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Champion ML, Becker DA, McIlwraith C, Blanchard CT, Szychowski JM, Kim DJ, Jauk VC, Harper LM, Casey BM, Tita AT. Contemporary Test Performance of the Random Urine Protein-to-creatinine Ratio. Am J Perinatol 2024; 41:1055-1061. [PMID: 35240698 DOI: 10.1055/a-1786-8847] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
OBJECTIVE The random urine protein-to-creatinine ratio (UPCR) is a screening test used for predicting clinically significant proteinuria (urine protein ≥ 300 mg) during pregnancy. No consensus exists on the optimal random UPCR cutoff for performing follow-up 24 hour urine (24H) total protein collection. We aim to evaluate the test performance of random UPCR in predicting proteinuria in a contemporary cohort. STUDY DESIGN This was a retrospective cohort study of pregnant patients at our institution from 2014 to 2018 with a random UPCR and follow-up 24H protein collection. The primary analysis estimated the test characteristics (sensitivity, specificity, positive and negative predictive values) of using random UPCR for the detection of proteinuria defined as urine protein ≥300 mg on 24H protein collection. UPCR cutoffs from 0.10 to 0.30 mg/dL were evaluated, receiver operator characteristic (ROC) curve was constructed, and area under the curve (AUC) was determined. A secondary analysis examined the correlation between UPCR and 24H protein using least squares regression and Pearson correlation. RESULTS Paired UPCR and 24H collection results were available for 1,120 patients. Mean gestational age at time of UPCR was 31.1 ± 5.1 weeks and 687 (61.3%) of patients had a 24H ≥300 mg. UPCR <0.10 mg/dL effectively excluded proteinuria ≥300 mg on 24H collection, while UPCR ≥0.18 mg/dL correctly classifies proteinuria with 91% sensitivity, 57% specificity, 77% positive predictive value, and 79% negative predictive value. UPCR ≥1.07 mg/dL had 100% specificity for 24 hour proteinuria. The area under ROC curve was 0.86. UPCR and 24H collection were highly correlated with a Pearson correlation coefficient of 0.85. After our institution lowered the threshold to obtain a 24H from UPCR ≥0.20 mg/dL to ≥0.10 mg/dL in May 2017, the percentage of patients meeting criteria for 24H collection increased from 57.8 to 84.4%. CONCLUSION The AUC and Pearson correlation suggest random UPCR is a high performance test for the prediction of proteinuria on 24H. Optimal test performance is dependent upon clinical consideration and upon the implications of the disease or condition. A random UPCR screen positive threshold of 0.18 mg/dL maximizes sensitivity to identify clinically significant proteinuria. KEY POINTS · Random urine protein to creatinine ratio is a high performance test for proteinuria.. · A random UPCR threshold of 0.18 mg/dL maximizes sensitivity to identify proteinuria.. · Optimal test performance is dependent on the disease or clinical condition..
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Affiliation(s)
- Macie L Champion
- 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
| | - David A Becker
- 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
| | - Claire McIlwraith
- 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
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Jeff M Szychowski
- Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, Alabama
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, Alabama
| | - Dhong-Jin Kim
- 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
| | - Victoria C Jauk
- 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
| | - Brian M Casey
- 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
| | - 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
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Hu M, Blanchard CT, Seasely AR, Lu M, Szychowski JM, Casey B, Tita AT, Saade G, Subramaniam A. Postpartum Outcomes in Patients Receiving Venous Thromboembolism Prophylaxis during Antepartum Admission. Am J Perinatol 2024. [PMID: 38608670 DOI: 10.1055/s-0044-1785672] [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: 04/14/2024]
Abstract
OBJECTIVE We evaluated if venous thromboembolism (VTE) prophylaxis in the inpatient antepartum period was associated with wound hematomas, VTE occurrence, and other adverse outcomes. STUDY DESIGN This study is a secondary analysis of a retrospective cohort of patients who delivered at University of Alabama at Birmingham (UAB). Patients receiving outpatient anticoagulation (AC) were excluded. We grouped patients into those who received inpatient antepartum prophylactic AC and those who did not. The primary outcome was wound hematomas from delivery to 6 weeks postpartum (PP). Secondary outcomes included VTE occurrence and select adverse outcomes, including other wound complications, unplanned procedures, mode of anesthesia, and intensive care unit (ICU) admission. Analyses were performed with no AC group as the reference. A sensitivity analysis excluding those who received inpatient PP AC was performed. RESULTS Of 1,035 included patients, only 169 patients received inpatient prophylactic AC. They were older, had higher body mass indices, and more comorbidities. Patients receiving inpatient antepartum AC had higher wound hematomas (adjusted odds ratio [aOR] 23.81; 95% confidence interval [CI] 7.04-80.47). They had similar risk for developing VTE as the control group (aOR 2.68; 95% CI 0.19-37.49) but were more likely to have wound complications (aOR 2.36; 95% CI 1.24-4.47), maternal deaths (p < 0.05), and require PP ICU admission (aOR 13.38; 95% CI 4.79-37.35). When excluding those receiving any PP AC, there was no difference in bleeding complications between the two groups and VTE rates remained unchanged. Rates of maternal deaths and PP ICU admissions remained higher in those who received inpatient antepartum AC prophylaxis. CONCLUSION In this small cohort study, increased wound hematomas were found in those who received inpatient antepartum AC prophylaxis with no difference in VTE occurrence. While adverse events were increased in the inpatient AC group, this was mostly associated with PP AC prophylaxis. Larger studies should be conducted to describe the true benefits and risks of antepartum AC prophylaxis and determine efficacy of this widely used practice. KEY POINTS · Peripartum chemoprophylaxis is associated with increased wound hematomas.. · VTE is rare, despite its association with significant peripartum morbidity/mortality.. · Large studies are needed to guide practices that optimize the risk/benefit ratio of chemoprophylaxis..
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Affiliation(s)
- Muhan Hu
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Christina T Blanchard
- 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
| | - Angela R Seasely
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Michelle Lu
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Jeff M Szychowski
- Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, Alabama
- Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama
| | - Brian Casey
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Alan T Tita
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama
| | - George Saade
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston, Texas
| | - Akila Subramaniam
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama
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Ostby SA, Blanchard CT, Sanjanwala AR, Szychowski JM, Leath CA, Huh WK, Subramaniam A. Feasibility, Safety, and Provider Perspectives of Bipolar Electrosurgical Cautery Device for (Opportunistic or Complete) Salpingectomy at the Time of Cesarean Delivery. Am J Perinatol 2024; 41:804-813. [PMID: 35728603 DOI: 10.1055/s-0042-1748525] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
OBJECTIVE The aim of the study is to evaluate the use of a bipolar electrocautery device for complete salpingectomy at cesarean to improve procedure completion rates, operative time, and surgeon reported satisfaction as compared with standard bilateral tubal ligation (BTL) and suture-cut-tie salpingectomy. STUDY DESIGN This is a prospective cohort study of women undergoing planned, non-emergent cesarean with desired sterilization with complete salpingectomy utilizing a bipolar electrocautery device. Study patients were compared with historic controls from a randomized controlled trial (RCT) of complete salpingectomy via suture-cut-tie method versus BTL conducted at our institution (SCORE trial, NCT02374827). Outcomes were compared with groups from the original RCT. RESULTS Thirty-nine women were consecutively enrolled (12/2018-11/2019) into the device arm of the study and compared with the original SCORE cohort (n = 40 BTL, n = 40 salpingectomy without a device). Salpingectomy performance with the bipolar electrocautery device was successfully completed in 100% (39/39) of enrolled women, with one device failure requiring the use of a second device, as compared with 95% (38/40) in the BTL (p = 0.49) and 67.5% (27/40) in salpingectomies without a device (p < 0.001). Mean operative time of sterilization procedure alone demonstrated device use as having the shortest operative time of all (device salpingectomy 5.0 ± 3.6 vs. no device 18.5 ± 8.3 minutes, p < 0.001; and vs. BTL 6.9 ± 5.0, p = 0.032). Mean sterilization procedure endoscopic band ligation (EBL) was demonstrated to be significantly different between each group, least amongst BTL followed by device (6.3 ± 4.8 vs. 8.4 ± 24.8, p < 0.001), and most by suture-cut-tie method (17.7 ± 14.3, p < 0.001 compared with device). Surgeon reported attitudes of complete salpingectomy performance in general practice outside an academic setting was greater with a device than without (79.5 vs. 35.3%; p < 0.001). CONCLUSION Use of a bipolar electrocautery device improved operative times and surgeon satisfaction for salpingectomy at cesarean over standard suture ligation. Device use improved surgeon reported outcomes and may improve incorporation of complete salpingectomy at cesarean. KEY POINTS · Electrocautery bipolar device use was safe at the time of salpingectomy during cesarean.. · Greater surgeon satisfaction occurs using a device than without.. · Decreased surgical time with device use is seen making the procedure equal to BTL..
