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COZZI-GLASER GD, BLANCHARD CT, STANFORD JN, OBEN AG, JAUK VC, SZYCHOWSKI JM, SUBRAMANIAM A, BATTARBEE AN, CASEY BM, Tita AT, Sinkey RG. Outcomes in low-risk patients before and after an institutional policy offering 39-week elective induction of labor. J Matern Fetal Neonatal Med 2024; 37:2295223. [PMID: 38124289 PMCID: PMC10958525 DOI: 10.1080/14767058.2023.2295223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 12/11/2023] [Indexed: 12/23/2023]
Abstract
OBJECTIVE Elective induction of labor versus expectant management at 39 weeks gestation in low-risk nulliparous patients was shown in the ARRIVE randomized trial of over 6000 patients to decrease risks of cesarean delivery without significant change in the composite perinatal outcome. We aimed to pragmatically analyze the effect of offering elective induction of labor (eIOL) to all low-risk patients. METHODS Retrospective cohort study of low-risk nulliparous and multiparous patients delivering live, non-anomalous singletons at a single center at greater than or equal to 39 0/7 weeks gestational age. Those with prior or planned cesarean delivery, ruptured membranes, medical comorbidities, or contraindications to vaginal delivery were excluded. Patients were categorized as before (pre-eIOL; 1/2012-3/2014) or after (post-eIOL; 3/2019-12/2021) an institution-wide policy offering eIOL at 39 0/7 weeks. Births occurring April 2014 to December 2018 were allocated to a separate cohort (during-eIOL) given increased exposure to eIOL as our center recruited participants for the ARRIVE trial. The primary outcome was cesarean birth. Secondary outcomes included select maternal (e.g. chorioamnionitis, operative delivery, postpartum hemorrhage) and neonatal morbidities (e.g. birthweight, small- and large-for gestational age, hypoglycemia). Characteristics and outcomes were compared between the pre and during-eIOL, and pre and post-eIOL groups; adjusted OR (95% CI) were calculated using multivariable regression. Subgroup analysis by parity was planned. RESULTS Of 10,758 patients analyzed, 2521 (23.4%) were pre-eIOL, 5410 (50.3%) during-eIOL, and 2827 (26.3%) post-eIOL. Groups differed with respect to labor type, age, race/ethnicity, marital and payor status, and gestational age at care entry. Post-eIOL was associated with lower odds of cesarean compared to pre-eIOL (aOR 0.83 [95% CI 0.72-0.96]), which was even lower among those specifically undergoing labor induction (aOR 0.58 [0.48-0.70]. During-eIOL was also associated with lower odds of cesarean compared to pre-eIOL (aOR 0.79 [0.69-0.90]). Both during and post-eIOL groups were associated with higher odds of chorioamnionitis, operative delivery, and hemorrhage compared to pre-eIOL. However, only among post-eIOL were there fewer neonates weighing ≥4000 g, large-for-gestational age infants, and neonatal hypoglycemia compared to pre-IOL. CONCLUSION An institutional policy offering eIOL at 39 0/7 to low-risk patients was associated with a lower cesarean birth rate, lower birthweights and lower neonatal hypoglycemia, and an increased risk of chorioamnionitis and hemorrhage.
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Affiliation(s)
- Gabriella D COZZI-GLASER
- Center for Women’s Reproductive Health, University of Alabama at Birmingham
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham
| | | | - Jenna N STANFORD
- Center for Women’s Reproductive Health, University of Alabama at Birmingham
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham
| | - Ayamo G OBEN
- Center for Women’s Reproductive Health, University of Alabama at Birmingham
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham
| | - Victoria C JAUK
- Center for Women’s Reproductive Health, University of Alabama at Birmingham
| | - Jeff M SZYCHOWSKI
- Center for Women’s Reproductive Health, University of Alabama at Birmingham
- Department of Biostatistics, University of Alabama at Birmingham
| | - Akila SUBRAMANIAM
- Center for Women’s Reproductive Health, University of Alabama at Birmingham
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham
| | - Ashley N BATTARBEE
- Center for Women’s Reproductive Health, University of Alabama at Birmingham
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham
| | - Brian M CASEY
- Center for Women’s Reproductive Health, University of Alabama at Birmingham
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham
| | - Alan T Tita
- Center for Women’s Reproductive Health, University of Alabama at Birmingham
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham
| | - Rachel G Sinkey
- Center for Women’s Reproductive Health, University of Alabama at Birmingham
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham
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Ho SJ, Chaput D, Sinkey RG, Garces AH, New EP, Okuka M, Sang P, Arlier S, Semerci N, Steffensen TS, Rutherford TJ, Alsina AE, Cai J, Anderson ML, Magness RR, Uversky VN, Cummings DAT, Tsibris JCM. Proteomic studies of VEGFR2 in human placentas reveal protein associations with preeclampsia, diabetes, gravidity, and labor. Cell Commun Signal 2024; 22:221. [PMID: 38594674 PMCID: PMC11003095 DOI: 10.1186/s12964-024-01567-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Accepted: 03/09/2024] [Indexed: 04/11/2024] Open
Abstract
VEGFR2 (Vascular endothelial growth factor receptor 2) is a central regulator of placental angiogenesis. The study of the VEGFR2 proteome of chorionic villi at term revealed its partners MDMX (Double minute 4 protein) and PICALM (Phosphatidylinositol-binding clathrin assembly protein). Subsequently, the oxytocin receptor (OT-R) and vasopressin V1aR receptor were detected in MDMX and PICALM immunoprecipitations. Immunogold electron microscopy showed VEGFR2 on endothelial cell (EC) nuclei, mitochondria, and Hofbauer cells (HC), tissue-resident macrophages of the placenta. MDMX, PICALM, and V1aR were located on EC plasma membranes, nuclei, and HC nuclei. Unexpectedly, PICALM and OT-R were detected on EC projections into the fetal lumen and OT-R on 20-150 nm clusters therein, prompting the hypothesis that placental exosomes transport OT-R to the fetus and across the blood-brain barrier. Insights on gestational complications were gained by univariable and multivariable regression analyses associating preeclampsia with lower MDMX protein levels in membrane extracts of chorionic villi, and lower MDMX, PICALM, OT-R, and V1aR with spontaneous vaginal deliveries compared to cesarean deliveries before the onset of labor. We found select associations between higher MDMX, PICALM, OT-R protein levels and either gravidity, diabetes, BMI, maternal age, or neonatal weight, and correlations only between PICALM-OT-R (p < 2.7 × 10-8), PICALM-V1aR (p < 0.006), and OT-R-V1aR (p < 0.001). These results offer for exploration new partnerships in metabolic networks, tissue-resident immunity, and labor, notably for HC that predominantly express MDMX.
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Grants
- Department of Obstetrics and Gynecology, University of South Florida
- Department of Cell Biology, Microbiology and Molecular Biology, University of South Florida
- Lisa Muma Weitz Microscopy Laboratory, University of South Florida
- Department of Chemistry, University of South Florida
- Tampa General Hospital, Tampa, Florida
- Teasley Foundation
- Department of Molecular Medicine, University of South Florida
- Department of Biology, University of Florida
- Emerging Pathogens Institute, University of Florida
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Affiliation(s)
- Shannon J Ho
- Department of Obstetrics and Gynecology, University of South Florida, Tampa, FL, USA
| | - Dale Chaput
- Department of Cell Biology, Microbiology and Molecular Biology, University of South Florida, Tampa, FL, USA
| | - Rachel G Sinkey
- Department of Obstetrics and Gynecology, University of South Florida, Tampa, FL, USA
| | - Amanda H Garces
- Lisa Muma Weitz Microscopy Laboratory, University of South Florida, Tampa, FL, USA
| | - Erika P New
- Department of Obstetrics and Gynecology, University of South Florida, Tampa, FL, USA
| | - Maja Okuka
- Department of Obstetrics and Gynecology, University of South Florida, Tampa, FL, USA
| | - Peng Sang
- Department of Chemistry, University of South Florida, Tampa, FL, USA
| | - Sefa Arlier
- Department of Obstetrics and Gynecology, University of South Florida, Tampa, FL, USA
| | - Nihan Semerci
- Department of Obstetrics and Gynecology, University of South Florida, Tampa, FL, USA
| | | | - Thomas J Rutherford
- Department of Obstetrics and Gynecology, University of South Florida, Tampa, FL, USA
- Cancer Center, Tampa General Hospital, Tampa, FL, USA
| | - Angel E Alsina
- Transplant Surgery Center, Tampa General Hospital, Tampa, FL, USA
| | - Jianfeng Cai
- Department of Chemistry, University of South Florida, Tampa, FL, USA
| | - Matthew L Anderson
- Department of Obstetrics and Gynecology, University of South Florida, Tampa, FL, USA
- Cancer Center, Tampa General Hospital, Tampa, FL, USA
| | - Ronald R Magness
- Department of Obstetrics and Gynecology, University of South Florida, Tampa, FL, USA
| | - Vladimir N Uversky
- Department of Molecular Medicine, University of South Florida, Tampa, FL, USA
| | - Derek A T Cummings
- Department of Biology and Emerging Pathogens Institute, University of Florida, Gainesville, FL, USA
| | - John C M Tsibris
- Department of Obstetrics and Gynecology, University of South Florida, Tampa, FL, USA.
- Department of Molecular Medicine, University of South Florida, Tampa, FL, USA.
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Sanusi AA, Sinkey RG, Tita ATN. Clinical Trials That Have Changed Obstetric Practice: The Chronic Hypertension and Pregnancy (CHAP) Trial. Clin Obstet Gynecol 2024:00003081-990000000-00144. [PMID: 38465909 DOI: 10.1097/grf.0000000000000857] [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: 03/12/2024]
Abstract
We describe the evolution of treatment recommendations for chronic hypertension (CHTN) in pregnancy, the CHTN and pregnancy (CHAP) trial, and its impact on obstetric practice. The US multicenter CHAP trial showed that antihypertensive treatment for mild CHTN in pregnancy [blood pressures (BP)<160/105 mm Hg] to goal<140/90 mm Hg, primarily with labetalol or nifedipine compared with no treatment unless BP were severe reduced the composite risk of superimposed severe preeclampsia, indicated preterm birth <35 weeks, placental abruption, and fetal/neonatal death. As a result of this trial, professional societies in the United States recommended treatment of patients with CHTN in pregnancy to BP goal<140/90 mm Hg.
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Affiliation(s)
- Ayodeji A Sanusi
- Center for Women's Reproductive Health
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Rachel G Sinkey
- Center for Women's Reproductive Health
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Alan T N Tita
- Center for Women's Reproductive Health
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, University of Alabama at Birmingham, Birmingham, Alabama
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Sinkey RG, Blanchard CT, Sanusi A, Elkins C, Szychowski JM, Harper LM, Tita AT. Physiologic blood pressure patterns in pregnancies with mild chronic hypertension. Pregnancy Hypertens 2024; 36:101118. [PMID: 38460322 DOI: 10.1016/j.preghy.2024.101118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 12/25/2023] [Accepted: 02/27/2024] [Indexed: 03/11/2024]
Abstract
OBJECTIVES To assess physiologic blood pressure (BP) changes throughout pregnancy in patients with mild chronic hypertension (CHTN) who do and do not develop preeclampsia (PEC), compared to patients with normal BP. STUDY DESIGN Retrospective cohort of singleton gestations with CHTN at a single tertiary center from 2000 to 2014 and a randomly selected cohort of patients without CHTN and normal pregnancy outcomes (NML) in the same time period with BP measurements available <12 weeks gestational age. MAIN OUTCOME MEASURES The primary outcome was gestational age (GA) at nadir of systolic and diastolic BP. Secondary outcomes included perinatal death, umbilical cord pH, maternal and neonatal length of stay, GA at delivery, and mode of delivery. Quadratic mixed models were used to estimate SBP and DBP throughout gestation. RESULTS Of 367 pregnancies with CHTN, 268 (73%) had CHTN without PEC and 99 (27%) had CHTN with PEC; 198 NML pregnancies were used as a comparison group. The median GA nadir for patients in the NML, CHTN without PEC, and CHTN with PEC for SBP were 20, 24, and 21, respectively. For DBP, the median GA nadir were 22, 24, and 21 for patients in the NML, CHTN without PEC, and CHTN with PEC cohorts, respectively. Adverse secondary outcomes were more frequent in patients with CHTN who developed PEC. CONCLUSIONS BP trajectories in pregnancy are different between patients with CHTN with PEC, CHTN without PEC, and patients with normal BP. These findings may be useful in assessing patients' risks for developing preeclampsia during pregnancy.
