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
We sought to examine perinatal outcomes in women with a body mass index (BMI) of 25 kg/m2 comparing those whose weight gain met 2009 IOM guidelines to women meeting 1990 IOM guidelines.
This is a retrospective cohort study utilizing birth records linked to hospital discharge data for all term, singleton infants born to overweight, Missouri residents (2000–2006) with a BMI of 25 kg/m2. We excluded congenital anomalies, mothers with diabetes, hypertension, or previous cesarean delivery.
Fourteen thousand nine hundred fifty-five women gained 25–35 lbs (1990 guidelines); 1.6% delivered low birth weight (LBW) infants and 1.1% delivered macrosomic infants. Eight thousand three hundred fifty women gained 15–25 lbs (2009 guidelines); 3.4% delivered LBW infants and 0.6% delivered macrosomic infants. Women who gained 15–25 lbs were 1.99 (95% CI 1.67, 2.38) times more likely to have a LBW infant and 0.59 (95% CI 0.40, 0.76) times less likely to deliver a macrosomic infant.
Limiting weight gain in women with a BMI of 25 kg/m2, per the 2009 guidelines, increases the risk of LBW deliveries and decreases the risk of macrosomia but does not reduce associated adverse perinatal outcomes. Further studies should explore the optimal weight gain to reduce these outcomes.
Gestational weight gain; infant outcomes
Evaluate the clinical and economic consequences of fetal trisomy 21 (T21) screening with non-invasive prenatal testing (NIPT) in high-risk pregnant women.
Using a decision-analytic model, we estimated the number of T21 cases detected, the number of invasive procedures performed, corresponding euploid fetal losses and total costs for three screening strategies: first trimester combined screening (FTS), integrated screening (INT) or NIPT, whereby NIPT was performed in high-risk patients (women 35 years or older or women with a positive conventional screening test). Modeling was based on a 4 million pregnant women cohort in the US.
NIPT, at a base case price of $795, was more clinically effective and less costly (dominant) over both FTS and INT. NIPT detected 4823 T21 cases based on 5330 invasive procedures. FTS detected 3364 T21 cases based on 108 364 procedures and INT detected 3760 cases based on 108 760 procedures. NIPT detected 28% and 43% more T21 cases compared to INT and FTS, respectively, while reducing invasive procedures by >95% and reducing euploid fetal losses by >99%. Total costs were $3786M with FTS, $3919M with INT and $3403M with NIPT.
NIPT leads to improved T21 detection and reduction in euploid fetal loss at lower total healthcare expenditures.
Aneuploidy screening; cell-free DNA; cost-effectiveness; Down syndrome; non-invasive prenatal testing; trisomy 21
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
To estimate the multiple dimensions of risk faced by pregnant women and their health care providers when comparing the risks of stillbirth at term with the risk of infant death after birth.
This is a retrospective cohort study that included all nonanomalous, term deliveries in the state of California from 1997 to 2006 (N=3,820,826). The study compared infant mortality rates after delivery at each week of term pregnancy with the rates of a composite fetal–infant mortality that would occur after expectant management for 1 additional week.
The risk of stillbirth at term increases with gestational age from 2.1 per 10,000 ongoing pregnancies at 37 weeks of gestation up to 10.8 per 10,000 ongoing pregnancies at 42 weeks of gestation. At 38 weeks of gestation, the risk of expectant management carries a similar risk of death as delivery, but at each later gestational age, the mortality risk of expectant management is higher than the risk of delivery (39 weeks of gestation: 12.9 compared with 8.8 per 10,000; 40 weeks of gestation: 14.9 compared with 9.5 per 10,000; 41 weeks of gestation: 17.6 compared with 10.8 per 10,000).
Infant mortality rates at 39, 40, and 41 weeks of gestation are lower than the overall mortality risk of expectant management for 1 week.