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Affiliation(s)
- Stuart A Ostby
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Center for Women's Reproductive Health, Birmingham, Alabama
| | - Christina T Blanchard
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Center for Women's Reproductive Health, Birmingham, Alabama
| | - Aalok R Sanjanwala
- Division of Maternal-Fetal Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Jeff M Szychowski
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Center for Women's Reproductive Health, Birmingham, Alabama
| | - Charles A Leath
- Division of Gynecologic Oncology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Warner K Huh
- Division of Gynecologic Oncology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Akila Subramaniam
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Center for Women's Reproductive Health, Birmingham, Alabama
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Collins IC, Blanchard CT, Tipre M, Oben A, Robinson A, Kako T, Joly JM, Cribbs MG, Casey B, Tita A, Sinkey R. Breastfeeding Practices in Patients with Heart Disease Stratified by Area Deprivation Index. Breastfeed Med 2024; 19:256-261. [PMID: 38502815 DOI: 10.1089/bfm.2023.0295] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/21/2024]
Abstract
Objective: We sought to evaluate breastfeeding (BF) practices in patients with maternal cardiac disease (MCD) stratified by area deprivation index (ADI) to identity communities at risk. Study Design: Retrospective cohort of patients managed by the University of Alabama at Birmingham (UAB) Cardio-Obstetrics Program. Patients were included if they had ≥1 prenatal visit with the Cardio-Obstetrics team, delivered at UAB, and had a street address on file. The primary outcome was BF rate at hospital discharge. Secondary outcomes included BF intent on admission and BF at the postpartum (PP) visit. ADI reports socioeconomic disadvantage at the census tract level; 1 = least deprived and 100 = most deprived. Baseline characteristics and BF rates were compared by ADI categories: Low (ADI 1-33), medium (ADI 34-66), and high (ADI 67-100). Results: One hundred and forty-eight patients were included: 14 (10%) low, 42 (28%) medium, and 92 (62%) high ADI. Patients in the high ADI category were younger relative to those in the medium or low ADI (26 versus 28 versus 32 years; p < 0.01) and less likely to be married or living with a partner (30.4% versus 58.5% versus 71.4%; p < 0.01), There was no difference in BF intent between the lowest, medium, and highest ADI categories (85.7% versus 85.4% versus 81.6%; p = 0.38) or BF rates at hospital discharge (100% versus 92.7% versus 85.6%, p = 0.23). However, there was a significant difference in BF rates at the PP visit (90% versus 63.0% versus 38.6%; p < 0.01) even after controlling for differences in baseline characteristics (odds ratio = 0.11 (95% confidence interval [0.01-0.93]), p = 0.043). Conclusions: There was an association between living in a resource-poor community and early cessation of BF in our population of patients with MCD. Community-based interventions targeting mothers with heart disease living in high ADI communities may help these individuals achieve higher BF rates.
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Affiliation(s)
- Isabel C Collins
- University of Alabama at Birmingham Marnix E. Heersink School of Medicine, Birmingham, Alabama, USA
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Christina T Blanchard
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Center for Women's Reproductive Health, Birmingham, Alabama, USA
| | - Meghan Tipre
- Division of Hematology/Oncology, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Ayamo Oben
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Center for Women's Reproductive Health, Birmingham, Alabama, USA
| | - Ashton Robinson
- University of Alabama at Birmingham Marnix E. Heersink School of Medicine, Birmingham, Alabama, USA
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Tavonna Kako
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Center for Women's Reproductive Health, Birmingham, Alabama, USA
| | - Joanna M Joly
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, Alabama, USA
| | - Marc G Cribbs
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, Alabama, USA
| | - Brian Casey
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Center for Women's Reproductive Health, Birmingham, Alabama, USA
| | - Alan Tita
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Center for Women's Reproductive Health, Birmingham, Alabama, USA
| | - Rachel Sinkey
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Center for Women's Reproductive Health, Birmingham, Alabama, USA
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Oben AG, Blanchard CT, Robinson A, Girling I, Joly JM, Cribbs M, Tita A, Casey B, Sinkey R. Racial Disparities in Breastfeeding Rates in Patients with Heart Disease. J Racial Ethn Health Disparities 2024:10.1007/s40615-024-01933-1. [PMID: 38509443 DOI: 10.1007/s40615-024-01933-1] [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] [Received: 09/28/2023] [Revised: 01/17/2024] [Accepted: 01/31/2024] [Indexed: 03/22/2024]
Abstract
OBJECTIVE To evaluate racial disparities in breastfeeding rates in patients with heart disease. STUDY DESIGN Retrospective cohort of pregnant patients with maternal cardiac disease managed by a Cardio-Obstetrics program. Patients self-identifying as Non-Hispanic Black (NHB) and Non-Hispanic White (NHW), who attended ≥ 1 prenatal visit at the Cardio-Obstetrics Program and delivered at the same hospital between March 2015 and June 2019 were included. The primary outcome was breastfeeding rate at discharge from the delivery-associated hospitalization. Secondary outcomes included breastfeeding intent on admission and breastfeeding rates at the postpartum visit among patients who initiated breastfeeding. RESULTS 138 pregnant patients with cardiac disease were included: 58 (42%) NHB and 80 (58%) NHW patients. Parity, marital status and insurance were statistically different between groups. NHB patients were more likely to have government insurance compared to NHW patients (77.6% vs. 40%; p < 0.001). There was a significant difference in the intent to breastfeed upon admission for the delivery-associated hospitalization (74.2% NHB vs. NHW 91.3%; p = 0.01), but not at hospital discharge (84.5% NHB vs. 93.8% NHW; p = 0.08). However, breastfeeding rates were significantly lower among NHB patients at the postpartum visit among the entire cohort (38.2% in NHB vs. 61.1% in NHW women; p = 0.036) and among those who initiated breastfeeding (35.3% NHB vs. 61.1% NHW, p = 0.018). CONCLUSIONS Despite similar breastfeeding rates at hospital discharge, NHB patients with maternal cardiac disease were less likely to intend to breastfeed at admission and/or continue breastfeeding by the postpartum visits. Qualitative studies understanding these differences are crucial to improve breastfeeding rates, especially for NHB patients with maternal cardiac disease.
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Affiliation(s)
- Ayamo G Oben
- University of Alabama at Birmingham Marnix E. Heersink School of Medicine, Birmingham, AL, USA.
