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Jacobson LT, Bakhache N, Dowling J, Okut H, Zackula R, Robbins DC, Stern JE, Grainger DA, Befort C. Electronic Monitoring of Mom's Schedule (eMOMS TM): A Qualitative Study of Experiences in a Lifestyle Change Program with Lactation Support. Am J Health Promot 2023; 37:953-963. [PMID: 37461383 DOI: 10.1177/08901171231189540] [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] [Indexed: 08/19/2023]
Abstract
PURPOSE To elicit feedback from participants who completed the eMOMSTM study, a feasibility randomized controlled trial (NCT04021602), on their perceptions of program strengths and weaknesses. STUDY DESIGN Qualitative - Semi-structured, telephone interview guide using open-ended questions. SETTING Rural Great Plains state, United States. PARTICIPANTS Of 26 individuals who completed the eMOMSTM study, 24 consented to an interview. METHOD Interviews were completed between October 2020 and May 2021. Audio-recordings were transcribed verbatim and organized in Microsoft 365. Data were analyzed using an exploratory, inductive thematic analysis. RESULTS Participants' mean age was 27.5 (± 5.4) years and mean pre-pregnancy BMI was 29.5 kg/m2 (± 2.7). The majority (71%) were non-Hispanic White and 54% had a high school education/some college. Based on specific areas of inquiry, the following themes emerged: convenience of online program access using Facebook, importance of health coach's support and online interaction, positivity toward improving one's health, increased consciousness of health behaviors, diverse lactation educational needs, importance of educational materials on depression, and grief over the loss of birth expectations during COVID-19. CONCLUSION Findings suggest participants' perceived value of a lifestyle change program coupled with lactation education and support delivered using social media. Findings inform future studies to further adapt lifestyle change programs.
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Affiliation(s)
- Lisette T Jacobson
- Department of Population Health, University of Kansas School of Medicine-Wichita, Wichita, KS, USA
- Department of Obstetrics and Gynecology, University of Kansas School of Medicine-Wichita, Wichita, KS, USA
| | - Nathalie Bakhache
- Department of Population Health, University of Kansas School of Medicine-Wichita, Wichita, KS, USA
| | - Jolynn Dowling
- School of Nursing, Wichita State University, Wichita, KS, USA
| | - Hayrettin Okut
- Department of Population Health, University of Kansas School of Medicine-Wichita, Wichita, KS, USA
- University of Kansas School of Medicine-Wichita, Wichita, KS, USA
| | - Rosey Zackula
- University of Kansas School of Medicine-Wichita, Wichita, KS, USA
| | - David C Robbins
- Diabetes Institute, University of Kansas Medical Center-Kansas City, Kansas City, KS, USA
| | - Judy E Stern
- Department of Obstetrics and Gynecology, Dartmouth-Hitchcock Health and the Geisel School of Medicine, Lebanon, NH, USA
| | - David A Grainger
- Department of Obstetrics and Gynecology, University of Kansas School of Medicine-Wichita, Wichita, KS, USA
| | - Christie Befort
- Department of Population Health, University of Kansas School of Medicine-Kansas City, Kansas City, KS, USA
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Jacobson LT, Wolfe M, Zackula R, Okut H, Hampton FE, Grainger DA, Griebel-Thompson AK, Ling Kong K, Befort C. Electronic Monitoring Of Mom's Schedule (eMOMS TM): Recruitment of pregnant populations with elevated BMI in a feasibility randomized controlled trial. Prev Med Rep 2023; 34:102254. [PMID: 37292426 PMCID: PMC10244679 DOI: 10.1016/j.pmedr.2023.102254] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 01/27/2023] [Accepted: 05/19/2023] [Indexed: 06/10/2023] Open
Abstract
Underrepresentation of pregnant populations in randomized controlled trials of lifestyle change interventions is concerning due to high attrition and providers' limited clinical time. The purpose of this evaluative study was to assess intervention uptake of pregnant individuals enrolled in a three-arm feasibility randomized controlled trial, electronic Monitoring Of Mom's Schedule (eMOMSTM), examining lifestyle changes and lactation support alone, and in combination. Measures included: (1) participation and completion rates, and characteristics of intervention completers versus other eligible participants; and (2) provider experiences with screening and enrolling pregnant participants. Pregnant people with a pre-pregnancy body mass index ≥ 25 and < 35 kg/m2 were enrolled into the eMOMSTM trial between September 2019 - December 2020. Of the 44 consented participants, 35 were randomized, at a participation rate of 35%, and 26 completed the intervention, resulting in a completion rate of 74%. Intervention completers were slightly older and entered the study earlier in pregnancy compared to non-completers. Completers were more likely to be first-time mothers, resided in urban areas, had higher educational attainment, and were slightly more racially and ethnically diverse. A majority of providers reported willingness to participate, believed the study aligned with their organization's mission, and were satisfied with using iPads for screening. Lessons learned to guide recruitment success include use of: (1) designated research staff in combination with physician support; and (2) user-friendly technology to help mitigate time burden on physicians and their staff. Future work should focus on successful strategies to recruit/retain pregnant populations in clinical trials.
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Affiliation(s)
- Lisette T. Jacobson
- University of Kansas School of Medicine-Wichita, Department of Population Health, 1010 North Kansas, Wichita, KS 67214, USA
- University of Kansas School of Medicine-Wichita, Department of Obstetrics and Gynecology, 1010 North Kansas, Wichita, KS 67214, USA
| | - Michael Wolfe
- Ascension Via Christi Hospitals Wichita, Inc., Ascension Via Christi Maternal Fetal Medicine Clinic, 1515 South Clifton Avenue, Suite 130, Wichita, KS 67218, USA
| | - Rosey Zackula
- University of Kansas School of Medicine-Wichita, Office of Research, 1010 North Kansas, Wichita, KS 67214, USA
| | - Hayrettin Okut
- University of Kansas School of Medicine-Wichita, Department of Population Health, 1010 North Kansas, Wichita, KS 67214, USA
- University of Kansas School of Medicine-Wichita, Office of Research, 1010 North Kansas, Wichita, KS 67214, USA
| | - Faith E. Hampton
- University of Kansas School of Medicine-Wichita, Department of Population Health, 1010 North Kansas, Wichita, KS 67214, USA
| | - David A. Grainger
- University of Kansas School of Medicine-Wichita, Department of Obstetrics and Gynecology, 1010 North Kansas, Wichita, KS 67214, USA
| | - Adrianne K. Griebel-Thompson
- Baby Health Behavior Lab, Division of Health Services and Outcomes Research, Children’s Mercy Research Institute, Children’s Mercy Hospital, Kansas City, MO 64108, USA
| | - Kai Ling Kong
- Baby Health Behavior Lab, Division of Health Services and Outcomes Research, Children’s Mercy Research Institute, Children’s Mercy Hospital, Kansas City, MO 64108, USA
| | - Christie Befort
- University of Kansas School of Medicine-Kansas City, Department of Population Health, 3901 Rainbow Boulevard, Mailstop 1003, Kansas City, KS 66160, USA
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Jacobson LT, Collins TC, Lucas M, Zackula R, Okut H, Nazir N, Robbins D, Stern JE, Wolfe M, Grainger DA. Electronic Monitoring Of Mom's Schedule (eMOMS™): Protocol for a feasibility randomized controlled trial to improve postpartum weight, blood sugars, and breastfeeding among high BMI women. Contemp Clin Trials Commun 2020; 18:100565. [PMID: 32346648 PMCID: PMC7183152 DOI: 10.1016/j.conctc.2020.100565] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 03/19/2020] [Accepted: 03/28/2020] [Indexed: 12/23/2022] Open
Abstract
Background Overweight and obesity are major risk factors for gestational diabetes among U.S. women. Evidence suggests that longer duration of breastfeeding among women with a history of gestational diabetes is associated with lower incidence of developing type 2 diabetes after pregnancy. Women may potentially benefit from a lifestyle change program that includes breastfeeding education and support. Purpose To describe the design and justification of a combined breastfeeding, national Diabetes Prevention Program (DPP)-based feasibility randomized controlled trial, the electronic Monitoring Of Mom's Schedule (eMOMSTM) study. eMOMSTM compares the feasibility and efficacy of three interventions on six-month postpartum weight loss among women with a BMI ≥25. Methods The intervention is delivered via Facebook and includes three groups: DPP and breastfeeding (eMOMS1); DPP only (eMOMS2); and Usual Care (eMOMS3). Recruitment is ongoing at two clinical sites (rural and urban). A total of 72 women, 24 per group, will be randomly assigned to one of the three groups. It is anticipated that women in eMOMS1 will have greater weight loss and increased length of breastfeeding at three and six months postpartum compared to women in eMOMS2 and eMOMS3. Additional data will be collected on metabolic markers, anthropometrics, physical activity, nutrition, breastfeeding, and depression. Program cost will be compared to that of traditionally scheduled group meetings. Expected study completion date: October 2021. Conclusions This study has the potential to define a high impact, cost effective intervention that can improve public health by reducing negative health outcomes associated with gestational diabetes among an at-risk population.
