To provide information on overall medication use throughout pregnancy, with particular focus on the first trimester and specific prescription medications.
The Slone Epidemiology Center Birth Defects Study (BDS), 1976 to 2008, and the National Birth Defects Prevention Study (NBDPS), 1997 to 2003, which together interviewed over 30,000 women about their antenatal medication use.
Over the last three decades, first trimester use of prescription medication increased by over 60%, and use of four or more medications more than tripled. By 2008, approximately 50% of women reported taking at least 1 medication. Use of some specific medications markedly decreased or increased. Prescription medication use increased with maternal age and education, was highest for non-Hispanic whites, and varied by state.
These data reflect the widespread and growing use of medications by pregnant women and reinforce the need to study their respective fetal risks and safety.
Medications; OTC Medications; Pregnancy; Prescription Medications; Epidemiology
To evaluate the fetal renal artery impedance in the context of inflammation-associated preterm birth (PTB).
We conducted a prospective Doppler assessment of the fetal renal artery impedance in 70 singleton fetuses. The study group consisted of 56 premature fetuses (28.1 [25.3–30.6] weeks at enrollment). Gestational age (GA) reference ranges were generated based on fetuses with uncomplicated pregnancies (n=14). Doppler studies included renal artery pulsatility index (PI), resistance index (RI), systolic/diastolic (S/D) ratio and presence-or-absence of end-diastolic blood flow. We assessed amniotic fluid (AF) inflammation by proteomic profiling (SELDI-TOF). Data were interpreted in relationship to amniotic fluid index (AFI), cord blood interleukin-6 (IL-6) and erythropoietin (EPO) levels. The cardiovascular and metabolic profiles of the neonates were investigated in the first 24 hours of life.
Fetuses delivered by mothers with intra-amniotic inflammation had higher cord blood IL-6 but not EPO levels. Fetal inflammation did not affect either renal artery PI,RI,S/D ratio or end-diastolic blood flow. Neonates delivered in the context of intraamniotic inflammation had higher serum blood urea nitrogen levels, which correlated significantly with AF IL-6 levels. The renal artery RI and SD ratio were inversely correlated with the AFI independent of GA, cord blood IL-6 and status of the membranes.
The fetus is capable of sustaining normal renal artery impedance despite inflammation. Resistance in the renal vascular bed affects urine output independent of inflammation.
We reviewed literature examining predictors of urinary fistula repair outcomes in developing country settings, including fistula and patient characteristics, and peri-operative factors. We searched Medline for articles published between January 1970 and December 2010, excluding articles that were 1) case reports, cases series or contained 20 or fewer subjects; 2) focused on fistula in developed countries; and 3) did not include a statistical analysis of the association between facility or individual-level factors and surgical outcomes. Twenty articles were included; 17 were observational studies. Surgical outcomes included fistula closure, residual incontinence following closure, and any incontinence (dry vs. wet). Scarring and urethral involvement were associated with poor prognosis across all outcomes. Results from randomized controlled trials examining prophylactic antibiotic use and repair outcomes were inconclusive. Few observational studies examining peri-operative interventions accounted for confounding by fistula severity. We conclude that a unified, standardized evidence-base for informing clinical practice is lacking.
Developing countries; obstetric fistula; surgical outcomes; systematic review
To determine racial/ethnic differences in perinatal outcomes among women with gestational diabetes mellitus (GDM).
Retrospective cohort study of 32,193 singleton births among GDMs in California from 2006, using Vital Statistics Birth and Death Certificate and Patient Discharge Data. Women were divided by race/ethnicity: White, Black, Hispanic, or Asian. Multivariable logistic regression analyzed associations between race/ethnicity and adverse outcomes, controlling for potential confounders. Outcomes included: primary cesarean, preeclampisa, neonatal hypoglycemia, preterm delivery, macrosomia, fetal anomaly, respiratory distress syndrome (RDS).
Compared to other races, Black women had higher odds of preeclampsia [aOR=1.57, 95%CI(1.47-1.95)], neonatal hypoglycemia [aOR=1.79, 95%CI(1.07-3.00)], and preterm delivery <37 weeks [aOR=1.56, 95%CI(1.33-1.83)]. Asians had the lowest odds of primary cesarean [aOR=0.75, 95%CI(0.69-0.82)], large for gestational age infants [aOR=0.40, 95%CI(0.33-0.48)], and neonatal RDS [aOR=0.54, 95%CI(0.40-0.73)].
Perinatal outcomes among women with GDM differ by race/ethnicity and may be attributed to inherent sociocultural differences that may impact glycemic control, the development of chronic co-morbidities, genetic variability, and variation in access to as well as quantity and quality of prenatal care.
Gestational Diabetes; Perinatal Outcomes; Race/Ethnicity
Genital tract secretions exhibit bactericidal activity against Escherichia coli. We hypothesized that this defense may be modulated during pregnancy.
Secretions were collected by vaginal swab from 70 pregnant women (35–37 weeks gestation) and 35 non-pregnant controls. Escherichia coli were mixed with swab eluants or control buffer and colonies enumerated to measure bactericidal activity. Cytokines, chemokines and antimicrobial peptides were quantified by Luminex or ELISA.
Pregnant women had significantly greater bactericidal activity, higher concentrations of pro-inflammatory cytokines and lower levels of beta defensins compared to controls. Seven (10%) pregnant and 8 (23%) non-pregnant women were vaginally colonized with Escherichia coli; colonization was inversely associat ed with bactericidal activity.
The soluble mucosal immune environment is altered in pregnancy. We speculate that the observed changes may protect against colonization and ascending infection and could provide a biomarker to identify pregnant women at risk for infectious complications including preterm birth.
Cytokines/chemokines; Defensins; E. coli; Pregnancy
To identify risk factors for cerebral lesions among survivors of TTTS treated with laser surgery.
A multilevel regression analysis examined risk factors for neonatal cerebral lesions identified by imaging. Imaging was routine in “high-risk survivors”, defined as those delivered at <32 weeks' gestation, and by clinical indications if born later. Severe lesions were defined as: intraventricular hemorrhage grade III–IV, cystic periventricular leukomalacia, ventriculomegaly and/or hydrocephalus, microcephaly, infarctions, porencephalic/Dandy-Walker cysts, or bilateral other cysts.
For 262 consecutive laser-treated TTTS patients, 18 neonates had severe lesions identified among 427 individual survivors (4.2%) and 242 “high-risk survivors” (7.4%). Forty-six newborns had any cerebral lesion, resulting in lesion rates of 10.8%–19.0%. Delivery <32 weeks' (OR=4.95, p<0.001) and <28 weeks' (OR=6.25, p<0.001) gestation were associated with increased likelihood of any cerebral lesion.
This cohort showed low rates (4–7%) of severe neonatal cerebral lesions, with prematurity being the primary risk factor.
cerebral lesions; imaging; neurological; outcome; twin-twin transfusion syndrome
We evaluated vitamin D insufficiency in a nationally representative sample of women and assessed the role of vitamin supplementation.
We conducted secondary analysis of 928 pregnant and 5173 nonpregnant women aged 13–44 years from the National Health and Nutrition Examination Survey 2001–2006.
The mean 25-hydroxyvitamin D (25[OH]D) level was 65 nmol/L for pregnant women and 59 nmol/L for nonpregnant women. The prevalence of 25(OH)D <75 nmol/L was 69% and 78%, respectively. Pregnant women in the first trimester had similar 25(OH)D levels as nonpregnant women (55 vs 59 nmol/L), despite a higher proportion taking vitamin D supplementation (61% vs 32%). However, first-trimester women had lower 25(OH)D levels than third-trimester women (80 nmol/L), likely from shorter duration of supplement use.