We examined body mass index (BMI) as a screening tool for gestational diabetes (GDM) and its sensitivity among different racial/ethnic groups. In a retrospective cohort study of 24,324 pregnant women at University of California, San Francisco, BMI was explored as a screening tool for GDM and was stratified by race/ethnicity. Sensitivity and specificity were examined using chi-square test and receiver-operator characteristic curves. BMI of ≥25.0 kg/m2 as a screening threshold identified GDM in >76% of African-Americans, 58% of Latinas, and 46% of Caucasians, but only 25% of Asians (p<0.001). Controlling for confounders and comparing to a BMI of ≤25, African-Americans had the greatest increased risk of GDM (adjusted odds ratio [AOR] 5.1, 95% confidence interval [CI]: 3.0 to 8.5), followed by Caucasians (AOR 3.6, 95% CI: 2.7 to 4.8), Latinas (AOR 2.7, 95% CI: 1.9 to 3.8), and Asians (AOR 2.3, 95% CI: 1.8 to 3.0). BMI’s screening characteristics to predict GDM varied by race/ethnicity. BMI can be used to counsel regarding the risk of developing GDM, but alone it is not a good screening tool.
Body mass index; gestational diabetes mellitus; glucose loading test; race/ethnicity; receiver-operator characteristic curve
The purpose of this study was to determine the effect of maternal superobesity (body mass index [BMI], ≥50 kg/m2) compared with morbid obesity (BMI, 40–49.9 kg/m2) or obesity (BMI, 30–39.9 kg/m2) on perinatal outcomes.
We conducted a retrospective cohort study of birth records that were linked to hospital discharge data for all liveborn singleton term infants who were born to obese Missouri residents from 2000–2006. We excluded major congenital anomalies and women with diabetes mellitus or chronic hypertension.
There were 64,272 births that met the study criteria, which included 1185 superobese mothers (1.8%). Superobese women were significantly more likely than obese women to have preeclampsia (adjusted relative risk [aRR], 1.7; 95% confidence interval [CI], 1.4 –2.1), macrosomia (aRR, 1.8; 95% CI, 1.3–2.5), and cesarean delivery (aRR, 1.8; 95% CI, 1.5–2.1). Almost one-half of all superobese women (49.1%) delivered by cesarean section, and 33.8% of superobese nulliparous women underwent scheduled primary cesarean delivery.
Women with a BMI of ≥50 kg/m2 are at significantly increased risk for perinatal complications compared with obese women with a lower BMI.
pregnancy outcome; superobesity
To examine the association between active phase arrest and perinatal outcomes.
This was a retrospective cohort study of women with term, singleton, cephalic gestations diagnosed with active phase arrest of labor, defined as no cervical change for two hours despite adequate uterine contractions. Women with active phase arrest who underwent a cesarean delivery were compared to those who delivered vaginally and women who delivered vaginally with active phase arrest were compared to those without active phase arrest. The association between active phase arrest, mode of delivery, and perinatal outcomes was evaluated using univariable and multivariable logistic regression models.
We identified 1,014 women with active phase arrest: 33% (335) went on to deliver vaginally and the rest were delivered by cesarean. Cesarean delivery was associated with an increased risk of chorioamnionitis (aOR 3.37, 95% CI [2.21–5.15]), endomyometritis (aOR 48.41, [6.61–354]), postpartum hemorrhage (aOR 5.18, [3.42–7.85]), and severe postpartum hemorrhage (aOR 14.97, [1.77–126]). There were no differences in adverse neonatal outcomes. Among women who delivered vaginally, women with active phase arrest had significantly increased odds of chorioamnionitis (aOR 2.70, [1.22–2.36]]), and shoulder dystocia (aOR 2.37, [1.33–4.25]). However, there were no differences in the serious sequelae associated with these outcomes, including neonatal sepsis and Erb’s palsy.
Efforts to achieve vaginal delivery in the setting of active phase arrest may reduce the maternal risks associated with cesarean delivery without additional risk to the neonate
To compare the different mortality risks between delivery and expectant management in women with gestational diabetes mellitus (GDM).
This is a retrospective cohort study that included singleton pregnancies of women diagnosed with GDM delivering at 36-42 weeks gestational age (GA) in California from 1997-2006. A composite mortality rate was developed to estimate the risk of expectant management at each GA incorporating the stillbirth risk during the week of continuing pregnancy plus the infant mortality risk at the GA one week hence.