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Affiliation(s)
- Lisette T Jacobson
- University of Kansas School of Medicine-Wichita, Department of Population Health, 1010 North Kansas, Wichita, KS, 67214, USA
| | - Tracie C Collins
- University of Kansas School of Medicine-Wichita, Department of Population Health, 1010 North Kansas, Wichita, KS, 67214, USA.,The University of New Mexico, College of Population Health, 1 University of New Mexico, Albuquerque, NM, 87131, USA
| | - Meredith Lucas
- University of Kansas School of Medicine-Wichita, Department of Population Health, 1010 North Kansas, Wichita, KS, 67214, USA
| | - Rosey Zackula
- University of Kansas School of Medicine-Wichita, Office of Research, 1010 North Kansas, Wichita, KS, 67214, USA
| | - Hayrettin Okut
- University of Kansas School of Medicine-Wichita, Office of Research, 1010 North Kansas, Wichita, KS, 67214, USA
| | - Niaman Nazir
- University of Kansas School of Medicine-Kansas City, Department of Population Health, 3901 Rainbow Boulevard, Mailstop 1003, Kansas City, KS, 66160, USA
| | - David Robbins
- University of Kansas Medical Center-Kansas City, Diabetes Institute, 3901 Rainbow Boulevard, Mailstop 1064, Kansas City, KS, 66160, USA
| | - Judy E Stern
- Dartmouth-Hitchcock Medical Center and the Geisel School of Medicine, Department of Obstetrics and Gynecology, One Medical Center Drive, Lebanon, NH, 03756, USA
| | - Michael Wolfe
- Ascension Via Christi Hospitals Wichita, Inc., Ascension Via Christi Maternal Fetal Medicine Clinic, 1515 South Clifton Avenue, Suite 130, Wichita, KS, 67218, USA
| | - David A Grainger
- University of Kansas School of Medicine-Wichita, Department of Obstetrics and Gynecology, 1010 North Kansas, Wichita, KS, 67214, USA
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Haring A, Duong J, Woods NK, DeAllie A, Grainger DA, Robbins A. Piloting a Breastfeeding-Friendly Provider's Office Protocol at a Private Obstetrical Clinic [24E]. Obstet Gynecol 2019. [DOI: 10.1097/01.aog.0000559016.80908.09] [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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Jain T, Grainger DA, Ball GD, Gibbons WE, Rebar RW, Robins JC, Leach RE. 30 years of data: impact of the United States in vitro fertilization data registry on advancing fertility care. Fertil Steril 2019; 111:477-488. [DOI: 10.1016/j.fertnstert.2018.11.015] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Revised: 11/14/2018] [Accepted: 11/14/2018] [Indexed: 12/18/2022]
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Dubaut JP, Dong F, Tjaden BL, Grainger DA, Duong J, Tatpati LL. Prescribing Bioidentical Menopausal Hormone Therapy: A Survey of Physician Views and Practices. J Womens Health (Larchmt) 2018; 27:859-866. [DOI: 10.1089/jwh.2017.6637] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Jamie P. Dubaut
- Department of Obstetrics and Gynecology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Fanglong Dong
- Graduate College of Biomedical Sciences, Western University of Health Sciences, Pomona, California
| | - Bruce L. Tjaden
- Department of Obstetrics and Gynecology, University of Kansas School of Medicine–Wichita, Wichita, Kansas
| | - David A. Grainger
- Department of Obstetrics and Gynecology, University of Kansas School of Medicine–Wichita, Wichita, Kansas
| | - Jennifer Duong
- Department of Obstetrics and Gynecology, University of Kansas School of Medicine–Wichita, Wichita, Kansas
| | - Laura L. Tatpati
- Department of Obstetrics and Gynecology, University of Kansas School of Medicine–Wichita, Wichita, Kansas
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Hipp H, Crawford S, Kawwass JF, Boulet SL, Grainger DA, Kissin DM, Jamieson D. National trends and outcomes of autologous in vitro fertilization cycles among women ages 40 years and older. J Assist Reprod Genet 2017; 34:885-894. [PMID: 28455751 DOI: 10.1007/s10815-017-0926-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [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: 10/13/2016] [Accepted: 04/13/2017] [Indexed: 11/24/2022] Open
Abstract
PURPOSE The purpose of the study was to describe trends in and investigate variables associated with clinical pregnancy and live birth in autologous in vitro fertilization (IVF) cycles among women ≥40 years. METHODS We used autologous IVF cycle data from the National ART Surveillance System (NASS) for women ≥40 years at cycle start. We assessed trends in fresh and frozen cycles (n = 371,536) from 1996 to 2013. We reported perinatal outcomes and determined variables associated with clinical pregnancy and live birth in fresh cycles between 2007 and 2013. RESULTS From 1996 to 2013, the total number of cycles in women ≥40 years increased from 8672 to 28,883 (p < 0.0001), with frozen cycles almost tripling in the last 8 years. Cycles in women ≥40 years accounted for 16.0% of all cycles in 1996 and 21.0% in 2013 (p < 0.0001). For fresh cycles from 2007 to 2013 (n = 157,890), the cancelation rate was 17.1%. Among cycles resulting in transfer (n = 112,414), the live birth rate was 16.1%. The following were associated with higher live birth rates: multiparity, fewer prior ART cycles, use of standard agonist or antagonist stimulation, lower gonadotropin dose, ovarian hyperstimulation syndrome, more oocytes retrieved, use of pre-implantation genetic screening/diagnosis, transferring more and/or blastocyst stage embryos, and cryopreserving more supernumerary embryos. Of the singleton infants born (n = 14,992), 86.9% were full term and 88.3% normal birth weight. CONCLUSIONS The NASS allows for a comprehensive description of IVF cycles in women ≥40 years in the USA. Although live birth rate is less than 20%, identifying factors associated with IVF success can facilitate treatment option counseling.
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Affiliation(s)
- Heather Hipp
- Division of Reproductive Endocrinology and Infertility, Emory University School of Medicine, Emory University, 550 Peachtree Street, Suite 1800, Atlanta, GA, 30308, USA. .,Division of Reproductive Health, US Centers for Disease Control and Prevention, 4770 Buford Highway, Atlanta, GA, 30341, USA.
| | - Sara Crawford
- Division of Reproductive Health, US Centers for Disease Control and Prevention, 4770 Buford Highway, Atlanta, GA, 30341, USA
| | - Jennifer F Kawwass
- Division of Reproductive Endocrinology and Infertility, Emory University School of Medicine, Emory University, 550 Peachtree Street, Suite 1800, Atlanta, GA, 30308, USA.,Division of Reproductive Health, US Centers for Disease Control and Prevention, 4770 Buford Highway, Atlanta, GA, 30341, USA
| | - Sheree L Boulet
- Division of Reproductive Health, US Centers for Disease Control and Prevention, 4770 Buford Highway, Atlanta, GA, 30341, USA
| | - David A Grainger
- The Center for Reproductive Medicine, 9300 E. 29th Street N., Suite 102, Wichita, KS, 67226, USA
| | - Dmitry M Kissin
- Division of Reproductive Health, US Centers for Disease Control and Prevention, 4770 Buford Highway, Atlanta, GA, 30341, USA
| | - Denise Jamieson
- Division of Reproductive Health, US Centers for Disease Control and Prevention, 4770 Buford Highway, Atlanta, GA, 30341, USA
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Winters AA, Bou-Ghannam S, Thorp H, Hawayek JA, Atkinson DL, Bartlett CE, Silva FJ, Hsu EW, Moreno AP, Grainger DA, Patel AN. Evaluation of Multiple Biological Therapies for Ischemic Cardiac Disease. Cell Transplant 2016; 25:1591-1607. [DOI: 10.3727/096368916x691501] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Affiliation(s)
| | - Sophia Bou-Ghannam
- Department of Bioengineering, University of Utah, Salt Lake City, UT, USA
| | - Hallie Thorp
- Department of Bioengineering, University of Utah, Salt Lake City, UT, USA
| | - Jose A. Hawayek
- University of Utah School of Medicine, Salt Lake City, UT, USA
| | | | | | | | - Edward W. Hsu
- Department of Bioengineering, University of Utah, Salt Lake City, UT, USA
| | - Alonso P. Moreno
- Department of Bioengineering, University of Utah, Salt Lake City, UT, USA
- Nora Eccles Cardiovascular and Training Research Institute, Salt Lake City, UT, USA
| | - David A. Grainger
- Department of Bioengineering, University of Utah, Salt Lake City, UT, USA
| | - Amit N. Patel
- University of Utah School of Medicine, Salt Lake City, UT, USA
- Department of Bioengineering, University of Utah, Salt Lake City, UT, USA
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Bennis L, Delmore J, Dong F, Grainger DA, Duong J. The Death of the Vaginal Hysterectomy [122]. Obstet Gynecol 2015. [DOI: 10.1097/01.aog.0000463083.43405.58] [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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Marsh CA, Farr SL, Chang J, Kissin DM, Grainger DA, Posner SF, Macaluso M, Jamieson DJ. Trends and factors associated with the Day 5 embryo transfer, assisted reproductive technology surveillance, USA, 2001-2009. Hum Reprod 2012; 27:2325-31. [PMID: 22627658 DOI: 10.1093/humrep/des168] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
