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Parnell AS, Correa A, Reece EA. Pre-pregnancy Obesity as a Modifier of Gestational Diabetes and Birth Defects Associations: A Systematic Review. Matern Child Health J 2017; 21:1105-1120. [PMID: 28120287 DOI: 10.1007/s10995-016-2209-4] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Objective Inconsistent findings of associations between gestational diabetes mellitus (GDM) and birth defects suggest unaccounted confounders may underlie the actual basis for such associations. We conducted a systematic review to assess observed associations between GDM and birth defects and the extent to which these could be explained by pre-pregnancy obesity. Methods Using a combination of search terms for GDM and birth defects, we searched PubMed, Scopus, CINAHL, and ClinicalTrials.gov for human-based studies published through September 2013. Studies were eligible for inclusion if they included information on maternal diabetes status, method of diagnosis of GDM, and assessment of birth defects. Twenty-four of 768 potential articles were included. We collected information on study design, location and period, method of determination of diabetes status, types of birth defects, and measures of association reported. Results There was no evidence for consistent association of GDM with birth defects, with the exception of a weak association between GDM and congenital heart defects. When stratified by maternal pre-pregnancy BMI, an association between GDM and congenital heart defects and between GDM and neural tube defects was evident only in women with both GDM and pre-pregnancy obesity. Conclusions for Practice Our findings suggest reported associations between GDM and birth defects may be due, in part, to undiagnosed metabolic disorders associated with obesity, such as pregestational diabetes mellitus, rather than GDM. These findings highlight the need for increased efforts for pre-pregnancy screening for undiagnosed diabetes and awareness of the importance of weight management among women of childbearing age with obesity.
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Affiliation(s)
- Aimee S Parnell
- Department of Pediatrics, University of Mississippi School of Medicine, 2500 North State Street, Jackson, MS, 39216, USA.
- Children's of Mississippi, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS, 39216, USA.
| | - Adolfo Correa
- Department of Pediatrics, University of Mississippi School of Medicine, 2500 North State Street, Jackson, MS, 39216, USA
- Department of Medicine, University of Mississippi School of Medicine, 2500 North State Street, Jackson, MS, 39216, USA
| | - E Albert Reece
- University of Maryland School of Medicine, 655 W. Baltimore Street, Room 14-029, Baltimore, MD, 21201-1559, USA
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Affiliation(s)
- Aimee S Parnell
- Department of Pediatrics, University of Mississippi School of Medicine, Jackson, MS 39216, USA.,Children's of Mississippi, Blair E. Batson Hospital for Children, Jackson, MS 39216, USA.,School of Graduate Studies, University of Mississippi School of Medicine, Jackson, MS 39216, USA
| | - Adolfo Correa
- Department of Pediatrics, University of Mississippi School of Medicine, Jackson, MS 39216, USA.,Department of Medicine, University of Mississippi School of Medicine, Jackson, MS 39216, USA
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Batlivala SP, Courtney KS, Ebeid MR, Parnell AS. "Not-so-identical" twins with trisomy 21 and perimembranous ventricular septal defects. Turk Kardiyol Dern Ars 2016; 44:346-9. [PMID: 27372623 DOI: 10.5543/tkda.2016.96605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
While trisomy 21 is a common genetic disorder in singletons, the incidence among identical twins is very rare, occurring in approximately 1-2 per 1000 twin gestations. Trisomy 21 is associated with high incidence of congenital heart defects, and commonly occurs with ventricular septal defects (VSDs). Physiologic burden of VSDs depends on prevalence of anatomic and other circulatory factors. A case of identical twins with trisomy 21 and large VSDs is described in the present report. Though genetically identical, phenotypes varied significantly. One twin was managed medically, while the other developed more significant heart failure, requiring operative repair.