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Affiliation(s)
- Rachel G Sinkey
- Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, AL, USA; Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL, USA.
| | - Christina T Blanchard
- Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, AL, USA; Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Ayodeji Sanusi
- Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, AL, USA; Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Cooper Elkins
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL, USA; University of Alabama Heersink School of Medicine, Birmingham, AL, USA
| | - Jeff M Szychowski
- Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, AL, USA; Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Lorie M Harper
- Department of Obstetrics and Gynecology, University of Texas at Austin, Austin, TX, USA
| | - Alan T Tita
- Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, AL, USA; Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL, USA
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Davis AM, Blanchard CT, Subramaniam A, Sinkey RG, Tita AT, Battarbee AN. Physiologic Treatment of Severe Hypertension in Pregnancy and Postpartum. Obstet Gynecol 2024; 143:277-280. [PMID: 38033320 PMCID: PMC10841714 DOI: 10.1097/aog.0000000000005472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 08/07/2023] [Accepted: 10/26/2023] [Indexed: 12/02/2023]
Abstract
We aimed to evaluate physiologic treatment of severe hypertension. This was a retrospective cohort study of pregnant and postpartum patients with severe hypertension (systolic blood pressure [BP] 160 mm Hg or higher or diastolic BP 110 mm Hg or higher) treated with intravenous labetalol or hydralazine at a single tertiary care center between 2013 and 2018. Patients were classified as having physiologic treatment if they had hyperdynamic physiology (pulse pressure 65 mm Hg or higher) and received labetalol or had vasoconstrictive physiology (diastolic BP 100 mm Hg or higher) and received hydralazine. The primary outcome was number of antihypertensive doses to achieve nonsevere BP. Of 1,120 patients included in the analysis, 653 had physiologic treatment and 467 had nonphysiologic treatment, with 16 (1.4%) excluded for inability to classify physiology. Physiologic treatment was associated with fewer antihypertensive doses (1.4±0.9 doses vs 1.6±1.4 doses; adjusted β -0.28, 95% CI, -0.42 to -0.14) and lower odds of medication conversion (2.5% vs 4.7%; adjusted odds ratio 0.48, 95% CI, 0.24-0.93) but no difference in time to nonsevere BP (31 minutes [interquartile range 16-66 minutes] vs 34 minutes [interquartile range 15-76 minutes]; adjusted hazard ratio 1.0, 95% CI, 0.9-1.2). Physiologic treatment of severe hypertension warrants further evaluation.
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Affiliation(s)
- Allison M Davis
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, and the Center for Women's Reproductive Health, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
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Sinkey RG, Ogunsile FJ, Kanter J, Bean C, Greenberg M. Society for Maternal-Fetal Medicine Consult Series #68: Sickle cell disease in pregnancy. Am J Obstet Gynecol 2024; 230:B17-B40. [PMID: 37866731 PMCID: PMC10961101 DOI: 10.1016/j.ajog.2023.10.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2023]
Abstract
Pregnant individuals with sickle cell disease have an increased risk of maternal and perinatal morbidity and mortality. However, prepregnancy counseling and multidisciplinary care can lead to favorable maternal and neonatal outcomes. In this consult series, we summarize what is known about sickle cell disease and provide guidance for sickle cell disease management during pregnancy. The following are Society for Maternal-Fetal Medicine recommendations.
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Bushman ET, Blanchard CT, Cozzi GD, Davis AM, Harper L, Robbins LS, Jones B, Szychowski JM, Digre KB, Casey BM, Tita AT, Sinkey RG. Occipital Nerve Block Compared With Acetaminophen and Caffeine for Headache Treatment in Pregnancy: A Randomized Controlled Trial. Obstet Gynecol 2023; 142:1179-1188. [PMID: 37769308 PMCID: PMC10591891 DOI: 10.1097/aog.0000000000005386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 06/07/2023] [Accepted: 07/20/2023] [Indexed: 09/30/2023]
Abstract
OBJECTIVE To evaluate the efficacy of occipital nerve block compared with standard care , defined as acetaminophen with caffeine, for treatment of acute headache in pregnancy. METHODS We conducted a single-center, unblinded, parallel, randomized controlled trial of pregnant patients with headache and pain score higher than 3 on the visual rating scale. Patients with secondary headache, preeclampsia, or allergy or contraindication to study medications were excluded. Participants were randomized to occipital nerve block or standard care (oral 650 mg acetaminophen and 200 mg caffeine). Crossover treatment was given at 2 hours and second-line treatment at 4 hours to those with worsening visual rating scale score or visual rating scale score higher than 3. The primary outcome was headache improvement to a visual rating scale score of 3 or lower within 2 hours of initial therapy. Secondary outcomes included serial visual rating scale scores, receipt of crossover or second-line therapy, patient satisfaction, and perinatal outcomes. Outcomes were assessed in an intention-to-treat analysis. We estimated that a sample of 62 would provide 80% power to detect a difference from 85% to 50% between groups. RESULTS From February 2020 to May 2022, 62 participants were randomized to occipital nerve block (n=31) or standard care (n=31). Groups were similar except payer status. The primary outcome, headache improvement to visual rating scale score of 3 or lower, was not significantly different between groups (64.5% vs 51.6%, P =.30). The occipital nerve block group experienced lower median [interquartile range] visual rating scale scores at 1 hour (2 [0-5] vs 6 [2-7], P =.014), and more patients in the occipital nerve block group had visual rating scale scores of 3 or lower at 1 hour. Among patients receiving crossover treatment at 2 hours, the standard care group had a significantly lower visual rating scale score 1 hour after crossover to occipital nerve block than the occipital nerve block group receiving crossover to standard care ( P =.028). There were no significant differences in second-line treatment, refractory headache, satisfaction, or complications. Patients receiving occipital nerve block delivered earlier (36.6 weeks vs 37.8 weeks), but preterm birth did not differ between groups. CONCLUSION Occipital nerve block is an effective and quick-acting treatment option for acute headache in pregnancy. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov , NCT03951649.
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Affiliation(s)
- Elisa T Bushman
- Center for Women's Reproductive Health, the Department of Obstetrics and Gynecology, the Department of Biostatistics, and the Department of Neurology, University of Alabama at Birmingham, Birmingham, Alabama; the Department of Women's Health, University of Texas at Austin, Dell Medical School, Austin, Texas; and the Department of Neuro-ophthalmology, University of Utah, Salt Lake City, Utah
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Toluhi AA, Richardson MR, Julian ZI, Sinkey RG, Knight CC, Budhwani H, Szychowski JM, Wingate MS, Tita AT, Baskin ML, Turan JM. Contribution of Health Care Practitioner and Maternity Services Factors to Racial Disparities in Alabama: A Qualitative Study. Obstet Gynecol 2023; 142:873-885. [PMID: 37678848 PMCID: PMC10510788 DOI: 10.1097/aog.0000000000005326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 01/31/2023] [Revised: 04/06/2023] [Accepted: 04/13/2023] [Indexed: 09/09/2023]
Abstract
OBJECTIVE Black patients are three times more likely to die of pregnancy-related causes than White patients in the United States, and Alabama has the third worst maternal mortality rate in the nation. We sought to identify health care practitioner and maternity service factors contributing to disparities in Alabama, as well as potential strategies to address these contributors. METHODS We conducted key informant interviews with obstetricians, nurses, doulas, lactation counselors, health system administrators, and representatives of professional organizations who deliver maternity care to racially and ethnically diverse patients in Alabama. The interview guide was developed using Howell's conceptual framework on racial and ethnic disparities in severe maternal morbidity and mortality. Adopting a thematic analysis approach, we coded and analyzed transcripts using NVivo 12 software. Open coding and selective coding were conducted to identify themes related to health care practitioner- and maternity services-level determinants. RESULTS Overall, 20 health care practitioners or administrators were interviewed. Primary themes related to health care practitioners included implicit bias and explicit racism, lack of communication and lack of positive patient-health care practitioner relationships, lack of cultural sensitivity, and variation in clinical knowledge and experience. Primary themes related to maternity services included lack of accessibility, inadequate quality and content of care, lack of continuity of care, discriminatory facility policies, and workforce shortages and lack of diversity. Strategies suggested by participants to address these factors included bias trainings for health care practitioners, improvements in racial and interdisciplinary diversity in the maternity workforce, and evidence-based interventions such as group prenatal care, disparities dashboards, simulation trainings, early warning signs criteria, and coordinated care. CONCLUSION We gained diverse perspectives from health care practitioners and administrators on how maternity health care practitioner and maternity health services factors contribute to inequities in maternal health in Alabama. Strategies to address these contributing factors were multifaceted.
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Affiliation(s)
- Angelina A Toluhi
- Department of Health Policy and Organization, the Department of Obstetrics and Gynecology, the Center for Women's Reproductive Health, the School of Nursing, the Department of Biostatistics, and the Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama; the Department of Obstetrics and Gynecology, WellStar Kennestone Regional Medical Center, Marietta, Georgia; and the Center of Population Sciences for Health Equity, College of Nursing, Florida State University, Tallahassee, Florida
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Champion ML, Maier JG, Bushman ET, Barney JB, Casey BM, Sinkey RG. Systematic Review of Lymphangioleiomyomatosis Outcomes in Pregnancy and a Proposed Management Guideline. Am J Perinatol 2023:10.1055/a-2051-8395. [PMID: 36898409 PMCID: PMC10582203 DOI: 10.1055/a-2051-8395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/12/2023]
Abstract
OBJECTIVE Lymphangioleiomyomatosis (LAM) is a rare, multisystem disease that primarily affects women of reproductive age. Disease progression has been linked to estrogen exposure, and as such many patients are advised to avoid pregnancy. Data are limited regarding the interaction between LAM and pregnancy, and as such we performed a systematic review to summarize available literature reporting outcomes of pregnancies complicated by maternal LAM. STUDY DESIGN This was a systematic review including randomized controlled trials, observational studies, systematic reviews, case reports, clinical practice guidelines, and quality improvement studies with full-text manuscripts or abstracts in the English language with primary data on pregnant or postpartum patients with LAM. The primary outcome was maternal outcomes during pregnancy as well as pregnancy outcomes. Secondary outcomes were neonatal outcomes and long-term maternal outcomes. This search occurred in July 2020 and included MEDLINE, Scopus, clinicaltrials.gov, Embase, and Cochrane Central. Risk of bias was ascertained using the Newcastle-Ottawa Scale. Our systematic review was registered with PROSPERO as protocol number CRD 42020191402. RESULTS A total of 175 publications were identified in our initial search; ultimately 31 studies were included. Six (19%) studies were retrospective cohort studies and 25 (81%) studies were case reports. Patients diagnosed during pregnancy had worse pregnancy outcomes compared to those diagnosed with LAM prior to pregnancy. Multiple studies reported a significant risk of pneumothoraces during pregnancy. Other significant risks included preterm delivery, chylothoraces, and pulmonary function deterioration. A proposed strategy for preconception counseling and antenatal management is provided. CONCLUSION Patients diagnosed with LAM during pregnancy generally experience worse outcomes including recurrent pneumothoraces and preterm delivery as compared to patients with a LAM diagnosis prior to pregnancy. Given that there are limited studies available, and that the majority are low-quality evidence and subject to bias, further investigation of the interaction between LAM and pregnancy is warranted to guide patient care and counseling. KEY POINTS · Data are limited on the effects of lymphangioleiomyomatosis on pregnancy outcomes.. · We performed a systematic review to summarize pregnancy outcomes complicated by LAM.. · Patients diagnosed with LAM during pregnancy experience worse outcomes..