STUDY QUESTION What characteristics are associated with a Day 5 embryo transfer? SUMMARY ANSWER The use of the Day 5 embryo transfer has increased over time, with clinicians allowing women with typically 'poorer' prognostic characteristics to undergo a Day 5 embryo transfer. The mean number of embryos per Day 5 transfer decreased from 2001 to 2009, although the prevalence of the Day 5 single embryo transfer remains low and the rate of multiple births remains substantial. WHAT IS KNOWN AND WHAT THIS PAPER ADDS Day 5 embryo transfer may reduce the rate of multiple gestation pregnancy. US trends over time in the prevalence of the Day 5 transfer, changes in characteristics of patients receiving Day 5 transfer, and number of embryos transferred are unknown. DESIGN We used 2001-2009 US National assisted reproductive technology (ART) Surveillance System (NASS) data on 620,295 fresh IVF cycles derived from autologous oocytes with a Day 3 or 5 embryo transfer. Trends in the mean number of embryos transferred from 2001 to 2009 were assessed by the day of transfer. For 349,947 cycles from clinics performing both Days 3 and 5 embryo transfers, multivariable logistic regression was used to determine the characteristics associated with the Day 5 embryo transfer. We also compared the characteristics of the Day 5 embryo cycles in 2001 and 2009. MAIN RESULTS AND THE ROLE OF CHANCE Overall, the proportion of ART cycles using the Day 5 embryo transfer increased from 12% in 2001 to 36% in 2009 (P<0.0001), while the mean number of embryos transferred decreased from 2.4 to 2.1 (P<0.0001). Among Day 5 transfers, the rate of the single embryo transfer tripled from 4.5% in 2001 to 14.8% in 2009 (P<0.0001); and the rate of multiple births decreased from 44.8 to 41.1% (P<0.0001). In cycles initiated after 2001, maternal age<35 years, no prior ART cycles, ≥1 prior pregnancies, baseline follicle stimulating hormone<10 international units and ≥10 oocytes retrieved were associated with the Day 5 embryo transfer. Compared with 2001, in 2009, a broader range of candidates received the Day 5 transfer. BIAS Women undergoing multiple ART cycles over time are not linked. CONFOUNDING FACTORS AND OTHER REASONS FOR CAUTION We ran multivariable logistic regression to lessen the effects of the confounding factors. Cycle cancelation rates by the day of embryo transfer are unknown. GENERALIZABILITY TO OTHER POPULATIONS Generalizable to ART clinics included in NASS. STUDY FUNDING/COMPETING INTERESTS This study was funded by the Centres for Disease Control. The authors have no competing interests to declare.
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Affiliation(s)
- Courtney A Marsh
- Department of Obstetrics and Gynecology, University of Michigan Health System, 1500 E. Medical Center Drive, L4510 Women's Hospital, Ann Arbor, MI 48109, USA.
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Luke B, Brown MB, Misiunas RB, Gonzalez-Quintero VH, Nugent C, van de Ven C, Witter FR, Newman RB, D'Alton M, Hankins GDV, Grainger DA, Macones GA. The Hispanic Paradox in Twin Pregnancies. Twin Res Hum Genet 2012. [DOI: 10.1375/twin.8.5.532] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AbstractThe objective of this study was to compare length of gestation, fetal growth, and birthweight by race/ethnicity and pregravid weight groups in twin pregnancies. Three thousand and thirty-six twin pregnancies of 28 weeks or more gestation were divided by race/ethnicity (White, Black and Hispanic), and pregravid body mass index (BMI) groups (less than 25.0 vs. 25.0 or more). Outcomes were modeled using multiple regression, controlling for confounders, with White non-Hispanic women as the reference group. Hispanic women had the highest average birthweight and the longest gestation, as well as the lowest proportions of low birthweight, very low birthweight, preterm and early preterm births of the 3 race/ethnicity groups. In the multivariate analyses, Hispanic women had significantly longer gestations (by 7.8 days) and faster rates of fetal growth midgestation (20 to 28 weeks, by 17.4 g/week) and late gestation (after 28 weeks, by 5.3 g/week), whereas Black women had significantly slower rates of fetal growth (by 5.7 g/week and by 4.5 g/week, respectively). These findings in twins reflect the racial and ethnic disparities previously shown in singletons, including the Hispanic paradox of longer gestations and higher rates of fetal growth.
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Luke B, Brown MB, Stern JE, Grainger DA, Klein N, Cedars M. Effect of embryo transfer number on singleton and twin implantation pregnancy outcomes after assisted reproductive technology. J Reprod Med 2010; 55:387-394. [PMID: 21043364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
OBJECTIVE To evaluate the effect of embryo transfer number on singleton and twin pregnancy outcomes with one and two fetal heartbeats on early ultrasound, respectively. STUDY DESIGN The study included 23,645 singleton and 14,083 twin live births from the SART-CORS Online database of assisted reproductive technology cycles for 2004-2006. The data were limited to fresh embryo transfers among women who had additional embryos cryopreserved during the same cycle, resulting either in one fetal heartbeat on early ultrasound and a singleton live birth, or two fetal heartbeats and a twin live birth. Data were categorized by number of embryos transferred; the reference group was one for singletons and two for twins. The primary outcome measure was moderate growth restriction (birthweight for gestation z-score < -1), adjusted for potential confounders. RESULTS Risk for moderate growth restriction among singletons was increased by 15%, 23%, and 37%, respectively, with 2, 3, and > or = 4 embryos transferred, and among twins, by 50% and 105%, respectively, with 3 and > or = 4 embryos transferred. CONCLUSION The data demonstrate a significant residual adverse effect on intrauterine growth from transfer of multiple embryos. Whether this effect is due to compromised embryo quality, degenerating implantation sites, or other etiology is unclear.
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Affiliation(s)
- Barbara Luke
- Department of Obstetrics and Gynecology and Reproductive Biology, Michigan State Univesity, East Lansing, Michigan 48824, USA.
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Fujimoto VY, Luke B, Brown MB, Jain T, Armstrong A, Grainger DA, Hornstein MD. Racial and ethnic disparities in assisted reproductive technology outcomes in the United States. Fertil Steril 2010; 93:382-90. [PMID: 19081561 PMCID: PMC4786183 DOI: 10.1016/j.fertnstert.2008.10.061] [Citation(s) in RCA: 137] [Impact Index Per Article: 9.8] [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: 09/17/2008] [Revised: 10/20/2008] [Accepted: 10/29/2008] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To evaluate ethnic differences in assisted reproductive technology (ART) outcomes in the United States. DESIGN Historical cohort study. SETTING Clinic-based data. PATIENT(S) A total of 139,027 ART cycles from the Society for Assisted Reproductive Technology Clinic Outcome Reporting System online database for 2004-2006, limited to white, Asian, black, and Hispanic women. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Logistic regression was used to model the odds of pregnancy and live birth; among singletons and twins, the odds of preterm birth and fetal growth restriction. Results are presented as adjusted odds ratios, with white women as the reference group. RESULT(S) The odds of pregnancy were reduced for Asians (0.86), and the odds of live birth were reduced for all groups: Asian (0.90), black (0.62), and Hispanic (0.87) women. Among singletons, moderate and severe growth restriction were increased for all infants in all three minority groups (Asians [1.78, 2.05]; blacks [1.81, 2.17]; Hispanics [1.36, 1.64]), and preterm birth was increased among black (1.79) and Hispanic women (1.22). Among twins, the odds for moderate growth restriction were increased for infants of Asian (1.30) and black women (1.97), and severe growth restriction was increased among black women (3.21). The odds of preterm birth were increased for blacks (1.64) and decreased for Asians (0.70). CONCLUSION(S) There are significant disparities in ART outcomes according to ethnicity.
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Affiliation(s)
- Victor Y Fujimoto
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California at San Francisco, 2356 Sutter Street, 7th Floor, San Francisco, CA 94115-0916, USA.