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Affiliation(s)
- Sarosh P Batlivala
- University of Mississippi Medical Center, School of Medicine, Jackson, MS, USA; Division of Pediatric Cardiology, Blair E. Batson Hospital for Children, Jackson, MS USA.
| | - Kendra S Courtney
- University of Mississippi Medical Center, School of Medicine, Jackson, MS, USA
| | - Makram R Ebeid
- Division of Pediatric Cardiology, Blair E. Batson Hospital for Children, Jackson, MS USA
| | - Aimee S Parnell
- Division of Pediatric Cardiology, Blair E. Batson Hospital for Children, Jackson, MS USA
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Hood HW, Dodge-Khatami A, Parnell AS, Salazar JD. Biventricular Repair in a Neonate With Obstructive Inflow Cardiac Rhabdomyoma and Tuberous Sclerosis. World J Pediatr Congenit Heart Surg 2015; 6:307-10. [DOI: 10.1177/2150135114561689] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
A neonate with prenatally diagnosed large intracardiac rhabdomyomas and suspicion of tuberous sclerosis presented at birth with severe ductal-dependent obstruction at the tricuspid valve and an atrial septal defect (ASD). Biventricular repair at 9 days of life included tumor resection, repair of the posterior leaflet of the tricuspid valve with autologous pericardium, fenestrated ASD closure, and ductus ligation. After an uneventful postoperative recovery, follow-up echocardiography at two months showed excellent results with tricuspid valve competency and normal biventricular function. Overall prognosis will probably depend on issues pertaining to tuberous sclerosis.
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Affiliation(s)
- Hunter W. Hood
- Pediatric and Congenital Heart Surgery, Children’s Heart Center, University of Mississippi Medical Center, Jackson, MS, USA
| | - Ali Dodge-Khatami
- Pediatric and Congenital Heart Surgery, Children’s Heart Center, University of Mississippi Medical Center, Jackson, MS, USA
| | - Aimee S. Parnell
- Pediatric and Fetal Cardiology, Children’s Heart Center, University of Mississippi Medical Center, Jackson, MS, USA
| | - Jorge D. Salazar
- Pediatric and Congenital Heart Surgery, Children’s Heart Center, University of Mississippi Medical Center, Jackson, MS, USA
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O'Byrne ML, Yang W, Mercer-Rosa L, Parnell AS, Oster ME, Levenbrown Y, Tanel RE, Goldmuntz E. 22q11.2 Deletion syndrome is associated with increased perioperative events and more complicated postoperative course in infants undergoing infant operative correction of truncus arteriosus communis or interrupted aortic arch. J Thorac Cardiovasc Surg 2014; 148:1597-605. [PMID: 24629220 PMCID: PMC4127373 DOI: 10.1016/j.jtcvs.2014.02.011] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2013] [Revised: 01/13/2014] [Accepted: 02/03/2014] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The effect of genotype on the outcomes of infant cardiac operations has not been well established. The purpose of the present study was to investigate the effect of 22q11.2 deletion (22q11del) on infants with truncus arteriosus communis (TA) and interrupted aortic arch (IAA) undergoing operative correction during infancy. METHODS We conducted a retrospective cohort study of all infants who had undergone operative correction of TA or IAA at the Children's Hospital of Philadelphia from 1995 to 2007, comparing the perioperative outcomes (hospital length of stay, intensive care, mechanical ventilation, risk of cardiac and noncardiac events, number of consultations, and number of discharge medications) by 22q11del status. RESULTS A total of 104 patients were studied (55 with TA and 49 with IAA), of whom 40 (38%) were 22q11del positive. The 22q11del status was unknown in 9 (7 with TA and 2 with IAA). In patients with known deletion status, those with 22q11del had a longer hospital and intensive care length of stay. Subjects with 22q11del also required more frequent operative reintervention and more consultations and were prescribed more medications at discharge. No significant difference was found in method of feeding between those with and without 22q11del at discharge. CONCLUSIONS In this study, 22q11del is associated with perioperative outcomes in infants undergoing operative correction of TA and IAA, with longer hospital stays and greater resource utilization in the perioperative period. These findings should inform counseling and risk stratification and warrant additional study to identify genotype-specific management strategies to improve outcomes.
