 vs 61.6 mm; P = .03). Averaged across gestation, head circumference was significantly larger in fetuses of obese women than those of nonobese women (P = .02). Fetal abdominal circumference was not greater in the obese cohort than in the nonobese cohort but was significantly larger than in fetuses of normal-weight women (with body mass indexes between 19.0-24.9) commencing at 32 weeks (median, 282.1 vs 280.2 mm; P = .04). Starting from 30 weeks' gestation, estimated fetal weight was significantly larger for the fetuses of obese women (median, 1512 g [95% CI, 1494-1530 g] vs 1492 g [95% CI, 1484-1499 g]) and the difference grew as gestational age increased. Birth weight was higher by almost 100 g in neonates born to obese women than to nonobese women (mean, 3373.2 vs 3279.5 g). CONCLUSIONS AND RELEVANCE As early as 32 weeks' gestation, fetuses of obese women had higher weights than fetuses of nonobese women. The mechanisms and long-term health implications of these findings are not yet established.
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Affiliation(s)
- Cuilin Zhang
- Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
| | - Mary L. Hediger
- Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
| | - Paul S. Albert
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Jagteshwar Grewal
- Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
| | | | - William A. Grobman
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Deborah A. Wing
- Division of Maternal-Fetal Medicine, Department of Obstetrics-Gynecology, University of California School of Medicine, Irvine,Fountain Valley Regional Hospital and Medical Center, Fountain Valley, California
| | - Roger B. Newman
- Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston
| | - Ronald Wapner
- Department of Obstetrics and Gynecology, Columbia University Medical Center, New York, New York
| | - Mary E. D’Alton
- Department of Obstetrics and Gynecology, Columbia University Medical Center, New York, New York
| | - Daniel Skupski
- Department of Obstetrics and Gynecology, New York-Presbyterian Hospital/Queens, Queens
| | - Michael P. Nageotte
- Department of Obstetrics and Gynecology, Miller Children’s Hospital/Long Beach Memorial Medical Center, Long Beach, California
| | - Angela C. Ranzini
- Division of Maternal and Fetal Medicine, Department of Obstetrics and Gynecology, St Peter’s University Hospital, New Brunswick, New Jersey
| | - John Owen
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology University of Alabama School of Medicine, Birmingham
| | - Edward K. Chien
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Women and Infants Hospital of Rhode Island, Providence
| | - Sabrina Craigo
- Department of Obstetrics and Gynecology, Tufts Medical Center, Boston, Massachusetts
| | - Sungduk Kim
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Katherine L. Grantz
- Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
| | - Germaine M. Buck Louis
- Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
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Tita ATN, Lai Y, Landon MB, Ramin SM, Casey B, Wapner RJ, Varner MW, Thorp JM, Sciscione A, Catalano P, Harper M, Saade GR, Caritis SN, Sorokin Y, Peaceman AM, Tolosa JE. Predictive Characteristics of Elevated 1-Hour Glucose Challenge Test Results for Gestational Diabetes. Am J Perinatol 2017; 34:1464-1469. [PMID: 28724164 PMCID: PMC5685869 DOI: 10.1055/s-0037-1604243] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Objective To estimate the optimal screen-positive 1-hour 50 gm glucose challenge test (GCT) threshold for gestational diabetes (GDM) and predictive characteristics of increasing screen-positive GCT threshold values (135-199 mg/dL) for GDM. Study Design Secondary analysis of a multicenter mild GDM study. At 24-30 weeks' gestation, women with elevated GCT (135-199 mg/dL) completed a diagnostic 3-hour oral glucose tolerance test (OGTT). A novel change-point analysis method was used to compare the GDM rates for adjacent GCT values, delineating categories of changing risk such that values within categories have equal risk for GDM. Positive (PPV) and negative (NPV) predictive values for GDM were computed for increasing GCT cut-offs. Results In 7280 women with both GCT (135-199 mg/dL) and OGTT results, 4 GDM risk-equivalent GCT categories were identified with escalations at 144, 158, and 174 mg/dL (all p-values <0.05). The PPV for GDM increased from 33% to 64% as GCT increased from 135 to 199 mg/dL while the NPV decreased from 80% to 67%. PPVs were only 20% and 61% for risk-equivalent categories of 135-143 and 174-199 mg/dL respectively. Conclusion Elevated GCT cut-off values between 135-143 mg/dL may carry equivalent GDM risk. No threshold GCT value <199 mg/dL alone sufficiently predicts GDM.
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Affiliation(s)
- Alan T N Tita
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Yinglei Lai
- The Biostatistics Center, The George Washington University, Washington, District of Columbia
| | | | - Susan M Ramin
- University of Texas Health Science Center, Houston-Children's Memorial Hermann Hospital, Houston, Texas
| | - Brian Casey
- University of Texas Southwestern Medical Center, Dallas, Texas
| | | | | | - John M Thorp
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | | | - Patrick Catalano
- MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio
| | - Margaret Harper
- Wake Forest University Health Sciences, Winston-Salem, North Carolina
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Parry S, Sciscione A, Haas DM, Grobman WA, Iams JD, Mercer BM, Silver RM, Simhan HN, Wapner RJ, Wing DA, Elovitz MA, Schubert FP, Peaceman A, Esplin MS, Caritis S, Nageotte MP, Carper BA, Saade GR, Reddy UM, Parker CB. Role of early second-trimester uterine artery Doppler screening to predict small-for-gestational-age babies in nulliparous women. Am J Obstet Gynecol 2017; 217:594.e1-594.e10. [PMID: 28712949 DOI: 10.1016/j.ajog.2017.06.013] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Revised: 06/04/2017] [Accepted: 06/08/2017] [Indexed: 12/20/2022]
Abstract
BACKGROUND Trophoblastic invasion of the uterine spiral arteries substantially increases compliance to accommodate increased blood flow to the placenta. Failure of this process impedes uterine artery blood flow, and this may be detected by uterine artery Doppler flow studies. However, the clinical utility of uterine artery Doppler flow studies in the prediction of adverse pregnancy outcomes in a general population remains largely unknown. OBJECTIVE We sought to determine the utility of early second-trimester uterine artery Doppler studies as a predictor of small-for-gestational-age neonates. STUDY DESIGN Nulliparous women with a viable singleton pregnancy were recruited during their first trimester into an observational prospective cohort study at 8 institutions across the United States. Participants were seen at 3 study visits during pregnancy and again at delivery. Three indices of uterine artery Doppler flow (resistance index, pulsatility index, and diastolic notching) were measured in the right and left uterine arteries between 16 weeks 0 days' and 22 weeks 6 days' gestation. Test characteristics for varying thresholds in the prediction of small for gestational age (defined as birthweight <5th percentile for gestational age [Alexander growth curve]) were evaluated. RESULTS Uterine artery Doppler indices, birthweight, and gestational age at birth were available for 8024 women. Birthweight <5th percentile for gestational age occurred in 358 (4.5%) births. Typical thresholds for the uterine artery Doppler indices were all associated with birthweight <5th percentile for gestational age (P < .0001 for each), but the positive predictive values for these cutoffs were all <15% and areas under receiver operating characteristic curves ranged from 0.50-0.60. Across the continuous scales for these measures, the areas under receiver operating characteristic curves ranged from 0.56-0.62. Incorporating maternal age, early pregnancy body mass index, race/ethnicity, smoking status prior to pregnancy, chronic hypertension, and pregestational diabetes in the prediction model resulted in only modest improvements in the areas under receiver operating characteristic curves ranging from 0.63-0.66. CONCLUSION In this large prospective cohort, early second-trimester uterine artery Doppler studies were not a clinically useful test for predicting small-for-gestational-age babies.
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Bustos ML, Caritis SN, Jablonski KA, Reddy UM, Sorokin Y, Manuck T, Varner MW, Wapner RJ, Iams JD, Carpenter MW, Peaceman AM, Mercer BM, Sciscione A, Rouse DJ, Ramin SM. The association among cytochrome P450 3A, progesterone receptor polymorphisms, plasma 17-alpha hydroxyprogesterone caproate concentrations, and spontaneous preterm birth. Am J Obstet Gynecol 2017; 217:369.e1-369.e9. [PMID: 28522317 DOI: 10.1016/j.ajog.2017.05.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Accepted: 05/07/2017] [Indexed: 12/13/2022]
Abstract
BACKGROUND Infants born <37 weeks' gestation are of public health concern since complications associated with preterm birth are the leading cause of mortality in children <5 years of age and a major cause of morbidity and lifelong disability. The administration of 17-alpha hydroxyprogesterone caproate reduces preterm birth by 33% in women with history of spontaneous preterm birth. We demonstrated previously that plasma concentrations of 17-alpha hydroxyprogesterone caproate vary widely among pregnant women and that women with 17-alpha hydroxyprogesterone caproate plasma concentrations in the lowest quartile had spontaneous preterm birth rates of 40% vs rates of 25% in those women with higher concentrations. Thus, plasma concentrations are an important factor in determining drug efficacy but the reason 17-alpha hydroxyprogesterone caproate plasma concentrations vary so much is unclear. Predominantly, 17-alpha hydroxyprogesterone caproate is metabolized by CYP3A4 and CYP3A5 enzymes. OBJECTIVE We sought to: (1) determine the relation between 17-alpha hydroxyprogesterone caproate plasma concentrations and single nucleotide polymorphisms in CYP3A4 and CYP3A5; (2) test the association between progesterone receptor single nucleotide polymorphisms and spontaneous preterm birth; and (3) test whether the association between plasma concentrations of 17-alpha hydroxyprogesterone caproate and spontaneous preterm birth varied by progesterone receptor single nucleotide polymorphisms. STUDY DESIGN In this secondary analysis, we evaluated genetic polymorphism in 268 pregnant women treated with 17-alpha hydroxyprogesterone caproate, who participated in a placebo-controlled trial to evaluate the benefit of omega-3 supplementation in women with history of spontaneous preterm birth. Trough plasma concentrations of 17-alpha hydroxyprogesterone caproate were measured between 25-28 weeks of gestation after a minimum of 5 injections of 17-alpha hydroxyprogesterone caproate. We extracted DNA from maternal blood samples and genotyped the samples using TaqMan (Applied Biosystems, Foster City, CA) single nucleotide polymorphism genotyping assays for the following single nucleotide polymorphisms: CYP3A4*1B, CYP3A4*1G, CYP3A4*22, and CYP3A5*3; and rs578029, rs471767, rs666553, rs503362, and rs500760 for progesteronereceptor. We adjusted for prepregnancy body mass index, race, and treatment group in a multivariable analysis. Differences in the plasma concentrations of 17-alpha hydroxyprogesterone caproate by genotype were evaluated for each CYP single nucleotide polymorphism using general linear models. The association between progesterone receptor single nucleotide polymorphisms and frequency of spontaneous preterm birth was tested using logistic regression. A logistic model also tested interaction between 17-alpha hydroxyprogesterone caproate concentrations with each progesterone receptor single nucleotide polymorphism for the outcome of spontaneous preterm birth. RESULTS The association between CYP single nucleotide polymorphisms *22, *1G, *1B, and *3 and trough plasma concentrations of 17-alpha hydroxyprogesterone caproate was not statistically significant (P = .68, .44, .08, and .44, respectively). In an adjusted logistic regression model, progesterone receptor single nucleotide polymorphisms rs578029, rs471767, rs666553, rs503362, and rs500760 were not associated with the frequency of spontaneous preterm birth (P = .29, .10, .76, .09, and .43, respectively). Low trough plasma concentrations of 17-alpha hydroxyprogesterone caproate were statistically associated with a higher frequency of spontaneous preterm birth (odds ratio, 0.78; 95% confidence ratio, 0.61-0.99; P = .04 for trend across quartiles), however no significant interaction with the progesterone receptor single nucleotide polymorphisms rs578029, rs471767, rs666553, rs503362, and rs500760 was observed (P = .13, .08, .10, .08, and .13, respectively). CONCLUSION The frequency of recurrent spontaneous preterm birth appears to be associated with trough 17-alpha hydroxyprogesterone caproate plasma concentrations. However, the wide variation in trough 17-alpha hydroxyprogesterone caproate plasma concentrations is not attributable to polymorphisms in CYP3A4 and CYP3A5 genes. Progesterone receptor polymorphisms do not predict efficacy of 17-alpha hydroxyprogesterone caproate. The limitations of this secondary analysis include that we had a relative small sample size (n = 268) and race was self-reported by the patients.
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Affiliation(s)
- Martha L Bustos
- Department of Obstetrics and Gynecology at University of Pittsburgh, Pittsburgh, PA
| | - Steve N Caritis
- Department of Obstetrics and Gynecology at University of Pittsburgh, Pittsburgh, PA.
| | | | - Uma M Reddy
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD
| | | | - Tracy Manuck
- University of North Carolina at Chapel Hill, Chapel Hill, NC
| | | | | | | | | | | | - Brian M Mercer
- Case Western Reserve University-MetroHealth Medical Center, Cleveland, OH
| | | | | | - Susan M Ramin
- University of Texas Health Science Center at Houston, Houston, TX
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Grobman WA, Wing DA, Albert P, Kim S, Grewal J, Guille C, Newman R, Chien EK, Owen J, D'Alton ME, Wapner R, Sciscione A, Grantz KL. Maternal Depressive Symptoms, Perceived Stress, and Fetal Growth. J Ultrasound Med 2017; 36:1639-1648. [PMID: 28393386 PMCID: PMC5967616 DOI: 10.7863/ultra.16.08085] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Accepted: 10/24/2016] [Indexed: 05/06/2023]
Abstract
OBJECTIVES To determine whether longitudinal fetal growth is altered among pregnant women reporting greater perceived stress or more symptoms of depression. METHODS This analysis was based on a multicenter longitudinal study of fetal growth. Women were screened at gestational ages of 8 weeks to 13 weeks 6 days for low-risk status and underwent serial sonographic examinations. At each study visit during pregnancy, women were asked to complete the Cohen Perceived Stress Scale (PSS) and Edinburgh Postpartum Depression Survey (EPDS). Growth curves for estimated fetal weight and individual biometric parameters were created by using linear mixed models with cubic splines and compared on the basis of whether women scored 15 or higher on the PSS or 10 or higher on the EPDS either at the start of or at any time during pregnancy. RESULTS Of the 2334 women enrolled in the study, 2088 (89%) and 2108 (90%) completed the PSS and EPDS, respectively, at least once in all trimesters. The longitudinal growth curves of estimated fetal weight as well as all individual biometric parameters were similar (P > .05) regardless of whether the participants reported PSS of 15 or higher or EPDS of 10 or higher in the first trimester or whether these scores persisted throughout the pregnancy. Similarly, effect modification by race/ethnicity was not statistically significant for the biometric parameters under study (P > .05 for all race/ethnicity interactions). CONCLUSIONS More depressive symptoms and greater perceived stress, as quantified by the EPDS and the PSS, respectively, are not associated with alterations in fetal growth throughout gestation.
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Affiliation(s)
- William A Grobman
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Deborah A Wing
- University of California, Irvine, and Long Beach Memorial Medical Center/Miller Children's Hospital, Irvine, California, USA
| | - Paul Albert
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland, USA
| | - Sungduk Kim
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland, USA
| | - Jagteshwar Grewal
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland, USA
| | - Constance Guille
- Medical University of South Carolina, Charleston, South Carolina, USA
| | - Roger Newman
- Medical University of South Carolina, Charleston, South Carolina, USA
| | - Edward K Chien
- Women and Infants Hospital of Rhode Island, Providence, Rhode Island, USA
| | - John Owen
- University of Alabama, Birmingham, Alabama, USA
| | - Mary E D'Alton
- Columbia University Medical Center, New York, New York, USA
| | - Ronald Wapner
- Columbia University Medical Center, New York, New York, USA
| | | | - Katherine L Grantz
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland, USA
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