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Seifer DB, Zackula R, Grainger DA. Trends of racial disparities in assisted reproductive technology outcomes in black women compared with white women: Society for Assisted Reproductive Technology 1999 and 2000 vs. 2004–2006. Fertil Steril 2010; 93:626-35. [DOI: 10.1016/j.fertnstert.2009.02.084] [Citation(s) in RCA: 89] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2008] [Revised: 02/25/2009] [Accepted: 02/25/2009] [Indexed: 11/27/2022]
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Luke B, Brown MB, Grainger DA, Cedars M, Klein N, Stern JE. Practice patterns and outcomes with the use of single embryo transfer in the United States. Fertil Steril 2010; 93:490-8. [DOI: 10.1016/j.fertnstert.2009.02.077] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2008] [Revised: 02/13/2009] [Accepted: 02/25/2009] [Indexed: 11/26/2022]
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Baker VL, Luke B, Brown MB, Alvero R, Frattarelli JL, Usadi R, Grainger DA, Armstrong AY. Multivariate analysis of factors affecting probability of pregnancy and live birth with in vitro fertilization: an analysis of the Society for Assisted Reproductive Technology Clinic Outcomes Reporting System. Fertil Steril 2009; 94:1410-1416. [PMID: 19740463 DOI: 10.1016/j.fertnstert.2009.07.986] [Citation(s) in RCA: 86] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2009] [Revised: 07/10/2009] [Accepted: 07/13/2009] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To evaluate factors predictive of clinical pregnancy and of pregnancy loss from assisted reproductive technology (ART) using data from the Society for Assisted Reproductive Technology database for 2004-2006. DESIGN Retrospective cohort. SETTING Clinic-based data. PATIENT(S) The study population included 225,889 fresh embryo transfer cycles using autologous oocytes and partner semen. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Clinical intrauterine gestation (presence of gestational sac) and live birth (>or=22 weeks gestation and >or=300 g birth weight). RESULT(S) Increasing maternal age was significantly associated with a reduced odds of conception and increased fetal loss until 19 weeks gestation, but not with later pregnancy loss. Intracytoplasmic sperm injection (ICSI), assisted hatching, and increasing number of embryos transferred had significant positive effects on the odds of conception and pregnancy continuation through the first trimester, but did not affect the risk of later loss. Blacks, Asians, and Hispanics had significantly lower odds of clinical pregnancy compared with whites. Also compared with whites, Hispanics and Asians had a significantly greater risk of pregnancy loss in the second and third trimesters, and blacks had a significantly greater risk of pregnancy loss in all trimesters. CONCLUSION(S) Certain demographic and ART treatment parameters influenced chance of conception and early pregnancy loss, whereas black race and Hispanic ethnicity were also significantly associated with late pregnancy loss in ART-conceived pregnancies.
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Affiliation(s)
- Valerie L Baker
- Division of Reproductive Endocrinology, Department of Obstetrics and Gynecology, Stanford University Medical Center, Stanford, California.
| | - Barbara Luke
- Department of Obstetrics, Gynecology, and Reproductive Biology and Department of Epidemiology, Michigan State University, East Lansing, Michigan
| | - Morton B Brown
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, Michigan
| | - Ruben Alvero
- Division of Reproductive Endocrinology, Department of Obstetrics and Gynecology, University of Colorado Denver, Aurora, Colorado
| | | | | | - David A Grainger
- Center for Reproductive Medicine, University of Kansas, Wichita, Kansas
| | - Alicia Y Armstrong
- Program in Reproductive and Adult Endocrinology Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
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Luke B, Brown MB, Grainger DA, Stern JE, Klein N, Cedars MI. The effect of early fetal losses on singleton assisted-conception pregnancy outcomes. Fertil Steril 2009; 91:2578-85. [DOI: 10.1016/j.fertnstert.2008.03.068] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2008] [Revised: 03/26/2008] [Accepted: 03/26/2008] [Indexed: 10/21/2022]
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Seifer DB, Frazier LM, Grainger DA. Disparity in assisted reproductive technologies outcomes in black women compared with white women. Fertil Steril 2008; 90:1701-10. [DOI: 10.1016/j.fertnstert.2007.08.024] [Citation(s) in RCA: 97] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2007] [Revised: 08/09/2007] [Accepted: 08/09/2007] [Indexed: 11/25/2022]
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Luke B, Brown MB, Grainger DA, Baker VL, Ginsburg E, Stern JE. The sex ratio of singleton offspring in assisted-conception pregnancies. Fertil Steril 2008; 92:1579-85. [PMID: 18950756 DOI: 10.1016/j.fertnstert.2008.08.107] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2008] [Revised: 08/20/2008] [Accepted: 08/20/2008] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To evaluate the effect of intracytoplasmic sperm injection (ICSI) and male factor infertility on the sex ratio in births from assisted reproductive technology. DESIGN Historic cohort study. SETTING Clinic-based data. PATIENT(S) The study population included 15,164 singleton live births in the Society for Assisted Reproductive Technology national database for 2005 from cycles using ejaculated sperm, categorized by the use of insemination or ICSI and the absence or presence of male factor infertility, and cleavage- versus blastocyst-stage embryo transfers (ETs). INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) The probability of a male infant with and without the use of ICSI and in the presence or absence of male factor infertility. RESULT(S) The sex ratio for all U.S. live births in 2005 was 52.5%, versus 48.9% for cleavage-stage and 51.6% for blastocyst-stage embryos. With blastocyst-stage embryos, the sex ratios were 49.6% and 54.9% with and without ICSI and 52.6% and 50.0% with and without male factor infertility, respectively. With cleavage-stage embryos, the sex ratio was not significantly affected by ICSI or male factor infertility, singly or in combination. CONCLUSION(S) The use of ICSI, particularly with blastocyst-stage embryos, is associated with a decrease in the sex ratio of male infants.
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Affiliation(s)
- Barbara Luke
- Department of Obstetrics, Gynecology, and Reproductive Biology and Department of Epidemiology, Michigan State University, East Lansing, Michigan 48824 , USA.
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Stern JE, Cedars MI, Jain T, Klein NA, Beaird CM, Grainger DA, Gibbons WE. Assisted reproductive technology practice patterns and the impact of embryo transfer guidelines in the United States. Fertil Steril 2007; 88:275-82. [PMID: 17445805 DOI: 10.1016/j.fertnstert.2006.09.016] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2006] [Revised: 09/19/2006] [Accepted: 09/19/2006] [Indexed: 11/22/2022]
Abstract
OBJECTIVE [1] To evaluate trends in number of embryos transferred and resultant high-order multiple (HOM) pregnancy rates by Society for Assisted Reproductive Technology (SART)-member clinics between 1996 and 2003 and [2] to relate these practice patterns and outcomes to clinic compliance with SART-American Society for Reproductive Medicine (ASRM) embryo transfer guidelines. DESIGN Retrospective. SETTING Society for Assisted Reproductive Technology-member fertility centers in the United States. PATIENT(S) Five hundred thirty-six thousand, five hundred twenty-four fresh, nondonor IVF cycles. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Number of embryos transferred; pregnancy rates; implantation rates; and proportion of singleton, twin, and HOM pregnancies. RESULT(S) The number of embryos transferred declined each year. High-order multiple pregnancy rates also declined, whereas the twin rates remained stable. The most pronounced declines in number transferred occurred immediately after publication of SART-ASRM embryo transfer guidelines. After stratifying clinics according to mean and modal number of embryos transferred, clinics transferring the fewest embryos in women <35 years of age had the highest mean implantation and pregnancy rates. Furthermore, the percentage of clinics transferring two embryos to a majority of women <35 years of age increased from 3.3% in 1996 to 49.9% in 2003. CONCLUSION(S) The implementation of SART-ASRM embryo transfer guidelines is associated with significant reductions in the number of embryos being transferred, along with reductions of HOM pregnancies. Initiatives to further reduce twin pregnancies and encourage singleton gestation outcomes are outlined.
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Affiliation(s)
- Judy E Stern
- Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire 03756, USA.
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Luke B, Hediger ML, Min L, Nugent C, Newman R, Hankins G, Grainger DA. The effect of weight gain by 20 weeks gestation on twin birthweight and postpartum weight. Am J Obstet Gynecol 2006. [DOI: 10.1016/j.ajog.2006.10.271] [Citation(s) in RCA: 3] [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: 11/26/2022]
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Hediger ML, Luke B, Grainger DA, Witter F, Newman R, Gonzalez-Quintero VH. Twin intrapair crown-rump length discordancy and risk of very preterm birth. Am J Obstet Gynecol 2006. [DOI: 10.1016/j.ajog.2006.10.174] [Citation(s) in RCA: 3] [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: 11/28/2022]
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Farley DM, Grainger DA, Tjaden BL, Frazier LM, Maki JE. Use of a gestational carrier for a patient with recurrent adverse pregnancy outcomes from early onset severe pre-eclampsia. Fertil Steril 2006; 87:189.e1-3. [PMID: 17084396 DOI: 10.1016/j.fertnstert.2006.04.050] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2005] [Revised: 04/10/2006] [Accepted: 04/10/2006] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To describe the first reported case of gestational carrier treatment to prevent severe early onset pre-eclampsia. DESIGN Case report. SETTING A university-based reproductive endocrinology and infertility clinic and a tertiary care hospital. PATIENT(S) A 29-year-old woman and her husband with three consecutive pregnancies complicated by early onset severe pre-eclampsia causing fetal demises at 22 and 24 weeks gestation; a neonatal death at 25 weeks gestation; and life-threatening maternal hemolysis, elevated liver enzymes, and low platelets. INTERVENTION(S) An IVF procedure in the patient using her husband's sperm with the transfer of two embryos to a friend who offered to be a gestational carrier. MAIN OUTCOME MEASURE(S) Successful IVF cycle in the patient and uncomplicated pregnancy and delivery in the gestational carrier. RESULT(S) The gestational carrier achieved a pregnancy and progressed without complications to delivery of a healthy, 3.2-kg infant at 39 weeks gestation. CONCLUSION(S) The use of a gestational carrier deserves consideration as a treatment option in patients with poor reproductive histories because of early onset severe pre-eclampsia and hemolysis, elevated liver enzymes, and low platelets syndrome. This experience also suggests that development of pre-eclampsia may be in large part maternally rather than embryologically or paternally driven.