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Affiliation(s)
- Michael L O'Byrne
- Division of Cardiology, Department of Pediatrics, Children's Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine, Philadelphia, Pa.
| | - Wei Yang
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pa
| | - Laura Mercer-Rosa
- Division of Cardiology, Department of Pediatrics, Children's Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine, Philadelphia, Pa
| | - Aimee S Parnell
- Division of Cardiology, Department of Pediatrics, Children's Healthcare of Mississippi, University of Mississippi Medical Center, Jackson, Miss
| | - Matthew E Oster
- Children's Healthcare of Atlanta, Department of Pediatrics, Emory University School of Medicine, Atlanta, Ga
| | - Yosef Levenbrown
- Department of Anesthesiology and Critical Care, Alfred I. duPont Hospital for Children, Wilmington, Del, and Jefferson Medical College, Philadelphia, Pa
| | - Ronn E Tanel
- Department of Pediatrics, University of California, San Francisco, School of Medicine, and Division of Pediatric Cardiology, UCSF Benioff Children's Hospital, San Francisco, Calif
| | - Elizabeth Goldmuntz
- Division of Cardiology, Department of Pediatrics, Children's Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine, Philadelphia, Pa
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Parnell AS, Shults J, Gaynor JW, Leonard MB, Dai D, Feudtner C. Accuracy of the all patient refined diagnosis related groups classification system in congenital heart surgery. Ann Thorac Surg 2013; 97:641-50. [PMID: 24200398 DOI: 10.1016/j.athoracsur.2013.08.012] [Citation(s) in RCA: 11] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2013] [Revised: 07/30/2013] [Accepted: 08/07/2013] [Indexed: 11/27/2022]
Abstract
BACKGROUND Administrative data are increasingly used to evaluate clinical outcomes and quality of care in pediatric congenital heart surgery (CHS) programs. Several published analyses of large pediatric administrative data sets have relied on the All Patient Refined Diagnosis Related Groups (APR-DRG, version 24) diagnostic classification system. The accuracy of this classification system for patients undergoing CHS is unclear. METHODS We performed a retrospective cohort study of all 14,098 patients 0 to 5 years of age undergoing any of six selected congenital heart operations, ranging in complexity from isolated closure of a ventricular septal defect to single-ventricle palliation, at 40 tertiary-care pediatric centers in the Pediatric Health Information Systems database between 2007 and 2010. Assigned APR-DRGs (cardiac versus noncardiac) were compared using χ2 or Fisher's exact tests between those patients admitted during the first day of life versus later and between those receiving extracorporeal membrane oxygenation support versus those not. Recursive partitioning was used to assess the greatest determinants of APR-DRG type in the model. RESULTS Every patient admitted on day 1 of life was assigned to a noncardiac APR-DRG (p<0.001 for each procedure). Similarly, use of extracorporeal membrane oxygenation was highly associated with misclassification of CHS patients into a noncardiac APR-DRG (p<0.001 for each procedure). Cases misclassified into a noncardiac APR-DRG experienced a significantly increased mortality (p<0.001). CONCLUSIONS In classifying patients undergoing CHS, APR-DRG coding has systematic misclassifications, which may result in inaccurate reporting of CHS case volumes and mortality.
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Affiliation(s)
- Aimee S Parnell
- Department of Pediatrics, Children's Healthcare of Mississippi, University of Mississippi School of Medicine, Jackson, Mississippi.
| | - Justine Shults
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Department of Biostatistics and Epidemiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - J William Gaynor
- Department of Surgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Mary B Leonard
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Department of Biostatistics and Epidemiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania; Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Dingwei Dai
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Chris Feudtner
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Department of Biostatistics and Epidemiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania; Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
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Pinder M, CharafEddine A, Parnell AS, DiBardino DJ, Knudson JD. Osteosarcoma with Cardiac Metastasis in a 22-year-old Man: A Case Report and Review of Cardiac Tumors. CONGENIT HEART DIS 2013; 9:E147-52. [DOI: 10.1111/chd.12113] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/26/2013] [Indexed: 11/27/2022]
Affiliation(s)
- Marco Pinder
- Department of Pediatrics; University of Mississippi Medical Center/Batson Children's Hospital
| | - Ahmad CharafEddine
- Department of Pediatrics; Division of Cardiology; University of Mississippi Medical Center/Batson Children's Hospital
| | - Aimee S. Parnell
- Department of Pediatrics; Division of Cardiology; University of Mississippi Medical Center/Batson Children's Hospital
| | - Daniel J. DiBardino
- Department of Surgery; Division of Congenital Heart Surgery; University of Mississippi Medical Center/Batson Children's Hospital
| | - Jarrod D. Knudson
- Department of Pediatrics; Divisions of Critical Care and Cardiology; University of Mississippi Medical Center/Blair E. Batson Hospital for Children; Jackson Miss USA
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