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Champion ML, Bushman ET, Martin KD, Battarbee AN, Robbins LS, Andrews WW, Tita AT. Reevaluating Associations between Prenatal Care Utilization and Current Trends in Preterm Birth. Am J Perinatol 2024. [PMID: 38537690 DOI: 10.1055/a-2295-6524] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/13/2024]
Abstract
OBJECTIVE Studies have suggested an association between prenatal care (PNC) and preterm birth (PTB). We evaluated trends in PTB and association of PNC and PTB. STUDY DESIGN This was a retrospective cohort study of singleton, viable nonanomalous deliveries from 1991 to 2018. PNC utilization was defined by World Health Organization using number of visits: adequate (≥8), suboptimal (5-7), and inadequate (<5). Primary outcome was PTB. Tests of trend were used to assess changes in PTB over time. Baseline characteristics and outcomes were compared. Logistic regression estimated the association of PNC and PTB. We evaluated for effect modification by year of birth. RESULTS Of 92,294 patients, 14,057 (15%) had PTB. Inadequate and suboptimal PNC were associated with higher odds of PTB compared to adequate PNC (adjusted odds ratios [aOR 6.21], 95% confidence interval [CI] 5.84-6.60; aOR 3.57, 95% CI 3.36-3.79). Inadequate PNC was associated with higher odds of PTB over time (effect modification p < 0.0001). Inadequate PNC was associated with 5.4 times higher odds of PTB in 1998, 7.0 times in 2008, and 9.1 times in 2018. CONCLUSION Despite an increase in adequate PNC, there was a rise in PTB associated with inadequate and suboptimal PNC. PNC utilization was a stronger risk factor in recent years with higher PTB in patients who attended more than five PNC visits. KEY POINTS · PNC utilization is associated with the risk of PTB.. · Despite an increase in PNC utilization, PTB rates have increased.. · There is an even stronger association between PNC utilization and PTB over time..
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Affiliation(s)
- Macie L Champion
- Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, Alabama
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Elisa T Bushman
- Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, Alabama
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Kimberly D Martin
- Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, Alabama
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Ashley N Battarbee
- Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, Alabama
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Lindsay S Robbins
- Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, Alabama
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama
| | - William W Andrews
- Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, Alabama
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Alan T Tita
- Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, Alabama
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama
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Champion ML, Maier JG, Bushman ET, Barney JB, Casey BM, Sinkey RG. Systematic Review of Lymphangioleiomyomatosis Outcomes in Pregnancy and a Proposed Management Guideline. Am J Perinatol 2023:10.1055/a-2051-8395. [PMID: 36898409 PMCID: PMC10582203 DOI: 10.1055/a-2051-8395] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/12/2023]
Abstract
OBJECTIVE Lymphangioleiomyomatosis (LAM) is a rare, multisystem disease that primarily affects women of reproductive age. Disease progression has been linked to estrogen exposure, and as such many patients are advised to avoid pregnancy. Data are limited regarding the interaction between LAM and pregnancy, and as such we performed a systematic review to summarize available literature reporting outcomes of pregnancies complicated by maternal LAM. STUDY DESIGN This was a systematic review including randomized controlled trials, observational studies, systematic reviews, case reports, clinical practice guidelines, and quality improvement studies with full-text manuscripts or abstracts in the English language with primary data on pregnant or postpartum patients with LAM. The primary outcome was maternal outcomes during pregnancy as well as pregnancy outcomes. Secondary outcomes were neonatal outcomes and long-term maternal outcomes. This search occurred in July 2020 and included MEDLINE, Scopus, clinicaltrials.gov, Embase, and Cochrane Central. Risk of bias was ascertained using the Newcastle-Ottawa Scale. Our systematic review was registered with PROSPERO as protocol number CRD 42020191402. RESULTS A total of 175 publications were identified in our initial search; ultimately 31 studies were included. Six (19%) studies were retrospective cohort studies and 25 (81%) studies were case reports. Patients diagnosed during pregnancy had worse pregnancy outcomes compared to those diagnosed with LAM prior to pregnancy. Multiple studies reported a significant risk of pneumothoraces during pregnancy. Other significant risks included preterm delivery, chylothoraces, and pulmonary function deterioration. A proposed strategy for preconception counseling and antenatal management is provided. CONCLUSION Patients diagnosed with LAM during pregnancy generally experience worse outcomes including recurrent pneumothoraces and preterm delivery as compared to patients with a LAM diagnosis prior to pregnancy. Given that there are limited studies available, and that the majority are low-quality evidence and subject to bias, further investigation of the interaction between LAM and pregnancy is warranted to guide patient care and counseling. KEY POINTS · Data are limited on the effects of lymphangioleiomyomatosis on pregnancy outcomes.. · We performed a systematic review to summarize pregnancy outcomes complicated by LAM.. · Patients diagnosed with LAM during pregnancy experience worse outcomes..
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Affiliation(s)
- Macie L. Champion
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Center for Women’s Reproductive Health at the University of Alabama at Birmingham, Birmingham, Alabama
| | - Julia G. Maier
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Center for Women’s Reproductive Health at the University of Alabama at Birmingham, Birmingham, Alabama
| | - Elisa T. Bushman
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Center for Women’s Reproductive Health at the University of Alabama at Birmingham, Birmingham, Alabama
| | - Joseph B. Barney
- Department of Pulmonary, Allergy, and Critical Care Medicine, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama
| | - Brian M. Casey
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Center for Women’s Reproductive Health at the University of Alabama at Birmingham, Birmingham, Alabama
| | - Rachel G. Sinkey
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Center for Women’s Reproductive Health at the University of Alabama at Birmingham, Birmingham, Alabama
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Fleenor R, Champion ML, Battarbee AN. Optimal timing of delivery in patients with pregestational diabetes mellitus. Am J Obstet Gynecol 2023. [DOI: 10.1016/j.ajog.2022.11.1212] [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: 01/09/2023]
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McCarley C, Blanchard CT, Champion ML, Nassel A, Battarbee AN, Subramaniam A. The association between social vulnerability index and neonatal intensive care unit admission. Am J Obstet Gynecol 2023. [DOI: 10.1016/j.ajog.2022.11.222] [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: 01/09/2023]
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Champion ML, Blanchard CT, Shrestha KS, Nassel A, Battarbee AN, Subramaniam A. The association between social vulnerability index and preeclampsia. Am J Obstet Gynecol 2023. [DOI: 10.1016/j.ajog.2022.11.440] [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: 01/09/2023]
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Orfanakos VB, Champion ML, Nassel A, Subramaniam A, Battarbee AN. Social vulnerability and adverse outcomes in patients with gestational and pregestational diabetes. Am J Obstet Gynecol 2023. [DOI: 10.1016/j.ajog.2022.11.710] [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: 01/09/2023]
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Abstract
OBJECTIVE A recent randomized controlled trial suggested that early gestational diabetes mellitus (GDM) screening in patients with obesity (body mass index [BMI] ≥30 kg/m2) does not improve perinatal outcomes. The American College of Obstetrics and Gynecology currently recommends early screening for gestational diabetes in patients who are overweight with one or more additional risk factors. We evaluated the effect of screening based on the number of additional risk factors for development of gestational diabetes. STUDY DESIGN This was a secondary analysis of a multicenter randomized controlled trial of obese patients with singleton nonanomalous fetuses comparing early (14-20 weeks' gestation) with routine (24-28 weeks' gestation) GDM screening. Exclusion criteria were pregestational diabetes, major medical illnesses, bariatric surgery, chronic steroid use, and prior cesarean. Early versus routine GDM screening groups were compared and stratified by the number of additional risk factors for GDM (0, 1, 2, and ≥3). The primary outcome was an adverse perinatal composite outcome composed of: macrosomia, primary cesarean delivery, hypertensive disorders of pregnancy, shoulder dystocia, neonatal hyperbilirubinemia, and neonatal hypoglycemia. Analyses examined effects of early versus routine screening by the number of additional risk factors and their possible interaction on the incidences of the primary outcome and GDM. RESULTS Of 913 patients, 5% had 0, 52% had 1, 33% had 2, and 10% had ≥3 additional risk factors. Baseline characteristics, including the number and type of risk factors, were similar between early and routine screening groups. Breslow-Day test for interaction between early versus routine screening and the number of additional risk factors was not significant for either the primary outcome (p = 0.37) or the diagnosis of GDM (p = 0.28). The incidence of GDM and the adverse perinatal composite outcome increased as the number of risk factors increased (p < 0.001). CONCLUSION In patients with BMI ≥30 kg/m2 and additional risk factors, early GDM screening does not prevent adverse outcomes. KEY POINTS · The ACOG currently recommends early screening for gestational diabetes if patients have risk factors.. · Even in patients with multiple risk factors, early screening for GDM does not improve outcomes.. · Patients with three or more risk factors may have worse outcomes if they undergo early screening..
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Affiliation(s)
- Macie L Champion
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Center for Women's Reproductive Health, The University of Alabama at Birmingham, Birmingham, Alabama
| | - Victoria C Jauk
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Center for Women's Reproductive Health, The University of Alabama at Birmingham, Birmingham, Alabama
| | - Joseph R Biggio
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Ochsner Health System, New Orleans, Louisiana
| | - Jeff M Sychowski
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Center for Women's Reproductive Health, The University of Alabama at Birmingham, Birmingham, Alabama
- Department of Biostatistics, The University of Alabama at Birmingham, Birmingham, Alabama
| | - Alan T Tita
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Center for Women's Reproductive Health, The University of Alabama at Birmingham, Birmingham, Alabama
| | - Lorie M Harper
- Department of Women's Health, The University of Texas at Austin Dell Medical School, Austin, Texas
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Champion ML, Becker DA, McIlwraith C, Blanchard CT, Szychowski JM, Kim DJ, Jauk VC, Harper LM, Casey BM, Tita AT. Contemporary Test Performance of the Random Urine Protein-to-creatinine Ratio. Am J Perinatol 2022. [PMID: 35240698 DOI: 10.1055/a-1786-8847] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
OBJECTIVE The random urine protein-to-creatinine ratio (UPCR) is a screening test used for predicting clinically significant proteinuria (urine protein ≥ 300 mg) during pregnancy. No consensus exists on the optimal random UPCR cutoff for performing follow-up 24 hour urine (24H) total protein collection. We aim to evaluate the test performance of random UPCR in predicting proteinuria in a contemporary cohort. STUDY DESIGN This was a retrospective cohort study of pregnant patients at our institution from 2014 to 2018 with a random UPCR and follow-up 24H protein collection. The primary analysis estimated the test characteristics (sensitivity, specificity, positive and negative predictive values) of using random UPCR for the detection of proteinuria defined as urine protein ≥300 mg on 24H protein collection. UPCR cutoffs from 0.10 to 0.30 mg/dL were evaluated, receiver operator characteristic (ROC) curve was constructed, and area under the curve (AUC) was determined. A secondary analysis examined the correlation between UPCR and 24H protein using least squares regression and Pearson correlation. RESULTS Paired UPCR and 24H collection results were available for 1,120 patients. Mean gestational age at time of UPCR was 31.1 ± 5.1 weeks and 687 (61.3%) of patients had a 24H ≥300 mg. UPCR <0.10 mg/dL effectively excluded proteinuria ≥300 mg on 24H collection, while UPCR ≥0.18 mg/dL correctly classifies proteinuria with 91% sensitivity, 57% specificity, 77% positive predictive value, and 79% negative predictive value. UPCR ≥1.07 mg/dL had 100% specificity for 24 hour proteinuria. The area under ROC curve was 0.86. UPCR and 24H collection were highly correlated with a Pearson correlation coefficient of 0.85. After our institution lowered the threshold to obtain a 24H from UPCR ≥0.20 mg/dL to ≥0.10 mg/dL in May 2017, the percentage of patients meeting criteria for 24H collection increased from 57.8 to 84.4%. CONCLUSION The AUC and Pearson correlation suggest random UPCR is a high performance test for the prediction of proteinuria on 24H. Optimal test performance is dependent upon clinical consideration and upon the implications of the disease or condition. A random UPCR screen positive threshold of 0.18 mg/dL maximizes sensitivity to identify clinically significant proteinuria. KEY POINTS · Random urine protein to creatinine ratio is a high performance test for proteinuria.. · A random UPCR threshold of 0.18 mg/dL maximizes sensitivity to identify proteinuria.. · Optimal test performance is dependent on the disease or clinical condition..
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Affiliation(s)
- Macie L Champion
- Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, Alabama
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama
| | - David A Becker
- Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, Alabama
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Claire McIlwraith
- Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, Alabama
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Christina T Blanchard
- Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, Alabama
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Jeff M Szychowski
- Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, Alabama
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, Alabama
| | - Dhong-Jin Kim
- Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, Alabama
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Victoria C Jauk
- Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, Alabama
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Lorie M Harper
- Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, Alabama
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Brian M Casey
- Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, Alabama
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Alan T Tita
- Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, Alabama
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama
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Champion ML, Battarbee AN, Biggio JR, Casey BM, Harper LM. Postpartum glucose intolerance following early gestational diabetes mellitus. Am J Obstet Gynecol MFM 2022; 4:100609. [PMID: 35272093 PMCID: PMC9195159 DOI: 10.1016/j.ajogmf.2022.100609] [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] [Received: 12/17/2021] [Revised: 02/25/2022] [Accepted: 02/28/2022] [Indexed: 11/20/2022]
Abstract
BACKGROUND Patients with gestational diabetes mellitus are at increased risk for type 2 diabetes mellitus or glucose intolerance postpartum compared with those without diabetes mellitus. OBJECTIVE We aimed to evaluate the association between early gestational diabetes mellitus and postpartum dysglycemia compared with gestational diabetes mellitus diagnosed by routine screening in a cohort of patients with obesity. STUDY DESIGN This was a secondary analysis of a randomized controlled trial of patients with obesity and singleton, nonanomalous gestations that compared early gestational diabetes mellitus screening at 14 to 20 weeks of gestation with routine screening at 24 to 28 weeks of gestation. Patients were included in this analysis if they were diagnosed with gestational diabetes mellitus at the primary study site. The primary outcome was postpartum dysglycemia, defined as any abnormality on 2-hour oral glucose tolerance test 6 weeks postpartum or clinical diagnosis based on hyperglycemia requiring pharmacotherapy after delivery with deferred glucose tolerance test. Maternal characteristics and outcomes were compared in bivariable analysis, and logistic regression estimated the association between early gestational diabetes mellitus and postpartum dysglycemia. RESULTS Of 119 patients included in this analysis, 30 were diagnosed by screening at <20 weeks of gestation and 89 at 24 to 28 weeks of gestation. Patients were overall similar in baseline characteristics. Patients with early gestational diabetes mellitus were more likely to have postpartum dysglycemia than those with gestational diabetes mellitus diagnosed with routine screening (36.7% vs 14.6%; odds ratio, 3.38; 95% confidence interval, 1.31-8.73). Most patients with early gestational diabetes mellitus who had postpartum dysglycemia were diagnosed clinically (n=7/11), whereas none of the patients with gestational diabetes mellitus established by routine testing were diagnosed with postpartum dysglycemia clinically. All (100%) patients with early gestational diabetes mellitus who completed a postpartum glucose tolerance test had dysglycemia compared with only 45% of patients with gestational diabetes mellitus diagnosed on routine screening. The proportion of patients who followed up for postpartum visits and the timing of follow-up were similar between groups. Postpartum glucose tolerance test completion was low but also similar between groups. CONCLUSION Although postpartum glucose tolerance test completion is low, patients with gestational diabetes mellitus before 20 weeks of gestation, seem to be at higher risk for postpartum dysglycemia than those with gestational diabetes mellitus diagnosed at routine screening in a cohort of patients with obesity. Larger studies are needed to confirm these findings, but postpartum follow-up and diabetes mellitus testing may be even more important to improve long-term health in patients with early gestational diabetes mellitus.
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Affiliation(s)
- Macie L Champion
- Center for Women's Reproductive Health, The University of Alabama at Birmingham, Birmingham, AL (Drs. Champion, Battarbee, Casey); Department of Obstetrics and Gynecology, The University of Alabama at Birmingham, Birmingham, AL (Drs. Champion, Battarbee, Casey); Department of Women's Health, The University of Texas at Austin Dell Medical School, Austin, TX (Dr. Harper); Women's Services, Section of Maternal Fetal Medicine, Ochsner Health, New Orleans, LA (Dr. Biggio).
| | - Ashley N Battarbee
- Center for Women's Reproductive Health, The University of Alabama at Birmingham, Birmingham, AL (Drs. Champion, Battarbee, Casey); Department of Obstetrics and Gynecology, The University of Alabama at Birmingham, Birmingham, AL (Drs. Champion, Battarbee, Casey); Department of Women's Health, The University of Texas at Austin Dell Medical School, Austin, TX (Dr. Harper); Women's Services, Section of Maternal Fetal Medicine, Ochsner Health, New Orleans, LA (Dr. Biggio)
| | - Joseph R Biggio
- Center for Women's Reproductive Health, The University of Alabama at Birmingham, Birmingham, AL (Drs. Champion, Battarbee, Casey); Department of Obstetrics and Gynecology, The University of Alabama at Birmingham, Birmingham, AL (Drs. Champion, Battarbee, Casey); Department of Women's Health, The University of Texas at Austin Dell Medical School, Austin, TX (Dr. Harper); Women's Services, Section of Maternal Fetal Medicine, Ochsner Health, New Orleans, LA (Dr. Biggio)
| | - Brian M Casey
- Center for Women's Reproductive Health, The University of Alabama at Birmingham, Birmingham, AL (Drs. Champion, Battarbee, Casey); Department of Obstetrics and Gynecology, The University of Alabama at Birmingham, Birmingham, AL (Drs. Champion, Battarbee, Casey); Department of Women's Health, The University of Texas at Austin Dell Medical School, Austin, TX (Dr. Harper); Women's Services, Section of Maternal Fetal Medicine, Ochsner Health, New Orleans, LA (Dr. Biggio)
| | - Lorie M Harper
- Center for Women's Reproductive Health, The University of Alabama at Birmingham, Birmingham, AL (Drs. Champion, Battarbee, Casey); Department of Obstetrics and Gynecology, The University of Alabama at Birmingham, Birmingham, AL (Drs. Champion, Battarbee, Casey); Department of Women's Health, The University of Texas at Austin Dell Medical School, Austin, TX (Dr. Harper); Women's Services, Section of Maternal Fetal Medicine, Ochsner Health, New Orleans, LA (Dr. Biggio)
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Cozzi GD, Blanchard CT, Champion ML, Todd A, Davis M, Chandler-Laney P, Casazza K, Casey BM, Tita AT, Szychowski JM, Subramaniam A. Factors Associated with Appropriate Gestational Weight Gain among Women with Obesity. Am J Perinatol 2022; 39:272-280. [PMID: 32854132 PMCID: PMC9105824 DOI: 10.1055/s-0040-1715529] [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 compare attendance of nutritional counseling, dietary composition, exercise patterns, and socioeconomic factors among obese women with inappropriate gestational weight gain (iGWG) versus appropriate GWG (aGWG). STUDY DESIGN Medicaid-eligible women receiving prenatal care at a tertiary care center from January 2013 to December 2015 were offered individualized nutritional counseling by a registered dietitian encouraging well-balanced meals and 150 min/wk of exercise. We conducted a prospective case-control study of obese women (body mass index or BMI ≥30) with a singleton gestation with iGWG (<11 or >20 pounds) versus aGWG (11-20 pounds). Dietary intake, activity level, and socioeconomic factors were compared with Chi-square, Fisher's exact, Student's t-test, and Wilcoxon Rank Sum tests as indicated, and odds ratios with 95% confidence intervals were calculated. Multivariate regression analysis for significant variables was performed. A subgroup analysis of women with BMI ≥40 was planned. RESULTS A total of 401 women were analyzed: 78% (n = 313) with iGWG and 22% (n = 88) with aGWG. Demographics were similar between groups. Women with iGWG less frequently reported physician reinforcement of counseling and reported more physical inactivity and unemployment; there were no differences in caloric intake or macronutrient profile between groups. Multivariate regression identified physician reinforcement and employment as independent predictors of aGWG. Among women with BMI ≥40 (n = 133), those with iGWG (78%) were less likely to attend counseling, report physician reinforcement of counseling, and have adequate caloric and protein intake when compared with those with aGWG (22%). Activity level and socioeconomic factors were not different between groups. CONCLUSION Physician reinforcement of nutritional counseling, greater activity level, and employment are associated with aGWG in women with BMI ≥30, while individualized professional nutritional counseling and dietary modifications were further associated with aGWG in women with BMI ≥40. Thus, greater focus should be placed on enhancing exposure to counseling and altering nutritional and exercise choices to optimize aGWG. KEY POINTS · Physician reinforcement of nutritional counseling by a dietitian is crucial for obese women.. · Physical inactivity and unemployment are associated with inappropriate gestational weight gain.. · Nutritional counseling is associated with appropriate gestational weight gain in women with BMI ≥40..
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Affiliation(s)
- Gabriella D. Cozzi
- Center for Women’s Reproductive Health, University of Alabama at Birmingham, Birmingham, Alabama,Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Christina T. Blanchard
- Center for Women’s Reproductive Health, University of Alabama at Birmingham, Birmingham, Alabama,Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Macie L. Champion
- Center for Women’s Reproductive Health, University of Alabama at Birmingham, Birmingham, Alabama,Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Allison Todd
- Department of Nutritional Sciences, University of Alabama at Birmingham, Birmingham, Alabama
| | - Margaret Davis
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama,Department of Nutritional Sciences, University of Alabama at Birmingham, Birmingham, Alabama
| | - Paula Chandler-Laney
- Department of Nutritional Sciences, University of Alabama at Birmingham, Birmingham, Alabama
| | - Krista Casazza
- Department of Nutritional Sciences, University of Alabama at Birmingham, Birmingham, Alabama,Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama
| | - Brian M. Casey
- Center for Women’s Reproductive Health, University of Alabama at Birmingham, Birmingham, Alabama,Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Alan T. Tita
- Center for Women’s Reproductive Health, University of Alabama at Birmingham, Birmingham, Alabama,Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Jeff M. Szychowski
- Center for Women’s Reproductive Health, University of Alabama at Birmingham, Birmingham, Alabama,Department of Biostatistics, University of Alabama at Birmingham, Birmingham, Alabama
| | - Akila Subramaniam
- Center for Women’s Reproductive Health, University of Alabama at Birmingham, Birmingham, Alabama,Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama
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Page M, Lu MY, Blanchard CT, Ausbeck EB, Oglesby KR, Cozzi GD, Bushman ET, Ruzic MF, Mahalingam M, Dunk SA, Champion ML, Szychowski JM, Subramaniam A, Casey BM. Postpartum wound morbidity according to timing of prophylactic anticoagulation administration. Am J Obstet Gynecol 2022. [DOI: 10.1016/j.ajog.2021.11.743] [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: 11/01/2022]
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Champion ML, Jauk VC, Szychowski JM, Battarbee AN, Tita AT, Casey BM, Subramaniam A. Duration of intrapartum ampicillin prophylaxis and neonatal outcomes. Am J Obstet Gynecol 2022. [DOI: 10.1016/j.ajog.2021.11.922] [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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Gardner AB, Champion ML, Battarbee AN. Exploring racial/ethnic groups at risk for gestational diabetes mellitus: genetic differences or effects of racism? Am J Obstet Gynecol 2022. [DOI: 10.1016/j.ajog.2021.11.1015] [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: 11/01/2022]
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Champion ML, Martin KD, Lawson S, Subramaniam A, Battarbee AN. The impact of diabetes and obesity on postoperative complications after cesarean delivery. Am J Obstet Gynecol 2022. [DOI: 10.1016/j.ajog.2021.11.1266] [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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Champion ML, Steele R, Sinkey R, Tita AT, Harper LM. Baseline renal function and adverse outcomes in pregnancies complicated by pregestational diabetes. J Matern Fetal Neonatal Med 2021; 35:7330-7336. [DOI: 10.1080/14767058.2021.1947229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Macie L. Champion
- Division of Maternal Fetal Medicine. Department of Obstetrics and Gynecology, Center for Women’s Reproductive Health at the University of Alabama at Birmingham, Birmingham, AL, USA
| | - Robin Steele
- Division of Maternal Fetal Medicine. Department of Obstetrics and Gynecology, Center for Women’s Reproductive Health at the University of Alabama at Birmingham, Birmingham, AL, USA
| | - Rachel Sinkey
- Division of Maternal Fetal Medicine. Department of Obstetrics and Gynecology, Center for Women’s Reproductive Health at the University of Alabama at Birmingham, Birmingham, AL, USA
| | - Alan T. Tita
- Division of Maternal Fetal Medicine. Department of Obstetrics and Gynecology, Center for Women’s Reproductive Health at the University of Alabama at Birmingham, Birmingham, AL, USA
| | - Lorie M. Harper
- Department of Women’s Health, University of Texas at Austin Dell Seton Medical Center, Austin, TX, USA
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Ruzic MF, Blanchard CT, Robbins LS, Lu MY, Oglesby KR, Page MR, Ausbeck EB, Cozzi GD, Bushman ET, Mahalingam M, Dunk SA, Champion ML, Casey BM, Lazenby AJ, Muñoz Rogers RD, Tita A, Szychowski JM, Kim DJ, Subramaniam A. 582 Post-cesarean infections before and after implementation of adjunctive azithromycin in addition to standard antibiotics. Am J Obstet Gynecol 2021. [DOI: 10.1016/j.ajog.2020.12.603] [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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Champion ML, Blanchard CT, Oglesby KR, Page MR, Allison L, Ausbeck EB, Cozzi GD, Rogers RM, Bushman ET, Kaplan ER, Ruzic MF, Mahalingam M, Dunk SA, Casey BM, Tita A, Kim DJ, Szychowski JM, Lu MY, Subramaniam A. 557 Pregnancy outcomes associated with pragmatic use of aspirin at a single tertiary care center. Am J Obstet Gynecol 2021. [DOI: 10.1016/j.ajog.2020.12.578] [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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Dunk SA, Owen J, Lu MY, Blanchard CT, Oglesby KR, Page MR, Lazenby AJ, Ausbeck EB, Cozzi GD, Muñoz Rogers RD, Bushman ET, Kaplan ER, Ruzic MF, Mahalingham M, Champion ML, Casey BM, Tita A, Kim DJ, Szychowski JM, Subramaniam A. 764 Operative vaginal delivery as an independent risk factor for maternal postpartum infection. Am J Obstet Gynecol 2021. [DOI: 10.1016/j.ajog.2020.12.787] [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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Lu MY, Blanchard CT, Oglesby KR, Page MR, Lazenby AJ, Ausbeck EB, Cozzi GD, Muñoz Rogers RD, Bushman ET, Kaplan ER, Ruzic MF, Mahalingam M, Dunk SA, Champion ML, Casey BM, Tita A, Kim DJ, Szychowski JM, Subramaniam A. 59 Safety and efficacy of a risk-based obstetric heparin-based thromboprophylaxis regimen. Am J Obstet Gynecol 2021. [DOI: 10.1016/j.ajog.2020.12.057] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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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Champion ML, Blanchard CT, Cozzi GD, Todd A, Davis M, Chandler-Laney P, Casazza K, Casey BM, Tita A, Subramaniam A. 936 Sociodemographic factors and maternal and neonatal outcomes in obese women (BMI≥30). Am J Obstet Gynecol 2021. [DOI: 10.1016/j.ajog.2020.12.961] [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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Mahalingam M, Blanchard CT, Lu MY, Oglesby KR, Page MR, Lazenby AJ, Ausbeck EB, Cozzi GD, Rogers RM, Bushman ET, Kaplan ER, Ruzic MF, Dunk SA, Champion ML, Casey BM, Tita A, Szychowski JM, Subramaniam A. 823 African-American race and subsequent pregnancy outcomes after a prior preterm birth. Am J Obstet Gynecol 2021. [DOI: 10.1016/j.ajog.2020.12.846] [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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Champion ML, Battarbee AN, Knupp RJ, Biggio JR, Casey BM, Harper LM. 199 Postpartum glucose tolerance following early gestational diabetes. Am J Obstet Gynecol 2021. [DOI: 10.1016/j.ajog.2020.12.221] [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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Page MR, Blanchard CT, Lu MY, Subramaniam A, Oglesby KR, Ausbeck EB, Cozzi GD, Rogers RM, Bushman ET, Kaplan ER, Ruzic MF, Mahalingam M, Dunk SA, Champion ML, Kim DJ, Szychowski JM, Tita A, Casey BM. 794 Venous thromboembolism and adverse outcomes in highest-VTE risk gravidas compared to those at lower risk. Am J Obstet Gynecol 2021. [DOI: 10.1016/j.ajog.2020.12.817] [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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Jaber S, Blanchard CT, Lu MY, Oglesby KR, Page MR, Lazenby AJ, Ausbeck EB, Cozzi GD, Muñoz Rogers RD, Bushman ET, Kaplan ER, Ruzic MF, Mahalingam M, Dunk SA, Champion ML, Casey BM, Tita A, Kim DJ, Szychowski JM, Subramaniam A. 510 Contemporary trends in cesarean delivery rates and indications. Am J Obstet Gynecol 2021. [DOI: 10.1016/j.ajog.2020.12.531] [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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Abstract
PURPOSE OF REVIEW Gestational weight gain is a modifiable risk factor for adverse perinatal outcomes. After the Institute of Medicine (IOM) released updated recommendations for gestational weight gain in 2009, a multitude of studies were released examining the recommendations, particularly for women with obesity. As the obesity epidemic continues, many physicians are interested in minimizing gestational weight gain for all women. Our aim was to review the evidence for the association of gestational weight gain and perinatal outcomes, particularly for weight gain outside the IOM guidelines. RECENT FINDINGS Gestational weight gain is associated with several adverse perinatal outcomes including fetal growth, preterm delivery, cesarean delivery, gestational diabetes, hypertensive disorders of pregnancy, and infant mortality as well as with long-term offspring metabolic health outcomes. Multiple randomized controlled trials have been conducted evaluating the efficacy of lifestyle intervention on gestational weight gain, and while lifestyle interventions may alter gestational weight gain, they have not been associated with improvement in perinatal outcomes. Weight loss during pregnancy is associated with decreased risks of macrosomia and cesarean delivery; however, given an association with low birth weight, it is not currently recommended. Excessive gestational weight gain is known to be associated with multiple adverse fetal and maternal outcomes. Lifestyle interventions during pregnancy may be helpful in decreasing excessive weight gain, but have not shown to be beneficial for most adverse pregnancy outcomes. More research is needed before making recommendations for weight loss in women with obesity during pregnancy.
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Affiliation(s)
- Macie L Champion
- Division of Maternal Fetal Medicine. Department of Obstetrics and Gynecology, Center for Women's Reproductive Health at the University of Alabama at Birmingham, 1700 6th Ave S, Birmingham, AL, 35233, USA.
| | - Lorie M Harper
- Division of Maternal Fetal Medicine. Department of Obstetrics and Gynecology, Center for Women's Reproductive Health at the University of Alabama at Birmingham, 1700 6th Ave S, Birmingham, AL, 35233, USA
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Cozzi GD, Blanchard CT, Champion ML, Todd A, Davis M, Chandler-Laney P, Casazza K, Casey BM, Tita AT, Subramaniam A. 748: Factors associated with appropriate gestational weight gain among obese women. Am J Obstet Gynecol 2020. [DOI: 10.1016/j.ajog.2019.11.762] [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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Maier J, Blanchard CT, Szychowski JM, Mazzoni S, Rajapreyar I, Novara A, Champion ML, Goepfert A, Cribbs M, Boozer M, Harper LM, Tita AT, Sinkey R. 1187: Immediate postpartum long-acting reversible contraception in women with heart disease. Am J Obstet Gynecol 2020. [DOI: 10.1016/j.ajog.2019.11.1199] [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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Champion ML, Jauk VC, Biggio JR, Szychowski JM, Tita AT, Harper LM. 440: Early gestational diabetes screening in class III obesity (BMI≥40). Am J Obstet Gynecol 2020. [DOI: 10.1016/j.ajog.2019.11.456] [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: 10/25/2022]
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Champion ML, Jauk VC, Biggio JR, Szychowski JM, Tita AT, Harper LM. 71: Early gestational diabetes screening based on ACOG guidelines. Am J Obstet Gynecol 2020. [DOI: 10.1016/j.ajog.2019.11.087] [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: 10/25/2022]
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Champion ML, Becker DA, Blanchard CT, Jauk VC, Harper LM, Casey BM, Tita AT. 454: Test performance of the random urine protein-to-creatinine ratio for predicting significant proteinuria during pregnancy. Am J Obstet Gynecol 2019. [DOI: 10.1016/j.ajog.2018.11.475] [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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Barrington DA, Champion ML, Boitano TKL, Walters-Haygood CL, Farmer MB, Alvarez RD, Estes JM, Leath CA. Characteristics of African American women at high-risk for ovarian cancer in the southeast: Results from a Gynecologic Cancer Risk Assessment Clinic. Gynecol Oncol 2018; 149:337-340. [PMID: 29486991 DOI: 10.1016/j.ygyno.2018.02.014] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Revised: 02/05/2018] [Accepted: 02/18/2018] [Indexed: 12/01/2022]
Abstract
OBJECTIVES Describe patient characteristics in African American (AA) women seen for gynecologic cancer related genetic counseling at a large southeastern comprehensive cancer center. METHODS We reviewed an IRB approved, prospective observational cohort of patients from a Gynecologic Cancer Risk Assessment Clinic. Data evaluated included personal cancer history, family history, frequency of genetic testing, frequency/type of genetic mutations, and frequency of surgical intervention. Standard statistical statistics were utilized. RESULTS 1227 patients were evaluated from 2003 to 2015, of which 95 (7.7%) were AA. Sixteen patients had a personal history of ovarian cancer. 21 women (22%) underwent genetic counseling only; subsequent genetic testing was not recommended based on absence of risk factors. Of the seventy-four AA patients in whom genetic testing was recommended, sixty-six (69.5%) completed testing. Of women tested, 37 (56%) had abnormal results. Eight and 14 patients had pathogenic variants in BRCA1 and BRCA2, respectively. Two were found to have pathogenic PALB2 variants; one had a pathogenic ATM variant and one constitutional MLH1 epimutation case was identified. Eleven had BRCA variants of uncertain significance. Of the patients with abnormal testing, six of 22 women with pathogenic BRCA variants underwent risk-reducing salpingo-oophorectomy (RRSO). CONCLUSIONS Our study demonstrates that in a region where AAs represent 27% of the population, the proportion of AA patients referred to a Gynecologic Cancer Risk Assessment Clinic remains low. Pathogenic variant and variant of uncertain significance rates were high in patients tested, likely representing a selection bias of high-risk patients. Endeavors should continue to identify minorities at risk for ovarian cancer and institute measures to provide thorough genetic counseling and testing.
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Affiliation(s)
- David A Barrington
- University of Alabama at Birmingham, Department of Obstetrics & Gynecology, United States
| | - Macie L Champion
- University of Alabama at Birmingham, Department of Obstetrics & Gynecology, United States
| | - Teresa K L Boitano
- University of Alabama at Birmingham, Department of Obstetrics & Gynecology, United States
| | | | - Meagan B Farmer
- University of Alabama at Birmingham, Department of Medical Genetics, United States
| | - Ronald D Alvarez
- University of Alabama at Birmingham, Division of Gynecologic Oncology, United States
| | - Jacob M Estes
- University of Alabama at Birmingham, Division of Gynecologic Oncology, United States
| | - Charles A Leath
- University of Alabama at Birmingham, Division of Gynecologic Oncology, United States.
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Abstract
Twenty-nine of 30 strains of Mycobacterium paratuberculosis isolated from clinical specimens were serologically identified. No cross-reactions were observed with Mycobacterium avium serotypes 1, 2, 4, and 8.
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Abstract
A rapid and economical micromethod for serotyping strains of Mycobacterium avium is described. Eighty-four of 91 strains representing 20 serotypes were successfully identified.
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