- Department of Obstetrics & Gynecology, University of Alabama at Birmingham, 1700 6th Ave South, Ste 10270, Birmingham, AL, 35233, USA.
| | - Christina T Blanchard
- University of Alabama at Birmingham Marnix E. Heersink School of Medicine, Birmingham, AL, USA
- Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Ashton Robinson
- University of Alabama at Birmingham Marnix E. Heersink School of Medicine, Birmingham, AL, USA
| | - Isabel Girling
- University of Alabama at Birmingham Marnix E. Heersink School of Medicine, Birmingham, AL, USA
| | - Joanna M Joly
- University of Alabama at Birmingham Marnix E. Heersink School of Medicine, Birmingham, AL, USA
- Department of Medicine, Division of Cardiovascular Disease, University of Alabama, Birmingham, AL, USA
| | - Marc Cribbs
- University of Alabama at Birmingham Marnix E. Heersink School of Medicine, Birmingham, AL, USA
- Department of Medicine, Division of Cardiovascular Disease, University of Alabama, Birmingham, AL, USA
| | - Alan Tita
- University of Alabama at Birmingham Marnix E. Heersink School of Medicine, Birmingham, AL, USA
- Department of Obstetrics & Gynecology, University of Alabama at Birmingham, 1700 6th Ave South, Ste 10270, Birmingham, AL, 35233, USA
- Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Brian Casey
- University of Alabama at Birmingham Marnix E. Heersink School of Medicine, Birmingham, AL, USA
- Department of Obstetrics & Gynecology, University of Alabama at Birmingham, 1700 6th Ave South, Ste 10270, Birmingham, AL, 35233, USA
- Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Rachel Sinkey
- University of Alabama at Birmingham Marnix E. Heersink School of Medicine, Birmingham, AL, USA
- Department of Obstetrics & Gynecology, University of Alabama at Birmingham, 1700 6th Ave South, Ste 10270, Birmingham, AL, 35233, USA
- Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, AL, USA
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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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Collins IC, Blanchard CT, Oben A, Robinson A, Kako T, Joly JM, Cribbs MG, Casey B, Tita A, Sinkey R. Breastfeeding practices among patients managed by a comprehensive cardio-obstetrics program. J Matern Fetal Neonatal Med 2023; 36:2253485. [PMID: 37691234 PMCID: PMC10580703 DOI: 10.1080/14767058.2023.2253485] [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: 05/01/2023] [Revised: 08/18/2023] [Accepted: 08/25/2023] [Indexed: 09/12/2023]
Abstract
Objective: To evaluate breastfeeding intent, rates at discharge, and continued breastfeeding at follow-up in patients managed in a comprehensive cardio-obstetrics program stratified by severity of maternal cardiac disease.Study Design: Retrospective cohort of patients managed by a comprehensive cardio-obstetrics program at the University of Alabama at Birmingham (UAB). Patients were included if they had ≥1 prenatal visit with the Cardio-Obstetrics team and delivered at UAB. The primary outcome was the breastfeeding rate on discharge from the delivery-associated hospitalization. Secondary outcomes included intent to breastfeed on admission and breastfeeding at the postpartum visit. Baseline characteristics and rates were compared between patients with less severe (mWHO I - II/III) vs. more severe (mWHO III - IV) maternal cardiac disease.Results: 147 patients were included: 85 (57.8%) mWHO class I - II and 62 (42.2%) mWHO class III-IV. Patients with more severe maternal cardiac disease had higher rates of chronic hypertension (22.6% vs. 9.4%; p = 0.027), lower gestational age at delivery (36.4 vs 37.7 weeks; p = 0.008), and higher rates of NICU admission (31.2% vs. 14.1%; p = 0.013). There were no significant differences between mWHO class I-II vs. mWHO class III-IV in intent to breastfeed upon admission to the delivery-associated hospitalization (84.7% vs. 82.3%; p = 0.67), breastfeeding rates upon discharge from the delivery-associated hospitalization (90.6% vs. 87.1%; p = 0.50), or breastfeeding rates at the postpartum visit (54.1% vs. 48.5%; p = 0.60).Conclusions: Despite potential barriers in this high-risk population, over 85% of patients breastfed upon discharge from the delivery-associated hospitalization. However, breastfeeding rates dropped by 40% at the postpartum visit. Strategies to support breastfeeding in the post-partum period in patients with maternal cardiac disease are imperative.
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Affiliation(s)
- Isabel C Collins
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Heersink School of Medicine, Birmingham, AL
- Department of Obstetrics & Gynecology, University of Alabama at Birmingham, Birmingham, AL
| | - Christina T Blanchard
- Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, AL
| | - Ayamo Oben
- Department of Obstetrics & Gynecology, University of Alabama at Birmingham, Birmingham, AL
- Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, AL
| | - Ashton Robinson
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Heersink School of Medicine, Birmingham, AL
- Department of Obstetrics & Gynecology, University of Alabama at Birmingham, Birmingham, AL
| | - Tavonna Kako
- Department of Obstetrics & Gynecology, University of Alabama at Birmingham, Birmingham, AL
- Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, AL
| | - Joanna M Joly
- Department of Medicine, Division of Cardiovascular Disease, University of Alabama at Birmingham, AL
| | - Marc G Cribbs
- Department of Medicine, Division of Cardiovascular Disease, University of Alabama at Birmingham, AL
| | - Brian Casey
- Department of Obstetrics & Gynecology, University of Alabama at Birmingham, Birmingham, AL
- Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, AL
| | - Alan Tita
- Department of Obstetrics & Gynecology, University of Alabama at Birmingham, Birmingham, AL
- Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, AL
| | - Rachel Sinkey
- Department of Obstetrics & Gynecology, University of Alabama at Birmingham, Birmingham, AL
- Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, AL
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Cozzi GD, Blanchard CT, Sanjanwala AR, Page MR, Kim DJ, Tita AT, Szychowski JM, Subramaniam A. Defining a Strategy for Laboratory Evaluation with Expectant Management of Preeclampsia. Am J Perinatol 2023; 40:1704-1714. [PMID: 34784612 DOI: 10.1055/s-0041-1739511] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE The objective of this study was to compare the frequency and timing of laboratory abnormalities and evaluate optimal laboratory testing strategies in women with preeclampsia (PE) undergoing expectant management. STUDY DESIGN Retrospective cohort study of women with inpatient expectant management of PE at ≥23 weeks at a tertiary center from 2015 to 2018 was conducted. Women ineligible for expectant management or with less than two laboratory sets (platelets, aspartate aminotransferase, and serum creatinine) before the decision to deliver were excluded. Women were categorized as per the American College of Obstetricians and Gynecologists' definitions by initial diagnosis: PE without severe features, superimposed preeclampsia (SiPE) without severe features, and their forms with severe features. The frequency and timing of laboratory abnormalities were compared across the four PE categories. Kaplan-Meier curves modeled time to a laboratory abnormality (event) with censoring for delivery and were compared using log-rank tests. Logistic regression analysis modeled the development of a laboratory abnormality as a function of testing time intervals (days) for each PE type. Receiver operating characteristic curves and areas under the curve (AUC) were calculated; optimal cut points were determined using the Liu method. RESULTS Among 636 women who met inclusion criteria, laboratory abnormalities were uncommon (6.3%). The median time to a laboratory abnormality among all women was ≤10 days, time being shortest in women with PE with severe features. Time to laboratory abnormality development did not differ significantly between the four PE groups (p = 0.36). Laboratory assessment intervals were most predictive for PE and SiPE with severe features (AUC = 0.87, AUC = 0.72). Optimal cutoffs were every 4 days for PE without severe features, 2 days for PE with severe features, 8 days for SiPE without severe features, and 3 days for SiPE with severe features. CONCLUSION Most laboratory abnormalities in PE occur earlier and more frequently in those with severe features. Individual phenotypes should undergo serial evaluation based on this risk stratification. KEY POINTS · Most laboratory abnormalities occur within 10 days of diagnosis.. · Laboratory abnormalities occur more often with severe features.. · Laboratory testing should occur according to disease severity..