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Affiliation(s)
- Macie L. Champion
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Center for Women’s Reproductive Health at the University of Alabama at Birmingham, Birmingham, Alabama
| | - Julia G. Maier
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Center for Women’s Reproductive Health at the University of Alabama at Birmingham, Birmingham, Alabama
| | - Elisa T. Bushman
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Center for Women’s Reproductive Health at the University of Alabama at Birmingham, Birmingham, Alabama
| | - Joseph B. Barney
- Department of Pulmonary, Allergy, and Critical Care Medicine, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama
| | - Brian M. Casey
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Center for Women’s Reproductive Health at the University of Alabama at Birmingham, Birmingham, Alabama
| | - Rachel G. Sinkey
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Center for Women’s Reproductive Health at the University of Alabama at Birmingham, Birmingham, Alabama
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Vilcassim MJR, Stowe S, Majumder R, Subramaniam A, Sinkey RG. Electronic Cigarette Use during Pregnancy: Is It Harmful? Toxics 2023; 11:278. [PMID: 36977043 PMCID: PMC10058591 DOI: 10.3390/toxics11030278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 03/14/2023] [Accepted: 03/15/2023] [Indexed: 06/18/2023]
Abstract
Although combustible cigarette smoking rates have declined in recent years, alternative tobacco product use, particularly electronic cigarette use ("vaping"), has increased among young adults. Recent studies indicate that vaping during pregnancy is on the rise, possibly due to the perception that it is a safer alternative to combustible cigarette smoking. However, e-cigarette aerosols may contain several newer, potentially toxic compounds, including some known developmental toxicants that may adversely impact both the mother and the fetus. However, there is paucity of studies that have examined the effects of vaping during pregnancy. While the adverse perinatal outcomes of cigarette smoking during pregnancy are well established, the specific risks associated with inhaling vaping aerosols during pregnancy requires more research. In this article, we discuss the existing evidence and knowledge gaps on the risks of vaping during pregnancy. Studies that investigate vaping-associated systemic exposure and its effects (i.e., biomarker analyses) and maternal and neonatal clinical health outcomes are needed to reach more robust conclusions. We particularly emphasize the need to go beyond comparative studies with cigarettes, and advocate for research that objectively evaluates the safety of e-cigarettes and other alternative tobacco products.
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Affiliation(s)
- M. J. Ruzmyn Vilcassim
- Department of Environmental Health Sciences, School of Public Health, The University of Alabama at Birmingham, Birmingham, AL 35233, USA;
| | - Samuel Stowe
- Department of Environmental Health Sciences, School of Public Health, The University of Alabama at Birmingham, Birmingham, AL 35233, USA;
| | - Rachel Majumder
- School of Health Professions, The University of Alabama at Birmingham, Birmingham, AL 35233, USA
| | - Akila Subramaniam
- Center for Women’s Reproductive Health, Division of Maternal Fetal Medicine, Heersink School of Medicine, The University of Alabama at Birmingham, Birmingham, AL 35233, USA; (A.S.); (R.G.S.)
| | - Rachel G. Sinkey
- Center for Women’s Reproductive Health, Division of Maternal Fetal Medicine, Heersink School of Medicine, The University of Alabama at Birmingham, Birmingham, AL 35233, USA; (A.S.); (R.G.S.)
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11
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Sanusi AA, Sinkey RG. De Novo Postpartum Hypertension: Is Pregnancy a Stress Test or Risk Factor? Hypertension 2023; 80:288-290. [PMID: 36652531 PMCID: PMC9869464 DOI: 10.1161/hypertensionaha.122.20155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
- Ayodeji A Sanusi
- Center for Women's Reproductive Health, University of Alabama at Birmingham (A.A.S., R.G.S.)
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Alabama at Birmingham (A.A.S., R.G.S.)
| | - Rachel G Sinkey
- Center for Women's Reproductive Health, University of Alabama at Birmingham (A.A.S., R.G.S.)
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Alabama at Birmingham (A.A.S., R.G.S.)
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12
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Robbins LS, Szychowski JM, Nassel A, Arora G, Armour EK, Walker Z, Rajapreyar IN, Kraus A, Wingate M, Tita AT, Sinkey RG. Geographic disparities in peripartum cardiomyopathy outcomes. Am J Obstet Gynecol MFM 2023; 5:100788. [PMID: 36309247 DOI: 10.1016/j.ajogmf.2022.100788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 09/26/2022] [Accepted: 10/20/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND Cardiomyopathy causes more than a third of late postpartum pregnancy-related deaths in the United States, and racial disparities in outcomes among pregnant individuals with cardiomyopathy exist. Underlying community factors may contribute to disparities in peripartum cardiomyopathy outcomes. OBJECTIVE This study aimed to identify the geographic distribution of and disparities in peripartum cardiomyopathy outcomes, hypothesizing that patients living in communities with higher social vulnerability may have worse outcomes. STUDY DESIGN This was a retrospective cohort study of patients with peripartum cardiomyopathy per the National Heart, Lung, and Blood Institute definition from January 2000 to November 2017 at a single center, excluding those with a post office box address as a post office box address may not reflect the census tract in which a patient resides. Severe peripartum cardiomyopathy (vs less severe peripartum cardiomyopathy) was defined as ejection fraction <30%, death, intensive care unit admission, left ventricular assist device or implantable cardioverter defibrillator placement, or transplant. The US census tract for the patient's address was linked to the Centers for Disease Control and Prevention Social Vulnerability Index, a 0 to 1 scale of a community's vulnerability to external stresses on health, with higher values indicating greater vulnerability. The Social Vulnerability Index includes social factors divided into socioeconomic, household composition, minority status, and housing type and transportation themes. The Social Vulnerability Index and Social Vulnerability Index components were compared among patients by peripartum cardiomyopathy severity. RESULTS Of 95 patients in the original cohort, 5 were excluded because of the use of a post office box address. Of the remaining 90 patients, 56 met severe peripartum cardiomyopathy criteria. At baseline, individuals with and without severe peripartum cardiomyopathy had similar ages, marital status, payor type, tobacco use, gestational age at delivery, and mode of delivery; however, individuals with severe peripartum cardiomyopathy were more likely to be Black (vs White) (59% vs 29%; P<.007) and less likely to recover ejection fraction (EF) to ≥55% by 12 months (36% vs 62%; P=.02) than individuals with less severe peripartum cardiomyopathy. Patients with severe peripartum cardiomyopathy were more likely to live in areas with a higher Social Vulnerability Index (0.51 vs 0.31; P=.002) and with more residents who were unemployed, impoverished, without a high school diploma, in single-parent households, of minority status, without a vehicle, and in institutionalized group quarters than patients with less severe peripartum cardiomyopathy. The median income was lower in communities of individuals with severe peripartum cardiomyopathy than in communities of individuals with less severe peripartum cardiomyopathy. CONCLUSION Patients with severe peripartum cardiomyopathy outcomes were more likely to live in communities with greater social vulnerability than patients with less severe peripartum cardiomyopathy outcomes. To reduce disparities and maternal mortality rates, resources may need to be directed to socially vulnerable communities.
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Affiliation(s)
- Lindsay S Robbins
- Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, VA (Dr Robbins); Center for Maternal and Child Health Equity and Advocacy, Eastern Virginia Medical School Norfolk, VA (Dr Robbins)
| | - Jeff M Szychowski
- Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, AL (Drs Szychowski, Tita, and Sinkey); Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, AL (Dr Szychowski)
| | - Ariann Nassel
- Department of Health Policy and Organization, School of Public Health, University of Alabama at Birmingham, Birmingham, AL (Ms Nassel and Dr Wingate)
| | - Gazal Arora
- Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL (Mses Arora and Kraus)
| | - Emily K Armour
- Department of Obstetrics and Gynecology, University of Oklahoma, Norman, OK (Dr Armour)
| | - Zachary Walker
- Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, MA (Dr Walker)
| | - Indranee N Rajapreyar
- Department of Medicine, Division of Cardiology, Thomas Jefferson University, Philadelphia, PA (Dr Rajapreyar)
| | - Abigayle Kraus
- Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL (Mses Arora and Kraus)
| | - Martha Wingate
- Department of Health Policy and Organization, School of Public Health, University of Alabama at Birmingham, Birmingham, AL (Ms Nassel and Dr Wingate)
| | - Alan T Tita
- Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, AL (Drs Szychowski, Tita, and Sinkey); Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL (Drs Tita and Sinkey)
| | - Rachel G Sinkey
- Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, AL (Drs Szychowski, Tita, and Sinkey); Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL (Drs Tita and Sinkey).
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13
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Murugesan S, Powell MF, Hussey H, Saravanakumar L, Sturdivant AB, Sinkey RG, Mobley JA, Jilling T, Berkowitz DE. Abstract P3130: Role Of The Placenta-derived Extracellular Vesicle-cargo Protein, Vasorin In Vascular Dysfunction In Preeclampsia. Circ Res 2022. [DOI: 10.1161/res.131.suppl_1.p3130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
We recently demonstrated that placenta-derived extracellular vesicles (pEVs) cargo play a role in vascular dysfunction in patients with severe preeclampsia (sPE). We focused our follow up studies on a novel protein vasorin (VASN) that has not as yet been studied in PE. Here, we hypothesize that decreased VASN in EVs cargo plays a significant role in the regulation of vascular endothelial proliferation and function in sPE.
Methods:
We manipulated VASN by overexpression and knockdown in human aortic endothelial cells (HAEC) and in murine aortic vascular rings (MVR) using adenoviral vectors encoding VASN (AD-VASN) or VASN shRNA (AD-shVASN), respectively. VASN levels in EVs, in HAEC and in MVR with/wo adenoviral overexpression or knockdown of VASN was done by western blotting. Migration of HAEC was studied by a scratch and repair migration assay and contractile function of MVR was assessed by wire myography. A PE-like vascular dysfunction was produced in timed pregnant mice by intravenous injection of an adenoviral vector encoding the short form of FMS-like tyrosine kinase 1 (sFLT-1) on embryonic day 10.5 (E10.5) of pregnancy. Plasma from sFLT-1 -injected and control untreated (UT) mice were collected on E15.5,E17.5 and E19.5.
Results:
We confirmed our findings with proteomics and using western blotting we detected a significant reduction in VASN levels in both urinary and plasma-derived EVs in sPE patients when compared to normotensive. Moreover, we detected a time-dependent significant reduction of VASN in EVs from plasma of sFLT-1 injected mice whereas UT mice exhibited a time-dependent increase of VASN. Western blotting also confirmed over-expression and knock down of VASN in HAEC and in MVR treated with AD-VASN and AD-shVASN, respectively. Treatment of HAEC with EVs from sPE, but not by EVs from NTP inhibited migration, and pretreatment with AD-VASN but not with AD-shVASN rescued migration upon treatment with EVs from PE. Treatment of MVR with EVs from sPE, but not by EVs from NTP inhibited acetylcholine (ACh)-induced vasorelaxation. Pretreatment with AD-VASN, but not with AD-shVASN rescued ACh-induced vasorelaxation upon treatment with EVs from sPE.
Conclusion:
Over-expression of VASN using adenoviral vectors rescued inhibitory effects of EVs from sPE on migration of HAEC and ACh-induced vasorelaxation in MVR, suggesting that reduced VASN content in EVs from sPE plays a mechanistic role in vascular dysfunction observed in sPE.
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14
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Seasely AR, Sinkey RG, Dean SJ, Descartes M, Duncan VE. Placental Pathology in Maternal Ornithine Transcarbamylase Deficiency. Pediatr Dev Pathol 2022; 25:278-284. [PMID: 34958254 DOI: 10.1177/10935266211055286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Ornithine transcarbamylase (OTC) deficiency is the most common urea cycle disorder, inherited in an X-linked manner. Males are severely affected. Female phenotypes vary from asymptomatic to severe, and symptoms may be triggered by high metabolic states like childbirth. Literature on OTC deficiency in pregnancy and placental pathology is limited. METHODS Pathology records were searched at a single referral center from 2000-2020 and identified three placental cases from two mothers heterozygous for OTC deficiency. Placental pathology and maternal and neonatal history were reviewed in detail. RESULTS The placenta from one symptomatic mother carrying an affected male fetus showed widespread high-grade fetal vascular malperfusion (FVM) lesions of varying age. These lesions were not seen in the two placentas from the asymptomatic mother. DISCUSSION In cases of symptomatic maternal OTC deficiency, our findings highlight the need for placental examination. Since thrombotic events in the placenta have the potential to associate with fetal and neonatal endothelial damage, a high index of suspicion for neonatal thrombosis may be warranted.