Adolescent and adult women of childbearing age have a high prevalence of vitamin D insufficiency. Current prenatal multivitamins (400 IU vitamin D) helped to raise serum 25(OH)D levels, but higher doses and longer duration may be required.
epidemiology; nutrition; pregnancy; supplementation; vitamin D
To determine the prevalence and characteristics of vulvodynia among women in southeast Michigan.
A population-based study of adult women was conducted, using telephone recruitment and completion of a self-administered survey. Weighted estimates of vulvodynia prevalence and characteristics were determined.
Over a year, 2542 women were recruited and 2269 (89.3%) completed the self-administered survey. The weighted prevalence of vulvodynia was 8.3% (95% CI=7.0, 9.8) or approximately 101,000 women in the targeted population. Prevalence remained stable through age 70, and thereafter declined. Among sexually active women, prevalence was similar at all ages. Of 208 women meeting vulvodynia criteria, 101 (48.6%) had sought treatment, and only 3 (1.4%) had been diagnosed with vulvodynia (unweighted values). Previous vulvodynia symptoms had resolved in 384 (16.9%) women after a mean duration of 12.5 years.
Vulvodynia is common, although rarely diagnosed. Prevalence remains high among sexually active women of any age.
population-based; pain; prevalence; Vulvar Diseases/*epidemiology; vulvodynia
To determine if genetic polymorphisms in the aryl hydrocarbon receptor signaling pathway are associated with menopausal hot flashes via hormone levels.
Women (n=639) aged 45–54 years completed a study survey and provided blood for genetic and hormone analyses. The associations were analyzed using multivariable logistic regression and generalized linear models.
Women carrying CYP1B1 (rs1800440) GG genotype had 3-fold greater odds of experiencing hot flashes for ≥1 year compared to the AA genotype [adjusted odds ratio (aOR): 3.05 (1.12–8.25)]. Adding serum estradiol concentrations to the confounder-adjusted model resulted in a non-significant association [aOR: 2.59 (0.91–7.18)]. Carriers of both CYP1B1 (rs1800440) G and CYP1B1 (rs1058636) G alleles had higher odds of experiencing hot flashes for ≥1 year compared to women homozygous for the major alleles [aOR: 1.77 (1.06–2.96)], even after adjustment for serum estradiol.
CYP1B1 is associated with menopausal hot flashes via pathways that may involve changes in serum estradiol concentration.
AHR; CYP1B1; hot flashes; polymorphism; risk factor
To characterize the labor of women attempting trial of labor after cesarean (TOLAC) who experience uterine rupture.
Secondary analysis of a nested case-control study of women attempting TOLAC. Women experiencing uterine rupture (cases) were compared to 2 reference groups, successful TOLAC and failed TOLAC. Interval censored regression was used to estimate the median time to progress 1-cm in dilation and the total time from 4–10-cm.
115 cases were compared to 341 successful TOLAC and 120 failed TOLAC. The time to progress 1-cm was similar between groups until 7-cm dilation. After 7-cm, cases of uterine rupture required longer to progress than successful TOLAC (median (95th percentile) (hrs) from 7–8-cm 0.38 (1.91) vs 0.16 (0.79), from 8–9-cm 0.28 (1.10) vs 0.10 (0.39)). Women with a uterine rupture had similar labor curves to those with a failed TOLAC.
Women with labor dystocia in the active phase of labor should be closely monitored for uterine rupture in TOLAC.
We examined the association of second trimester maternal plasma 25-hydroxyvitamin D (25[OH]D) during pregnancy with gestational diabetes mellitus(GDM).
Among 1314 pregnant women participating in Project Viva, a birth cohort study, we measured 25(OH)D levels at 26–28 weeks’ gestation during GDM screening using a 1-hour 50g glucose challenge test.
We found 25(OH)D levels <25nmol/L in 44/1087(4.0%) women with normal glucose tolerance, 9/159(5.7%) women with impaired glucose tolerance and 9/68(13.2%) women with GDM. Analyses adjusted for sociodemographics, season, maternal BMI, gestational weight gain and dietary factors, suggested that women with 25(OH)D levels <25 vs. ≥25 nmol/L may have higher odds of GDM (2.2 [0.8, 5.5]). Glucose levels after the glucose challenge test were inversely associated with 25(OH)D levels(P <0.01).
Second trimester 25(OH)D levels were inversely associated with glucose levels after 1-hour 50g glucose challenge test and low 25(OH)D levels may be associated with increased risk of GDM.
Vitamin D; Gestational Diabetes Mellitus; 25-hydroxyvitamin D; GDM; pregnancy
To evaluate the association between maternal medication use during pregnancy and cerebral white matter damage and cerebral palsy (CP) among very preterm infants.
This analysis of data from the ELGAN Study included 877 infants born <28 weeks gestation. Mothers were interviewed, charts reviewed, placentas were cultured and assessed histologically, and children evaluated at 24 months corrected age. A diagnostic algorithm classified neurologic findings as quadriparetic CP, diparetic CP, hemiparetic CP, or no CP.
After adjustment for the potential confounding of disorders for which medications might have been indicated, the risk of quadraparetic CP remained elevated among the infants of mothers who consumed aspirin (OR=3.0, 95% CI 1.3,6.9) and non-steroidal anti-inflammatory medications (NSAIDs) (OR=2.4, 95% CI 1.04,5.8). The risk of diparetic CP was also associated with maternal consumption of an NSAID, but only if the consumption was not approved by a physician (OR=3.5, 95% CI 1.1,11.0)
The possibility that aspirin and NSAID use in pregnancy could lead to perinatal brain damage cannot be excluded.
Cerebral palsy; cerebral white matter damage; preterm
To evaluate fetal responses to strenuous exercise in physically active and inactive women.
45 healthy women (15 Non-Exercisers, 15 Regularly Active, 15 Highly Active) underwent a peak treadmill test at 28-0/7 to 32-6/7 weeks. Fetal well-being [umbilical artery Dopplers, fetal heart tracing/rate, biophysical profile (BPP)] was evaluated pre and post-exercise. Uterine artery Dopplers were also obtained.
Umbilical and uterine artery Doppler indices were similar among activity groups and did not change with exercise (P>.05). BPP and fetal heart tracings were reassuring in all groups. However, subgroup analyses showed transient post-exercise fetal heart rate decelerations and elevated umbilical and uterine artery Doppler indices in 5 Highly Active women. Following this, BPP and fetal heart tracings were reassuring.
Overall fetal well-being is reassuring after short-duration, strenuous exercise in both active and inactive pregnant women. A subset of Highly Active women experienced transient fetal heart rate decelerations and Doppler changes immediately after exercise. Athletes may push beyond a threshold intensity at which fetal well-being may be compromised. However, potential impact on neonatal outcomes is unknown.
Exercise; Fetal-well being; Pregnancy; Umbilical artery Doppler; Uterine artery Doppler
Currently, there are >2 million survivors of breast cancer in the United States. Two years after cancer treatment, patients may transition to primary care providers and/or gynecologists. Many of these survivors may have difficulties with menopausal symptoms. If they do not know already, some of these women may want or need risk assessment for hereditary-or treatment-induced second cancers. At least 20% will also have significant psychologic, sexual, and/or relationship difficulties that require attention. All of the women will need assistance to learn and follow recommendations for surveillance, detecting recurrence, and promoting wellness. Thus, gynecologists play a critical role in helping these patients in their health care transitions. To assist the gynecologists, we have reviewed the evaluation and management of common sequelae of breast cancer diagnoses and treatments.
breast cancer; depression; menopause; sexuality
To estimate leiomyoma-related inpatient care in the United States for 2007 with predictions for the ensuing 40 years.
We used the 2007 Nationwide Inpatient Sample to estimate hospitalizations and inpatient surgeries for uterine leiomyoma in US women 15 to 54 years. We used the US Census Bureau population projections to predict leiomyoma-related inpatient care through 2050.
In 2007, 355,135 women were hospitalized for leiomyoma (rate = 42 per 10,000 women-years). Black women had increased rates of hospitalization, hysterectomy, and myomectomy (relative risk, 3.5, 2.4, 6.8, respectively) compared with white women. Leiomyoma-related hospitalizations are predicted to increase 23% (to 437,874) between 2007 and 2050, with 20% and 31% increases in leiomyoma-related hysterectomies and myomectomies.
Leiomyoma-related inpatient care and major surgery remains substantial despite advances in less invasive treatment options. Given population growth, the projected burden of leiomyoma-related inpatient care will increase significantly by 2050, differentially impacting black vs white women.
fibroids; health care costs; health disparities; hysterectomy; leiomyoma; myomectomy
Evaluate the interaction between repeated course antenatal corticosteroids and inflammation gene polymorphisms with neurodevelopmental outcomes at age 2.
Nested case-control analysis of a randomized controlled trial of single versus repeated course antenatal corticosteroids. Cases had mental and/or psychomotor delay at age 2. Controls had normal neurodevelopment. Previous analyses of 125 cases and 147 controls identified 4 inflammation gene polymorphisms associated with neurodevelopmental delay at age 2.
The interaction between repeated course corticosteroids and the IL6 -174 genotype with neurodevelopmental delay was significant (P=0.046). The IL6 -174 GG genotype was associated with neurodevelopmental delay at age 2 in the single course corticosteroid group (OR 6.47; 95%CI 1.86-22.50). Exposure to repeated course antenatal corticosteroids abrogated this genotype effect (OR 1.30; 95%CI 0.48-3.54). Results were unchanged after controlling for potential confounders.
Repeated course antenatal steroids may reduce the increased risk of neurodevelopmental delay at age 2 associated with IL6 -174 GG genotype.
antenatal corticosteroids; interleukin-6 (IL6); inflammation; neurodevelopmental delay; gene polymorphisms
To compare the efficacy and side effects of a high-dose vaginal misoprostol regimen to concentrated intravenous oxytocin plus low-dose vaginal misoprostol for mid-trimester labor induction.
Women at 14-24 weeks, with obstetric or fetal indications for delivery and no prior cesarean, were randomly assigned to receive either vaginal misoprostol 600 μg ×1, then 400 μg q 4 hr × 5 (Group 1) or escalating-dose concentrated oxytocin infusions (277-1667 mU/min) plus vaginal misoprostol 400 μg × 1, then 200 μg q 6 hr × 2, then 100 μg × 1 (Group 2). Analysis was by intent to treat. Primary outcomes were live birth rate and induction-to-delivery interval.
The intended sample size was 70 women per group; however, the trial was terminated at the initial interim analysis due to a highly significant difference in one of the primary study outcomes. Twenty women were assigned to Group 1 and 18 were assigned to the Group 2. Median induction-to-delivery interval was significantly shorter in Group 1 (12 hr, range 4 - 44 hr) versus Group 2 (18 hr, range 7 - 36 hr; p=0.01). Induction success rate at 12 hours was significantly higher in the Group 1 (60%), compared to Group 2 (22%, p=.02). No significant difference was noted in the live birth rate between Group 1 and 2 (13%, 0%, p = 0.16). The incidence of retained placenta requiring curettage, chorioamnionitis, intrapartum fever, nausea, emesis, and diarrhea were similar between both groups.
Compared to concentrated oxytocin plus low-dose vaginal misoprostol, high-dose vaginal misoprostol significantly shortens mid-trimester labor inductions.
Misoprostol; Concentrated Oxytocin; Pregnancy Termination; Labor Induction; Prostaglandins
More women than ever before are both Human Immunodeficiency Virus-infected and menopausal, because of increased survival and more frequent diagnosis in older women. Such a woman has the combined burden of her infection, its treatment, comorbid conditions, and aging. Thus she is at risk for a variety of problems such as disorders of bone mineral density and deficiencies in cognitive functioning. In addition to this, she experiences menopause in a unique fashion, with more symptoms and perhaps at an earlier age. The clinician caring for her must take a proactive approach to this multitude of factors that may affect her health and well-being.
bone mineral density; cognitive impairment; HIV-infected woman; menopause; vasomotor symptoms
To assess incidence of, and risk factors for abnormal anal cytology and anal intraepithelial neoplasia (AIN) 2–3 in HIV-infected women.
This prospective study assessed 100 HIV-infected women with anal and cervical specimens for cytology and high risk HPV testing over three semi-annual visits.
Thirty-three women were diagnosed with an anal cytologic abnormality at least once. Anal cytology abnormality was associated with current CD4 count <200 cells/mm3, anal HPV infection and history of other sexually transmitted infections (STIs). Twelve subjects were diagnosed with AIN2-3: four after AIN1 diagnosis and four after ≥1 negative anal cytology. AIN2-3 trended towards an association with history of cervical cytologic abnormality and history of STI.
Repeated annual anal cytology screening for HIV-infected women, particularly for those with increased immunosuppression, anal and/or cervical HPV, history of other STIs, or abnormal cervical cytology, will increase the likelihood of detecting AIN2-3.
anal cytology; anal HPV; cervical HPV; HIV
Mouse embryonic exposure to alcohol, lithium, and homocysteine results in intrauterine growth restriction (IUGR) and cardiac defects. Our present study focuses on the placental effects.
We analyzed the hypothesis that expression of nonmuscle myosin (NMM)-II isoforms involved in cell motility, mechanosensing, and extracellular matrix assembly, are altered by the three factors in human trophoblast (HTR8/SVneo) cells in vitro and in the mouse placenta in vivo.
After exposure during gastrulation to alcohol, homocysteine, or lithium, ultrasonography defined embryos exhibiting abnormal placental blood flow.
NMM-IIA /NMM-IIB are differentially expressed in trophoblasts and in mouse placental vascular endothelial cells under pathological conditions. Misexpression of NMM-IIA/ NMM-IIB in the affected placentas continued stably to mid-gestation, but can be prevented by folate and myo-inositol supplementation.
It is concluded that folate and myo-inositol initiated early in mouse pregnancy can restore NMM-II expression, permit normal placentation/embryogenesis, and prevent IUGR induced by alcohol, lithium, and homocysteine.
mouse; placenta; human trophoblasts; nonmuscle myosin II; alcohol; lithium; homocysteine; folate
To study neonatal outcomes in early preterm births by delivery route
Delivery precursors were analyzed in 4,352 singleton deliveries, 24 0/7–31 6/7 weeks’ gestation. In a subset (N=2,906) eligible for a trial of labor, neonatal mortality in attempted vaginal delivery (VD) was compared to planned cesarean delivery (CD) stratified by presentation.
Delivery precursors were classified as maternal or fetal conditions (45.7%), PPROM (37.7%) and preterm labor (16.6%). For vertex presentation, 79% attempted VD and 84% were successful. There was no difference in neonatal mortality. For breech presentation, at 24 0/7 – 27 6/7 weeks’ gestation, 31.7% attempted VD and 27.6% were successful; neonatal mortality was increased (25.2% versus 13.2%, p=0.003). At 28 0/7 – 31 6/7 weeks’ gestation, 30.5% attempted VD and 17.2% were successful; neonatal mortality was increased (6.0% vs. 1.5%, P= 0.016).
Attempted VD for vertex presentation has a high success rate with no difference in neonatal mortality unlike breech presentation.
early preterm birth; precursors; route of delivery
To determine if bed delivery without stirrups reduces the incidence of perineal lacerations compared to delivery in stirrups.
In this randomized trial we compared bed delivery without stirrups to delivery in stirrups in nulliparous women. The primary outcome was any perineal laceration (first- through fourth-degree).
108 women were randomized to delivery without stirrups and 106 to stirrups. A total of 82 (76%) women randomized to no stirrups sustained perineal lacerations compared to 83 (78%) in women allocated to stirrups, p = .8. There was no significant difference in the severity of lacerations or in obstetric outcomes such as prolonged second stage of labor, forceps delivery, or cesarean birth. Similarly, infant outcomes were unaffected.
Our results do not incriminate stirrups as a cause of perineal lacerations. Alternatively, our findings of no difference in perineal lacerations suggest that delivering in bed without stirrups confers no advantages nor disadvantages.
delivery position; delivery posture; stirrups; bed delivery
To determine if endothelial microparticles (EMPs), markers of endothelial damage, are associated with soluble fms-like tyrosine kinase 1 (sFlt1), soluble endoglin (sEnd), and placental growth factor (PlGF) in women with preeclampsia. STUDY DESIGN: A prospective cohort study was conducted on 20 preeclamptic women and 20 controls. EMP’s measured by flow cytometry, sFlt1, sEnd, and PlGF were measured at time of enrollment, 48 hours, and 1 week postpartum.
Preeclamptic CD31+/42−, CD 62E+, and CD105+ EMP levels were significantly elevated in preeclamptics vs. controls at time of enrollment. The sFlt1:PlGF ratio was correlated with CD31+/42− and CD 105+ EMPs (r=0.69 and r=0.51, respectively) in preeclampsia. Levels of CD31+/42− EMPs remained elevated 1-week postpartum (p=0.026).
EMPs are elevated in preeclampsia. The correlation of EMPs and the sFlt1:PlGF ratio suggests that anti-angiogenesis is related to apoptosis of the endothelia. Endothelial damage persists one week after delivery.
Endothelial microparticles; preeclampsia; pregnancy; sFlt:PlGF ratio; soluble fms-like tyrosine kinase 1 (sFlt1)
The objective of the study was to examine the impact of chronic hypertension and pregestational diabetes on pregnancy outcomes.
This was a retrospective cohort study of 532,088 women undergoing singleton births in California in 2006. Women were categorized into chronic hypertension, pregestational diabetes, both, or neither. Pregnancy outcomes were compared using the χ2 test and multivariable logistic regression to control for potential confounders.
We identified differences in perinatal outcomes between the groups. The rate of preterm birth in women with both conditions was 35.5% versus 25.5% in women with chronic hypertension versus 19.4% in women with pregestational diabetes (P < .001). The rate of small for gestational age was 18.2% in women with both versus 18.3% in women with chronic hypertension versus 9.7% in women with pre-gestational diabetes (P <.001).
The impact of having both chronic hypertension and pregestational diabetes in pregnancy varies, depending on the outcome examined. Although some had an additive effect (eg, stillbirth), others did not (eg, preeclampsia).
chronic hypertension; perinatal outcomes; pregestational diabetes
We sought to evaluate the risk of intrauterine fetal death (IUFD) in small-for-gestational-age (SGA) fetuses.
We analyzed a retrospective cohort of all births in the United States in 2005, as recorded in a national database. We calculated the risk of IUFD within 3 sets of SGA threshold categories as well as within non-SGA pregnancies using the number of at-risk fetuses as the denominator.
The risk of IUFD increased with gestational age and was inversely proportional to percentile of birthweight for gestational age. The risk for IUFD in those <3rd percentile was as high as 58.0 IUFDs per 10,000 at-risk fetuses, 43.9 for <5th percentile, and 26.3 for <10th percentile compared to 5.1 for non-SGA gestations.
There is an increase in the risk of IUFD in SGA fetuses compared to non-SGA fetuses at all gestational ages with the greatest risk demonstrated in the lowest percentile cohort evaluated.
birthweight; fetal death; small for gestational age; stillbirth