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Affiliation(s)
- Gabriella D 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
| | - Christina T Blanchard
- 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
| | - Aalok R Sanjanwala
- 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
| | - Margaret R Page
- 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
| | - Dhong-Jin Kim
- 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
| | - 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
| | - Jeff M Szychowski
- Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, Alabama
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, Alabama
| | - Akila Subramaniam
- 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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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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Meyer I, Blanchard CT, Szychowski JM, Richter HE. Five-year surgical outcomes of transvaginal apical approaches in women with advanced pelvic organ prolapse. Int Urogynecol J 2023; 34:2171-2181. [PMID: 37039859 DOI: 10.1007/s00192-023-05501-9] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 01/30/2023] [Indexed: 04/12/2023]
Abstract
INTRODUCTION AND HYPOTHESIS In women with advanced prolapse, differences in vaginal apex anchoring sites may impact surgical outcomes over time. The primary aim was to compare 5-year surgical outcomes of uterosacral ligament suspension (ULS) versus sacrospinous ligament fixation (SSLF) in women with advanced (stage III-IV) prolapse. METHODS A secondary analysis was conducted in a subset of women with advanced prolapse from a multicenter randomized trial comparing ULS versus SSLF and its extended follow-up, using publicly accessible de-identified datasets. The primary outcome was time to failure, defined as any one of (1) apical descent > 1/3 into the vaginal canal or anterior/posterior compartment beyond the hymen, (2) bothersome vaginal bulge symptoms, or (3) re-treatment. Secondary outcomes include symptom severity measured by the Pelvic Organ Prolapse Distress Inventory (POPDI) and adverse events. RESULTS Of 285 women, 90/147 (61.2%) in ULS and 88/138 (63.8%) in SSLF had advanced prolapse. Baseline characteristics did not differ between groups except for median-vaginal deliveries (3.0 [2.0, 5.0] versus 3.0 [2.0, 4.0], p < 0.01). The median time to failure was 1.7 years ULS versus 2.0 years SSLF (p = 0.42). Surgical failure increased over time in both groups with no intergroup difference; by year 5, the estimated failure rate was 67.7% ULS versus 71.5% SSLF (adjusted difference -3.8; 95%CI [-21.9, 14.2]). No differences were noted in individual failure components (p > 0.05). POPDI scores improved over 5 years without intergroup difference (ULS -68.0 ± 61.1 versus SSLF -69.9 ± 60.3, adjusted difference -0.1 [-20.0, 19.9]). No difference in adverse events were observed (p > 0.05). CONCLUSION In women with advanced prolapse, surgical failure, symptom severity, and adverse events did not differ between ULS and SSLF over 5 years.
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Affiliation(s)
- Isuzu Meyer
- Division of Urogynecology and Pelvic Reconstructive Surgery, Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL, 35249, USA.
| | - Christina T Blanchard
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jeff M Szychowski
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Holly E Richter
- Division of Urogynecology and Pelvic Reconstructive Surgery, Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL, 35249, USA
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Cozzi GD, Blanchard CT, Edwards JT, Szychowski JM, Subramaniam A, Battarbee AN. Optimal predelivery hemoglobin to reduce transfusion and adverse perinatal outcomes. Am J Obstet Gynecol MFM 2023; 5:100810. [PMID: 36379441 PMCID: PMC10559786 DOI: 10.1016/j.ajogmf.2022.100810] [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: 08/19/2022] [Revised: 10/20/2022] [Accepted: 11/09/2022] [Indexed: 11/14/2022]
Abstract
BACKGROUND Maternal anemia has been associated with poor obstetrical outcomes; however, the optimal hemoglobin level for reducing blood transfusion at delivery has not been well-defined. OBJECTIVE This study aimed to measure the association of maternal anemia immediately before delivery with peripartum transfusion and other adverse perinatal outcomes. We also sought to identify the optimal hemoglobin level for predicting transfusion. STUDY DESIGN This was a retrospective cohort study of patients who had hemoglobin or hematocrit collected before delivery of live, nonanomalous neonates at ≥23 weeks' gestation at a single center (2013-2018). Patients were excluded if they had sickle cell disease or were receiving anticoagulation. Patients were categorized as having anemia or no anemia on the basis of predelivery hemoglobin or hematocrit levels using criteria set by the American College of Obstetricians and Gynecologists. The primary outcome was transfusion of ≥1 unit of packed red blood cells during the delivery admission. Secondary outcomes included select adverse perinatal outcomes. Bivariable analyses compared baseline characteristics and outcomes between the anemia and no-anemia groups. Multivariable logistic regression estimated the association between anemia and outcomes. The hemoglobin cutoff optimizing sensitivity and specificity for transfusion was identified by the Liu method. RESULTS Of the 18,357 patients included in the analysis, 5444 (30%) had predelivery anemia (mean hemoglobin, 10.0±0.8 g/dL) vs 12,913 (70%) who did not (mean hemoglobin, 12.3±1.1 g/dL). Patients with anemia were more likely to be non-Hispanic Black and publicly insured and less likely to be nulliparous. Anemia was associated with 5-fold higher odds of packed red blood cell transfusion (6.0% vs 1.3%; adjusted odds ratio, 5.23 [95% confidence interval, 4.09-6.69]) compared with no anemia. For each 1 g/dL increase in predelivery hemoglobin, the odds of transfusion were 56% lower (adjusted odds ratio, 0.44 [confidence interval, 0.40-0.48]). The optimal hemoglobin for prediction of transfusion was 10.6 g/dL (sensitivity: 80%, specificity: 86%). There was no association between anemia and composite maternal or neonatal morbidity after adjustment for covariates, but anemia was associated with higher odds of postpartum readmission (adjusted odds ratio, 1.35 [1.11-1.64]). CONCLUSION Maternal anemia before delivery was associated with 5-fold higher odds of packed red blood cell transfusion and postpartum readmission, but not other perinatal morbidity. Optimizing predelivery hemoglobin, particularly ≥10.6 g/dL, may reduce peripartum transfusion.
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Affiliation(s)
- Gabriella D Cozzi
- From the Center for Women's Reproductive Health, The University of Alabama at Birmingham, Birmingham, AL (Dr Cozzi, Ms Blanchard, and Drs Edwards, Szychowski, Subramaniam, and Battarbee); Departments of Obstetrics and Gynecology, The University of Alabama at Birmingham, Birmingham, AL (Drs Cozzi, Edwards, Szychowski, Subramaniam, and Battarbee).