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Affiliation(s)
- Angela R Seasely
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Center for Women's Reproductive Health, 9968University of Alabama at Birmingham, Birmingham, AL, USA.,Department of Genetics, 9968University of Alabama at Birmingham, Birmingham, AL, USA
| | - Rachel G Sinkey
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Center for Women's Reproductive Health, 9968University of Alabama at Birmingham, Birmingham, AL, USA
| | - Sarah Joy Dean
- Department of Genetics, 9968University of Alabama at Birmingham, Birmingham, AL, USA
| | - Maria Descartes
- Department of Genetics, 9968University of Alabama at Birmingham, Birmingham, AL, USA
| | - Virginia E Duncan
- Department of Pathology, Perinatal Section, 9968University of Alabama at Birmingham, Birmingham, AL, USA
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15
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Jaber S, Jauk VC, Cozzi GD, Sanjanwala AR, Becker DA, Harper LM, Casey BM, Sinkey RG, Subramaniam A. Quantifying the additional maternal morbidity in women with preeclampsia with severe features in whom immediate delivery is recommended. Am J Obstet Gynecol MFM 2022; 4:100565. [PMID: 35033750 DOI: 10.1016/j.ajogmf.2022.100565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 12/21/2021] [Accepted: 01/09/2022] [Indexed: 10/19/2022]
Abstract
BACKGROUND Preeclampsia with severe features when diagnosed at less than 34 weeks is associated with maternal morbidity and is managed by immediate delivery or inpatient expectant management. OBJECTIVE This study aimed to compare maternal morbidity in women with preeclampsia with severe features in whom the American College of Obstetricians and Gynecologists recommends immediate delivery versus those eligible for expectant management. STUDY DESIGN This was a retrospective cohort study of women with preeclampsia with severe features delivered between 23 to 34 weeks of gestation from 2013 to 2017 at a single tertiary center. Women were categorized into 2 groups: (1) those recommended by the American College of Obstetricians and Gynecologists for immediate delivery, that is, ineligible for expectant management, and (2) those eligible for expectant management. The primary outcome was composite postpartum maternal morbidity, which included maternal intensive care unit admission, stroke, death, and other severe morbidities. The secondary outcomes included select adverse perinatal outcomes. Groups were compared and adjusted odds ratios (95% confidence intervals) calculated. RESULTS Of the 1172 women with preeclampsia identified during the study period, 543 with preeclampsia with severe features were included for analysis: 211 (39%) were ineligible for expectant management and 332 (61%) were eligible for expectant management. Baseline characteristics, including age, body mass index, race and ethnicity, parity, marital status, and gestational age at preeclampsia diagnosis, were similar between the 2 groups. Women ineligible for expectant management had significantly higher composite postpartum maternal morbidity (adjusted odds ratio, 5.02 [95% confidence interval, 1.35-18.69]). In addition, those ineligible for expectant management were more likely to have postpartum intensive care unit admission (adjusted odds ratio, 4.19 [95% confidence interval, 1.09-16.16]) and postpartum hemoglobin level of <7 g/dL (adjusted odds ratio, 5.07 [95% confidence interval, 1.35-19.08]). There was no demonstrable difference in neonatal outcomes between the 2 groups. CONCLUSION Women with preeclampsia with severe features who were ineligible for expectant management per the American College of Obstetricians and Gynecologists guidelines had a 5-fold increased risk of maternal morbidity, confirming the need for escalation of care and delivery without delay.
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Affiliation(s)
- Sara Jaber
- Department of Obstetrics and Gynecology, Beaumont Hospital Royal Oak, Royal Oak, MI (Dr Jaber).
| | - Victoria C Jauk
- Center for Women's Reproductive Health, The University of Alabama at Birmingham, Birmingham, AL (Ms Jauk and Drs Cozzi, Casey, Sinkey, and Subramaniam)
| | - Gabriella D Cozzi
- Center for Women's Reproductive Health, The University of Alabama at Birmingham, Birmingham, AL (Ms Jauk and Drs Cozzi, Casey, Sinkey, and Subramaniam); Department of Obstetrics and Gynecology, The University of Alabama at Birmingham, Birmingham, AL (Drs Cozzi, Casey, Sinkey, and Subramaniam)
| | - Aalok R Sanjanwala
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh, Pittsburgh, PA (Dr Sanjanwala)
| | - David A Becker
- Department of Obstetrics and Gynecology, College of Medicine, The University of Oklahoma, Oklahoma City, OK (Dr Becker)
| | - Lorie M Harper
- Department of Women's Health, Dell Medical School, The University of Texas at Austin, Austin, TX (Dr Harper)
| | - Brian M Casey
- Center for Women's Reproductive Health, The University of Alabama at Birmingham, Birmingham, AL (Ms Jauk and Drs Cozzi, Casey, Sinkey, and Subramaniam); Department of Obstetrics and Gynecology, The University of Alabama at Birmingham, Birmingham, AL (Drs Cozzi, Casey, Sinkey, and Subramaniam)
| | - Rachel G Sinkey
- Center for Women's Reproductive Health, The University of Alabama at Birmingham, Birmingham, AL (Ms Jauk and Drs Cozzi, Casey, Sinkey, and Subramaniam); Department of Obstetrics and Gynecology, The University of Alabama at Birmingham, Birmingham, AL (Drs Cozzi, Casey, Sinkey, and Subramaniam)
| | - Akila Subramaniam
- Center for Women's Reproductive Health, The University of Alabama at Birmingham, Birmingham, AL (Ms Jauk and Drs Cozzi, Casey, Sinkey, and Subramaniam); Department of Obstetrics and Gynecology, The University of Alabama at Birmingham, Birmingham, AL (Drs Cozzi, Casey, Sinkey, and Subramaniam)
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16
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Davis AM, Blanchard CT, Subramaniam A, Sinkey RG, Tita AT, Battarbee AN. Tailored physiologic treatment of severe hypertension in pregnancy: a novel approach to hypertension management. Am J Obstet Gynecol 2022. [DOI: 10.1016/j.ajog.2021.11.479] [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: 11/17/2022]
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17
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Odibo AO, Sinkey RG, Zhang F, Salama N, Stout MJ, Tuuli MG, Frolova AI, Ros ST, Lockwood C. Impact of higher dose on pharmacokinetics of 17-alpha hydroxyl progesterone caproate (17OHPC) in obese women. Am J Obstet Gynecol 2022. [DOI: 10.1016/j.ajog.2021.11.738] [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: 11/24/2022]
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18
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Seasely AR, Gaonkar M, Battarbee AN, Casey BM, Sinkey RG, Dionne-Odom J, Szychowski JM, Tita AT, Subramaniam A. Are abnormal coagulation studies upon hospital admission in gravidas with COVID-19 associated with adverse outcomes? Am J Obstet Gynecol 2022. [PMCID: PMC8696657 DOI: 10.1016/j.ajog.2021.11.1176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
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19
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Murugesan S, Hussey H, Saravanakumar L, Sinkey RG, Sturdivant AB, Powell MF, Berkowitz DE. Extracellular Vesicles From Women With Severe Preeclampsia Impair Vascular Endothelial Function. Anesth Analg 2021; 134:713-723. [PMID: 34871190 DOI: 10.1213/ane.0000000000005812] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Preeclampsia (PE) manifesting as hypertension and organ injury is mediated by vascular dysfunction. In biological fluids, extracellular vesicles (EVs) containing microRNA (miRNA), protein, and other cargo released from the placenta may serve as carriers to propagate injury, altering the functional phenotype of endothelial cells. PE has been consistently correlated with increased levels of placenta-derived EVs (pEVs) in maternal circulation. However, whether pEVs impaired endothelial cell function remains to be determined. In this study, we hypothesize that pEVs from pregnant women with severe PE (sPE) impair endothelial function through altered cell signaling. METHODS We obtained plasma samples from women with sPE (n = 14) and normotensive pregnant women (n = 15) for the isolation of EVs. The total number of EV and pEV contribution was determined by quantifying immunoreactive EV-cluster of designation 63 (CD63) and placental alkaline phosphatase (PLAP) as placenta-specific markers, respectively. Vascular endothelial functional assays were determined by cell migration, electric cell-substrate impedance sensing in human aortic endothelial cells (HAECs), and wire myography in isolated blood vessels, preincubated with EVs from normotensive and sPE women. RESULTS Plasma EV and pEV levels were increased in sPE when compared to normotensive without a significant size distribution difference in sPE (108.8 ± 30.2 nm) and normotensive-EVs (101.3 ± 20.3 nm). Impaired endothelial repair and proliferation, reduced endothelial barrier function, reduced endothelial-dependent vasorelaxation, and decreased nitrite level indicate that sPE-EVs induced vascular endothelial dysfunction. Moreover, sPE-EVs significantly downregulated endothelial nitric oxide synthase (eNOS and p-eNOS) when compared to normotensive-EV. CONCLUSIONS EVs from sPE women impair endothelial-dependent vascular functions in vitro.
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Affiliation(s)
- Saravanakumar Murugesan
- From the Department of Anesthesiology and Perioperative Medicine, Division of Molecular and Translational Biomedicine
| | - Hanna Hussey
- From the Department of Anesthesiology and Perioperative Medicine, Division of Molecular and Translational Biomedicine
| | - Lakshmi Saravanakumar
- From the Department of Anesthesiology and Perioperative Medicine, Division of Molecular and Translational Biomedicine
| | - Rachel G Sinkey
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, School of Medicine, The University of Alabama at Birmingham, Birmingham, Alabama
| | - Adam B Sturdivant
- From the Department of Anesthesiology and Perioperative Medicine, Division of Molecular and Translational Biomedicine
| | - Mark F Powell
- From the Department of Anesthesiology and Perioperative Medicine, Division of Molecular and Translational Biomedicine
| | - Dan E Berkowitz
- From the Department of Anesthesiology and Perioperative Medicine, Division of Molecular and Translational Biomedicine
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20
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Oben AG, Walker ZW, Blanchard CT, Szychowski JM, Maier JG, Rajapreyar I, Cribbs MG, Tita A, Sinkey RG. Racial disparities in reliable contraceptive use in women with heart disease. EUR J CONTRACEP REPR 2021; 27:174-179. [PMID: 34870553 DOI: 10.1080/13625187.2021.2010042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE The aim of the study was to investigate the differences in reliable contraceptive use between black women and white women with maternal cardiac disease. METHODS The study comprised a retrospective cohort of women with maternal cardiac disease managed by the University of Alabama at Birmingham (UAB) Comprehensive Pregnancy and Heart Program (CPHP). Women were included if they had attended one or more prenatal visits at the UAB CPHP and delivered at the UAB hospital between March 2015 and June 2019. The primary outcome was reliable contraceptive use within 2 months postpartum, defined by receipt of long-acting reversible contraception (i.e., an intrauterine contraceptive device or an etonogestrel implant) or female sterilisation. All outcomes were compared based on self-reported race. RESULTS One hundred and forty-nine women met the inclusion criteria. Black women (n = 63) were more likely than white women (n = 86) to use reliable contraception (65% vs 43%; p = 0.008). Black women were less likely than white women to be undecided or decline contraception at the time of admission (13% vs 27%; p = 0.037). There was no difference in reliable contraceptive use between black women (n = 20, 63%) and white women (n = 23, 72%) with modified World Health Organisation (WHO) class III/IV lesions (p = 0.42). CONCLUSION Black women with maternal cardiac disease were more likely than white women to receive reliable contraception. Interventions to prevent unintended pregnancy in women with maternal cardiac disease should focus on improving reliable contraceptive use, especially for women with modified WHO class III/IV lesions.
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Affiliation(s)
- Ayamo G Oben
- Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, AL, USA.,Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Zachary W Walker
- Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, AL, USA.,Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Christina T Blanchard
- Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, AL, USA.,Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jeff M Szychowski
- Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, AL, USA.,Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL, USA.,Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Julia G Maier
- Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, AL, USA.,Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Indranee Rajapreyar
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Marc G Cribbs
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Alan Tita
- Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, AL, USA.,Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Rachel G Sinkey
- Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, AL, USA.,Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL, USA
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21
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Sinkey RG, Blanchard CT, Maier J, Novara A, Mazzoni SE, Goepfert AR, Boozer M, Rajapreyar I, Cribbs M, Szychowski JM, Tita ATN. The effects of offering immediate postpartum placement of IUDs and implants to pregnant patients with heart disease. Contraception 2021; 105:55-60. [PMID: 34529951 DOI: 10.1016/j.contraception.2021.09.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 09/06/2021] [Accepted: 09/08/2021] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To evaluate the effects of offering immediate postpartum long-acting reversible contraception to pregnant patients with heart disease. STUDY DESIGN Retrospective cohort of pregnant patients with cardiac disease managed by a Comprehensive Pregnancy & Heart Program. Patients were divided into 2 cohorts: pre-immediate postpartum LARC Program implementation (March 2015 to January 2017) and post-implementation (February 2017 to June 2019). The primary outcome was LARC (intrauterine device [IUD] or etonogestrel implant) use postpartum, defined as LARC either immediately postpartum or at the postpartum visit. Secondary outcomes included contraception intent at delivery and IUD expulsion rate of IUDs placed immediately postpartum. RESULTS Of 159 included patients, 96 (60%) delivered during the post-implementation period. LARC use tripled after program implementation, 11% vs 35%, p < 0.01. Specifically, immediate postpartum IUD use increased from 1 (1.6%) to 10 (10.4%), p = 0.05, and use of immediate postpartum implant increased from 0 to 14 (14.6%), p = 0.002. Rates of women without contraception plans at delivery decreased from 32% to 14%, p < 0.01, as did the number of women using medroxyprogesterone acetate: 16% vs 4%, p = 0.01. Tubal ligation rates were not different before and after program implementation: 24% and 29%, p = 0.46. Postpartum visit rates were similar between Pre and Post groups: 70% and 72%, p = 0.78, respectively. One immediate postpartum IUD expulsion occurred. CONCLUSION LARC use tripled in pregnant patients in an obstetric heart disease program after implementation of an immediate postpartum LARC Program. Access to immediate postpartum IUDs and implants should be a public health priority for women with heart disease to reduce their disproportionate burden of maternal morbidity and mortality.