In women with GDM, the risk of expectant management is lower than the risk of delivery at 36 weeks, (17.4 vs. 19.3 per 10,000), but at 39 weeks, the risk of expectant management exceeds that of delivery (RR 1.8, 95% CI: 1.2 – 2.6).
In women with GDM, infant mortality rates at 39 weeks are lower than the overall mortality risk of expectant management for one week absolute risks of stillbirth and infant death are low.
expectant management; gestational diabetes; infant mortality; stillbirth
To examine the effect of first trimester obstetric ultrasound (OBUS) on the measurement of the effect of complications ascribed to postterm pregnancies.
We conducted a retrospective cohort study of all term, singleton pregnancies delivered at our institution who had an OBUS at ≤24 weeks of gestation. Those women who underwent an OBUS at ≤12 weeks of gestation (OBUS12) were compared to those who had an OBUS at 13–24 weeks of gestation (OBUS13–24). The primary outcome measures were the rates of postterm pregnancies greater than 41 or 42 weeks’ gestation. Secondary outcomes were the differences between the postterm and term gestations in maternal and neonatal outcomes.
In the OBUS12 group, the rate of postterm pregnancy ≥42 weeks was lower (2.7%) as compared to the OBUS13–24 group (3.7%, p=0.022). With regards to reaching 41 weeks of gestation, the OBUS12 group was again lower (18.2%) as compared to the OBUS13–24 group (22.1%, p<0.001). There were also fewer postterm inductions at ≥42 weeks in the OBUS12 group (1.8%) as compared to the OBUS13–24 group (2.6%, p=0.017). When comparing perinatal outcomes between those women who reached 41 weeks of gestation and those prior to 41 weeks of gestation, the OBUS12 group demonstrated greater differences between these two groups.
Our findings suggest that earlier obstetric ultrasound, which leads to better pregnancy dating, reduces the rate of estimated postterm pregnancies. This may, in turn, reduce unnecessary intervention and lead to better identification of postterm pregnancies at greater risk of complications.
pregnancy dating; ultrasound; complications of pregnancy; post-term; post-dates
We sought to estimate when rates of maternal pregnancy complications increase beyond 37 weeks of gestation.
We designed a retrospective cohort study of all low-risk women delivered beyond 37 weeks gestational age from 1995 to 1999 within a mature managed care organization. Rates of mode of delivery and maternal complications of labor and delivery were examined by gestational age with both bivariate and multivariable analyses.
We found that among the 119,254 women who delivered at 37 completed weeks and beyond that the rates of operative vaginal delivery (OR 1.15, 95% CI 1.09, 1.22), 3rd or 4th degree perineal laceration (OR 1.15, 95% CI 1.06, 1.24), and chorioamnionitis (OR 1.32, 95% CI 1.21, 1.44) all increased at 40 weeks as compared to 39 weeks of gestation (p<0.001), and rates of postpartum hemorrhage (OR 1.21, 95% CI (1.10, 1.32), endomyometritis (OR 1.46, 95% CI 1.14, 1.87) and primary cesarean delivery (1.28, 95% CI 1.20, 1.36) increased at 41 weeks of gestation (p< 0.001). The cesarean indications of nonreassuring fetal heart rate (OR 1.81, 95% CI 1.49, 2.19) and cephalo-pelvic disproportion (OR 1.64, 95% CI 1.40, 1.94) increased at 40 weeks of gestation (p<0.001)
We found that the risk of maternal peripartum complications increase as pregnancy progresses beyond 40 weeks of gestation. Management of pregnancies that progress past their EDC should include counseling regarding the risks of increasing gestational age.
Rates of operative delivery, postpartum hemorrhage, chorioamnionitis, perineal lacerations, and endomyometritis all increase beyond 40 weeks of gestation.
complications of pregnancy; postterm; post-dates; cesarean delivery
To estimate the risk of short-term complications in neonates born between 34 and 36 weeks by week of gestation.
This is a retrospective cohort study.
Deliveries in 2005 in the United States of America.
Singleton live births between 34 and 40 weeks gestational age.
Gestational age was subgrouped into 34, 35, 36 and 37–40 completed weeks. Statistical comparisons were performed using chi-square test and multivariable logistic regression models, with 37–40 weeks gestational age designated as referent.