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Affiliation(s)
- Darren M Farley
- Department of Obstetrics and Gynecology, University of Kansas School of Medicine-Wichita, Wichita, Kansas 67226, USA
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Abstract
Couples with fertility problems seeking treatment with assisted reproductive technologies (ART) such as in vitro fertilization should receive preconception counseling on all factors that are provided when counseling patients without fertility problems. Additional counseling should address success rates and possible risks from ART therapies. Success rates from ART are improving, with the highest live birth rates averaging about 40% per cycle among women less than 35 years old. A woman's age lowers the chance of achieving a live birth, as do smoking, obesity, and infertility diagnoses such as hydrosalpinx, uterine leiomyoma, or male factor infertility. Singletons conceived with ART may have lower birth weights. Animal studies suggest that genetic imprinting disorders may be induced by certain embryo culture conditions. The major risk from ovarian stimulation is multiple gestation. About one-third of live-birth deliveries from ART have more than one infant, and twins represent 85% of these multiple-birth children. There are more complications in multiple gestation pregnancies, infants are more likely to be born preterm and with other health problems, and families caring for multiples experience more stress. Transferring fewer embryos per cycle reduces the multiple birth rate from ART, but the patient may have to pay for additional cycles of ART because of a lower likelihood of pregnancy.
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Affiliation(s)
- David A. Grainger
- Department of Obstetrics and Gynecology, University of Kansas School of Medicine-Wichita, Wichita, Kansas USA
- Women’s Research Institute, Wichita, Kansas USA
- Department of Preventive Medicine and Public Health, University of Kansas School of Medicine-Wichita, Wichita, Kansas USA
| | - Linda M. Frazier
- Department of Obstetrics and Gynecology, University of Kansas School of Medicine-Wichita, Wichita, Kansas USA
- Women’s Research Institute, Wichita, Kansas USA
- Department of Preventive Medicine and Public Health, University of Kansas School of Medicine-Wichita, Wichita, Kansas USA
- Departments of Obstetrics and Gynecology and Preventive Medicine and Public Health, University of Kansas School of Medicine-Wichita, 1010 N. Kansas Avenue, Wichita, KS 67214 USA
| | - Courtney A. Rowland
- Department of Obstetrics and Gynecology, University of Kansas School of Medicine-Wichita, Wichita, Kansas USA
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Luke B, Brown MB, Misiunas RB, Gonzalez-Quintero VH, Nugent C, van de Ven C, Witter FR, Newman RB, D'Alton M, Hankins GDV, Grainger DA, Macones GA. The Hispanic paradox in twin pregnancies. Twin Res Hum Genet 2006; 8:532-7. [PMID: 16212843 DOI: 10.1375/183242705774310088] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The objective of this study was to compare length of gestation, fetal growth, and birthweight by race/ethnicity and pregravid weight groups in twin pregnancies. Three thousand and thirty-six twin pregnancies of 28 weeks or more gestation were divided by race/ethnicity (White, Black and Hispanic), and pregravid body mass index (BMI) groups (less than 25.0 vs. 25.0 or more). Outcomes were modeled using multiple regression, controlling for confounders, with White non-Hispanic women as the reference group. Hispanic women had the highest average birthweight and the longest gestation, as well as the lowest proportions of low birthweight, very low birthweight, preterm and early preterm births of the 3 race/ethnicity groups. In the multivariate analyses, Hispanic women had significantly longer gestations (by 7.8 days) and faster rates of fetal growth midgestation (20 to 28 weeks, by 17.4 g/week) and late gestation (after 28 weeks, by 5.3 g/week), whereas Black women had significantly slower rates of fetal growth (by 5.7 g/week and by 4.5 g/week, respectively). These findings in twins reflect the racial and ethnic disparities previously shown in singletons, including the Hispanic paradox of longer gestations and higher rates of fetal growth.
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Affiliation(s)
- Barbara Luke
- University of Miami School of Nursing and Health Studies, Coral Gables, Florida, USA.
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Luke B, Brown MB, Misiunas RB, Mauldin JG, Newman RB, Nugent C, Gonzalez-Quintero VH, Witter FR, Hankins GDV, D'Alton M, Macones GA, Grainger DA. Elevated maternal glucose concentrations and placental infection in twin pregnancies. J Reprod Med 2005; 50:241-5. [PMID: 15916206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
OBJECTIVE To evaluate the association between maternal screening glucose concentration and placental infection in nondiabetic twin pregnancies. STUDY DESIGN One thousand sixty-one nondiabetic twin pregnancies at > or =28 weeks' gestation were divided into 3 groups based on the screening 50-g fasting glucose concentration at 24-28 weeks: lowest quartile (< 96 mg/dL), middle 2 quartiles (96-128 mg/dL) and upper quartile (> 128 mg/dL). Outcomes were modeled using general linear and multinomial logistic regression, controlling for confounding factors. RESULTS The middle and highest glucose groups were associated with increased risks for clinical chorioamnionitis (adjusted OR [AOR] 3.18, 95% CI 1.34, 7.54; AOR 6.80, CI 1.89, 24.53, respectively). Birth at <32 weeks and histologic diagnosis of placental infection (chorioamnionitis, funisitis, necrosis, vasculitis or villitis) were significantly associated only with the highest glucose group (AOR 1.79, CI 1.02, 3.13; AOR 6.95, CI 1.10, 8.68, respectively). CONCLUSION Elevated screening glucose in nondiabetic twin pregnancies may be a marker of placental inflammation and infection.
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Affiliation(s)
- Barbara Luke
- Departments of Obstetrics and Gynecology, University of Miami School of Medicine, Miami, Florida, USA.
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27
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Luke B, Hediger M, Min SJ, Brown MB, Misiunas RB, Gonzalez-Quintero VH, Nugent C, Witter FR, Newman RB, Hankins GDV, Grainger DA, Macones GA. Gender mix in twins and fetal growth, length of gestation and adult cancer risk. Paediatr Perinat Epidemiol 2005; 19 Suppl 1:41-7. [PMID: 15670121 DOI: 10.1111/j.1365-3016.2005.00616.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
This study evaluated the effect of gender mix (the gender combinations of twin pairs) on fetal growth and length of gestation, and reviewed the literature on the long-term effects of this altered fetal milieu on cancer risk. In singletons, it is well established that females weigh less than males at all gestations, averaging 125-135 g less at full term. This gender difference is generally believed to be the result of the effect of androgens on fetal growth. The gender difference in fetal growth is greater before the third trimester and less towards term, with males growing not only more, but also earlier than females. Plurality is a known risk factor for reduced fetal growth and birthweight. Compared with singletons, the mean birthweight percentiles of twins fall substantially (by 10% or more) below the singleton 10th percentile by 28 weeks, below the singleton 50th percentile by 30 weeks, and below the singleton 90th percentile by 34 weeks. In unlike-gender twin pairs, it has been reported that the female prolongs gestation for her brother, resulting in a higher birthweight for the male twin than that of like-gender male twins. Other researchers have demonstrated that females in unlike-gender pairs had higher birthweights than females in like-gender pairs. Analyses from our consortium on 2491 twin pregnancies with known chorionicity showed longer gestations and faster rates of fetal growth in both males and females in unlike-gender pairs compared with like-gender male or female pairs, although these differences were not statistically significant. The post-natal effects for females growing in an androgenic-anabolic environment include increased sensation-seeking behaviour and aggression, lowered visual acuity, more masculine attitudes and masculinising effects of the auditory system and craniofacial growth. In contrast, there is no evidence to suggest that there might be a similar feminising effect on males from unlike-gender pairs. This hormonal exposure in utero may influence adult body size and susceptability to breast cancer.
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Affiliation(s)
- Barbara Luke
- Department of Epidemiology and Public Health, University of Miami School of Medicine, Miami, FL, USA.