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Affiliation(s)
- Rachel G Sinkey
- Department of Obstetrics & Gynecology, University of Alabama at Birmingham, Birmingham, AL, United States; Center for Women's Reproductive Health, Birmingham, AL, United States.
| | | | - Julia Maier
- Department of Obstetrics & Gynecology, University of Alabama at Birmingham, Birmingham, AL, United States; Center for Women's Reproductive Health, Birmingham, AL, United States
| | - Alexia Novara
- Department of Obstetrics & Gynecology, University of Alabama at Birmingham, Birmingham, AL, United States; Center for Women's Reproductive Health, Birmingham, AL, United States
| | - Sara E Mazzoni
- Department of Obstetrics & Gynecology, University of Alabama at Birmingham, Birmingham, AL, United States; Center for Women's Reproductive Health, Birmingham, AL, United States
| | - Alice R Goepfert
- Department of Obstetrics & Gynecology, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Margaret Boozer
- Department of Obstetrics & Gynecology, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Indranee Rajapreyar
- Department of Medicine, Division of Cardiovascular Disease, University of Alabama at Birmingham, AL, United States
| | - Marc Cribbs
- Department of Medicine, Division of Cardiovascular Disease, University of Alabama at Birmingham, AL, United States
| | - Jeff M Szychowski
- Center for Women's Reproductive Health, Birmingham, AL, United States; Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Alan T N Tita
- Department of Obstetrics & Gynecology, University of Alabama at Birmingham, Birmingham, AL, United States; Center for Women's Reproductive Health, Birmingham, AL, United States
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22
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Bushman ET, Cozzi G, Sinkey RG, Smith CH, Varner MW, Digre K. Randomized Controlled Trials of Headache Treatments in Pregnancy: A Systematic Review. Am J Perinatol 2021; 38:e102-e108. [PMID: 32120417 DOI: 10.1055/s-0040-1705180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Headaches affect 88% of reproductive-aged women. Yet data are limited addressing treatment of headache in pregnancy. While many women experience improvement in pregnancy, primary and secondary headaches can develop. Consequently, pregnancy is a time when headache diagnosis can influence maternal and fetal interventions. This study was aimed to summarize existing randomized control trials (RCTs) addressing headache treatment in pregnancy. STUDY DESIGN We searched PubMed, CINAHL, EMBASE, ClinicalTrials.gov, Cochrane Library, CINAHL, and SCOPUS from January 1, 1970 through June 31, 2019. Studies were eligible if they were English-language RCTs addressing treatment of headache in pregnancy. Conference abstracts and studies investigating postpartum headache were excluded. Three authors reviewed English-language RCTs addressing treatment of antepartum headache. To be included, all authors agreed each article to meet the following criteria: predefined control group, participants underwent randomization, and treatment of headache occurred in the antepartum period. If inclusion criteria were met no exclusions were made. Our systematic review registration number was CRD42019135874. RESULTS A total of 193 studies were reviewed. Of the three that met inclusion criteria all were small, with follow-up designed to measure pain reduction and showed statistical significance. CONCLUSION Our systematic review of RCTs evaluating treatment of headache in pregnancy revealed only three studies. This paucity of data limits treatment, puts women at risk for worsening headache disorders, and delays diagnosis placing both the mother and fetus at risk for complications.
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Affiliation(s)
- Elisa T Bushman
- Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, Alabama.,Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Gabriella Cozzi
- Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, Alabama.,Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Rachel G Sinkey
- Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, Alabama.,Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Catherine H Smith
- Lister Hill Library of the Health Sciences, University of Alabama at Birmingham, Birmingham, Alabama
| | - Michael W Varner
- Department of Obstetrics and Gynecology, University of Utah Health Sciences Center, Salt Lake City, Utah
| | - Kathleen Digre
- Departments of Neurology and Ophthalmology, University of Utah Health Sciences Center, Salt Lake City, Utah
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23
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Oben AG, Johnson BM, Tita ATN, Andrews WW, Hibberd PL, Subramaniam A, Sinkey RG. A systematic review of biomarkers associated with maternal infection in pregnant and postpartum women. Int J Gynaecol Obstet 2021; 157:42-50. [PMID: 33999419 DOI: 10.1002/ijgo.13747] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 04/20/2021] [Accepted: 05/14/2021] [Indexed: 01/29/2023]
Abstract
BACKGROUND Serum biomarkers are commonly used to support the diagnosis of infection in non-pregnant patients whose clinical presentation suggests infection. The utility of serum biomarkers for infection in pregnant and postpartum women is uncertain. SEARCH STRATEGY PubMed, CINAHL, EMBASE, ClinicalTrials.gov, Cochrane Library, CINAHL, and SCOPUS were searched from inception to February 2020. SELECTION CRITERIA Full-text manuscripts in English were included if they reported the measurement of maternal serum biomarkers-and included a control group-to identify infection in pregnant and postpartum women. DATA COLLECTION AND ANALYSIS two authors independently screened manuscripts, extracted data, and assessed methodologic quality. MAIN RESULTS Interleukin-6 (IL-6), C-reactive protein, procalcitonin, insulin-like growth factor binding protein 1, tumor necrosis factor-α, calgranulin B, neopterin, and interferon-γ inducible protein 10 reliably indicated infection. Intercellular adhesion molecule 1, monocyte chemotactic and activating factor, soluble IL-6 receptor, and IL-8 were not useful markers in pregnant and postpartum women. CONCLUSIONS Findings suggest that certain biomarkers have diagnostic value when maternal infection is suspected, but also confirms limitations in this population.
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Affiliation(s)
- Ayamo G Oben
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL, USA.,Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Brittany M Johnson
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL, USA.,Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Alan T N Tita
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL, USA.,Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - William W Andrews
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL, USA.,Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Patricia L Hibberd
- Department of Global Health, Boston University School of Public Health, Boston, MA, USA
| | - Akila Subramaniam
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL, USA.,Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Rachel G Sinkey
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL, USA.,Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, AL, USA
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24
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Robbins LS, Szychowski JM, Nassel A, Armour EK, Walker ZW, Rajapreyar I, Wingate M, Tita A, Sinkey RG. 1063 Social vulnerability may underly racial disparities in peripartum cardiomyopathy outcomes. Am J Obstet Gynecol 2021. [DOI: 10.1016/j.ajog.2020.12.1088] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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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25
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Robbins LS, Blanchard CT, Sinkey RG, Harris SL, Tita AT, Harper LM. Prenatal Tobacco Exposure and Childhood Neurodevelopment among Infants Born Prematurely. Am J Perinatol 2021; 38:218-223. [PMID: 32862421 DOI: 10.1055/s-0040-1715845] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 10/23/2022]
Abstract
OBJECTIVE Nicotine is an established neuroteratogen, and prenatal tobacco exposure alters the structure of the developing nervous system. An association between prenatal tobacco exposure and impaired neurologic function is less well established. We examine the association between prenatal tobacco exposure and childhood neurodevelopment among infants born preterm. STUDY DESIGN Secondary analysis of a multicenter randomized controlled trial assessing the benefits of magnesium sulfate for the prevention of cerebral palsy in preterm infants. Women were included if they delivered a singleton and nonanomalous infant before 37 weeks. Exposure was any self-reported prenatal tobacco use. Primary outcome was the original trial composite outcome of moderate or severe cerebral palsy at 2 years of age, or stillbirth, or infant death by 1 year of age. Secondary outcomes included components of the composite and mild cerebral palsy at 2 years, Bayley Scales of Infant Development II motor and mental scores, death before two years, and use of auditory aids or corrective lenses. Multivariable logistic regression models were performed to estimate adjusted odds ratios (aOR) with 95% confidence intervals. RESULTS Of 1,826 women included, 503 (27.5%) used tobacco. Tobacco users were more likely to be older, unmarried, and white; have a prior preterm birth; have received no prenatal care; and to use illicit drugs or alcohol. Gestational age at delivery, betamethasone exposure, and magnesium exposure were not different between groups. There were no differences in the composite primary outcome or in rates of cerebral palsy by tobacco use. Moderate developmental delay was more common among tobacco exposed in bivariate but not adjusted analysis (20.5 vs. 15.9%, p = 0.035). In adjusted analysis, tobacco exposure was associated with increased use of corrective lenses (5.0 vs. 2.9%, aOR: 2.28, 95% confidence interval: 1.28-4.07). CONCLUSION Prenatal tobacco exposure is not associated with neurodevelopmental impairment in infants born preterm. However, tobacco exposure may be associated with impaired vision. KEY POINTS · Tobacco exposure is not associated with impaired neurodevelopment in this preterm population.. · Prenatal tobacco exposure is associated with increased need for corrective lenses.. · Tobacco use in pregnancy may be a risk factor for poorer visual acuity in children..
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Affiliation(s)
- Lindsay S Robbins
- Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, Alabama.,Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Christina T Blanchard
- Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, Alabama
| | - Rachel G Sinkey
- Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, Alabama.,Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Stacy L Harris
- Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, Alabama
| | - Alan T Tita
- Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, Alabama.,Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Lorie M Harper
- Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, Alabama.,Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama
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26
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Knupp RJ, Subramaniam A, Tita A, Sinkey RG, Battarbee AN. 241 Hypertensive disorders of pregnancy at term: timing of development versus indication for delivery. Am J Obstet Gynecol 2021. [DOI: 10.1016/j.ajog.2020.12.263] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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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27
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Sanusi A, Yuanfan Y, Battarbee AN, Sinkey RG, Szychowski JM, Tita A, Subramaniam A. 1138 Predicting spontaneous labor beyond 39 weeks among expectantly managed gravidas. Am J Obstet Gynecol 2021. [DOI: 10.1016/j.ajog.2020.12.1162] [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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28
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Sinkey RG, Battarbee AN, Bello NA, Ives CW, Oparil S, Tita ATN. Prevention, Diagnosis, and Management of Hypertensive Disorders of Pregnancy: a Comparison of International Guidelines. Curr Hypertens Rep 2020; 22:66. [PMID: 32852691 PMCID: PMC7773049 DOI: 10.1007/s11906-020-01082-w] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [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] [Indexed: 12/19/2022]
Abstract
PURPOSE OF REVIEW Hypertensive disorders of pregnancy (HDP)-gestational hypertension, preeclampsia, and eclampsia-are a leading cause of adverse maternal and perinatal outcomes internationally. Prevention, timely diagnosis, and prompt management can reduce associated morbidity. The purpose of this review is to compare international guidelines pertaining to HDP. RECENT FINDINGS Fourteen HDP guidelines were compared relative to guidelines for the United States (US) where the authors practice. Aspirin is universally recommended for high-risk women to reduce preeclampsia risk. Recommended dose and gestational age at initiation vary. Diagnoses of chronic hypertension, gestational hypertension, and preeclampsia in pregnant women are similar, although blood pressure (BP) thresholds for antihypertensive medication initiation and treatment targets vary due to the limitations in high-quality evidence. There are differences among international HDP guidelines related to dose and timing of aspirin initiation, thresholds for antihypertensive medication initiation, and BP targets. However, all guidelines acknowledge the significant morbidity associated with HDP and advocate for timely diagnosis and management to reduce associated morbidity and mortality. More research is needed to understand optimal BP thresholds at which to initiate antihypertensive medication regimens and BP targets in pregnancy.
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Affiliation(s)
- Rachel G Sinkey
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, University of Alabama at Birmingham, 1700 6th Avenue South, 176F Suite 10270, Birmingham, AL, 35249, USA.
- Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, AL, USA.
| | - Ashley N Battarbee
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, University of Alabama at Birmingham, 1700 6th Avenue South, 176F Suite 10270, Birmingham, AL, 35249, USA
- Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Natalie A Bello
- Department of Medicine, Division of Cardiology, Columbia College of Physicians and Surgeons, New York, NY, USA
| | - Christopher W Ives
- Tinsley Harrison Internal Medicine Residency Program, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Suzanne Oparil
- Department of Medicine, Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Alan T N Tita
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, University of Alabama at Birmingham, 1700 6th Avenue South, 176F Suite 10270, Birmingham, AL, 35249, USA
- Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, AL, USA
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29
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Sinkey RG, Rajapreyar IN, Szychowski JM, Armour EK, Walker Z, Cribbs MG, Howard TF, Wetta LA, Subramaniam A, Tita AT. Racial disparities in peripartum cardiomyopathy: eighteen years of observations. J Matern Fetal Neonatal Med 2020; 35:1891-1898. [PMID: 32508175 PMCID: PMC7719601 DOI: 10.1080/14767058.2020.1773784] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Background: Black women have greater than a three-fold risk of pregnancy-associated death compared to White women; cardiomyopathy is a leading cause of maternal mortality.Objectives: This study examined racial disparities in health outcomes among women with peripartum cardiomyopathy.Study design: Retrospective cohort of women with peripartum cardiomyopathy per the National Heart, Lung, and Blood Institute definition from January 2000 to November 2017 from a single referral center. Selected health outcomes among Black and White women were compared; primary outcome was ejection fraction at diagnosis. Secondary outcomes included cardiovascular outcomes, markers of maternal morbidity, resource utilization, and subsequent pregnancy outcomes.Results: Ninety-five women met inclusion criteria: 48% Black, 52% White. Nearly all peripartum cardiomyopathy diagnoses were postpartum (95.4% Black, 93% White, p=.11). Ejection fraction at diagnosis was not different between Black and White women (26.8 ± 12.5 vs. 28.7 ± 9.9, p=.41). Though non-significant, fewer Black women had myocardial recovery to EF ≥55% (35 vs. 53%, p=.07); however, 11 (24%) of Black women vs. 1 (2%) White woman had an ejection fraction ≤35% at 6-12 months postpartum (p<.01). More Black women underwent implantable cardioverter defibrillator placement: n = 15 (33%) vs. n = 7 (14%), p=.03. Eight women (8.4%) died in the study period, not different by race (p=.48). Black women had higher rates of healthcare utilization. In the subsequent pregnancy, Black women had a lower initial ejection fraction (40 vs. 55%, p=.007) and were less likely to recover postpartum (37.5 vs. 55%, p=.02).Conclusions: Black and White women have similar mean ejection fraction at diagnosis of peripartum cardiomyopathy, but Black women have more severe left ventricular systolic dysfunction leading to worse outcomes, increased resource use, and lower ejection fraction entering the subsequent pregnancy.
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Affiliation(s)
- Rachel G Sinkey
- Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, AL, USA.,Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Indranee N Rajapreyar
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jeff M Szychowski
- Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, AL, USA.,Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL, USA.,Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Emily K Armour
- Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, AL, USA.,Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Zachary Walker
- Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, AL, USA.,Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Marc G Cribbs
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Tera F Howard
- Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, AL, USA.,Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Luisa A Wetta
- Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, AL, USA.,Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Akila Subramaniam
- Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, AL, USA.,Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Alan T Tita
- Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, AL, USA.,Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL, USA
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30
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Battarbee AN, Sinkey RG, Harper LM, Oparil S, Tita AT. Chronic hypertension in pregnancy. Am J Obstet Gynecol 2020; 222:532-541. [PMID: 31715148 DOI: 10.1016/j.ajog.2019.11.1243] [Citation(s) in RCA: 60] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 10/31/2019] [Accepted: 11/02/2019] [Indexed: 01/25/2023]
Abstract
Chronic hypertension and associated cardiovascular disease are among the leading causes of maternal and perinatal morbidity and death in the United States. Chronic hypertension in pregnancy is associated with a host of adverse outcomes that include preeclampsia, cesarean delivery, cerebrovascular accidents, fetal growth restriction, preterm birth, and maternal and perinatal death. There are several key issues related to the diagnosis and management of chronic hypertension in pregnancy where data are limited and further research is needed. These challenges and recent guidelines for the management of chronic hypertension are reviewed. Well-timed pregnancies are of utmost importance to reduce the risks of chronic hypertension; long-acting reversible contraceptive options are preferred. Research to determine optimal blood pressure thresholds for diagnosis and treatment to optimize short- and long-term maternal and perinatal outcomes should be prioritized along with interventions to reduce extant racial and ethnic disparities.
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31
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Sinkey RG, Guzeloglu-Kayisli O, Arlier S, Guo X, Semerci N, Moore R, Ozmen A, Larsen K, Nwabuobi C, Kumar D, Moore JJ, Buckwalder LF, Schatz F, Kayisli UA, Lockwood CJ. Thrombin-Induced Decidual Colony-Stimulating Factor-2 Promotes Abruption-Related Preterm Birth by Weakening Fetal Membranes. Am J Pathol 2020; 190:388-399. [PMID: 31955792 DOI: 10.1016/j.ajpath.2019.10.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2019] [Revised: 09/25/2019] [Accepted: 10/11/2019] [Indexed: 12/14/2022]
Abstract
Preterm premature rupture of membranes (PPROM) and thrombin generation by decidual cell-expressed tissue factor often accompany abruptions. Underlying mechanisms remain unclear. We hypothesized that thrombin-induced colony-stimulating factor-2 (CSF-2) in decidual cells triggers paracrine signaling via its receptor (CSF2R) in trophoblasts, promoting fetal membrane weakening and abruption-associated PPROM. Decidua basalis sections from term (n = 10), idiopathic preterm birth (PTB; n = 8), and abruption-complicated pregnancies (n = 8) were immunostained for CSF-2. Real-time quantitative PCR measured CSF2 and CSF2R mRNA levels. Term decidual cell (TDC) monolayers were treated with 10-8 mol/L estradiol ± 10-7 mol/L medroxyprogesterone acetate (MPA) ± 1 IU/mL thrombin pretreatment for 4 hours, washed, and then incubated in control medium with estradiol ± MPA. TDC-derived conditioned media supernatant effects on fetal membrane weakening were analyzed. Immunostaining localized CSF-2 primarily to decidual cell cytoplasm and cytotrophoblast cell membranes. CSF-2 immunoreactivity was higher in abruption-complicated or idiopathic PTB specimens versus normal term specimens (P < 0.001). CSF2 mRNA was higher in TDCs versus cytotrophoblasts (P < 0.05), whereas CSF2R mRNA was 1.3 × 104-fold higher in cytotrophoblasts versus TDCs (P < 0.001). Thrombin enhanced CSF-2 secretion in TDC cultures fourfold (P < 0.05); MPA reduced this effect. Thrombin-pretreated TDC-derived conditioned media supernatant weakened fetal membranes (P < 0.05), which MPA inhibited. TDC-derived CSF-2, acting via trophoblast-expressed CSFR2, contributes to thrombin-induced fetal membrane weakening, eliciting abruption-related PPROM and PTB.
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Affiliation(s)
- Rachel G Sinkey
- Department of Obstetrics and Gynecology, University of South Florida, Morsani College of Medicine, Tampa, Florida
| | - Ozlem Guzeloglu-Kayisli
- Department of Obstetrics and Gynecology, University of South Florida, Morsani College of Medicine, Tampa, Florida
| | - Sefa Arlier
- Department of Obstetrics and Gynecology, University of South Florida, Morsani College of Medicine, Tampa, Florida; Department of Obstetrics & Gynecology, Adana City Education and Research Hospital, Adana, Turkey
| | - Xiaofang Guo
- Department of Obstetrics and Gynecology, University of South Florida, Morsani College of Medicine, Tampa, Florida
| | - Nihan Semerci
- Department of Obstetrics and Gynecology, University of South Florida, Morsani College of Medicine, Tampa, Florida
| | - Robert Moore
- Division of Neonatology, Department of Pediatrics, MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio
| | - Asli Ozmen
- Department of Obstetrics and Gynecology, University of South Florida, Morsani College of Medicine, Tampa, Florida
| | - Kellie Larsen
- Department of Obstetrics and Gynecology, University of South Florida, Morsani College of Medicine, Tampa, Florida
| | - Chinedu Nwabuobi
- Department of Obstetrics and Gynecology, University of South Florida, Morsani College of Medicine, Tampa, Florida
| | - Deepak Kumar
- Division of Neonatology, Department of Pediatrics, MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio
| | - John J Moore
- Division of Neonatology, Department of Pediatrics, MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio
| | - Lynn F Buckwalder
- Department of Obstetrics & Gynecology, Yale University School of Medicine, New Haven, Connecticut
| | - Frederick Schatz
- Department of Obstetrics and Gynecology, University of South Florida, Morsani College of Medicine, Tampa, Florida
| | - Umit A Kayisli
- Department of Obstetrics and Gynecology, University of South Florida, Morsani College of Medicine, Tampa, Florida
| | - Charles J Lockwood
- Department of Obstetrics and Gynecology, University of South Florida, Morsani College of Medicine, Tampa, Florida.
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32
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Sinkey RG, Rajapreyar I, Robbins LS, Dionne-Odom J, Pogwizd SM, Casey BM, Tita ATN. Heart Failure with Preserved Ejection Fraction in a Postpartum Patient with Superimposed Preeclampsia and COVID-19. AJP Rep 2020; 10:e165-e168. [PMID: 32509415 PMCID: PMC7272215 DOI: 10.1055/s-0040-1712926] [Citation(s) in RCA: 3] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 04/30/2020] [Indexed: 12/15/2022] Open
Abstract
Our understanding of COVID-19 in pregnant and postpartum women is rapidly evolving. We present a case from March 2020 of a 25-year-old G2P2002 whose delivery was complicated by preeclampsia with severe features who presented to the emergency department 9 days after cesarean delivery with chest tightness and dyspnea on exertion. On presentation she had severe hypertension, pulmonary edema, elevated brain natriuretic peptide, and high-sensitivity troponin-I, suggesting a diagnosis of hypertensive emergency leading to heart failure with a preserved ejection fraction resulting in pulmonary edema and abnormal cardiac screening tests. However, bilateral opacities were seen on a computed tomography of the chest, and COVID-19 testing was positive. A high index of suspicion for both COVID-19 and cardiovascular complications are critical for optimal patient outcomes and protection of health care workers.
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Affiliation(s)
- Rachel G Sinkey
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama.,Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, Alabama
| | - Indranee Rajapreyar
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Lindsay S Robbins
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama.,Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, Alabama
| | - Jodie Dionne-Odom
- Division of Infectious Disease, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Steven M Pogwizd
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Brian M Casey
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama.,Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, Alabama
| | - Alan T N Tita
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama.,Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, Alabama
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Brown JA, Sinkey RG, Steffensen TS, Louis-Jacques AF, Louis JM. Neonatal Abstinence Syndrome among Infants Born to Mothers with Sickle Cell Hemoglobinopathies. Am J Perinatol 2020; 37:326-332. [PMID: 31756755 DOI: 10.1055/s-0039-1700865] [Citation(s) in RCA: 4] [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 The objective of this study is to examine risk factors for neonatal abstinence syndrome (NAS) among infants born to mothers with sickle cell hemoglobinopathies (SCH). STUDY DESIGN Retrospective cohort study of nonanomalous, singleton infants born to mothers with laboratory confirmed SCH. Infants were included if they were diagnosed with NAS prior to hospital discharge. The outcome of interest was the association of maternal variables with NAS. RESULTS Of 131 infants born to mothers with SCH, 4% (n = 5) were diagnosed with NAS. Mothers of infants with NAS were more likely to have SC disease (80%) compared with other SCH (20%), p = 0.001. Fifteen women had antepartum (AP) admissions for pain and/or sickle crisis. Of these patients, four infants (29%) were diagnosed with NAS. The median (5th and 95th percentile) maternal AP length of stay for women with infants diagnosed with NAS to mothers with sickle cell disease was 132 (5, 180) days (p = 0.02). CONCLUSION Incidence of NAS among mothers with SCH is low; severe disease characterized by AP sickle cell crisis requiring prolonged AP admission for pain control significantly increases the risk of NAS. Further studies are needed to investigate the association of maternal opioid dose and NAS.
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Affiliation(s)
- Jewel A Brown
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of South Florida, Morsani College of Medicine, Tampa, Florida
| | - Rachel G Sinkey
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of South Florida, Morsani College of Medicine, Tampa, Florida
| | | | - Adetola F Louis-Jacques
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of South Florida, Morsani College of Medicine, Tampa, Florida
| | - Judette M Louis
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of South Florida, Morsani College of Medicine, Tampa, Florida
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Cawyer CR, Kuper SG, Ausbeck E, Sinkey RG, Owen J. The added value of screening fetal echocardiography after normal cardiac views on a detailed ultrasound. Prenat Diagn 2019; 39:1148-1154. [PMID: 31499581 DOI: 10.1002/pd.5557] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Revised: 08/19/2019] [Accepted: 08/23/2019] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Evaluate fetal echocardiography's ability to detect critical (lesions requiring immediate neonatal intensive care) congenital heart disease (CHD) after normal anatomic cardiac views on detailed ultrasound. METHODS Singletons with both a detailed ultrasound at 18 + 0 to 22 + 6 weeks and echocardiogram performed at least 14 days later and at 20 + 0 to 24 + 6 weeks. Cases with cardiac pathology on detailed ultrasound were excluded. Different combinations of cardiac views were described: Basic (four-chamber, outflow tracts), Expanded (plus three-vessel view), and Complete (plus ductal/aortic arches). "Normal" was defined on either 2D gray scale or color Doppler. Primary outcome was rates of critical CHD missed on ultrasound but seen on fetal echocardiogram. RESULTS One thousand two hundred twenty-three women had normal Basic cardiac views. One thousand one hundred ninety (97.3%) were confirmed normal on echocardiogram. Twenty-one (1.71%) total CHDs were missed, and three were critical (0.25%; 95% CI, 0.03%-0.53%). Of the 1,223 women, 763 had Complete views. Ten (1.31%) total CHDs were missed and one (0.13%; 95% CI, 0.13%-0.36%) was confirmed critical. CONCLUSION Fetal echocardiography can increase CHD detection despite normal cardiac anatomy on detailed ultrasound; however, CHDs missed are rarely critical. Approximately 750 fetal echocardiograms need to be performed to detect one critical CHD with Complete normal cardiac views on detailed ultrasound.
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Affiliation(s)
- Chase R Cawyer
- Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, Alabama
| | - Spencer G Kuper
- Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, Alabama
| | - Elizabeth Ausbeck
- Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, Alabama
| | - Rachel G Sinkey
- Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, Alabama
| | - John Owen
- Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, Alabama
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Rajapreyar IN, Sinkey RG, Joly JM, Pamboukian SV, Lenneman A, Hoopes CW, Kopf S, Hayes A, Moussa H, Acharya D, Aryal S, Weeks P, Cribbs M, Wetta L, Tallaj J. Management of reproductive health after cardiac transplantation. J Matern Fetal Neonatal Med 2019; 34:1469-1478. [PMID: 31238747 DOI: 10.1080/14767058.2019.1636962] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Pregnancy after cardiac transplantation poses immense challenges. Maternal risks include hypertensive disorders of pregnancy, rejection, and failure of the cardiac allograft that may lead to death. Fetal risks include potential teratogenic effects of immunosuppression and prematurity. Because of the high-risk nature of pregnancy in a heart transplant patient, management of reproductive health after cardiac transplantation should include preconception counseling to all women in the reproductive age group before and after cardiac transplantation. Reliable contraception is vital as nearly half of the pregnancies in this population are unintended. Despite the associated risks, successful pregnancies after cardiac transplantation have been reported. A multidisciplinary approach proposed in this review is essential for successful outcomes. A checklist for providers to guide management is provided.
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Affiliation(s)
- Indranee N Rajapreyar
- Department of Medicine, Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Rachel G Sinkey
- Department of Obstetrics and Gynecology, Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Joanna M Joly
- Department of Medicine, Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, AL, USA.,Birmingham VA Medical Center, Birmingham, AL, USA
| | - Salpy V Pamboukian
- Department of Medicine, Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Andrew Lenneman
- Department of Medicine, Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Charles W Hoopes
- Department of Surgery, Division of Cardiothoracic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Sabrina Kopf
- Department of Transplant Operations, Cardiothoracic Transplant Program, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Allison Hayes
- Department of Transplant Operations, Cardiothoracic Transplant Program, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Hind Moussa
- Department of Obstetrics and Gynecology and Maternal Fetal Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - Deepak Acharya
- Department of Medicine, Division of Cardiology, University of Arizona College of Medicine, Tucson, AZ, USA
| | - Sudeep Aryal
- Department of Medicine, Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Phillip Weeks
- Department of Pharmacy, Memorial Hermann Texas Medical Center, Houston, TX, USA
| | - Marc Cribbs
- Department of Medicine, Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Luisa Wetta
- Department of Obstetrics and Gynecology, Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jose Tallaj
- Department of Medicine, Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, AL, USA.,Birmingham VA Medical Center, Birmingham, AL, USA
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Affiliation(s)
- Rachel G Sinkey
- From the Department of Obstetrics and Gynecology (R.G.S.), University of Alabama at Birmingham
| | - Suzanne Oparil
- Vascular Biology and Hypertension Program, Division of Cardiovascular Disease, Department of Medicine (S.O.), University of Alabama at Birmingham
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Robbins LS, Blanchard CT, Sinkey RG, Harris SL, Tita AT, Harper LM. 13: Effect of prenatal tobacco use on perinatal outcomes and childhood neurodevelopment among infants born prematurely. Am J Obstet Gynecol 2019. [DOI: 10.1016/j.ajog.2018.11.015] [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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Sinkey RG, Blanchard CT, Szychowski JM, Ausbeck E, Subramaniam A, Tita AT. 26: Elective induction of labor at 39 weeks versus expectant management in low-risk multiparous women. Am J Obstet Gynecol 2019. [DOI: 10.1016/j.ajog.2018.11.029] [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: 10/27/2022]
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Sinkey RG, Odibo AO. Vasa previa screening strategies: decision and cost-effectiveness analysis. Ultrasound Obstet Gynecol 2018; 52:522-529. [PMID: 29786153 DOI: 10.1002/uog.19098] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Revised: 04/25/2018] [Accepted: 05/05/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To perform a decision and cost-effectiveness analysis comparing four screening strategies for the antenatal diagnosis of vasa previa in singleton pregnancies. METHODS A decision-analytic model was constructed comparing vasa previa screening strategies. Published probabilities and costs were applied to four transvaginal screening scenarios that were carried out at the time of mid-trimester ultrasound: no screening, ultrasound-indicated screening, screening only pregnancies conceived by in-vitro fertilization (IVF) and universal screening. Ultrasound-indicated screening was defined as performing transvaginal ultrasound at the time of the routine anatomy ultrasound scan in response to one of the following sonographic findings associated with an increased risk of vasa previa: low-lying placenta, marginal or velamentous cord insertion or bilobed or succenturiate lobed placenta. The primary outcome was cost per quality-adjusted life year (QALY) in US$. The analysis was performed from a healthcare system perspective with a willingness-to-pay threshold of $100 000 per QALY selected. One-way and multivariate sensitivity analysis (Monte-Carlo simulation) was performed. RESULTS This decision-analytic model demonstrated that screening pregnancies conceived by IVF was the most cost-effective strategy, with an incremental cost effectiveness ratio (ICER) of $29186.50/QALY. Ultrasound-indicated screening was the second most cost-effective, with an ICER of $56096.77/QALY. These data were robust to all one-way and multivariate sensitivity analyses performed. CONCLUSIONS Within the baseline assumptions, transvaginal ultrasound screening for vasa previa appears to be most cost-effective when performed among IVF pregnancies. However, both IVF and ultrasound-indicated screening strategies fall within contemporary willingness-to-pay thresholds, suggesting that both strategies may be appropriate to apply in clinical practice. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- R G Sinkey
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - A O Odibo
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of South Florida, Tampa, FL, USA
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Sinkey RG, Lacevic J, Reljic T, Hozo I, Gibson KS, Odibo AO, Djulbegovic B, Lockwood CJ. Elective induction of labor at 39 weeks among nulliparous women: The impact on maternal and neonatal risk. PLoS One 2018; 13:e0193169. [PMID: 29694344 PMCID: PMC5918610 DOI: 10.1371/journal.pone.0193169] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Accepted: 02/06/2018] [Indexed: 11/18/2022] Open
Abstract
Objective Optimal management of pregnancies at 39 weeks gestational age is unknown. Therefore, we sought to perform a comparative effectiveness analysis of elective induction of labor (eIOL) at 39 weeks among nulliparous women with non-anomalous singleton, vertex fetuses as compared to expectant management (EM) which included IOL for medical or obstetric indications or at 41 weeks in undelivered mothers. Materials and methods A Monte Carlo micro-simulation model was constructed modeling two mutually exclusive health states: eIOL at 39 weeks, or EM with IOL for standard medical or obstetrical indications or at 41 weeks if undelivered. Health state distribution probabilities included maternal and perinatal outcomes and were informed by a review of the literature and data derived from the Consortium of Safe Labor. Analyses investigating preferences for maternal versus infant health were performed using weighted utilities. Primary outcome was determining which management strategy posed less maternal and neonatal risk. Secondary outcomes were rates of cesarean deliveries, maternal morbidity and mortality, stillbirth, neonatal morbidity and mortality, and preferences regarding the importance of maternal and perinatal health. Results A management strategy of eIOL at 39 weeks resulted in less maternal and neonatal risk as compared to EM with IOL at 41 weeks among undelivered patients. Cesarean section rates were higher in the EM arm (35.9% versus 13.9%, p<0.01). When analysis was performed only on patients with an unfavorable cervix, 39 week eIOL still resulted in fewer cesarean deliveries as compared to EM (8.0% versus 26.1%, p<0.01). There was no statistical difference in maternal mortality (eIOL 0% versus EM 0.01%, p = 0.32) but there was an increase in maternal morbidity among the EM arm (21.2% versus 16.5, p<0.01). There were more stillbirths (0.13% versus 0%, p<0.0003), neonatal deaths (0.25% versus 0.12%, p< 0.03), and neonatal morbidity (12.1% versus 9.4%, p<0.01) in the EM arm as compared to the eIOL arm. Preference modeling revealed that 39 week eIOL was favored over EM. Conclusions and relevance Mathematical modeling revealed that eIOL at 39 weeks resulted in lower population risks as compared to EM with induction of labor at 41 weeks. Specifically, eIOL at 39 weeks resulted in a lower cesarean section rate, lower rates of maternal morbidity, fewer stillbirths and neonatal deaths, and lower rates of neonatal morbidity.
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Affiliation(s)
- Rachel G. Sinkey
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, University of Alabama at Birmingham, Birmingham, Alabama
- * E-mail:
| | - Jasmin Lacevic
- University of South Florida Health Program for Comparative Effectiveness Research, University of South Florida Morsani College of Medicine, Tampa, Florida
| | - Tea Reljic
- University of South Florida Health Program for Comparative Effectiveness Research, University of South Florida Morsani College of Medicine, Tampa, Florida
| | - Iztok Hozo
- Department of Mathematics, Indiana University Northwest, Gary, Indiana
| | - Kelly S. Gibson
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, MetroHealth Medical Center-Case Western Reserve University, Cleveland, Ohio
| | - Anthony O. Odibo
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, University of South Florida, Tampa, Florida
- Tampa General Hospital, Tampa, Florida
| | | | - Charles J. Lockwood
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, University of South Florida, Tampa, Florida
- Tampa General Hospital, Tampa, Florida
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Abstract
The literature abounds with examples of racial/ethnic disparities in both obstetric outcomes and care. Disparities in maternal mortality are well documented with non-Hispanic blacks carrying the burden of the highest maternal mortality rates. Maternal deaths likely represent only the "tip of the iceberg" with respect to pregnancy complications, leading many to explore risk factors and disparities in severe maternal morbidity, a more common precursor to maternal mortality. This review article explores commonly cited indicators of severe maternal morbidity and includes a review of the epidemiological literature supporting or refuting disparities among each indicator.
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Affiliation(s)
- Sarah J Holdt Somer
- Department of Obstetrics and Gynecology, University of South Florida College of Medicine, Tampa, FL
| | - Rachel G Sinkey
- Department of Obstetrics and Gynecology, University of South Florida College of Medicine, Tampa, FL
| | - Allison S Bryant
- Department of Obstetrics and Gynecology, Massachusetts General Hospital, 55 Fruit St, Founders 4, Boston, MA 02114.
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Abstract
OBJECTIVE To evaluate outcomes among pregnancies with cerclage as compared to cerclage and adjunctive progesterone. METHODS A retrospective cohort study was performed from 1 October 2011-30 June 2015 including women with a singleton gestation with vaginal cerclage. Exclusion criteria included multiple gestations, simultaneous 17-alpha hydroxyprogesterone caproate (17-OHPC) and vaginal progesterone (vag-p) use, and patients lost to follow-up. Primary outcome was prevention of preterm birth less than 35 (PTB <35) weeks gestational age (GA). RESULTS One hundred thirty-six patients met inclusion criteria; 73 women had cerclage only, 53 had cerclage and 17-OHPC, 10 had cerclage and vag-p. GA at cerclage placement was similar across groups (p = 0.068). There was a difference in prevention of PTB <35 weeks GA among groups (p = 0.035) with a trend toward earlier delivery among patients with cerclage and vag-p. Rates of PTB <35 weeks in the cerclage (29%) and cerclage and 17-OHPC groups (34%) were similar (p = 0.533). The odds ratio for risk of PTB <35 weeks among women with cerclage and vag-p as compared to all other patients was 5.21 (95%CI: 1.3-21.2). CONCLUSION The combination of cerclage with intramuscular progesterone resulted in similar PTB prevention as compared to cerclage alone. There may be an association between cerclage, vaginal progesterone and higher rates of PTB which may be attributed to characteristics of the group rather than the therapies studied.
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Affiliation(s)
- Rachel G Sinkey
- a Department of Obstetrics and Gynecology , University of South Florida Morsani College of Medicine , Tampa , FL , USA
| | - Mercedes R Garcia
- a Department of Obstetrics and Gynecology , University of South Florida Morsani College of Medicine , Tampa , FL , USA
| | - Anthony O Odibo
- a Department of Obstetrics and Gynecology , University of South Florida Morsani College of Medicine , Tampa , FL , USA
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Louis-Jacques AF, Salihu HM, King LM, Paothong A, Sinkey RG, Pradhan A, Riggs BM, Siegel EM, Salemi JL, Whiteman VE. A positive association between umbilical cord RBC folate and fetal TL at birth supports a potential for fetal reprogramming. Nutr Res 2016; 36:703-9. [DOI: 10.1016/j.nutres.2016.01.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Revised: 01/11/2016] [Accepted: 01/28/2016] [Indexed: 01/06/2023]
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Sinkey RG, Salihu HM, King LM, Paothong A, Louis-Jacques A, Pradhan A, Bruder KL, Zoorob R, Siegel E, Riggs B, Whiteman VE. Homocysteine Levels Are not Related to Telomere Length in Cord Blood Leukocytes of Newborns. Am J Perinatol 2016; 33:552-9. [PMID: 26692203 DOI: 10.1055/s-0035-1570318] [Citation(s) in RCA: 2] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Objective Elevated homocysteine (HC) levels and/or shortened telomere length (TL) are associated with adverse medical conditions. Our objective is to investigate the relationship between HC and TL in cord blood leukocytes of newborns. Study Design This is a nested study from a prospective cohort from 2011 to 2012 in pregnant women admitted for delivery at a university-affiliated hospital. Cord blood was collected at delivery and genomic DNA was analyzed using quantitative PCR. The telomere-to-single copy gene ratio method was employed to quantify TL. Newborn HC levels were measured. generalized linear regression modeling (GLM) and bootstrap statistical analyses were performed. Results Seventy-seven maternal-fetal dyads with a mean gestational age of 39 weeks were included. The distribution of the coefficient of homocysteine showed most values greater than zero demonstrating that homocysteine had a positive relationship with TL. In 915 of 10,000 (9.15%) iterations, the p-value was < 0.05 demonstrating a positive effect. Conclusion Increasing newborn concentrations of HC are not associated with decreasing TL. Larger, prospective studies are needed to confirm these findings and long-term implications.
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Affiliation(s)
- Rachel G Sinkey
- Department of Obstetrics and Gynecology, University of South Florida Morsani College of Medicine, Tampa, Florida
| | - Hamisu M Salihu
- Department of Family and Community Medicine, Baylor College of Medicine, Houston, Texas
| | - Lindsey M King
- Department of Epidemiology and Biostatistics, College of Public Health, University of South Florida, Tampa, Florida
| | - Arnut Paothong
- Department of Epidemiology and Biostatistics, College of Public Health, University of South Florida, Tampa, Florida
| | - Adetola Louis-Jacques
- Department of Obstetrics and Gynecology, University of South Florida Morsani College of Medicine, Tampa, Florida
| | - Anupam Pradhan
- Department of Global Health, College of Public Health, University of South Florida, Tampa, Florida
| | - Karen L Bruder
- Department of Obstetrics and Gynecology, University of South Florida Morsani College of Medicine, Tampa, Florida
| | - Roger Zoorob
- Department of Family and Community Medicine, Baylor College of Medicine, Houston, Texas
| | - Erin Siegel
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Bridget Riggs
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Valerie E Whiteman
- Department of Obstetrics and Gynecology, University of South Florida Morsani College of Medicine, Tampa, Florida
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Sinkey RG, Pavelka JC, Guenther JM, Schuler KM, Basil JB. Combination Risk-Reducing Breast, Gynecologic and Reconstructive Surgery Among High-Risk Women: Does Surgical Order Impact Outcome? J Gynecol Surg 2016. [DOI: 10.1089/gyn.2015.0110] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Rachel G. Sinkey
- Department of Obstetrics and Gynecology, St. Elizabeth Hospital, Edgewood, KY
- Department of Obstetrics and Gynecology, TriHealth Hospital, Cincinnati, OH
| | - James C. Pavelka
- Department of Obstetrics and Gynecology, St. Elizabeth Hospital, Edgewood, KY
- Department of Obstetrics and Gynecology, TriHealth Hospital, Cincinnati, OH
| | - Joseph M. Guenther
- Department of General Surgery, St. Elizabeth Hospital, Edgewood, KY
- Department of General Surgery, TriHealth Hospital, Cincinnati, OH
| | - Kevin M. Schuler
- Department of Obstetrics and Gynecology, St. Elizabeth Hospital, Edgewood, KY
- Department of Obstetrics and Gynecology, TriHealth Hospital, Cincinnati, OH
| | - Jack B. Basil
- Department of Obstetrics and Gynecology, St. Elizabeth Hospital, Edgewood, KY
- Department of Obstetrics and Gynecology, TriHealth Hospital, Cincinnati, OH
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Abstract
Cost-effectiveness analyses allow assessment of whether marginal gains from new technology are worth increased costs. Several studies have examined cost-effectiveness of Down syndrome (DS) screening and found it to be cost-effective. Noninvasive prenatal screening also appears to be cost-effective among high-risk women with respect to DS screening, but not for the general population. Chromosomal microarray (CMA) is a genetic sequencing method superior to but more expensive than karyotype. In light of CMAs greater ability to detect genetic abnormalities, it is cost-effective when used for prenatal diagnosis of an anomalous fetus. This article covers methodology and salient issues of cost-effectiveness.
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Affiliation(s)
- Rachel G Sinkey
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of South Florida, 2 Tampa General Circle, Tampa, FL 33606, USA.
| | - Anthony O Odibo
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of South Florida, 2 Tampa General Circle, Tampa, FL 33606, USA
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Sinkey RG, Habli MA, South AP, Gibler WW, Burns PW, Eschenbacher MA, Warshak CR. Sonographic markers associated with adverse neonatal outcomes among fetuses with gastroschisis: an 11-year, single-center review. Am J Obstet Gynecol 2016; 214:275.e1-275.e7. [PMID: 26454131 DOI: 10.1016/j.ajog.2015.09.081] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [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] [Received: 07/10/2015] [Revised: 09/04/2015] [Accepted: 09/21/2015] [Indexed: 11/20/2022]
Abstract
BACKGROUND Gastroschisis complicates 1 in 2000 births and is readily identifiable during prenatal ultrasound scans. Outcomes in fetuses that are affected by gastroschisis vary widely from stillbirth or neonatal death to uncomplicated surgical correction, which makes prenatal counseling challenging. OBJECTIVE The goal of our study was to identify sonographic markers that are associated with perinatal death and morbidity that include significant bowel injury, necrotizing enterocolitis, and the need for bowel resection in fetuses with gastroschisis. STUDY DESIGN We identified a cohort of fetuses that were diagnosed with gastroschisis from 2003-2014. Sonographic markers that were reviewed included growth restriction, abdominal circumference, oligohydramnios, bowel dilation, and gastric bubble characteristics. We evaluated these markers both at diagnosis and near delivery. Four adverse perinatal outcomes were assessed: perinatal death, necrotizing enterocolitis, need for bowel resection, and a composite of significant bowel injury, which included a diagnosis of bowel atresia or necrosis at the time of surgical exploration. Logistic regression was performed to calculate odds ratios and 95% confidence intervals for each marker and outcome. RESULTS One hundred seventy-seven patients were identified, and 154 of these patients met inclusion criteria after exclusions for delivery <24 weeks gestation, other associated anomalies, lethal karyotype, or lost to follow-up evaluation. Markers at the time of diagnosis (median gestational age, 21 weeks [25th,75th interquartile range, 19, 24 weeks]) that were associated with perinatal death were abdominal circumference <5th percentile (odds ratio, 5.56; 95% confidence interval, 1.25-24.76), abnormal gastric bubble (odds ratio, 11.20; 95% confidence interval, 2.15-58.33), and abnormal stomach location (odds ratio, 17.1; 95% confidence interval, 2.99-97.85). An abnormal stomach location (odds ratio, 5.53; 95% confidence interval, 1.03-29.72) before delivery was associated with perinatal death. Gastric dilation before delivery (odds ratio, 4.36; 95% confidence interval, 1.10-17.34)] was associated with the need for bowel resection. CONCLUSION Early sonographic markers of increased perinatal mortality rates include abdominal circumference <5th percentile and an abnormal gastric bubble.
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Affiliation(s)
- Rachel G Sinkey
- Department of Obstetrics and Gynecology, TriHealth Hospital, Cincinnati, OH
| | - Mounira A Habli
- Cincinnati Fetal Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Andrew P South
- Division of Neonatology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Wei W Gibler
- Department of Obstetrics and Gynecology, University of Cincinnati, Cincinnati, OH
| | - Patricia W Burns
- Cincinnati Fetal Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | | | - Carri R Warshak
- Cincinnati Fetal Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
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Sinkey RG, Garcia MR, Odibo AO. 218: Does adjunctive use of progesterone in women with cerclage improve prevention of preterm birth? Am J Obstet Gynecol 2016. [DOI: 10.1016/j.ajog.2015.10.256] [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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Abstract
Vasa previa occurs when fetal blood vessels that are unprotected by the umbilical cord or placenta run through the amniotic membranes and traverse the cervix. If membranes rupture, these vessels may rupture, with resultant fetal hemorrhage, exsanguination, or even death. Prenatal diagnosis of vasa previa by ultrasound scans is approximately 98%. Approximately 28% of prenatally diagnosed cases result in emergent preterm delivery. Management of prenatally diagnosed vasa previa includes antenatal corticosteroids between 28-32 weeks of gestation, considerations for preterm hospitalization at 30-34 weeks of gestation, and scheduled delivery at 34-37 weeks of gestation.
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Affiliation(s)
- Rachel G Sinkey
- Society for Maternal-Fetal Medicine, 409 12 St. SW, Washington, DC 20024, USA.
| | - Anthony O Odibo
- Society for Maternal-Fetal Medicine, 409 12 St. SW, Washington, DC 20024, USA.
| | - Jodi S Dashe
- Society for Maternal-Fetal Medicine, 409 12 St. SW, Washington, DC 20024, USA.
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Sinkey RG, Smith KL. The first known case of alanine aminotransferase deficiency diagnosed during pregnancy. Eur J Obstet Gynecol Reprod Biol 2015; 191:141-2. [DOI: 10.1016/j.ejogrb.2015.06.001] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Accepted: 06/03/2015] [Indexed: 10/23/2022]
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