Main Outcome Measures
Perinatal morbidities, including 5-minute Apgar scores, hyaline membrane disease, neonatal sepsis/antibiotics use, and admission to the intensive care unit.
There were 175,112 neonates born between 34 and 36 weeks in 2005. Compared to neonates born between 37 and 40 weeks, neonates born at 34 weeks had higher odds of 5-minute Apgar<7 (adjusted odds ratio [aOR]=5.51, 95% CI [5.16–5.88]), hyaline membranes disease (aOR=10.2 [9.44–10.9]), mechanical ventilation use >6 hours (aOR=9.78 [8.99–10.6]) and antibiotics use (aOR=9.00 [8.43–9.60]). Neonates born at 35 weeks were similarly at risk of morbidity, with higher odds of 5-minute Apgar <7 (aOR 3.42 [3.23–3.63], surfactant use (aOR 3.74 [3.21–4.22], ventilation use >6 hours (aOR 5.53 [5.11–5.99] and NICU admission (aOR 11.3 [11.0–11.7). Further, neonates born at 36 weeks remain at higher risk of morbidity compared to deliveries at 37–40 weeks.
While the risk of undesirable neonatal outcomes decreases with increasing gestational age, the risk of neonatal complications in late preterm births remains higher compared to infants delivered at 37–40 weeks gestation.
late preterm births; perinatal outcomes
To examine perinatal outcomes in women with gestational diabetes mellitus treated with glyburide compared to insulin injections.
This is a retrospective cohort study of women diagnosed with gestational diabetes mellitus (GDM) who required pharmaceutical therapy and were enrolled in the Sweet Success California Diabetes and Pregnancy Program between 2001 and 2004, a California state-wide program. Women managed with glyburide were compared to women treated with insulin injections. Perinatal outcomes were compared using chi-square test and multivariable logistic regression models; statistical significance was indicated by p < 0.05 and 95% confidence intervals (CI).
Among the 10,682 women with GDM who required medical therapy and met study criteria, 2073 (19.4%) received glyburide and 8609 (80.6%) received subcutaneous insulin injections. Compared to insulin therapy and controlling for confounders, oral hypoglycemic treatment was associated with increased risk of birthweight >4000 g (aOR = 1.29; 95% CI [1.03–1.64]), and admission to the intensive care nursery (aOR = 1.46 [1.07–2.00]).
Neonates born to women with gestational diabetes managed on glyburide, and were more likely to be macrosomic and to be admitted to the intensive care unit compared to those treated with insulin injections. These findings should be examined in a large, prospective trial.
Gestational diabetes mellitus; treatment; perinatal outcomes
This study investigated the cost-effectiveness of treating mild gestational diabetes mellitus (GDM).
A decision analytic model was built to compare treating vs not treating mild GDM. The primary outcome was the incremental cost per quality-adjusted life year (QALY). All probabilities, costs, and benefits were derived from the literature. Base case, sensitivity analyses, and a Monte Carlo simulation were performed.
Treating mild GDM was more expensive, more effective, and cost-effective at $20,412 per QALY. Treatment remained cost-effective when the incremental cost to treat GDM was less than $3555 or if treatment met at least 49% of its reported efficacy at the baseline cost to treat of $1786.
Treating mild GDM is cost-effective in terms of improving maternal and neonatal outcomes including decreased rates of preeclampsia, cesarean sections, macrosomia, shoulder dystocia, permanent and transient brachial plexus injury, neonatal hypoglycemia, neonatal hyperbilirubinemia, and neonatal intensive care unit admissions.
cost-effectiveness; decision analysis; gestational; diabetes mellitus
VBAC; Pregnancy; Pregnancy complications; Cesarean section; Evidence review
The objective of the study was to evaluate the efficacy of an educational intervention at increasing the rates of postpartum (PP) follow-up for women with gestational diabetes mellitus (GDM).
A retrospective cohort study of all patients with GDM delivering during 2002–2009 was conducted. The primary outcome was obtaining PP diabetes testing. The 2002–2006 cohort was advised to obtain PP testing by their providers. The 2007–2009 cohort received educational counseling at the 37–38 week visit by a nurse educator. Univariate and multivariable statistical tests were utilized.