| | - Christina T Blanchard
- From the Center for Women's Reproductive Health, The University of Alabama at Birmingham, Birmingham, AL (Dr Cozzi, Ms Blanchard, and Drs Edwards, Szychowski, Subramaniam, and Battarbee)
| | - Joseph T Edwards
- From the Center for Women's Reproductive Health, The University of Alabama at Birmingham, Birmingham, AL (Dr Cozzi, Ms Blanchard, and Drs Edwards, Szychowski, Subramaniam, and Battarbee); Departments of Obstetrics and Gynecology, The University of Alabama at Birmingham, Birmingham, AL (Drs Cozzi, Edwards, Szychowski, Subramaniam, and Battarbee)
| | - Jeff M Szychowski
- From the Center for Women's Reproductive Health, The University of Alabama at Birmingham, Birmingham, AL (Dr Cozzi, Ms Blanchard, and Drs Edwards, Szychowski, Subramaniam, and Battarbee); Departments of Obstetrics and Gynecology, The University of Alabama at Birmingham, Birmingham, AL (Drs Cozzi, Edwards, Szychowski, Subramaniam, and Battarbee); Departments of Obstetrics and Biostatistics, The University of Alabama at Birmingham, Birmingham, AL (Dr Szychowski)
| | - Akila Subramaniam
- From the Center for Women's Reproductive Health, The University of Alabama at Birmingham, Birmingham, AL (Dr Cozzi, Ms Blanchard, and Drs Edwards, Szychowski, Subramaniam, and Battarbee); Departments of Obstetrics and Gynecology, The University of Alabama at Birmingham, Birmingham, AL (Drs Cozzi, Edwards, Szychowski, Subramaniam, and Battarbee)
| | - Ashley N Battarbee
- From the Center for Women's Reproductive Health, The University of Alabama at Birmingham, Birmingham, AL (Dr Cozzi, Ms Blanchard, and Drs Edwards, Szychowski, Subramaniam, and Battarbee); Departments of Obstetrics and Gynecology, The University of Alabama at Birmingham, Birmingham, AL (Drs Cozzi, Edwards, Szychowski, Subramaniam, and Battarbee)
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McCarley C, Blanchard CT, Champion ML, Nassel A, Battarbee AN, Subramaniam A. The association between social vulnerability index and neonatal intensive care unit admission. Am J Obstet Gynecol 2023. [DOI: 10.1016/j.ajog.2022.11.222] [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: 01/09/2023]
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14
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Champion ML, Blanchard CT, Shrestha KS, Nassel A, Battarbee AN, Subramaniam A. The association between social vulnerability index and preeclampsia. Am J Obstet Gynecol 2023. [DOI: 10.1016/j.ajog.2022.11.440] [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: 01/09/2023]
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15
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Robinson A, Blanchard CT, Oben A, Girling IC, Joly JM, Cribbs M, Tita AT, Casey BM, Sinkey R. Racial disparities in breastfeeding rates in postpartum patients with heart disease. Am J Obstet Gynecol 2023. [DOI: 10.1016/j.ajog.2022.11.757] [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: 01/09/2023]
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Girling IC, Blanchard CT, Oben A, Kako T, Robinson A, Joly JM, Cribbs M, Casey BM, Tita AT, Sinkey R. Breastfeeding practices among patients managed by a comprehensive cardio-obstetrics program. Am J Obstet Gynecol 2023. [DOI: 10.1016/j.ajog.2022.11.285] [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: 01/09/2023]
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Seasely AR, Blanchard CT, Nassel A, Odom JD, Sinkey R, Battarbee AN, Casey BM, Tita AT, Subramaniam A. Association of social vulnerability index on COVID-19 infection severity during pregnancy. Am J Obstet Gynecol 2023. [DOI: 10.1016/j.ajog.2022.11.192] [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: 01/09/2023]
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Seasely AR, Blanchard CT, Cooley A, Beitel D, Wang J, Travers CP, Sims B, Tita AT, Casey BM, Sinkey R. Evaluating maternal quality of life following a periviable delivery. Am J Obstet Gynecol 2023. [DOI: 10.1016/j.ajog.2022.11.748] [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: 01/09/2023]
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Girling IC, Blanchard CT, Oben A, Robinson A, Kako T, Tipre M, Joly JM, Cribbs M, Casey BM, Tita AT, Sinkey R. The effects of social determinants of health on breastfeeding practices in patients with heart disease. Am J Obstet Gynecol 2023. [DOI: 10.1016/j.ajog.2022.11.568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Seasely AR, Xue Y, Ausbeck EB, Jauk VC, Blanchard CT, Files P, Kuper SC, Casey BM, Szychowski JM, Harper LM, Tita AT, Subramaniam A. Outpatient Foley Catheter for Induction of Labor in Obese Nulliparous Patients: A Secondary Analysis of OFFSITE II Randomized Controlled Trial. Am J Perinatol 2022; 40:807-810. [PMID: 36477716 DOI: 10.1055/s-0042-1759645] [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: 12/12/2022]
Abstract
OBJECTIVE In the OFFSITE II randomized controlled trial, outpatient cervical ripening with a Foley catheter (CF) in nulliparous patients undergoing elective induction of labor (eIOL) shortened the time from admission to delivery. Given that patients with obesity have protracted labor and higher rates of failed IOL, we sought to determine if outpatient ripening with a CF may be even more beneficial for this high-risk group. STUDY DESIGN We performed a secondary analysis of the OFFSITE II randomized controlled trial. For this analysis, all patients from the primary trial were classified by their intervention assignment (inpatient vs. outpatient) and also by their admission body mass index (BMI) class (BMI ≥ 30 and BMI < 30 kg/m2). The primary outcome was time from labor and delivery (L&D) admission to delivery. Secondary outcomes included cesarean delivery, time from admission to hospital discharge, and rates of clinically diagnosed chorioamnionitis and endometritis. RESULTS In patients with BMI ≥ 30, the primary outcome, time from admission to delivery, (18.0 [13.5-20.9] vs. 20.4 [16.6-31.3] hours, p = 0.01), as well as total hospitalization length (3.2 [2.5-3.3] vs. 3.4 [3.1-4.3] days, p = 0.02) were shorter in the outpatient group. There were no differences in rates of chorioamnionitis or endometritis in outpatient compared with inpatient CF. Furthermore, in those with a BMI ≥ 30, the cesarean rate was significantly lower with outpatient CF (19.4% vs. 44.7%, p = 0.03); it was not statistically different in patients with BMI < 30. CONCLUSION In this exploratory retrospective secondary analysis of the OFFSITE II randomized control trial, we found that in patients with BMI ≥ 30 undergoing eIOL, outpatient CF was associated with a lower time from L&D admission until delivery. This was also associated with a shorter time of total hospital duration and decreased the rate of cesarean, a benefit not detected in the overall analysis presented in the primary study. In nulliparas undergoing induction of labor, ripening with outpatient cervical Foley may even more significantly reduce labor duration, total hospital duration, and the rate of cesarean in patients with obesity. KEY POINTS · Outpatient CF was associated with a lower time from L&D admission until delivery in obese nulliparas.. · Outpatient CF was associated with a shorter time of total hospital duration in obese nulliparas.. · Outpatient CF was associated with a decreased rate of cesarean birth in obese nulliparas..
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Affiliation(s)
- Angela R Seasely
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Yumo Xue
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Elizabeth B Ausbeck
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Victoria C Jauk
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Christina T Blanchard
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Pamela Files
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Spencer C Kuper
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Brian M Casey
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Jeff M Szychowski
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Lorie M Harper
- Department of Women's Health, University of Texas at Austin, Dell Medical School, Austin, Texas
| | - Alan T Tita
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Akila Subramaniam
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama
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Page MR, Cozzi GD, Blanchard CT, Lu MY, Ausbeck EB, Casey BM, Tita AT, Kim DJ, Szychowski JM, Subramaniam A. Venous thromboembolism and adverse outcomes in highest thromboembolism risk patients compared with those at lower risk. Am J Obstet Gynecol MFM 2022; 4:100720. [PMID: 35977704 DOI: 10.1016/j.ajogmf.2022.100720] [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: 05/31/2022] [Revised: 08/08/2022] [Accepted: 08/11/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND A risk-based institutional protocol for inpatient heparin-based venous thromboembolism prophylaxis in a general obstetrical population previously demonstrated a greater than 2-fold increase in wound hematomas with no change in the frequency of thromboembolism. OBJECTIVE We sought to compare the rates of thromboembolism and bleeding outcomes in patients at the highest risk for thromboembolism (eg, those with a history of thromboembolism or thrombophilia who require anticoagulation prophylaxis or therapy throughout pregnancy) than low-risk patients. STUDY DESIGN We performed a retrospective cohort study of all deliveries >20 weeks at a single center from 2013-2018. Patients were categorized as high-risk (received outpatient heparin-based prophylaxis or treatment) or low-risk (no outpatient anticoagulation). The primary outcome was newly diagnosed postpartum thromboembolism; the main secondary outcome was wound/perineal hematoma. The outcomes were compared between the high- and low-risk cohorts. Adjusted odds ratios (with 95% confidence intervals) were calculated with the low-risk group as reference. RESULTS Of 24,303 total deliveries, 395 (1.7%) were high-risk and 23,905 (98.3%) were low-risk. Among the low-risk patients, 8.6% received anticoagulation prophylaxis in accordance with our risk-based inpatient thromboembolism prophylaxis protocol. High-risk patients were more likely to be older and have a higher body mass index, earlier delivery gestational age, medical comorbidities, and pregnancy complications, eg, preeclampsia. Despite outpatient antepartum anticoagulation, high-risk patients had an 11-fold increased risk of thromboembolism (adjusted odds ratio, 11.1 [4.7-26.2]) than low-risk patients. High-risk patients also had significantly more wound/perineal hematomas (adjusted odds ratio, 4.8 [2.7-8.4]), overall wound complications (adjusted odds ratio, 3.0 [2.0-4.4]), blood transfusions, intensive care unit admissions, maternal deaths, and longer maternal lengths of stay. CONCLUSION Patients at the highest risk of obstetrical thromboembolism had an 11-fold increased risk of thromboembolism with a more moderate increase (∼5-fold) in postpartum wound and bleeding complications than low-risk patients. This more favorable risk or benefit profile supports current anticoagulation recommendations in high-risk patients.
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Affiliation(s)
- Margaret R Page
- Center for Women's Reproductive Health, The University of Alabama at Birmingham, Birmingham, AL (Drs Page and Cozzi, Ms Blanchard, Drs Lu, Casey, and Tita, Mr Kim, and Drs Szychowski and Subramaniam); Department of Obstetrics and Gynecology, The University of Alabama at Birmingham, Birmingham, AL (Drs Page and Cozzi, Ms Blanchard, Drs Casey and Tita, Mr Kim, and Drs Szychowski and Subramaniam).
| | - Gabriella D Cozzi
- Center for Women's Reproductive Health, The University of Alabama at Birmingham, Birmingham, AL (Drs Page and Cozzi, Ms Blanchard, Drs Lu, Casey, and Tita, Mr Kim, and Drs Szychowski and Subramaniam); Department of Obstetrics and Gynecology, The University of Alabama at Birmingham, Birmingham, AL (Drs Page and Cozzi, Ms Blanchard, Drs Casey and Tita, Mr Kim, and Drs Szychowski and Subramaniam)
| | - Christina T Blanchard
- Center for Women's Reproductive Health, The University of Alabama at Birmingham, Birmingham, AL (Drs Page and Cozzi, Ms Blanchard, Drs Lu, Casey, and Tita, Mr Kim, and Drs Szychowski and Subramaniam); Department of Obstetrics and Gynecology, The University of Alabama at Birmingham, Birmingham, AL (Drs Page and Cozzi, Ms Blanchard, Drs Casey and Tita, Mr Kim, and Drs Szychowski and Subramaniam)
| | - Michelle Y Lu
- Center for Women's Reproductive Health, The University of Alabama at Birmingham, Birmingham, AL (Drs Page and Cozzi, Ms Blanchard, Drs Lu, Casey, and Tita, Mr Kim, and Drs Szychowski and Subramaniam); Wildflower Obstetrics and Gynecology, Austin, TX (Dr Lu)
| | | | - Brian M Casey
- Center for Women's Reproductive Health, The University of Alabama at Birmingham, Birmingham, AL (Drs Page and Cozzi, Ms Blanchard, Drs Lu, Casey, and Tita, Mr Kim, and Drs Szychowski and Subramaniam); Department of Obstetrics and Gynecology, The University of Alabama at Birmingham, Birmingham, AL (Drs Page and Cozzi, Ms Blanchard, Drs Casey and Tita, Mr Kim, and Drs Szychowski and Subramaniam)
| | - Alan T Tita
- Center for Women's Reproductive Health, The University of Alabama at Birmingham, Birmingham, AL (Drs Page and Cozzi, Ms Blanchard, Drs Lu, Casey, and Tita, Mr Kim, and Drs Szychowski and Subramaniam); Department of Obstetrics and Gynecology, The University of Alabama at Birmingham, Birmingham, AL (Drs Page and Cozzi, Ms Blanchard, Drs Casey and Tita, Mr Kim, and Drs Szychowski and Subramaniam)
| | - Dhong-Jin Kim
- Center for Women's Reproductive Health, The University of Alabama at Birmingham, Birmingham, AL (Drs Page and Cozzi, Ms Blanchard, Drs Lu, Casey, and Tita, Mr Kim, and Drs Szychowski and Subramaniam); Department of Obstetrics and Gynecology, The University of Alabama at Birmingham, Birmingham, AL (Drs Page and Cozzi, Ms Blanchard, Drs Casey and Tita, Mr Kim, and Drs Szychowski and Subramaniam)
| | - Jeff M Szychowski
- Center for Women's Reproductive Health, The University of Alabama at Birmingham, Birmingham, AL (Drs Page and Cozzi, Ms Blanchard, Drs Lu, Casey, and Tita, Mr Kim, and Drs Szychowski and Subramaniam); Department of Obstetrics and Gynecology, The University of Alabama at Birmingham, Birmingham, AL (Drs Page and Cozzi, Ms Blanchard, Drs Casey and Tita, Mr Kim, and Drs Szychowski and Subramaniam); Department of Biostatistics, The University of Alabama at Birmingham, Birmingham AL (Dr Szychowski)
| | - Akila Subramaniam
- Center for Women's Reproductive Health, The University of Alabama at Birmingham, Birmingham, AL (Drs Page and Cozzi, Ms Blanchard, Drs Lu, Casey, and Tita, Mr Kim, and Drs Szychowski and Subramaniam); Department of Obstetrics and Gynecology, The University of Alabama at Birmingham, Birmingham, AL (Drs Page and Cozzi, Ms Blanchard, Drs Casey and Tita, Mr Kim, and Drs Szychowski and Subramaniam)
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Cozzi GD, Blanchard CT, Champion ML, Todd A, Davis M, Chandler-Laney P, Casazza K, Casey BM, Tita AT, Szychowski JM, Subramaniam A. Factors Associated with Appropriate Gestational Weight Gain among Women with Obesity. Am J Perinatol 2022; 39:272-280. [PMID: 32854132 PMCID: PMC9105824 DOI: 10.1055/s-0040-1715529] [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: 10/23/2022]
Abstract
OBJECTIVE This study aimed to compare attendance of nutritional counseling, dietary composition, exercise patterns, and socioeconomic factors among obese women with inappropriate gestational weight gain (iGWG) versus appropriate GWG (aGWG). STUDY DESIGN Medicaid-eligible women receiving prenatal care at a tertiary care center from January 2013 to December 2015 were offered individualized nutritional counseling by a registered dietitian encouraging well-balanced meals and 150 min/wk of exercise. We conducted a prospective case-control study of obese women (body mass index or BMI ≥30) with a singleton gestation with iGWG (<11 or >20 pounds) versus aGWG (11-20 pounds). Dietary intake, activity level, and socioeconomic factors were compared with Chi-square, Fisher's exact, Student's t-test, and Wilcoxon Rank Sum tests as indicated, and odds ratios with 95% confidence intervals were calculated. Multivariate regression analysis for significant variables was performed. A subgroup analysis of women with BMI ≥40 was planned. RESULTS A total of 401 women were analyzed: 78% (n = 313) with iGWG and 22% (n = 88) with aGWG. Demographics were similar between groups. Women with iGWG less frequently reported physician reinforcement of counseling and reported more physical inactivity and unemployment; there were no differences in caloric intake or macronutrient profile between groups. Multivariate regression identified physician reinforcement and employment as independent predictors of aGWG. Among women with BMI ≥40 (n = 133), those with iGWG (78%) were less likely to attend counseling, report physician reinforcement of counseling, and have adequate caloric and protein intake when compared with those with aGWG (22%). Activity level and socioeconomic factors were not different between groups. CONCLUSION Physician reinforcement of nutritional counseling, greater activity level, and employment are associated with aGWG in women with BMI ≥30, while individualized professional nutritional counseling and dietary modifications were further associated with aGWG in women with BMI ≥40. Thus, greater focus should be placed on enhancing exposure to counseling and altering nutritional and exercise choices to optimize aGWG. KEY POINTS · Physician reinforcement of nutritional counseling by a dietitian is crucial for obese women.. · Physical inactivity and unemployment are associated with inappropriate gestational weight gain.. · Nutritional counseling is associated with appropriate gestational weight gain in women with BMI ≥40..
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Affiliation(s)
- Gabriella D. 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
| | - Christina T. Blanchard
- 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
| | - Macie L. Champion
- 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
| | - Allison Todd
- Department of Nutritional Sciences, University of Alabama at Birmingham, Birmingham, Alabama
| | - Margaret Davis
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama,Department of Nutritional Sciences, University of Alabama at Birmingham, Birmingham, Alabama
| | - Paula Chandler-Laney
- Department of Nutritional Sciences, University of Alabama at Birmingham, Birmingham, Alabama
| | - Krista Casazza
- Department of Nutritional Sciences, University of Alabama at Birmingham, Birmingham, Alabama,Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama
| | - Brian M. Casey
- 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
| | - 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
| | - Jeff M. Szychowski
- Center for Women’s Reproductive Health, University of Alabama at Birmingham, Birmingham, Alabama,Department of Biostatistics, University of Alabama at Birmingham, Birmingham, Alabama
| | - Akila Subramaniam
- 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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Page M, Lu MY, Blanchard CT, Ausbeck EB, Oglesby KR, Cozzi GD, Bushman ET, Ruzic MF, Mahalingam M, Dunk SA, Champion ML, Szychowski JM, Subramaniam A, Casey BM. Postpartum wound morbidity according to timing of prophylactic anticoagulation administration. Am J Obstet Gynecol 2022. [DOI: 10.1016/j.ajog.2021.11.743] [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: 11/01/2022]
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24
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Oben A, Boateng E, Blanchard CT, Casey BM, Szychowski JM, Battarbee AN. Racial disparities in maternal and neonatal outcomes of pregnant patients with diabetes. Am J Obstet Gynecol 2022. [DOI: 10.1016/j.ajog.2021.11.360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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25
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Cozzi GD, Blanchard CT, Knupp RJ, Szychowski JM, Subramaniam A, Battarbee AN. Optimal pre-delivery hemoglobin to reduce transfusion and adverse perinatal outcomes. Am J Obstet Gynecol 2022. [DOI: 10.1016/j.ajog.2021.11.938] [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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26
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Oben A, Blanchard CT, Battarbee AN, Casey BM, Tita AT, Subramaniam A. Post-cesarean infections before and after implementation of adjunctive azithromycin: does presence of chorioamnionitis matter? Am J Obstet Gynecol 2022. [DOI: 10.1016/j.ajog.2021.11.1061] [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: 11/01/2022]
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27
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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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28
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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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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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Robbins LS, Perez WM, Casey BM, Blanchard CT, Tita AT, Harper LM. Intrapartum opioid analgesia and childhood neurodevelopmental outcomes among infants born preterm. Am J Obstet Gynecol MFM 2021; 3:100372. [PMID: 33831589 DOI: 10.1016/j.ajogmf.2021.100372] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 03/30/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND There are concerns regarding neurobehavioral changes in infants exposed to parenteral opioids during labor; however, long-term neurodevelopment remains unstudied. OBJECTIVE We aimed to examine the association between parenteral opioids used as labor analgesia and perinatal outcomes and childhood neurodevelopment until 2 years of age among infants born prematurely. We hypothesized that intrapartum exposure to parenteral opioids is associated with impaired neurodevelopment and adverse perinatal outcomes. STUDY DESIGN This was a secondary analysis of a multicenter, randomized controlled trial assessing magnesium for the prevention of cerebral palsy in infants at risk for preterm birth. Women delivering a singleton, nonanomalous, live infant before 37 weeks' gestation were considered for inclusion. Women were excluded if they had missing exposure or primary outcome data, were exposed to general anesthesia, or reported use of heroin or unspecified illicit drugs. Women reporting use of nonopioid illicit drugs such as cocaine and marijuana were not excluded. Groups were compared based on exposure or nonexposure to parenteral opioids (intravenous or intramuscular) used as labor analgesia. The primary outcome was any psychomotor or mental developmental delay at 24 months according to the Bayley Scales of Infant Development II. Secondary outcomes were the Bayley Scales of Infant Development II subdomains and adverse perinatal outcomes. Multivariable logistic regression models were performed and adjusted odds ratios with 95% confidence intervals were estimated. RESULTS Of the 1404 women included, 535 (38%) received parenteral opioids as labor analgesia. Women receiving parenteral opioids were more likely to be younger, Hispanic, and present with cervical dilation ≥4 cm. Parenteral opioid recipients had lower rates of illicit nonopioid drug or tobacco use, a lower rate of cesarean delivery, lower educational level and were less likely to be undergoing induction. Women receiving parenteral opioids who underwent cesarean delivery were less likely to do so because of a nonreassuring fetal status. In the unadjusted and adjusted analyses, there were no significant differences in the primary outcomes of psychomotor or mental developmental delay at 2 years of age (adjusted odds ratio, 0.96; confidence interval, 0.76-1.20). The only significant difference in secondary outcomes was a shorter O2 requirement duration in the parenteral opioid group (2 vs 4 days; P=.002). CONCLUSION Among a population of preterm infants vulnerable to neurologic impairment, intrapartum exposure to parenteral opioids was not associated with an increased risk for neurodevelopmental delay up to 2 years of age, nor did these infants have worse perinatal outcomes.
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Affiliation(s)
- Lindsay S Robbins
- Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, AL (Drs Robbins, Perez, and Casey, Ms Blanchard, and Drs Tita and Harper); Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL (Drs Robbins, Perez, Casey, Tita, and Harper).
| | - William M Perez
- Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, AL (Drs Robbins, Perez, and Casey, Ms Blanchard, and Drs Tita and Harper); Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL (Drs Robbins, Perez, Casey, Tita, and Harper)
| | - Brian M Casey
- Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, AL (Drs Robbins, Perez, and Casey, Ms Blanchard, and Drs Tita and Harper); Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL (Drs Robbins, Perez, Casey, Tita, and Harper)
| | - Christina T Blanchard
- Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, AL (Drs Robbins, Perez, and Casey, Ms Blanchard, and Drs Tita and Harper)
| | - Alan T Tita
- Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, AL (Drs Robbins, Perez, and Casey, Ms Blanchard, and Drs Tita and Harper); Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL (Drs Robbins, Perez, Casey, Tita, and Harper)
| | - Lorie M Harper
- Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, AL (Drs Robbins, Perez, and Casey, Ms Blanchard, and Drs Tita and Harper); Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL (Drs Robbins, Perez, Casey, Tita, and Harper)
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Liang MI, Summerlin SS, Blanchard CT, Boitano TKL, Huh WK, Bhatia S, Pisu M. Measuring Financial Distress and Quality of Life Over Time in Patients With Gynecologic Cancer-Making the Case to Screen Early in the Treatment Course. JCO Oncol Pract 2021; 17:e1576-e1583. [PMID: 33596114 DOI: 10.1200/op.20.00907] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Our objective was to measure the trajectory of financial distress and to determine its relationship with quality of life (QOL) among patients with cancer. MATERIALS AND METHODS We conducted a longitudinal survey of patients with gynecologic cancer starting a new line of systemic therapy at baseline, 3 months, and 6 months. Financial distress was measured using a Comprehensive Score for Financial Toxicity (COST) < 26, and QOL was measured using Functional Assessment of Cancer Therapy-General (FACT-G) with lower scores indicating worse responses. One-way repeated analysis of variances, generalized estimating equation models, and correlation coefficients were used to evaluate financial distress and QOL over time. RESULTS There were 90 of 121 (74%) baseline participants with a 6-month follow-up. The average age was 60 years, 29% were African-American, 57% had an annual income < $40,000 in US dollars, and 6% were uninsured. At baseline, 54% of patients screened positive for financial distress, which was unchanged at 3 months (50%, P = .27) but decreased at 6 months (46%, P = .04) compared with baseline. There was no change in average COST (23.6, 25.1, 25.6; P = .33) or FACT-G (70.8, 71.0, 72.8; P = .68) over time. Less financial distress was moderately correlated with better QOL (r = 0.63, 0.61, 0.60) at each time point. The presence of financial distress was associated with a 16-point decrease in FACT-G QOL score over time. CONCLUSION Upfront screening with COST identified 90% of patients who experienced financial distress, and COST did not change significantly over time. More severe financial distress was moderately correlated with worse QOL, and its presence was associated with a clinically meaningful 16-point decrease in QOL.
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Affiliation(s)
- Margaret I Liang
- Division of Gynecologic Oncology, Department of Obstetrics & Gynecology, University of Alabama at Birmingham, Birmingham, AL
| | - Sarah S Summerlin
- School of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Christina T Blanchard
- Center for Women's Reproductive Health, Department of Obstetrics & Gynecology, University of Alabama at Birmingham, Birmingham, AL
| | - Teresa K L Boitano
- Department of Obstetrics & Gynecology, University of Alabama at Birmingham, Birmingham, AL
| | - Warner K Huh
- Division of Gynecologic Oncology, Department of Obstetrics & Gynecology, University of Alabama at Birmingham, Birmingham, AL
| | - Smita Bhatia
- Division of Pediatric Hematology & Oncology, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL
| | - Maria Pisu
- Division of Preventive Medicine, Department of Internal Medicine, University of Alabama at Birmingham, Birmingham, AL
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Seasely AR, Xue Y, Ausbeck EB, Jauk VC, Blanchard CT, Files P, Kuper S, Casey BM, Szychowski JM, Harper LM, Tita A, Subramaniam A. 341 Outpatient cervical ripening with foley catheter for elective induction of labor (eIOL) in obese nulliparas. Am J Obstet Gynecol 2021. [DOI: 10.1016/j.ajog.2020.12.362] [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: 11/25/2022]
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Ruzic MF, Blanchard CT, Robbins LS, Lu MY, Oglesby KR, Page MR, Ausbeck EB, Cozzi GD, Bushman ET, Mahalingam M, Dunk SA, Champion ML, Casey BM, Lazenby AJ, Muñoz Rogers RD, Tita A, Szychowski JM, Kim DJ, Subramaniam A. 582 Post-cesarean infections before and after implementation of adjunctive azithromycin in addition to standard antibiotics. Am J Obstet Gynecol 2021. [DOI: 10.1016/j.ajog.2020.12.603] [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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Champion ML, Blanchard CT, Oglesby KR, Page MR, Allison L, Ausbeck EB, Cozzi GD, Rogers RM, Bushman ET, Kaplan ER, Ruzic MF, Mahalingam M, Dunk SA, Casey BM, Tita A, Kim DJ, Szychowski JM, Lu MY, Subramaniam A. 557 Pregnancy outcomes associated with pragmatic use of aspirin at a single tertiary care center. Am J Obstet Gynecol 2021. [DOI: 10.1016/j.ajog.2020.12.578] [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: 11/29/2022]
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Dunk SA, Owen J, Lu MY, Blanchard CT, Oglesby KR, Page MR, Lazenby AJ, Ausbeck EB, Cozzi GD, Muñoz Rogers RD, Bushman ET, Kaplan ER, Ruzic MF, Mahalingham M, Champion ML, Casey BM, Tita A, Kim DJ, Szychowski JM, Subramaniam A. 764 Operative vaginal delivery as an independent risk factor for maternal postpartum infection. Am J Obstet Gynecol 2021. [DOI: 10.1016/j.ajog.2020.12.787] [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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Lu MY, Blanchard CT, Oglesby KR, Page MR, Lazenby AJ, Ausbeck EB, Cozzi GD, Muñoz Rogers RD, Bushman ET, Kaplan ER, Ruzic MF, Mahalingam M, Dunk SA, Champion ML, Casey BM, Tita A, Kim DJ, Szychowski JM, Subramaniam A. 59 Safety and efficacy of a risk-based obstetric heparin-based thromboprophylaxis regimen. Am J Obstet Gynecol 2021. [DOI: 10.1016/j.ajog.2020.12.057] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Champion ML, Blanchard CT, Cozzi GD, Todd A, Davis M, Chandler-Laney P, Casazza K, Casey BM, Tita A, Subramaniam A. 936 Sociodemographic factors and maternal and neonatal outcomes in obese women (BMI≥30). Am J Obstet Gynecol 2021. [DOI: 10.1016/j.ajog.2020.12.961] [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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38
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Ausbeck EB, Blanchard CT, Straughn JM, Cox MG, Szychowski JM, Subramaniam A, Casey BM, Tita A. 151 Effect of implementation of a sepsis care pathway on maternal morbidity in obstetric patients. Am J Obstet Gynecol 2021. [DOI: 10.1016/j.ajog.2020.12.173] [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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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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Mahalingam M, Blanchard CT, Lu MY, Oglesby KR, Page MR, Lazenby AJ, Ausbeck EB, Cozzi GD, Rogers RM, Bushman ET, Kaplan ER, Ruzic MF, Dunk SA, Champion ML, Casey BM, Tita A, Szychowski JM, Subramaniam A. 823 African-American race and subsequent pregnancy outcomes after a prior preterm birth. Am J Obstet Gynecol 2021. [DOI: 10.1016/j.ajog.2020.12.846] [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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41
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Robbins LS, Blanchard CT, Szychowski JM, Mazzoni SE, Metz TD, Harper LM. 1041 State-level reproductive legislative climate and maternal, fetal, and infant mortality. Am J Obstet Gynecol 2021. [DOI: 10.1016/j.ajog.2020.12.1066] [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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42
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Knupp RJ, Blanchard CT, Szychowski JM, Battarbee AN, Subramaniam A. 237 Do latinas undergo general anesthesia for unscheduled cesarean delivery more than other women? Am J Obstet Gynecol 2021. [DOI: 10.1016/j.ajog.2020.12.259] [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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43
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Page MR, Blanchard CT, Lu MY, Subramaniam A, Oglesby KR, Ausbeck EB, Cozzi GD, Rogers RM, Bushman ET, Kaplan ER, Ruzic MF, Mahalingam M, Dunk SA, Champion ML, Kim DJ, Szychowski JM, Tita A, Casey BM. 794 Venous thromboembolism and adverse outcomes in highest-VTE risk gravidas compared to those at lower risk. Am J Obstet Gynecol 2021. [DOI: 10.1016/j.ajog.2020.12.817] [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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44
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Oben A, Blanchard CT, Ausbeck EB, Kuper S, Files P, Szychowski JM, Tita A, