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Shivraj P, Chadha R, Dynis D, Diepenbrock K, Hoffman BL, Ramin S, Wendel G. The American Board of Obstetrics and Gynecology's (ABOG) Remote Certifying Examination: Successes and Challenges. AJOG Global Reports 2022; 2:100136. [DOI: 10.1016/j.xagr.2022.100136] [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: 11/21/2022] Open
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Shivraj P, Novak A, Aziz S, Larsen W, Ramin S. The Certification Process Driving Patient Safety. Obstet Gynecol Clin North Am 2019; 46:269-280. [DOI: 10.1016/j.ogc.2019.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Myatt L, Hauth J, Leveno K, Peaceman A, Ramin S, Samuels P, Saade G, Sorokin Y, Clifton R, Reddy U, Silver R. Cell-Free Total and Fetal DNA in First Trimester Maternal Serum and Subsequent Development of Preeclampsia. Am J Perinatol 2017; 34:191-198. [PMID: 27398706 PMCID: PMC5358543 DOI: 10.1055/s-0035-1570383] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [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: 12/21/2022]
Abstract
Objective The objective of this study was to assess the relationship between first trimester cell-free total and fetal DNA in maternal plasma and the subsequent development of preeclampsia. Study Design Nested case-control study of patients enrolled in the Combined Antioxidant and Preeclampsia Prediction Studies prediction study of 175 women who did and 175 women who did not develop preeclampsia. The predictive values of cell-free total and fetal DNA and the subsequent development of preeclampsia were measured using receiver operating characteristic curves. Results Cell-free total DNA was higher in African American (median; 25-75%; 6.15; 0.14-28.73; p = 0.02) and Hispanic (4.95; 0.20-26.82; p = 0.037) compared with white women (2.33; 0.03-13.10). Levels of cell-free total DNA were also associated with maternal body mass index (BMI) (p = 0.02). Cell-free total DNA levels were similar between women who later developed preeclampsia (3.52; 0.11-25.3) and controls (3.74; 0.12-21.14, p = 0.96). Conclusion There is no significant difference in levels of cell-free total DNA in the first trimester in women who subsequently develop preeclampsia. Levels of cell-free total DNA in the first trimester are increased in African American and Hispanic compared with white women, and levels increase with increasing BMI.
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Affiliation(s)
- Leslie Myatt
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Maternal-Fetal Medicine Units Network, Bethesda, Maryland
| | - John Hauth
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Maternal-Fetal Medicine Units Network, Bethesda, Maryland
| | - Kenneth Leveno
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Maternal-Fetal Medicine Units Network, Bethesda, Maryland
| | - Alan Peaceman
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Maternal-Fetal Medicine Units Network, Bethesda, Maryland
| | - Susan Ramin
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Maternal-Fetal Medicine Units Network, Bethesda, Maryland
| | - Philip Samuels
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Maternal-Fetal Medicine Units Network, Bethesda, Maryland
| | - George Saade
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Maternal-Fetal Medicine Units Network, Bethesda, Maryland
| | - Yoram Sorokin
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Maternal-Fetal Medicine Units Network, Bethesda, Maryland
| | - Rebecca Clifton
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Maternal-Fetal Medicine Units Network, Bethesda, Maryland
| | - Uma Reddy
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Maternal-Fetal Medicine Units Network, Bethesda, Maryland
| | - Robert Silver
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Maternal-Fetal Medicine Units Network, Bethesda, Maryland
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Antony KM, Harris RA, Levison J, Banda B, Chiudzu G, Chirwa R, Nyondo M, Marko E, Chigano A, Ramin S, Phiri H, Raine S, Belfort M, Kazembe P, Aagaard K. 549: Population-based estimation of the peridontal disease rate in malawi and compliance with preventive/ treatment measures. Am J Obstet Gynecol 2016. [DOI: 10.1016/j.ajog.2015.10.593] [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: 11/27/2022]
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Kahr MK, De La Torre R, Racusin DA, Mastrobattista J, Ramin S, Clark S, Dildy G, Belfort M, Aagaard KM. 551: Birth rates among Hispanics and non-Hispanics and their representation in clinical trials in obstetrics and gynecology. Am J Obstet Gynecol 2016. [DOI: 10.1016/j.ajog.2015.10.595] [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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Mele L, Myatt L, Roberts J, Hauth J, Leveno K, Varner M, Wapner R, Thorp J, Peaceman A, Ramin S, Sciscione A, Tolosa J, Sorokin Y, Basraon S. Relationship of Early Pregnancy Waist-to-Hip Ratio versus Body Mass Index with Gestational Diabetes Mellitus and Insulin Resistance. Am J Perinatol 2016; 33:114-21. [PMID: 26352680 PMCID: PMC5283057 DOI: 10.1055/s-0035-1562928] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [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 To determine the risk of gestational diabetes mellitus (GDM) and insulin resistance (IR) in obesity defined by body mass index (BMI), waist-to-hip ratio (WHR), or both combined. METHODS Secondary analysis of a randomized multicenter trial of antioxidant supplementation versus placebo in nulliparous low-risk women to prevent pregnancy associated hypertension. Women between 9 and 16 weeks with data for WHR and BMI were analyzed for GDM (n = 2,300). Those with fasting glucose and insulin between 22 and 26 weeks (n = 717) were analyzed for IR by homeostatic model assessment of IR (normal, ≤ 75th percentile). WHR and BMI were categorized as normal (WHR, < 0.80; BMI, < 25 kg/m(2)); overweight (WHR, 0.8-0.84; BMI, 25-29.9 kg/m(2)); and obese (WHR, ≥ 0.85; BMI ≥ 30 kg/m(2)). Receiver operating characteristic curves and logistic regression models were used. RESULTS Compared with normal, the risks of GDM or IR were higher in obese by BMI or WHR. The subgroup with obesity by WHR but not by BMI had no increased risk of GDM. BMI was a better predictor of IR (area under the curve [AUC]: 0.71 [BMI], 0.65 [WHR], p = 0.03) but similar to WHR for GDM (AUC: 0.68 [BMI], 0.63 [WHR], p = 0.18). CONCLUSION Increased WHR and BMI in early pregnancy are associated with IR and GDM. BMI is a better predictor of IR compared with WHR. Adding WHR to BMI does not improve its ability to detect GDM or IR.
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Affiliation(s)
- Lisa Mele
- Biostatistics Center, George Washington University, Washington, District of Columbia
| | | | | | - John Hauth
- University of Alabama at Birmingham, Birmingham, Alabama
| | - Kenneth Leveno
- University of Texas Southwestern Medical Center, Dallas, Texas
| | - Michael Varner
- University of Utah Health Sciences Center, Salt Lake City, Utah
| | | | - John Thorp
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | | | - Susan Ramin
- University of Texas Health Science Center at Houston-Children's Memorial Hermann Hospital, Houston, Texas
| | | | - Jorge Tolosa
- Oregon Health & Science University, Portland, Oregon
| | | | - Sanmaan Basraon
- Department of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston, Texas
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Landon M, Lai Y, Klebanoff M, Ramin S, Wapner R, Varner M, Rouse D, Sciscione A, Catalano P, Saade G, Sorokin Y, Peaceman A, Stuebe A. Is There a Threshold Oral Glucose Tolerance Test Value for Predicting Adverse Pregnancy Outcome? Am J Perinatol 2015; 32:833-8. [PMID: 25594222 PMCID: PMC4609641 DOI: 10.1055/s-0034-1543949] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [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: 10/24/2022]
Abstract
OBJECTIVE This study aims to determine whether there is a threshold 3-hour oral glucose tolerance test (OGTT) value associated with accelerated risk of adverse pregnancy outcomes. STUDY DESIGN In a secondary analysis of a cohort of women with untreated mild gestational glucose intolerance, we used generalized additive models with smoothing splines to explore nonlinear associations between each of the 3-hour OGTT values (fasting, 1-hour, 2-hour, and 3-hour) and adverse pregnancy outcomes, including the study's composite outcome (perinatal mortality, hypoglycemia, hyperbilirubinemia, neonatal hyperinsulinemia, and/or birth trauma), large for gestational age birth weight, small for gestational age birth weight, shoulder dystocia, neonatal hypoglycemia, gestational hypertension (gHTN), and preeclampsia. RESULTS Among the 1,360 eligible women, each timed OGTT value was linearly associated with increased odds of composite adverse outcome. We found evidence of a departure from linearity only for the association between fasting glucose and gHTN/preeclampsia, with a stronger association for values of 85 to 94 mg/dL (p = 0.03). We found no evidence of departure from linearity for any other OGTT values and measured outcomes (all chi-square test p-values ≥ 0.05). CONCLUSION In a population of untreated women with mild gestational glucose intolerance and fasting OGTT < 95 mg/dL, we found an increasing risk of gHTN with a fasting glucose between 85 and 94 mg/dL.
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Affiliation(s)
- Mark Landon
- Department of Obstetrics and Gynecology, The Ohio State University, Columbus, Ohio
| | - Yinglei Lai
- George Washington University Biostatistics Center, Washington, District of Columbia
| | | | - Susan Ramin
- The University of Texas Health Science Center at Houston, Houston, Texas
| | - Ronald Wapner
- Department of Obstetrics and Gynecology, Columbia University, New York, New York
| | - Michael Varner
- Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, Utah
| | - Dwight Rouse
- University of Alabama at Birmingham, Birmingham, Alabama
| | | | - Patrick Catalano
- Case Western Reserve University-MetroHealth Medical Center, Cleveland, Ohio
| | - George Saade
- Department of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston, Texas
| | - Yoram Sorokin
- Department of Obstetrics and Gynecology, Wayne State University, Detroit, Michigan
| | - Alan Peaceman
- Department of Obstetrics and Gynecology, Northwestern University, Chicago, Illinois
| | - Alison Stuebe
- Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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Lai Y, Rouse D, Spong C, Leveno K, Varner M, Mercer B, Iams J, Wapner R, Sorokin Y, Thorp J, Ramin S, Malone F, O'Sullivan M, Hankins G, Caritis S, Horton A. Effect of magnesium sulfate administration for neuroprotection on latency in women with preterm premature rupture of membranes. Am J Perinatol 2015; 32:387-92. [PMID: 25241107 PMCID: PMC4369158 DOI: 10.1055/s-0034-1387930] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [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: 01/08/2023]
Abstract
OBJECTIVE This study aims to evaluate whether magnesium sulfate administration for neuroprotection prolongs latency in women with preterm premature rupture of membranes (PPROM) between 24 and 31(6/7) weeks' gestation. STUDY DESIGN This is a secondary analysis of a randomized controlled trial of magnesium sulfate for prevention of cerebral palsy. Gravid women with a singleton pregnancy between 24 and 31(6/7) weeks' gestation with PPROM without evidence of labor were randomized to receive magnesium sulfate, administered intravenously as a 6-g bolus followed by a constant infusion of 2 g per hour up to 12 hours, or placebo. Maternal outcomes for this analysis were delivery in less than 48 hours and in less than 7 days from randomization. Neonatal outcomes included a composite of respiratory distress syndrome, interventricular hemorrhage grades 3 or 4, periventricular leukomalacia, sepsis, necrotizing enterocolitis, retinopathy of prematurity, or death. RESULTS A total of 1,259 women were included. The rate of delivery < 48 hours was not different in the magnesium sulfate and the placebo groups (22.2 and 20.7%, p = 0.51). Delivery < 7 days was similar between groups (55.4 and 51.4%, p = 0.16). Median latency was also similar between groups (median [interquartile range], 6.0 days [range, 2.4-13.8 days] and 6.6 days [range, 2.4-15.1 days], p = 0.29). Composite neonatal outcomes did not differ between groups. CONCLUSION Magnesium sulfate administration given for neuroprotection in women with a singleton gestation with PPROM and without labor before 32 weeks does not impact latency.
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Affiliation(s)
- Yinglei Lai
- Department of Obstetrics and Gynecology, George Washington University Biostatistics Center, Washington, District of Columbia
| | - Dwight Rouse
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Catherine Spong
- The Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland
| | - Kenneth Leveno
- Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Michael Varner
- Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, Utah
| | - Brian Mercer
- Department of Obstetrics and Gynecology, Case Western Reserve University-MetroHealth Medical Center, Cleveland, Ohio
| | - Jay Iams
- Department of Obstetrics and Gynecology, The Ohio State University, Columbus, Ohio
| | - Ronald Wapner
- Department of Obstetrics and Gynecology, Thomas Jefferson University and Drexel University, Philadelphia, Pennsylvania
| | - Yoram Sorokin
- Department of Obstetrics and Gynecology, Wayne State University, Detroit, Michigan
| | - John Thorp
- Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Susan Ramin
- Department of Obstetrics and Gynecology, University of Texas Health Science Center at Houston-Children's Memorial Hermann Hospital, Houston, Texas
| | - Fergal Malone
- Department of Obstetrics and Gynecology, Columbia University, New York, New York
| | - Mary O'Sullivan
- Department of Obstetrics and Gynecology, University of Miami, Miami, Florida
| | - Gary Hankins
- Department of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston, Texas
| | - Steve Caritis
- Department of Obstetrics and Gynecology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Amanda Horton
- Department of Obstetrics and Gynecology, NorthShore University Health System, Evanston, Illinois
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Refuerzo JS, Gowen R, Pedroza C, Hutchinson M, Blackwell SC, Ramin S. A pilot randomized, controlled trial of metformin versus insulin in women with type 2 diabetes mellitus during pregnancy. Am J Perinatol 2015; 30:163-70. [PMID: 24896141 DOI: 10.1055/s-0034-1378144] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [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: 10/25/2022]
Abstract
OBJECTIVE Few studies support oral diabetic treatment in pregnant women with type 2 diabetes mellitus (T2DM). The objective of this study was to compare the effects of metformin versus insulin on achieving glycemic control and improving maternal and neonatal outcomes in pregnant women with T2DM. STUDY DESIGN A pilot randomized, controlled trial was conducted of metformin versus insulin for the treatment of T2DM during pregnancy. The primary outcome was glycemic control measured with hemoglobin A1c < 7% at delivery. Maternal and neonatal outcomes were compared between groups. RESULTS In this study, 8 women received metformin and 11 received insulin. All women in both groups achieved glycemic control by delivery (HgbA1c: metformin 5.96 ± 5.88 vs. insulin 6.34 ± 0.92%). There were similar rates of cesarean delivery, birth weights, neonatal intensive care unit admissions, respiratory distress syndrome, and neonatal dextrose treatment between groups. There was one case of fetal macrosomia in the insulin group, one case of shoulder dystocia in the metformin group and no cases of failed metformin therapy. CONCLUSION In this pilot study, glycemic control was achieved in women who received metformin and insulin. Larger studies are needed to determine whether metformin can be considered a reasonable alternative to insulin in pregnant women with T2DM.
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Affiliation(s)
- Jerrie S Refuerzo
- Division of Maternal Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, University of Texas Health Science Center at Houston, Houston, Texas
| | - Rose Gowen
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Texas Health Science Center at Brownsville, Brownsville, Texas
| | - Claudia Pedroza
- Center for Clinical Research and Evidence-Based Medicine, University of Texas Health Science Center at Houston, Houston, Texas
| | - Maria Hutchinson
- Division of Maternal Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, University of Texas Health Science Center at Houston, Houston, Texas
| | - Sean C Blackwell
- Division of Maternal Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, University of Texas Health Science Center at Houston, Houston, Texas
| | - Susan Ramin
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas
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Lai Y, Rouse D, Spong C, Mercer B, Varner M, Thorp J, Ramin S, Malone F, O'Sullivan M, Hankins G, Peaceman A. Length of latency with preterm premature rupture of membranes before 32 weeks' gestation. Am J Perinatol 2015; 32:57-62. [PMID: 24819145 PMCID: PMC4250427 DOI: 10.1055/s-0034-1373846] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVE The objective of the article is to describe latency for patients with preterm premature membrane rupture (PPROM) between 24(0/7) and 31(6/7) weeks' gestation. STUDY DESIGN Secondary analysis of data collected prospectively in a multicenter clinical trial of magnesium sulfate for cerebral palsy prevention. Women with PPROM and fewer than six contractions per hour at enrollment who were candidates for expectant management (n = 1,377) were included in this analysis. Length of latency was calculated in days by subtracting the time of delivery from the time of membrane rupture. RESULTS At each week of gestation, median latency between 24 and 28 weeks was similar at approximately 9 days, but it was significantly shorter with PPROM at 29, 30, and 31 weeks (p < 0.001). In addition, the percentage of patients remaining undelivered at 7 days and 14 days was similar for PPROM between 24 and 28 weeks, but it decreased significantly after that. For each gestational age, the proportion of patients remaining pregnant declined in a fashion similar to an exponential pattern. CONCLUSION Median latency after PPROM is similar from 24 to 28 weeks' gestation, but it shortens with PPROM at and after 29 weeks.
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Affiliation(s)
- Yinglei Lai
- Department of Obstetrics and Gynecology, The George Washington University Biostatistics Center, Washington, District of Columbia
| | - Dwight Rouse
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham Alabama
| | | | - Brian Mercer
- Department of Obstetrics and Gynecology, Case Western Reserve University-MetroHealth Medical Center, Cleveland, Ohio
| | - Michael Varner
- Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, Utah
| | - John Thorp
- Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Susan Ramin
- Department of Obstetrics and Gynecology, University of Texas Health Science Center at Houston, Houston, Texas
| | - Fergal Malone
- Department of Obstetrics and Gynecology, Columbia University, New York, New York
| | - Mary O'Sullivan
- Department of Obstetrics and Gynecology, University of Miami, Miami, Florida
| | - Gary Hankins
- Department of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston, Texas
| | - Alan Peaceman
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Mele L, Landon M, Spong C, Ramin S, Wapner R, Varner M, Rouse D, Thorp J, Catalano P, Harper M, Saade G, Sorokin Y, Peaceman A, Casey B. Does maternal body mass index influence treatment effect in women with mild gestational diabetes? Am J Perinatol 2015; 32:93-100. [PMID: 24839145 PMCID: PMC4314711 DOI: 10.1055/s-0034-1374815] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVE The aim of the article is to determine whether maternal body mass index (BMI) influences the beneficial effects of diabetes treatment in women with gestational diabetes mellitus (GDM). STUDY DESIGN Secondary analysis of a multicenter randomized treatment trial of women with GDM. Outcomes of interest were elevated umbilical cord c-peptide levels (> 90th percentile 1.77 ng/mL), large for gestational age (LGA) birth weight (> 90th percentile), and neonatal fat mass (g). Women were grouped into five BMI categories adapted from the World Health Organization International Classification of normal, overweight, and obese adults. Outcomes were analyzed according to treatment group assignment. RESULTS A total of 958 women were enrolled (485 treated and 473 controls). Maternal BMI at enrollment was not related to umbilical cord c-peptide levels. However, treatment of women in the overweight, Class I, and Class II obese categories was associated with a reduction in both LGA birth weight and neonatal fat mass. Neither measure of excess fetal growth was reduced with treatment in normal weight (BMI < 25 kg/m(2)) or Class III (BMI ≥ 40 kg/m(2)) obese women. CONCLUSION There was a beneficial effect of treatment on fetal growth in women with mild GDM who were overweight or Class I and Class II obese. These effects were not apparent for normal weight and very obese women.
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Affiliation(s)
- Lisa Mele
- The George Washington University Biostatistics Center, Washington, District of Columbia
| | - Mark Landon
- Department of Obstetrics and Gynecology, The Ohio State University, Columbus, Ohio
| | | | - Susan Ramin
- Department of Obstetrics and Gynecology, University of Texas Health Science Center at Houston, Houston, Texas
| | - Ronald Wapner
- Department of Obstetrics and Gynecology, Columbia University, New York, New York
| | - Michael Varner
- Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, Utah
| | - Dwight Rouse
- Department of Obstetrics and Gynecology, University of Alabama, Birmingham, Alabama
| | - John Thorp
- Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, North Carolina
| | - Patrick Catalano
- Department of Obstetrics and Gynecology, Case Western Reserve University-MetroHealth Medical Center, Cleveland, Ohio
| | - Margaret Harper
- Department of Obstetrics and Gynecology, Wake Forest University Health Sciences, Winston-Salem, North Carolina
| | - George Saade
- Department of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston, Texas
| | - Yoram Sorokin
- Department of Obstetrics and Gynecology, Wayne State University, Detroit, Michigan
| | - Alan Peaceman
- Department of Obstetrics and Gynecology, Northwestern University, Chicago, Illinois
| | - Brian Casey
- Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, Texas
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Smith J, Sallman MA, Berens P, Viteri O, Hutchinson M, Ramin S, Blackwell S, Refuerzo J. 658: Metformin improved lipid profiles in women with gestational diabetes in the first six weeks postpartum. Am J Obstet Gynecol 2015. [DOI: 10.1016/j.ajog.2014.10.864] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [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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Vidaeff A, Banadakoppa M, Yallampalli U, Ramin S, Belfort M, Yallampalli C. 119: Early evidence for increased complement activation in the amniotic fluid of women subsequently developing early-onset preeclampsia. Am J Obstet Gynecol 2015. [DOI: 10.1016/j.ajog.2014.10.165] [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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Yallampalli C, Vidaeff A, Yallampalli U, Ramin S, Fox K, Belfort M, Chauhan M. 451: Adrenomedullin2 (ADM2) is expressed in fetal membranes and lower amniotic fluid levels are associated with preeclampsia. Am J Obstet Gynecol 2015. [DOI: 10.1016/j.ajog.2014.10.497] [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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Ballas J, Sachs M, Lee W, Espinoza J, Ramin S, Aagaard K, Monga M. 580: Predictors and barriers to influenza and tdap vaccine uptake among women receiving prenatal care within an urban county hospital system. Am J Obstet Gynecol 2015. [DOI: 10.1016/j.ajog.2014.10.786] [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: 10/24/2022]
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Clifton R, Roberts J, Myatt L, Hauth J, Leveno K, Varner M, Thorp J, Mercer B, Peaceman A, Ramin S, Iams J, Sciscione A, Tolosa J, Sorokin Y, Makhlouf M. Adverse pregnancy outcomes among women with prior spontaneous or induced abortions. Am J Perinatol 2014; 31:765-72. [PMID: 24347257 PMCID: PMC4061262 DOI: 10.1055/s-0033-1358771] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVE The aim of the article is to determine whether prior spontaneous abortion (SAB) or induced abortion (IAB), or the interpregnancy interval are associated with subsequent adverse pregnancy outcomes in nulliparous women. METHODS We performed a secondary analysis of data collected from nulliparous women enrolled in a completed trial of vitamins C and E or placebo for preeclampsia prevention. Adjusted odds ratios (ORs) for maternal and fetal outcomes were determined for nulliparous women with prior SABs and IABs as compared with primigravid participants. RESULTS Compared with primigravidas, women with one prior SAB were at increased risk for perinatal death (adj. OR, 1.5; 95% CI, 1.1-2.3) in subsequent pregnancies. Two or more SABs were associated with an increased risk for spontaneous preterm birth (PTB) (adj. OR, 2.6, 95% CI, 1.7-4.0), preterm premature rupture of membranes (PROM) (adj. OR, 2.9; 95% CI, 1.6-5.3), and perinatal death (adj. OR, 2.8; 95% CI, 1.5-5.3). Women with one previous IAB had higher rates of spontaneous PTB (adj. OR, 1.4; 95% CI, 1.0-1.9) and preterm PROM (OR, 2.0; 95% CI, 1.4-3.0). An interpregnancy interval less than 6 months after SAB was not associated with adverse outcomes. CONCLUSION Nulliparous women with a history of SAB or IAB, especially multiple SABs, are at increased risk for adverse pregnancy outcomes.
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Affiliation(s)
- Rebecca Clifton
- The George Washington University Biostatistics Center, Washington, DC
| | - James Roberts
- Department of Obstetrics and Gynecology University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Leslie Myatt
- Department of Obstetrics and Gynecology, University of Cincinnati, Cincinnati, Ohio
| | - John Hauth
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Kenneth Leveno
- Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Michael Varner
- Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, Utah
| | - John Thorp
- Department of Obstetrics and Gynecology University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Brian Mercer
- Department of Obstetrics and Gynecology, Case Western Reserve University-MetroHealth Medical Center, Cleveland, Ohio
| | - Alan Peaceman
- Department of Obstetrics and Gynecology, Northwestern University, Chicago, Illinois
| | - Susan Ramin
- Department of Obstetrics and Gynecology University of Texas Health Science Center at Houston, Houston, Texas
| | - Jay Iams
- Department of Obstetrics and Gynecology, The Ohio State University, Columbus, Ohio
| | - Anthony Sciscione
- Department of Obstetrics and Gynecology, Drexel University, Philadelphia, Pennsylvania
| | - Jorge Tolosa
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, Oregon
| | - Yoram Sorokin
- Department of Obstetrics and Gynecology, Wayne State University, Detroit, Michigan
| | - Michel Makhlouf
- Department of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston, Texas
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Romero R, Mele L, Iams J, Peaceman A, Leveno K, Harper M, Caritis S, Mercer B, Thorp J, O'Sullivan M, Ramin S, Carpenter M, Rouse D, Sibai B, Sorokin Y. Umbilical cord serum interleukin-6, C-reactive protein, and myeloperoxidase concentrations at birth and association with neonatal morbidities and long-term neurodevelopmental outcomes. Am J Perinatol 2014; 31:717-26. [PMID: 24338120 PMCID: PMC4359689 DOI: 10.1055/s-0033-1359723] [Citation(s) in RCA: 20] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVE The aim of the study is to determine if umbilical cord serum concentrations of interleukin-6 (IL-6), C-reactive protein (CRP), and myeloperoxidase (MPO), in pregnancies at risk for preterm birth (PTB), are associated with neonatal morbidities and/or altered neurodevelopmental outcomes in the children. STUDY DESIGN Umbilical cord serum samples were collected at birth from 400 newborns delivered within a multicenter randomized controlled trial of repeated versus single course of antenatal corticosteroids (ACs), in women at increased risk for PTB. Newborns were followed through discharge and were evaluated between 36 and 42 months corrected age with neurological examination and Bayley Scales of Infant Development. Umbilical cord serum concentrations of IL-6, CRP, and MPO were determined using enzyme-linked immunoassays. Multivariate logistic regression analyses explored the relationship between umbilical cord serum IL-6, CRP, and MPO levels, adverse newborn outcomes, and PTB < 32 weeks of gestational age (GA). RESULTS Univariate analysis revealed that umbilical cord IL-6 above the 75th percentile was associated with increased respiratory distress syndrome (RDS) and chronic lung disease (CLD), but not with necrotizing enterocolitis (NEC), intraventricular hemorrhage (IVH), or neonatal sepsis; however, this association was not significant after adjusting for GA at delivery and treatment group. No significant associations between CRP or MPO and RDS, CLD, NEC, sepsis, or IVH were evident. Regression analysis revealed that CRP above the 75th percentile was associated with a decreased risk of CLD (odds ratio, 0.10; 95% confidence interval, 0.02-0.41). No associations between umbilical cord IL-6, CRP, or MPO and MDI < 70 or PDI < 70 were evident. Umbilical cord serum concentrations of IL-6, CRP, and MPO, above the 75th percentile, were associated with more frequent PTB < 32 weeks of GA. CONCLUSION Elevated umbilical cord serum concentration of CRP is associated with reduced risk for CLD even after adjusting for GA at delivery. Occurrence of levels > 75th percentile of IL-6, CRP, and MPO in umbilical cord serum was associated with PTB < 32 weeks of GA. Elevated umbilical cord serum concentrations of IL-6, CRP, and MPO at birth were not associated with poor neurodevelopmental outcomes.
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Affiliation(s)
| | - Lisa Mele
- Biostatistics Center, The George Washington University, Washington, District of Columbia
| | - Jay Iams
- Department of Obstetrics and Gynecology, The Ohio State University, Columbus, Ohio
| | - Alan Peaceman
- Department of Obstetrics and Gynecology, Northwestern University, Chicago, Illinois
| | - Kenneth Leveno
- Department of Obstetrics and Gynecology, The University of Texas Southwestern Medical Center, Dallas, Texas
| | - Margaret Harper
- Department of Obstetrics and Gynecology, Wake Forest University Health Sciences, Winston-Salem, North Carolina
| | - Steve Caritis
- Department of Obstetrics and Gynecology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Brian Mercer
- Department of Obstetrics and Gynecology, MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio
| | - John Thorp
- Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Mary O'Sullivan
- Department of Obstetrics and Gynecology, University of Miami, Miami, Florida
| | - Susan Ramin
- Department of Obstetrics and Gynecology, The University of Texas Health Science Center at Houston, Houston, Texas
| | - Marshall Carpenter
- Department of Obstetrics and Gynecology, Brown University, Providence, Rhode Island
| | - Dwight Rouse
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Baha Sibai
- Department of Obstetrics and Gynecology, University of Tennessee, Memphis, Tennessee
| | - Yoram Sorokin
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Wayne State University, Detroit, Michigan
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18
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Caritis SN, Venkataramanan R, Thom E, Harper M, Klebanoff MA, Sorokin Y, Thorp JM, Varner MW, Wapner RJ, Iams JD, Carpenter MW, Grobman WA, Mercer BM, Sciscione A, Rouse DJ, Ramin S. Relationship between 17-alpha hydroxyprogesterone caproate concentration and spontaneous preterm birth. Am J Obstet Gynecol 2014; 210:128.e1-6. [PMID: 24113254 DOI: 10.1016/j.ajog.2013.10.008] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [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: 07/10/2013] [Revised: 09/10/2013] [Accepted: 10/04/2013] [Indexed: 11/19/2022]
Abstract
OBJECTIVE 17-alpha hydroxyprogesterone caproate 250 mg weekly reduces recurrent spontaneous preterm birth in women with a prior spontaneous preterm birth by 33%. The dose is not based on pharmacologic considerations. A therapeutic concentration has not been determined hampering any attempt to optimize treatment. This study evaluated the relationship between 17-alpha hydroxyprogesterone caproate plasma concentrations and the rate of spontaneous preterm birth in women with singleton gestation. STUDY DESIGN A single blood sample was obtained between 25 and 28 weeks' gestation from 315 women with a spontaneous preterm birth who participated in a placebo-controlled, prospective, randomized clinical trial evaluating the benefit of omega-3 supplementation in reducing preterm birth. All women in the parent study received 17-alpha hydroxyprogesterone caproate and 434 received omega-3 supplementation and 418 received a placebo. Plasma from 315 consenting women was analyzed for 17-alpha hydroxyprogesterone caproate concentration. RESULTS There were no differences between placebo and omega-3 supplemented groups in demographic variables, outcomes or in mean 17-alpha hydroxyprogesterone caproate concentration. Plasma concentrations of 17-alpha hydroxyprogesterone caproate ranged from 3.7-56 ng/mL. Women with plasma concentrations of 17-alpha hydroxyprogesterone caproate in the lowest quartile had a significantly higher risk of spontaneous preterm birth (P = .03) and delivered at significantly earlier gestational ages (P = .002) than did women in the second to fourth quartiles. The lowest preterm birth rates were seen when median 17-alpha hydroxyprogesterone caproate concentrations exceeded 6.4 ng/mL. CONCLUSION Low plasma 17-alpha hydroxyprogesterone caproate concentration is associated with an increased risk of spontaneous preterm birth. This finding validates efficacy of this treatment but suggests that additional studies are needed to determine the optimal dosage.
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Affiliation(s)
- Steve N Caritis
- Department of Obstetrics and Gynecology and Reproductive Sciences and Pharmaceutical Sciences, University of Pittsburgh Schools of Medicine and Pharmacy, Pittsburgh, PA
| | - Raman Venkataramanan
- Department of Obstetrics and Gynecology and Reproductive Sciences and Pharmaceutical Sciences, University of Pittsburgh Schools of Medicine and Pharmacy, Pittsburgh, PA
| | - Elizabeth Thom
- The George Washington University Biostatistics Center, Washington, DC
| | - Margaret Harper
- Department of Obstetrics and Gynecology, Wake Forest University Health Sciences, Winston-Salem, and University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Mark A Klebanoff
- Maternal-Fetal Medicine Units, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD
| | - Yoram Sorokin
- Department of Obstetrics and Gynecology, Wayne State University, Detroit, MI
| | - John M Thorp
- Department of Obstetrics and Gynecology, Wake Forest University Health Sciences, Winston-Salem, and University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Michael W Varner
- Department of Obstetrics and Gynecology, University of Utah Health Sciences Center, Salt Lake City, UT
| | - Ronald J Wapner
- Department of Obstetrics and Gynecology, College of Physicians and Surgeons, Columbia University, New York, NY
| | - Jay D Iams
- Department of Obstetrics and Gynecology, The Ohio State University, Columbus, OH
| | - Marshall W Carpenter
- Department of Obstetrics and Gynecology, Women and Infants Hospital, Alpert Medical School, Brown University, Providence, RI
| | - William A Grobman
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Brian M Mercer
- Department of Obstetrics and Gynecology, Case Western Reserve University-MetroHealth Medical Center, Cleveland, OH
| | | | - Dwight J Rouse
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham School of Medicine, Birmingham, AL
| | - Susan Ramin
- Department of Obstetrics and Gynecology, University of Texas Health Science Center at Houston, Houston, TX
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19
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Yonkers KA, Wisner KL, Stewart DE, Oberlander TF, Dell DL, Stotland N, Ramin S, Chaudron L, Lockwood C. The Management of Depression During Pregnancy: A Report from the American Psychiatric Association and the American College of Obstetricians and Gynecologists. FOC 2012. [DOI: 10.1176/appi.focus.10.1.78] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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20
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Caritis SN, Sharma S, Venkataramanan R, Rouse DJ, Peaceman AM, Sciscione A, Spong CY, Varner MW, Malone FD, Iams JD, Mercer BM, Thorp JM, Sorokin Y, Carpenter M, Lo J, Ramin S, Harper M. Pharmacokinetics of 17-hydroxyprogesterone caproate in multifetal gestation. Am J Obstet Gynecol 2011; 205:40.e1-8. [PMID: 21620357 DOI: 10.1016/j.ajog.2011.03.028] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2011] [Revised: 02/18/2011] [Accepted: 03/14/2011] [Indexed: 10/18/2022]
Abstract
OBJECTIVE The purpose of this study was to define the pharmacokinetic parameters of 17-hydroxyprogesterone caproate (17-OHPC) in multifetal gestation. STUDY DESIGN Blood was obtained at 24-28 weeks' gestation and at 32-35 weeks gestation in 97 women with twin and 26 women with triplet gestation who were receiving 17-OHPC. Six of the women with twins had daily blood sampling for 7 days between 24 and 28 weeks' gestation, and pharmacokinetic parameters were estimated with the use of noncompartmental analysis. Modeling was applied to estimate the population parameters and to simulate various treatment scenarios. RESULTS The apparent half-life of 17-OHPC was 10 days. Body mass index significantly impacted 17-OHPC concentrations, but fetal number and parity did not. Apparent clearance was significantly greater in African American than in white women (P = .025). CONCLUSION This is the first pharmacokinetic analysis of 17-OHPC in pregnant women. Determination of half-life, covariates that affect plasma 17-OHPC concentrations, and the modeling of drug behavior provide insights into this drug's pharmacologic properties during multifetal pregnancy.
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21
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Holland M, Ramin S, Bishop K, Mastrobattista J. 374: Cidex OPA effectively eradicates bacteria after 5 minutes. Am J Obstet Gynecol 2009. [DOI: 10.1016/j.ajog.2009.10.389] [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: 10/20/2022]
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22
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Vidaeff A, Monga M, Bishop K, Ramin S. 474: Prospective investigation of second trimester thrombin activation and preterm birth. Am J Obstet Gynecol 2009. [DOI: 10.1016/j.ajog.2009.10.640] [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: 10/20/2022]
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23
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Nuthalapaty F, Lu G, Ramin S, Nuthalapaty E, Ramin KD, Ramsey PS. Is there a preferred gestational age threshold of viability?: A survey of maternal-fetal medicine providers. J Matern Fetal Neonatal Med 2009; 20:293-7. [PMID: 17437236 DOI: 10.1080/14767050701198821] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To characterize variation and factors associated with the perceived gestational age for the threshold of viability among maternal-fetal medicine (MFM) providers. METHODS We performed a web-based online survey of 1375 MFM providers. For this secondary analysis, a subset of survey questions targeted toward perceptions of the limit of viability was analyzed to identify how the respondents viewed the optimal threshold of viability gestational age. Comparative statistics were performed to assess various characteristics that influence the perceived threshold of viability. RESULTS Five hundred and eight providers (37%), representing all 50 states and 13 countries, responded to the survey. The reported threshold of viability varied among survey respondents: 22 weeks, 2.0%; 23 weeks, 37.2%; 24 weeks, 55.3%; 25 weeks, 3.4%; and 26 weeks, 2.2%. No significant differences were noted in the reported threshold of viability with respect to practitioner age (<50 years old vs. > or =50 years old, p = 0.42), nursery availability (level III vs. other, p = 0.46), and years in practice (<10 years vs. > or =10 years, p = 0.86). Significant differences in the reported threshold of viability were noted with respect to practitioner gender with males tending to have a lower gestational age threshold than females (p = 0.005). Significant differences were also noted among practitioners from academic vs. community/private practice settings (p = 0.008). A logisitic regression model, adusting for both gender and practice setting, revealed that male gender was independently associated with selection of a threshold of viability less than 24 weeks of gestation: male gender OR 1.8 (95% CI 1.3-2.7, p = 0.002); academic practice setting OR 1.1 (95% CI 0.8-1.6, p = 0.50). CONCLUSIONS Perceived threshold of viability among MFM providers varies with the majority of practitioners identifying 23-24 weeks of gestation. Significant difference, however, exists between practitioner genders.
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Affiliation(s)
- Francis Nuthalapaty
- Center for Research in Women's Health, Division of Maternal-Fetal Medicine, University of Alabama at Birmingham, Birmingham, AL 35249-7333, USA
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24
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Caritis SN, Rouse DJ, Peaceman AM, Sciscione A, Momirova V, Spong CY, Iams JD, Wapner RJ, Varner M, Carpenter M, Lo J, Thorp J, Mercer BM, Sorokin Y, Harper M, Ramin S, Anderson G. Prevention of preterm birth in triplets using 17 alpha-hydroxyprogesterone caproate: a randomized controlled trial. Obstet Gynecol 2009; 113:285-92. [PMID: 19155896 PMCID: PMC2790283 DOI: 10.1097/aog.0b013e318193c677] [Citation(s) in RCA: 103] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To assess whether 17 alpha-hydroxyprogesterone caproate reduces the rate of preterm birth in women carrying triplets. METHODS We performed this randomized, double-blinded, placebo-controlled trial in 14 centers. Healthy women with triplets were randomly assigned to weekly intramuscular injections of either 250 mg of 17 alpha-hydroxyprogesterone caproate or matching placebo, starting at 16-20 weeks and ending at delivery or 35 weeks of gestation. The primary study outcome was delivery or fetal loss before 35 weeks. RESULTS One hundred thirty-four women were assigned, 71 to 17 alpha-hydroxyprogesterone caproate and 63 to placebo; none were lost to follow-up. Baseline demographic data were similar in the two groups. The proportion of women experiencing the primary outcome (a composite of delivery or fetal loss before 35 0/7 weeks) was similar in the two treatment groups: 83% of pregnancies in the 17 alpha-hydroxyprogesterone caproate group and 84% in the placebo group, relative risk 1.0, 95% confidence interval 0.9-1.1. The lack of benefit of 17 alpha-hydroxyprogesterone caproate was evident regardless of the conception method or whether a gestational age cutoff for delivery was set at 32 or 28 weeks. CONCLUSION Treatment with 17 alpha-hydroxyprogesterone caproate did not reduce the rate of preterm birth in women with triplet gestations. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov, www.clinicaltrials.gov, NCT00099164 LEVEL OF EVIDENCE I.
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Affiliation(s)
- Steve N Caritis
- Departments of Obstetrics and Gynecology, University of Pittsburgh, Pittsburgh, PA 15213, USA.
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25
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Yonkers KA, Wisner KL, Stewart DE, Oberlander TF, Dell DL, Stotland N, Ramin S, Chaudron L, Lockwood C. The management of depression during pregnancy: a report from the American Psychiatric Association and the American College of Obstetricians and Gynecologists. Gen Hosp Psychiatry 2009; 31:403-13. [PMID: 19703633 PMCID: PMC3094693 DOI: 10.1016/j.genhosppsych.2009.04.003] [Citation(s) in RCA: 276] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2009] [Revised: 04/08/2009] [Accepted: 04/09/2009] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To address the maternal and neonatal risks of both depression and antidepressant exposure and develop algorithms for periconceptional and antenatal management. METHOD Representatives from the American Psychiatric Association, the American College of Obstetricians and Gynecologists and a consulting developmental pediatrician collaborated to review English language articles on fetal and neonatal outcomes associated with depression and antidepressant treatment during childbearing. Articles were obtained from Medline searches and bibliographies. Search keywords included pregnancy, pregnancy complications, pregnancy outcomes, depressive disorder, depressive disorder/dt, abnormalities/drug-induced/epidemiology, abnormalities/drug-induced/et. Iterative draft manuscripts were reviewed until consensus was achieved. RESULTS Both depressive symptoms and antidepressant exposure are associated with fetal growth changes and shorter gestations, but the majority of studies that evaluated antidepressant risks were unable to control for the possible effects of a depressive disorder. Short-term neonatal irritability and neurobehavioral changes are also linked with maternal depression and antidepressant treatment. Several studies report fetal malformations in association with first trimester antidepressant exposure but there is no specific pattern of defects for individual medications or class of agents. The association between paroxetine and cardiac defects is more often found in studies that included all malformations rather than clinically significant malformations. Late gestational use of selective serotonin reuptake inhibitor antidepressants is associated with transitory neonatal signs and a low risk for persistent pulmonary hypertension in the newborn. Psychotherapy alone is an appropriate treatment for some pregnant women; however, others prefer pharmacotherapy or may require pharmacological treatment. CONCLUSIONS Antidepressant use in pregnancy is well studied, but available research has not yet adequately controlled for other factors that may influence birth outcomes including maternal illness or problematic health behaviors that can adversely affect pregnancy.
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Affiliation(s)
- Kimberly A. Yonkers
- Department of Psychiatry, Epidemiology and Public Health, Yale School of Medicine, New Haven, CT 06510, USA,Department of Obstetrics and Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, CT 06510, USA,Corresponding author. Department of Psychiatry, Epidemiology and Public Health, Yale School of Medicine, New Haven, CT, USA. Fax: +1 203 764 6766. (K.A. Yonkers)
| | - Katherine L. Wisner
- Department of Psychiatry, Obstetrics and Gynecology, Women's Behavioral, HealthCARE, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA,Department of Reproductive Sciences, Epidemiology and Women's Studies, Women's Behavioral, HealthCARE, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA
| | - Donna E. Stewart
- Departments of Psychiatry, Obstetrics and Gynecology, Family and Community Medicine, Medicine, Surgery and Anesthesia, University Health Network Women's Health Program, University of Toronto, Toronto, Ontario, Canada M5G 2C4
| | - Tim F. Oberlander
- Department of Pediatrics, University of British Columbia, Human Early Experience Unit, Centre for Community Child Health Research, Child and Family Research Institute, Vancouver, British Columbia, Canada V6 3V4
| | - Diana L. Dell
- Duke University Medical Center, DUMC Box 3263, Durham, NC 27710, USA
| | - Nada Stotland
- Department of Psychiatry and Obstetrics, Rush Medical College Chicago, IL 60637, USA,Department of Gynecology, Rush Medical College Chicago, IL 60637, USA
| | - Susan Ramin
- The University of Texas Health Science Center at Houston, Department of Obstetrics, Gynecology, and Reproductive Sciences, Division of Maternal–Fetal Medicine, Houston, TX 77030, USA
| | - Linda Chaudron
- Department of Psychiatry, Pediatrics and Obstetrics and Gynecology, University of Rochester, Rochester, NY 14642, USA
| | - Charles Lockwood
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, PO Box 208063, New Haven, CT 06520-8063, USA
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Bakhshi T, Zabriskie RC, Bodie S, Kidd S, Ramin S, Paganessi LA, Gregory SA, Fung HC, Christopherson KW. Mesenchymal stem cells from the Wharton's jelly of umbilical cord segments provide stromal support for the maintenance of cord blood hematopoietic stem cells during long-term ex vivo culture. Transfusion 2008; 48:2638-44. [PMID: 18798803 PMCID: PMC3444149 DOI: 10.1111/j.1537-2995.2008.01926.x] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Hematopoietic stem cells (HSCs) are routinely obtained from marrow, mobilized peripheral blood, and umbilical cord blood. Mesenchymal stem cells (MSCs) are traditionally isolated from marrow. Bone marrow-derived MSCs (BM-MSCs) have previously demonstrated their ability to act as a feeder layer in support of ex vivo cord blood expansion. However, the use of BM-MSCs to support the growth, differentiation, and engraftment of cord blood may not be ideal for transplant purposes. Therefore, the potential of MSCs from a novel source, the Wharton's jelly of umbilical cords, to act as stromal support for the long-term culture of cord blood HSC was evaluated. STUDY DESIGN AND METHODS Umbilical cord-derived MSCs (UC-MSCs) were cultured from the Wharton's jelly of umbilical cord segments. The UC-MSCs were then profiled for expression of 12 cell surface receptors and tested for their ability to support cord blood HSCs in a long-term culture-initiating cell (LTC-IC) assay. RESULTS Upon culture, UC-MSCs express a defined set of cell surface markers (CD29, CD44, CD73, CD90, CD105, CD166, and HLA-A) and lack other markers (CD45, CD34, CD38, CD117, and HLA-DR) similar to BM-MSCs. Like BM-MSCs, UC-MSCs effectively support the growth of CD34+ cord blood cells in LTC-IC assays. CONCLUSION These data suggest the potential therapeutic application of Wharton's jelly-derived UC-MSCs to provide stromal support structure for the long-term culture of cord blood HSCs as well as the possibility of cotransplantation of genetically identical, HLA-matched, or unmatched cord blood HSCs and UC-MSCs in the setting of HSC transplantation.
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Affiliation(s)
- Tiki Bakhshi
- Division of Maternal-Fetal Medicine, The University of Texas Medical School at Houston, Houston, Texas, USA
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27
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Wapner RJ, Sorokin Y, Mele L, Johnson F, Dudley DJ, Spong CY, Peaceman AM, Leveno KJ, Malone F, Caritis SN, Mercer B, Harper M, Rouse DJ, Thorp JM, Ramin S, Carpenter MW, Gabbe SG. Long-term outcomes after repeat doses of antenatal corticosteroids. N Engl J Med 2007; 357:1190-8. [PMID: 17881751 DOI: 10.1056/nejmoa071453] [Citation(s) in RCA: 200] [Impact Index Per Article: 11.8] [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: 11/19/2022]
Abstract
BACKGROUND Previous trials have shown that repeat courses of antenatal corticosteroids improve some neonatal outcomes in preterm infants but reduce birth weight and increase the risk of intrauterine growth restriction. We report long-term follow-up results of children enrolled in a randomized trial comparing single and repeat courses of antenatal corticosteroids. METHODS Women at 23 through 31 weeks of gestation who remained pregnant 7 days after an initial course of corticosteroids were randomly assigned to weekly courses of betamethasone, consisting of 12 mg given intramuscularly and repeated once at 24 hours, or an identical-appearing placebo. We studied the children who were born after these treatments when they were between 2 and 3 years of corrected age. Prespecified outcomes included scores on the Bayley Scales of Infant Development, anthropometric measurements, and the presence of cerebral palsy. RESULTS A total of 556 infants were available for follow-up; 486 children (87.4%) underwent physical examination and 465 (83.6%) underwent Bayley testing at a mean (+/-SD) corrected age of 29.3+/-4.6 months. There were no significant differences in Bayley results or anthropometric measurements. Six children (2.9% of pregnancies) in the repeat-corticosteroid group had cerebral palsy as compared with one child (0.5% of pregnancies) in the placebo group (relative risk, 5.7; 95% confidence interval, 0.7 to 46.7; P=0.12). CONCLUSIONS Children who had been exposed to repeat as compared with single courses of antenatal corticosteroids did not differ significantly in physical or neurocognitive measures. Although the difference was not statistically significant, the higher rate of cerebral palsy among children who had been exposed to repeat doses of corticosteroids is of concern and warrants further study. (ClinicalTrials.gov number, NCT00015002 [ClinicalTrials.gov].).
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Sawady J, Mercer BM, Wapner RJ, Zhao Y, Sorokin Y, Johnson F, Dudley DJ, Spong CY, Peaceman AM, Leveno KJ, Harper M, Caritis SN, Miodovnik M, Thorp JM, Ramin S, Carpenter MW, Rouse DJ. The National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network Beneficial Effects of Antenatal Repeated Steroids study: impact of repeated doses of antenatal corticosteroids on placental growth and histologic findings. Am J Obstet Gynecol 2007; 197:281.e1-8. [PMID: 17826421 DOI: 10.1016/j.ajog.2007.06.041] [Citation(s) in RCA: 25] [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] [Subscribe] [Scholar Register] [Received: 03/12/2007] [Revised: 05/04/2007] [Accepted: 06/24/2007] [Indexed: 11/22/2022]
Abstract
OBJECTIVE In utero exposure to repeated doses of antenatal corticosteroids (ACSs) has been shown to reduce fetal growth. Our goal was to evaluate whether weekly betamethasone (R-ACS) alters placental growth and histologic findings. STUDY DESIGN In a multicenter randomized controlled trial of R-ACS vs a single course of ACS followed by weekly placebo (S-ACS), placentas were weighed after removal of the membranes and umbilical cord. A single pathologist who was masked to study group and pregnancy outcomes performed histologic evaluation for placental calcifications, infarction, fibrin deposition, and hemorrhage or thrombus formation, acute and chronic chorioamnionitis, fibromuscular vascular hyperplasia, nucleated red blood cells, and villous crowding, edema, fibrosis, or fibrinoid necrosis. Findings were compared between study groups and according to the number of courses of ACS. RESULTS One hundred ninety-four placentas were available for evaluation. Univariable analyses revealed no differences between study groups in any of the 19 evaluated histologic parameters between R-ACS and S-ACS groups overall or in analyses that were restricted to deliveries at < 32 or > or = 32 weeks of gestation. Calcifications were more common (P = .045) in the R-ACS group after controlling for other factors. Multivariable analysis revealed increasing gestational age at delivery, but not increasing ACS courses, to be associated with decreasing chorionic inflammation, villous edema, and fibrosis and with increasing villus crowding, fibrin deposition, and calcifications. Ninety-three placentas were weighed before formalin fixation. After controlling for delivery gestation and infant gender, placental weight was significantly lower in the R-ACS group (P = .017) and was related inversely to the number of ACS courses (P = .037). This finding was confirmed only for deliveries at > or = 32 weeks of gestation (525 vs 441 g for R-ACS and S-ACS group, respectively; P = .036). CONCLUSION Repeated antenatal corticosteroid treatments in pregnancy are associated with decreased placental growth in a dose-dependent fashion, but not with evident differences in histologic markers of placental inflammation, ischemia, or infarction. Histologic placental abnormalities should not be attributed to repeated courses of corticosteroids.
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Affiliation(s)
- Joram Sawady
- Department of Pathology, Metro Health Medical Center, Case Western Reserve University, Cleveland, OH, USA
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Rouse DJ, Caritis SN, Peaceman AM, Sciscione A, Thom EA, Spong CY, Varner M, Malone F, Iams JD, Mercer BM, Thorp J, Sorokin Y, Carpenter M, Lo J, Ramin S, Harper M, Anderson G. A trial of 17 alpha-hydroxyprogesterone caproate to prevent prematurity in twins. N Engl J Med 2007; 357:454-61. [PMID: 17671253 DOI: 10.1056/nejmoa070641] [Citation(s) in RCA: 297] [Impact Index Per Article: 17.5] [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: 11/19/2022]
Abstract
BACKGROUND In singleton gestations, 17 alpha-hydroxyprogesterone caproate (17P) has been shown to reduce the rate of recurrent preterm birth. This study was undertaken to evaluate whether 17P would reduce the rate of preterm birth in twin gestations. METHODS We performed a randomized, double-blind, placebo-controlled trial in 14 centers. Healthy women with twin gestations were assigned to weekly intramuscular injections of 250 mg of 17P or matching placebo, starting at 16 to 20 weeks of gestation and ending at 35 weeks. The primary study outcome was delivery or fetal death before 35 weeks of gestation. RESULTS Six hundred sixty-one women were randomly assigned to treatment. Baseline demographic data were similar in the two study groups. Six women were lost to follow-up; data from 655 were analyzed (325 in the 17P group and 330 in the placebo group). Delivery or fetal death before 35 weeks occurred in 41.5% of pregnancies in the 17P group and 37.3% of those in the placebo group (relative risk, 1.1; 95% confidence interval [CI], 0.9 to 1.3). The rate of the prespecified composite outcome of serious adverse fetal or neonatal events was 20.2% in the 17P group and 18.0% in the placebo group (relative risk, 1.1; 95% CI, 0.9 to 1.5). Side effects of the injections were frequent in both groups, occurring in 65.9% and 64.4% of subjects, respectively (P=0.69), but were generally mild and limited to the injection site. CONCLUSIONS Treatment with 17 alpha-hydroxyprogesterone caproate did not reduce the rate of preterm birth in women with twin gestations. (ClinicalTrials.gov number, NCT00099164 [ClinicalTrials.gov].).
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Affiliation(s)
- Dwight J Rouse
- Department of Obstetrics and Gynecology, Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham 35249-7333, USA.
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Bakhshi T, Bodie S, Kidd S, Zabriskie R, Ramin S, Christopherson K. Isolation of mesenchymal stem cells from the wharton's jelly of umbilical cord segments. Am J Obstet Gynecol 2006. [DOI: 10.1016/j.ajog.2006.10.408] [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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Wapner RJ, Sorokin Y, Thom EA, Johnson F, Dudley DJ, Spong CY, Peaceman AM, Leveno KJ, Harper M, Caritis SN, Miodovnik M, Mercer B, Thorp JM, Moawad A, O'Sullivan MJ, Ramin S, Carpenter MW, Rouse DJ, Sibai B, Gabbe SG. Single versus weekly courses of antenatal corticosteroids: evaluation of safety and efficacy. Am J Obstet Gynecol 2006; 195:633-42. [PMID: 16846587 DOI: 10.1016/j.ajog.2006.03.087] [Citation(s) in RCA: 212] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2005] [Revised: 02/16/2006] [Accepted: 03/21/2006] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The purpose of this study was to determine if weekly corticosteroids improve neonatal outcome without undue harm. STUDY DESIGN Women 23 to 32 weeks receiving 1 course of corticosteroids 7 to 10 days prior were randomized to weekly betamethasone or placebo. RESULTS The study was terminated by the independent data and safety monitoring committee with 495 of the anticipated 2400 patients enrolled. There was no significant reduction in the composite primary morbidity outcome (8.0% vs 9.1%, P = .67). Repeated courses significantly reduced neonatal surfactant administration (P = .02), mechanical ventilation (P = .004), CPAP (P = .05), pneumothoraces (P = .03). There was no significant difference in mean birth weight or head circumference. The repeat group had a reduction in multiples of the birth weight median by gestational age (0.88 vs 0.91) (P = .01) and more neonates weighing less than the 10th percentile (23.7 vs 15.3%, P = .02). Significant weight reductions occurred for the group receiving > or = 4 courses. CONCLUSION Repeat antenatal corticosteroids significantly reduce specific neonatal morbidities but do not improve composite neonatal outcome. This is accompanied by reduction in birth weight and increase in small for gestational age infants.
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Affiliation(s)
- Ronald J Wapner
- Department of Obstetrics and Gynecology, Drexel University College of Medicine, Philadelphia, PA, USA.
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Nuthalapaty FS, Ramin KD, Lu G, Ramin S, Nuthalapaty ES, Ramsey PS. The relationship between practice setting and management of preterm premature rupture of membranes. J Matern Fetal Neonatal Med 2005; 18:53-7. [PMID: 16105792 DOI: 10.1080/14767050500217681] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To compare preterm premature rupture of membranes (PPROM) management between maternal-fetal medicine (MFM) providers practicing in an academic university (AU) versus other settings (NAU). METHODS Secondary analysis of a national survey of 1375 MFM providers of whom 504 (37%) responded and answered queries on demographic and practice characteristics and various PPROM management issues. RESULTS Fifty-three percent of the respondents were in an AU practice setting. Providers in AU and NAU settings reported a similar prevalence of corticosteroid (99% vs. 100%), antibiotic (99% vs. 100%), and tocolytic (74% vs. 76%) use. There was significant variability between NAU and AU providers in issues related to the evaluation and expectant management of PPROM. NAU providers, as compared to AU providers, more commonly reported performing diagnostic amniocentesis in the acute evaluation of PPROM (72% vs. 61%, p = 0.02). There was a higher prevalence of fetal lung maturity assessment among NAU providers (84%) as compared to AU providers (73%, p = 0.005) and significant variability was noted with respect to the fetal lung maturity tests used (p < 0.0001). NAU providers continued expectant management later into gestation than AU providers (p = 0.002). Significant variability was also noted in the use of antepartum surveillance techniques (p = 0.01). CONCLUSION MFM practitioners from academic universities and non-academic settings utilize similar management strategies for PPROM in regard to corticosteroid, tocolytic, and antibiotic use. However, differences are evident in issues related to the evaluation and expectant management of patients with PPROM.
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Affiliation(s)
- Francis S Nuthalapaty
- Center for Research in Women's Health, Division of Maternal-Fetal Medicine, University of Alabama at Birmingham, Birmingham, Alabama 35249, USA.
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Herbst M, Doyle N, Ramin S. Cervical ripening for labor induction at term: A cost-analysis. Am J Obstet Gynecol 2004. [DOI: 10.1016/j.ajog.2004.10.569] [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: 10/26/2022]
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White A, Ramsey P, Guinn D, Lu G, Ramin S, Case A, Rouse D. Risk factors for wound complications in obese women undergoing cesarean delivery. Am J Obstet Gynecol 2004. [DOI: 10.1016/j.ajog.2004.10.134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Herbst M, Doyle N, Ramin S. Management of suspected fetal macrosomia: A cost-effectiveness analysis. Am J Obstet Gynecol 2004. [DOI: 10.1016/j.ajog.2004.10.568] [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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Ramsey PS, Nuthalapaty FS, Lu G, Ramin S, Nuthalapaty ES, Ramin KD. Contemporary management of preterm premature rupture of membranes (PPROM): a survey of maternal-fetal medicine providers. Am J Obstet Gynecol 2004; 191:1497-502. [PMID: 15507990 DOI: 10.1016/j.ajog.2004.08.005] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE This study was undertaken to characterize variations in the management for women with preterm premature rupture of membranes (PPROM) among maternal-fetal medicine (MFM) specialists in the context of current recommendations for clinical practice and evidenced-based practice. STUDY DESIGN We performed a Web-based survey of 1375 MFM providers. Participants were queried on practice characteristics and management issues including use of tocolytics, antibiotics, steroids, and timing of delivery. RESULTS A total of 508 providers (37%), representing all 50 states and 13 countries, responded to the survey. Only 30% reported a formal departmental protocol for managing women with PPROM. Consistent use of steroids (99.4%) and antibiotics (99.6%) were reported. Administration of steroids was confined to < or =32 weeks by 37%, and < or =34 weeks by 51% of practitioners. Repeated dosing of steroids was uncommon (16%). The antibiotics use and rationale for use varied among respondents. Tocolytics were used by 73% of respondents with magnesium sulfate the main agent used (98%). Use of tocolytics was generally used for 48 hours or less to attain steroid benefit (88%). Amniocentesis was used by 66% of practitioners in the acute evaluation of PPROM. Fetal lung maturity testing was reported by 78% with variability noted with respect to the test used. Outpatient management of women with PPROM after viability was noted by 43% of respondents. Gestational age at which expectant management is abandoned in women with PPROM varied significantly between respondents: > or =34 weeks by 56%, > pr =35 weeks by 26%, > or =36 weeks by 12%, and > or =37 weeks by 4.0%. CONCLUSION Although many management practices for women with PPROM are consistent with currently available evidence and practice recommendations, substantial variations still exist among MFM providers.
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Affiliation(s)
- Patrick S Ramsey
- Department of Obstetrics and Gynecology, Center for Research in Women's Health, The University of Alabama at Birmingham, 619 19th Street, S-458 Old Hillman Building, Birmingham, AL 35249-7333, USA.
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Ramsey P, Nuthalapaty F, Lu G, Ramin S, Nuthalapaty E, Ramin K. Contemporary management of preterm premature rupture of membranes (PPROM): a survey of maternal-fetal medicine providers. Am J Obstet Gynecol 2003. [DOI: 10.1016/j.ajog.2003.10.400] [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: 10/26/2022]
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Fonseca L, Ramin S, Lucas M, Sosa A, Day MC, Gilstrap L. Uterine contraction pressures in women undergoing a trial of labor after prior cesarean delivery. Am J Obstet Gynecol 2003. [DOI: 10.1016/j.ajog.2003.10.535] [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: 11/27/2022]
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Ramin S. Funisitis and outcome in infants less than 1,000 grams. Obstet Gynecol 2001. [DOI: 10.1016/s0029-7844(01)01313-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Alexander J, Lucas M, Ramin S, McIntire D, Leveno K. The course of labor with and without epidural analgesia. Am J Obstet Gynecol 1997. [DOI: 10.1016/s0002-9378(97)80740-5] [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: 10/24/2022]
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Berliner JA, Territo MC, Sevanian A, Ramin S, Kim JA, Bamshad B, Esterson M, Fogelman AM. Minimally modified low density lipoprotein stimulates monocyte endothelial interactions. J Clin Invest 1990; 85:1260-6. [PMID: 2318980 PMCID: PMC296561 DOI: 10.1172/jci114562] [Citation(s) in RCA: 698] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
The effect of minimally modified LDL (MM-LDL) on the ability of large vessel endothelial cells (EC) to interact with monocytes and neutrophils was examined. These LDL preparations, obtained by storage or by mild iron oxidation, were indistinguishable from native LDL to the LDL receptor and were not recognized by the scavenger receptor. Treatment of EC with as little as 0.12 micrograms/ml MM-LDL caused a significant increase in the production of chemotactic factor for monocytes (sevenfold) and increased monocyte binding (three- to fivefold). Monocyte binding was maximal after 4 h of EC exposure to MM-LDL, persisted for 48 h, and was inhibited by cycloheximide. In contrast, neutrophil binding was not increased after 1-24 h of exposure. Activity in the MM-LDL preparations was found primarily in the polar lipid fraction. MM-LDL was toxic for EC from one rabbit but not toxic for the cells from another rabbit or any human umbilical vein EC. The resistant cells became sensitive when incubated with lipoprotein in the presence of cycloheximide, whereas the sensitive strain became resistant when preincubated with sublethal concentrations of MM-LDL. We conclude that exposure of EC to sublethal levels of MM-LDL enhances monocyte endothelial interactions and induces resistance to the toxic effects of MM-LDL.
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Affiliation(s)
- J A Berliner
- Department of Pathology, University of California, School of Medicine, Los Angeles 90024-1732
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