The PP testing frequency was 53% for the 2007–2009 cohort, compared with 33% for the 2002–2006 cohort (P <.001). When stratified by race/ethnicity, increased rates of testing were seen in whites (28% to 53%, P <.001), Latinas (15% to 50%, P <.001), and Asians (43% to 59%, P = .005). There was a nonsignificant decrease in the African American follow-up, 28% to 17% (P =.414).
GDM precedes the development of type 2 diabetes. Antepartum education counseling increases postpartum diabetes testing. More efforts are needed to obtain universal screening.
gestational diabetes mellitus; postpartum screening
We sought to examine associations between gestational weight gain according to the 2009 Institute of Medicine (IOM) guidelines and perinatal outcomes in overweight/obese women with type 2 diabetes mellitus (T2DM).
This is a retrospective cohort study of 2310 women with T2DM enrolled in the California Diabetes and Pregnancy Program. Gestational weight gain was categorized by 2009 IOM guidelines. Perinatal outcomes were assessed using the χ2 test and multivariable logistic regression analysis.
With excessive gestational weight gain, the odds of having large-for-gestational age (adjusted odds ratio [aOR], 2.00; 95% confidence interval [CI], 1.33–3.00) or macrosomic (aOR, 2.59; 95% CI, 1.56 – 4.30) neonates and cesarean delivery (aOR, 1.47; 95% CI, 1.03–2.10) was higher. Women with excessive gestational weight gain per week had increased odds of preterm delivery (aOR, 1.57; 95% CI, 1.11–2.20).
In overweight or obese women with T2DM, gestational weight gain greater than the revised IOM guidelines was associated with higher odds of perinatal morbidity, suggesting these guidelines are applicable to a diabetic population.
gestational weight gain; perinatal outcomes; type 2 diabetes mellitus
Examine the effect of prepregnancy weight and maternal gestational weight gain on postterm delivery rates.
This was a retrospective cohort study of term, singleton births (N=375,003). We performed multivariable analyses of the association between postterm pregnancy and both prepregnancy body mass index (BMI) and maternal weight gain.
Prolonged or postterm delivery (41 or 42 weeks) was increasingly common with increasing prepregnancy weight (p<0.001) and increasing maternal weight gain (p<0.001). Underweight women were 10% less likely to deliver postterm than normal weight women who gain within the recommendations (aOR 0.90 (95% CI 0.83, 0.97)). Overweight women who gain within or above recommendations were also at increased risk of a 41 week delivery. Finally, obese women were at increased risk of a 41 week delivery with increasing risk with increasing weight (below, within, and above recommendations aOR 1.19, 1.21, and 1.27, respectively).
Elevated prepregnancy weight and weight gain both increase the risk of a postterm delivery. While most women do not receive preconceptional care, restricting weight gain to the within the recommended range can reduce the risk of postterm pregnancy in normal, overweight, and obese women.
postterm; prepregnancy weight; prolonged delivery; gestational weight gain
To determine the effect of maternal super-obesity (BMI ≥50 kg/m2) compared to morbid obesity (BMI 40–49.9 kg/m2) or obesity (BMI 30–39.9 kg/m2) on perinatal outcomes.
Retrospective cohort study of birth records linked to hospital discharge data for all live born singleton term infants born to obese Missouri residents from 2000–2006. We excluded major congenital anomalies and women with diabetes or chronic hypertension.
There were 64,272 births meeting study criteria, including 1,185 (1.8%) super-obese mothers. Super-obese women were significantly more likely than obese women to have preeclampsia (aRR 1.7, 95% CI 1.4, 2.1), macrosomia (aRR 1.8, 95% CI 1.3, 2.5), and cesarean delivery (aRR 1.8, 95% CI 1.5, 2.1). Almost half (49.1%) of all super-obese women delivered via cesarean, and 33.8% of super-obese nulliparous women underwent scheduled primary cesarean.
Women with a BMI ≥50 kg/m2 are at significantly increased risk for perinatal complications compared to obese women of lower BMI.
pregnancy outcomes; super-obesity
The American Academy of Pediatrics recommends exclusive breastfeeding until 6 months- of-age. The authors examined prevalence and risk factors for use of infant formulas, water, and teas at 4–6 weeks in Latino infants in the San Francisco Bay Area, a group at high risk for future obesity. They recruited a cohort of pregnant Latina women (N = 201). Infant dietary recall and postpartum depressive symptoms were assessed at 4–6 weeks. The authors found that 105 women (53.1%) were feeding infant formulas and 48 (25.4%) were supplementing with tea or water. Of those providing water or tea, 60.0% were providing daily supplementation. In multivariate analyses, risk for infant supplementation with water or tea was associated with postpartum depressive symptoms (relative risk, 1.8; 95% confidence interval, 1.1–3.0), cesarean delivery (relative risk, 1.9; 95% confidence interval, 1.3–2.9), and infant formula use (relative risk, 1.3; 95% confidence interval, 1.1–1.6). Early supplementation with water or teas and infant formulas should be discouraged in Latinos, given the high frequency observed in this population. J Hum Lact. 27(2):122–130.
perinatal depression; breastfeeding; infant feeding; complementary feeding; risk factors
To estimate which strategy is the most cost-effective for prevention of preterm birth and associated morbidity.
We used decision-analytic and cost-effectiveness analyses to estimate which of 4 strategies was superior based on quality-adjusted life-years (QALYs), cost in US dollars ($), and number of preterm births prevented.
Universal sonographic screening for cervical length and treatment with vaginal progesterone was the most cost-effective strategy and dominant over 3 alternatives: cervical length screening for women at increased risk for preterm birth and treatment with vaginal progesterone; risk-based treatment with 17 α-hydroxyprogesterone Caproate (17-OHP-C) without screening; no screening or treatment. Universal screening represented savings of $1,339 ($8,325 vs. $9,664) when compared to treatment with 17-OHP-C, and led to a reduction of 95,920 preterm births annually in the US.
Universal sonographic screening for short cervical length and treatment with vaginal progesterone appears cost-effective and yields the greatest reduction in preterm birth prior to 34 weeks.
Wide disparities in obstetrical outcomes exist between women of different race/ethnicities. The prevalence of preterm birth, fetal growth restriction, fetal demise, maternal mortality and inadequate receipt of prenatal care all vary by maternal race/ethnicity. These disparities have their roots in maternal health behaviors, genetics, the physical and social environments, and access to and quality of health care. Elimination of the health inequities due to sociocultural differences or access to or quality of health care will require a multidisciplinary approach. We aim to describe these obstetrical disparities, with an eye towards potential etiologies, thereby improving our ability to target appropriate solutions.
disparities; maternal mortality; obstetrical care; preterm birth; race/ethnicity
Latino children are at increased risk for mirconutrient deficiencies and problems of overweight and obesity. Exposures in pregnancy and early postpartum may impact future growth trajectories.
To evaluate the relationship between prenatal and postnatal maternal depressive symptoms experienced in pregnancy and infant growth from birth to 2 years of age in a cohort of Latino infants.
We recruited pregnant Latina mothers at two San Francisco hospitals and followed their healthy infants to 24 months of age. At 6, 12 and 24 months of age, infants were weighed and measured. Maternal depressive symptoms were assessed prenatally and at 4-6 weeks postpartum. Women who had high depressive symptoms at both time periods were defined as having chronic depression. Logistic mixed models were applied to compare growth curves and risk for overweight and underweight based on exposure to maternal depression.
We followed 181 infants to 24 months. At 12 and 24 months, respectively, 27.4% and 40.5% were overweight, and 5.6% and 2.2% were underweight. Exposure to chronic maternal depression was associated with underweight (OR = 12.12, 95%CI 1.86-78.78) and with reduced weight gain in the first 2 years of life (Coef = -0.48, 95% CI -0.94—0.01) compared with unexposed infants or infants exposed to episodic depression (depression at one time point). Exposure to chronic depression was also associated with reduced risk for overweight in the first 2 years of life (OR 0.28, 95%CI 0.03-0.92).
Exposure to chronic maternal depression in the pre- and postnatal period was associated with reduced weight gain in the first two years of life and greater risk for failure to thrive, in comparison with unexposed infants or those exposed episodically. The infants of mothers with chronic depression may need additional nutritional monitoring and intervention.