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Frazier LM, Grainger DA, Schieve LA, Toner JP. Follicle-stimulating hormone and estradiol levels independently predict the success of assisted reproductive technology treatment. Fertil Steril 2004; 82:834-40. [PMID: 15482756 DOI: 10.1016/j.fertnstert.2004.02.144] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2003] [Revised: 02/23/2004] [Accepted: 02/23/2004] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To evaluate the relationship between early follicular phase levels of FSH and E(2) and outcomes of therapy with assisted reproductive technologies (ART). DESIGN Retrospective cohort study. SETTING ART centers in the United States. PATIENT(S) Women receiving 19,682 ART procedures performed in 135 clinics. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Rates of clinical pregnancy, live birth delivery, and high ovarian response (>/=10 oocytes retrieved after stimulation). RESULT(S) The ratio of each FSH or E(2) value to the respective upper limit of normal value for the clinic was computed. Within each age group, rates of pregnancy, live birth, and high ovarian response decreased linearly as FSH levels increased. For example, among women 35 years of age and younger, pregnancy rates (PR) ranged from 41.1% (FSH ratio 0-0.5) to 18.5% (FSH ratio >2.0). The three outcomes exhibited a similar downward trend as E(2) ratios increased. When both hormone ratios were elevated, outcomes were least favorable. These relationships remained statistically significant after we adjusted for diagnosis, number of embryos transferred, previous births, previous ART therapy, and use of GIFT, zygote intrafallopian transfer (ZIFT), intracytoplasmic sperm injection (ICSI), or assisted hatching. CONCLUSION(S) The FSH and E(2) ratios predict ART success independent of age and other clinical prognostic factors.
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Affiliation(s)
- Linda M Frazier
- Department of Obstetrics and Gynecology, University of Kansas School of Medicine-Wichita, 67214, USA.
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Grainger DA, Soderstrom RM, Schiff SF, Glickman MG, DeCherney AH, Diamond MP. Ureteral injuries at laparoscopy: Insights into diagnosis, management, and prevention. Int J Gynaecol Obstet 2004. [DOI: 10.1016/0020-7292(90)90558-3] [Citation(s) in RCA: 3] [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: 11/28/2022]
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Abstract
OBJECTIVE To evaluate the role of recipient age on the outcome of donor egg cycles. DESIGN Retrospective cohort study of aggregated national cycles of donor egg therapy that are collected by Society for Assisted Reproductive Technology and the Centers for Disease Control and Prevention. SETTING Assisted reproductive technology centers in the United States that report their results to the Centers for Disease Control and Prevention by way of the Society for Assisted Reproductive Technology. PATIENT(S) Recipients of embryos (17,339 cycles) derived from donated eggs between 1996 and 1998. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Rates of implantation, clinical intrauterine pregnancy, pregnancy loss, and delivery based on the age of the recipient. RESULT(S) Success of donor egg therapy was remarkably constant among recipients aged 25 years through those in their late forties. At higher ages, declining rates of implantation, clinical pregnancy, and delivery were seen, along with small increases of pregnancy loss. During the course of the 3 years studied, fewer embryos were transferred and higher rates of implantation were observed. CONCLUSION(S) The success of donor egg therapy is unaffected by recipient age up to the later 40s, after which they begin to decline. Although recipient age per se is likely to be the major cause of this effect, other factors may contribute to this observation.
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Affiliation(s)
- James P Toner
- Atlanta Center for Reproductive Medicine, Woodstock, Georgia, USA
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Abstract
OBJECTIVE To examine multifetal pregnancy in older women and perinatal outcomes. DESIGN A cross-sectional study. SETTING A nationwide vital registry. PATIENT(S) A national population-based database that links the live birth, fetal, and infant death certificates reported of multiple gestations in the United States from 1995 to 1997. It includes 155,777 twin and 5,630 triplet pregnancies. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Very preterm birth (<33 weeks), very low birthweight (<1,500 g), and perinatal and infant deaths. RESULT(S) Compared with those with singleton pregnancies, women with multifetal gestation tended to be older, non-Hispanic white, better educated, married, and nulliparous and to have earlier and more frequent prenatal care. Pregnancies conceived by assisted reproductive technology accounted for an increasing number of multiple gestations in older women. In women with lower socioeconomic status, older age was associated with higher risks of poor perinatal outcomes in twin pregnancy (relative risks ranging from 1.0 to 1.9 with a dose-response pattern). However, in women with higher socioeconomic status, older women did not have a higher risk of poor perinatal outcomes than younger women. CONCLUSION(S) The effect of older maternal age on perinatal outcomes in multifetal pregnancies may have been altered by assisted reproductive technology, frequent prenatal surveillance, and advanced neonatal care.
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Affiliation(s)
- Jun Zhang
- Division of Epidemiology, Statistics and Prevention Research, National Institute of Child Health and Human Development, Bethesda, Maryland 20892, USA.
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Toner JP, Grainger DA, Frasier LM. Clinical outcomes among recipients of donated eggs: an analysis of the US national experience, 1996–1998. Fertil Steril 2002. [DOI: 10.1016/s0015-0282(02)04364-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [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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Grainger DA, Tjaden BL, Rowland C, Meyer WR. Thermal balloon and rollerball ablation to treat menorrhagia: two-year results of a multicenter, prospective, randomized, clinical trial. J Am Assoc Gynecol Laparosc 2000; 7:175-9. [PMID: 10806258 DOI: 10.1016/s1074-3804(00)80036-5] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
STUDY OBJECTIVE To evaluate 2-year follow-up results in patients participating in a randomized, clinical trial comparing uterine balloon therapy with rollerball endometrial ablation. STUDY DESIGN Prospective, randomized, clinical trial (Canadian Task Force classification I). SETTING Fourteen university-affiliated and private practice sites. PATIENTS Two hundred fifty-five women with menorrhagia. INTERVENTIONS Patients were randomized to rollerball or uterine balloon endometrial ablation. MEASUREMENTS AND MAIN RESULTS Patient satisfaction with both treatments was consistently high. Only 15 hysterectomies had been performed (6 for menorrhagia) at the end of 2 years, 11 in the rollerball group, 4 in the balloon therapy group. CONCLUSION Endometrial ablation by both procedures was highly successful in avoiding hysterectomy and relieving symptoms of menorrhagia. Additional benefits were reduction in dysmenorrhea and premenstrual syndrome.
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Affiliation(s)
- D A Grainger
- Division of Reproductive Endocrinology, University of Kansas School of Medicine Wichita, 2903 East Central, Wichita, KS 67214, USA
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Meyer WR, Beyler SA, Baker ST, Somkuti SG, Lowden DA, Grainger DA. Value of estradiol response after human chorionic gonadotropin administration in predicting in vitro fertilization success. Fertil Steril 1999; 72:542-5. [PMID: 10519632 DOI: 10.1016/s0015-0282(99)00281-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To determine whether the serum E2 response after the administration of exogenous hCG is predictive of outcome during IVF. DESIGN Prospective, noncomparative cohort. SETTING Two academic centers and one private-practice IVF program. PATIENT(S) Two hundred twenty-two couples undergoing IVF for infertility arising from ovarian dysfunction, asthenoteratospermia, endometriosis, tubal disease, or unexplained infertility. MAIN OUTCOME MEASURE(S) Implantation, pregnancy, and miscarriage rates were compared in cycles that demonstrated an increase, decrease, or plateau in the serum E2 level on the day after hCG administration. The effects of age, cause of infertility, and maximum E2 value on outcome were evaluated. RESULT(S) Ninety-two cycles resulted in a clinical pregnancy and 130 cycles failed. Of 115 cycles in which the E2 level rose, 42 (37%) resulted in an ongoing pregnancy; among cycles with plateauing E2 responses, 20 of 69 (29%) resulted in a pregnancy. Fifteen of 38 (39%) of cycles exhibiting a drop in serum E2 resulted in an ongoing pregnancy. No statistically significant differences in ongoing pregnancy rates were noted in the increasing, plateauing, or decreasing E2 response groups. CONCLUSION(S) E2 values obtained on the day after hCG administration are not predictive of outcome in women undergoing IVF.
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Affiliation(s)
- W R Meyer
- Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, 27599-7570, USA
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Shah AA, Stabinsky SA, Klusak T, Bradley KR, Steege JF, Grainger DA. Measurement of serosal temperatures and depth of thermal injury generated by thermal balloon endometrial ablation in ex vivo and in vivo models. Fertil Steril 1998; 70:692-7. [PMID: 9797100 DOI: 10.1016/s0015-0282(98)00245-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To evaluate the safety profile of endometrial ablation performed with a thermal balloon as defined by serosal temperature elevation and depth of injury. DESIGN Observational study with histopathologic correlation conducted in ex vivo and in vivo phases. SETTING Academic medical center. PATIENT(S) Twenty patients undergoing total abdominal hysterectomy. INTERVENTION(S) Endometrial ablation with a thermal balloon. MAIN OUTCOME MEASURE(S) Serosal temperature elevation and histologic depth of injury. RESULT(S) Ex vivo phase results revealed serosal temperatures remained within a safe physiologic range (<45 degrees C). Greatest depth of myometrial injury in the premenopausal uteri was 5.8 mm over the anterior lower uterine segment. In postmenopausal uterus. the greatest depth of myometrial injury was 3.8 mm in the anterior midline. In vivo phase results revealed mean (+/- SD) peak serosal temperatures of 36.1 +/- 1.6 degrees C. As with the ex vivo phase. histologic examination revealed deep endometrial and superficial myometrial damage to all areas. The greatest depth of myometrial injury occurred in the midfundus at 3.4 mm. CONCLUSION(S) No patients experienced complications or adverse events secondary to treatment. Results showed that transuterine thermal injury is a highly unlikely scenario. In both phases of this study, histologic examination revealed that temperatures exposed to the endometrial layer were sufficient to cause tissue damage.
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Affiliation(s)
- A A Shah
- Department of Obstetrics and Gynecology, Wesley Medical Center, University of Kansas School of Medicine, Wichita 67214, USA
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Meyer WR, Walsh BW, Grainger DA, Peacock LM, Loffer FD, Steege JF. Thermal balloon and rollerball ablation to treat menorrhagia: a multicenter comparison. Obstet Gynecol 1998; 92:98-103. [PMID: 9649102 DOI: 10.1016/s0029-7844(98)00141-0] [Citation(s) in RCA: 164] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To compare the clinical efficacy and safety of a thermal uterine balloon system with hysteroscopic rollerball ablation in the treatment of dysfunctional uterine bleeding. METHODS Two hundred fifty-five premenopausal women were treated in a randomized multicenter study comparing thermal uterine balloon therapy with hysteroscopic rollerball ablation for the treatment of menorrhagia. Preprocedural and postprocedural menstrual diary scores and quality-of-life questionnaires were obtained. Twelve-month follow-up data are presented on 239 women. RESULTS Twelve-month results indicated that both techniques significantly reduced menstrual blood flow with no clinically significant difference between the two groups as reflected by return to normal bleeding or less (balloon 80.2% and rollerball ablation 84.3%). Multiple quality-of-life questionnaire results were also similar, including percent of patients highly satisfied with their results (balloon 85.6% compared with rollerball 86.7%). A 90% decrease in diary scores was seen in more than 60% of patients in both groups. Procedural time was reduced significantly in the uterine balloon therapy group. Intraoperative complications occurred in 3.2% of the hysteroscopic rollerball patients, whereas no intraoperative complications occurred in the thermal balloon group. CONCLUSION In the treatment of dysfunctional uterine bleeding, uterine balloon therapy is as efficacious as hysteroscopic rollerball ablation and may be safer.
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Affiliation(s)
- W R Meyer
- Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, USA
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Grainger DA, Seifer DB. Laparoscopic management of ectopic pregnancy. Curr Opin Obstet Gynecol 1995; 7:277-82. [PMID: 7578967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Management of ectopic pregnancy includes a high index of suspicion coupled with established algorithms of diagnosis using serum beta-human chorionic gonadotropin and transvaginal ultrasound. Early diagnosis and intervention usually leads to conservation of the involved tube. Careful follow up for persistent ectopic pregnancy leads to appropriate medical or surgical management. The use of methotrexate, either systemically or by local injection, may provide an alternative to surgery in selected patients with ectopic pregnancy.
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Affiliation(s)
- D A Grainger
- Department of Obstetrics and Gynecology, University of Kansas School of Medicine-Wichita, USA
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Seifer DB, Silva PD, Grainger DA, Barber SR, Grant WD, Gutmann JN. Reproductive potential after treatment for persistent ectopic pregnancy **Presented in part at the conjoint meeting of The American Fertility Society and the Canadian Fertility and Andrology Society, Montreal, Quebec, Canada, October 11 to 14, 1993. Fertil Steril 1994. [DOI: 10.1016/s0015-0282(16)56841-1] [Citation(s) in RCA: 8] [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: 11/28/2022]
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Seifer DB, Silva PD, Grainger DA, Barber SR, Grant WD, Gutmann JN. Reproductive potential after treatment for persistent ectopic pregnancy. Fertil Steril 1994; 62:194-6. [PMID: 8005291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
We examined the success rate and reproductive outcome of 50 patients who had been treated for persistent EP after initial unsuccessful salpingostomy. All who underwent salpingectomy had successful treatment of their persistent EP. One treatment failure occurred after MTX. Of 50 women, 32 (61.5%) attempted conception after treatment for persistent EP. The cumulative clinical pregnancy rate after treatment for persistent EP was 59% at 36 months. There was a significant association between clinical pregnancy rate after persistent EP and those with normal contralateral fallopian tubes (P < 0.005). The relative risk of having a clinical pregnancy among those who attempted conception was 2.3 for those having a normal contralateral fallopian tube compared with those with a contralateral fallopian tube with obvious pathology. Intrauterine pregnancy rates after treatment of persistent EP were similar to those reported for primary treatment of EP.
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Affiliation(s)
- D B Seifer
- Brown University School of Medicine, Providence, Rhode Island
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Grainger DA. Reproductive endocrinology. Curr Opin Obstet Gynecol 1994; 6:251-3. [PMID: 8038412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Diamond MP, Grainger DA, Rossi G, Connolly-Diamond M, Sherwin RS. Counter-regulatory response to hypoglycemia in the follicular and luteal phases of the menstrual cycle. Fertil Steril 1993; 60:988-93. [PMID: 8243705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
OBJECTIVE To assess whether the phase of the menstrual cycle influences the counter-regulatory response to hypoglycemia. DESIGN Prospective randomized euglycemia-hypoglycemia clamp studies in the follicular and luteal phases of the menstrual cycle in the same woman. SETTINGS Clinical Research Center, Yale University School of Medicine. PATIENTS Eight regularly menstruating nonobese women. MAIN OUTCOME MEASURES Counter-regulatory hormonal response to hypoglycemia-epinephrine, norepinephrine, glucagon, cortisol, GH, and PRL; glucose homeostasis: rates of whole-body glucose appearance and utilization, and the rate of hepatic glucose production. RESULTS In the follicular and luteal phases of the cycle fasting glucose levels (88 +/- 1 and 85 +/- 2 mg/dL, mean +/- SEM, respectively; conversion factor to SI units, 0.05551), basal glucose turnover (2.37 +/- 0.20 and 2.63 +/- 0.13 mg/kg per minute), basal insulin levels (10 +/- 1 and 9 +/- 1 microU/mL; conversion factor to SI units, 6.0), and insulin levels during the clamp study (53 +/- 3 and 45 +/- 4 microU/mL) were not significantly different. During the euglycemic phase of both studies, glucose utilization rose twofold (to 4.73 +/- 0.31 and 4.39 +/- 0.31 mg/kg per minute): hepatic glucose production was suppressed; and counter-regulatory hormones remained unchanged. Induction of hypoglycemia produced increases in the concentrations of counter-regulatory hormones that were indistinguishable in both phases of the cycle. Similarly, the increase in hepatic glucose production provoked during hypoglycemia was similar in each phase of the cycle (1.20 +/- 0.24 and 1.28 +/- 0.36 mg/kg per minute). CONCLUSION The counter-regulatory hormonal response to hypoglycemia, as well as the metabolic sequelae of these hormonal changes, are similar in the follicular and luteal phases of the menstrual cycle.
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Affiliation(s)
- M P Diamond
- Department of Obstetrics and Gynecology, Yale University School of Medicine, New Haven, Connecticut
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Jessup MJ, Grainger DA, Kluzak TR, Webster BW. Diagnosing proximal tubal obstruction: evaluation of peak intrauterine pressures using four common cannula techniques in extirpated uteri. Obstet Gynecol 1993; 81:732-5. [PMID: 8469462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
OBJECTIVE To compare the ability of four chromotubation techniques to generate and maintain intrauterine pressures in the diagnosis of proximal tubal obstruction. METHODS Sixteen extirpated uteri were used for this study. A pressure catheter was placed through the fundus into the endometrial cavity. Three cannulas were evaluated: 1) the Cohen cannula with hold and no-hold techniques, 2) the BARD cervical cannula (dual intrauterine and intracervical balloons), and 3) the Harris-Kronner uterine manipulator-injector catheter with an intrauterine balloon. Intrauterine pressures were monitored while warm saline was infused. The studies were performed with the tubes obstructed, and measurements of peak attainable intrauterine pressures were recorded. Data were analyzed by t test, with significance set at P < .05. RESULTS Peak intrauterine pressures for the four groups were as follows: 1) Cohen cannula, not holding, 40.7 +/- 5.1 mmHg; 2) Cohen cannula, holding in place, 63.6 +/- 5.3 mmHg; 3) BARD cannula, 112.4 +/- 3.5 mmHg; and 4) Harris-Kronner cannula, 106.3 +/- 4.3 mmHg. The BARD and Harris-Kronner cannulas achieved significantly higher intrauterine pressures than either method of using the Cohen cannula (P < .001). There was no statistically significant difference between the BARD and Harris-Kronner cannulas. CONCLUSION Significant differences in achievable intrauterine pressures were demonstrated among catheters in our in vitro model. Based on these findings, we believe that the BARD, Harris-Kronner, or other intrauterine balloon-type cannula should be used before diagnosing proximal tubal obstruction.
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Affiliation(s)
- M J Jessup
- Department of Obstetrics and Gynecology, University of Kansas School of Medicine, Wichita
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Meyer WR, Grainger DA, DeCherney AH, Lachs MS, Diamond MP. Ovarian surgery on the rabbit. Effect of cortex closure on adhesion formation and ovarian function. J Reprod Med 1991; 36:639-43. [PMID: 1774725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Surgical reapproximation of serosal surfaces in an attempt to reduce adhesiogenesis remains a controversial issue. For the reproductive gynecologist, this tenet is especially appropriate to the ovarian cortical surface. Using a rabbit model (n = 22), an ovarian unipolar cautery incision was created, and surgical closure versus nonclosure was evaluated. Closure with continuous 6-0 polyglactin resulted in a significant increase in the degree of ovarian adhesion envelopment versus nonclosure (1.8 +/- 0.2 vs. 0.9 +/- 0.2, P less than .01). Surgical closure also resulted in a significant increase in the vascularity of the adhesions (P less than .05). Despite the increase in adhesion formation, ovarian function, as determined by the mean number of corpora lutea, pregnancies and the nidation index, was not different in sutured ovaries, unsutured ovaries or nonsurgically treated controls.
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Affiliation(s)
- W R Meyer
- Department of Obstetrics and Gynecology, Yale University School of Medicine, New Haven, Connecticut 06510
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Grainger DA, Webster BW. Methotrexate treatment of ectopic pregnancy. Obstet Gynecol 1991; 78:479-80. [PMID: 1876390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Grainger DA, Meyer WR, DeCherney AH, Diamond MP. Laparoscopic clips. Evaluation of absorbable and titanium with regard to hemostasis and tissue reactivity. J Reprod Med 1991; 36:493-5. [PMID: 1834838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Advanced laparoscopic techniques require laparoscopic means of providing hemostasis. We tested the hemostatic ability of laparoscopic surgical clips and their tissue reactivity as assessed by adhesion formation in an animal model. Twenty-six New Zealand white rabbits were randomized at laparotomy to one of three treatment groups: titanium surgical clips, absorbable surgical clips (both applied with a laparoscopic clip applicator) and chromic sutures of equal mass. Either the right fallopian tube was transected, with clips or sutures applied proximally and distally to control bleeding, or the clips or sutures were applied 5 mm apart and the tube transected. A clip or suture of the same material was placed on the midportion of the left fallopian tube. Necropsy was performed at 42 days, and each clip/suture site was scored for adhesions. All the materials were easily applied and effective in achieving hemostasis. The adhesion scores tended to be lower with the absorbable clips; however, there were no statistically significant differences between the groups. Laparoscopic clips are effective in providing hemostasis, are easily applied and cause no more adhesion formation than do conventional suture materials.
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Affiliation(s)
- D A Grainger
- Department of Obstetrics and Gynecology, Yale University School of Medicine, New Haven, Connecticut
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Diamond MP, Grainger DA, Laudano AJ, Starick-Zych K, DeFronzo RA. Effect of acute physiological elevations of insulin on circulating androgen levels in nonobese women. J Clin Endocrinol Metab 1991; 72:883-7. [PMID: 1826009 DOI: 10.1210/jcem-72-4-883] [Citation(s) in RCA: 51] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Extreme pharmacological elevation of the circulating insulin level acutely lowers dehydroepiandrosterone sulfate (DHEAS) levels. To assess whether more physiological elevations in plasma insulin (due to exogenous infusion or endogenous secretion) would have similar effects, we examined the levels of DHEAS, androstenedione, testosterone, and free testosterone before and after euglycemic hyperinsulinemic and hyperglycemic hyperinsulinemic clamp studies. Studies were performed in women within 20% of ideal body weight after an overnight fast. Androgen levels were measured before and at the conclusion of studies in which either insulin was infused exogenously at 1 mU/kg.min or endogenous insulin secretion was stimulated for 2 h by elevation of the plasma glucose concentration by 125 mg/dL above basal levels by an exogenous glucose infusion. Basal plasma DHEAS (6.2 +/- 0.5 mumol/L) declined to 5.2 +/- 0.4 mumol/L (P less than 0.001) during the euglycemic insulin clamp, without any significant change in testosterone, free testosterone, or androstenedione. During the hyperglycemic clamp, DHEAS fell from 6.7 +/- 0.5 to 5.1 +/- 0.4 mumol/L (P less than 0.001) in response to endogenous hyperinsulinemia; plasma testosterone, free testosterone, and androstenedione did not change significantly. There was no correlation between the elevation in plasma insulin concentration and the fall in DHEAS during either the euglycemic or hyperglycemic clamps. However, the magnitude of fall of DHEAS was directly correlated with the initial DHEAS level in both the euglycemic (r = 0.51; P less than 0.05) and hyperglycemic (r = 0.75; P less than 0.01) studies. This association of hyperinsulinemia with a reduction of circulating levels of DHEAS, but not other C-19 steroids (e.g. testosterone and androstenedione) may reflect differential mechanisms by which DHEAS levels are regulated and suggests that insulin either inhibits its biosynthesis and/or secretion, or enhances its MCR.
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Affiliation(s)
- M P Diamond
- Department of Obstetrics and Gynecology, Yale University School of Medicine, New Haven, Connecticut 06510
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Grainger DA, Soderstrom RM, Schiff SF, Glickman MG, DeCherney AH, Diamond MP. Ureteral injuries at laparoscopy: insights into diagnosis, management, and prevention. Obstet Gynecol 1990; 75:839-43. [PMID: 2139192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The increasing use of laparoscopy as a therapeutic method mandates a reappraisal of the risks involved. Complications frequently described include injuries to the large and small bowels, bladder, and blood vessels. The world literature reports only eight cases of ureteral injury at laparoscopy. In this report, we present five additional cases of ureteral injury occurring at laparoscopy, in addition to a summary of those previously reported. Patients tend to present in the early postoperative period (48-72 hours) with low back pain, abdominal pain, leukocytosis, and peritonitis. The diagnosis should be made by intravenous pyelography; if possible, the injury should be stented by either the retrograde or percutaneous route. The injuries, except for one apparent trocar injury, involved the use of electrocoagulation, both unipolar and bipolar. The injuries occurred most commonly near the uterosacral ligaments. In 38% (five of 13) of the cases, the laparoscopy was performed for treatment of endometriosis. Three of the 13 patients eventually lost renal function of the affected side; two of these underwent a nephrectomy. Because visualization of the ureter near the cervix at the time of laparoscopy is difficult, especially in the presence of disease, laparoscopic procedures in this area must be carried out with caution.
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Affiliation(s)
- D A Grainger
- Department of Obstetrics and Gynecology, Yale University School of Medicine, New Haven, Connecticut
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Thatcher SS, Grainger DA, True LD, DeCherney AH. Pelvic trophoblastic implants after laparoscopic removal of a tubal pregnancy. Obstet Gynecol 1989; 74:514-5. [PMID: 2548138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Laparoscopic removal of ectopic gestations is becoming increasingly popular. We present a case in which an early, unruptured ampullary ectopic pregnancy was identified clinically, removed during laparoscopy, and subsequently confirmed by pathology. The patient later presented with pain and with rising titers of beta-hCG. Laparotomy demonstrated multiple pelvic implants of trophoblastic tissue.
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Affiliation(s)
- S S Thatcher
- Department of Obstetrics and Gynecology, Yale University School of Medicine, New Haven, Connecticut
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Abstract
Hysteroscopy provides a means of accurately diagnosing and treating most forms of abnormal uterine bleeding. Submucous myomas and endometrial polyps may be easily removed with the resectoscope. If the myomas are large, pre-treatment with GnRH agonists will shrink the tumours, and facilitate hysteroscopic removal. One third of patients undergoing hysteroscopic myomectomy will have recurrent symptoms that require intervention. In the absence of malignancy, and in patients not desiring fertility, persistent dysfunctional uterine bleeding may be treated by endometrial ablation. These patients should be pre-treated with either danazol or GnRH agonists. Success with these techniques approaches 85%, but information about the long-term outcome for the majority of the reported cases is not available. Complications include uterine perforation and damage of intra-abdominal structures, fluid and electrolyte imbalance including pulmonary oedema, and anaphylactic reactions to certain distention media (32% dextran 70). These procedures provide the gynaecologist with an effective means of treating abnormal uterine bleeding without the attendant morbidity of a hysterectomy.
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Corfman RS, Grainger DA. Endometriosis-associated infertility. Treatment options. J Reprod Med 1989; 34:135-41. [PMID: 2522548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Formulating a treatment plan for infertility associated with endometriosis is difficult due to the lack of a cause-and-effect relationship between the disease and infertility. Several molecular and cellular mechanisms have been postulated as playing roles in endometriosis-associated infertility; they are reviewed here. Several medical and surgical treatment options are discussed, including danocrine, medroxyprogesterone acetate and gonadotropin releasing hormone agonists. A combined medical and surgical approach and occasional expectant management remain the treatments of choice.
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Affiliation(s)
- R S Corfman
- Department of Obstetrics and Gynecology, Yale University School of Medicine, New Haven, Connecticut 06510-8063
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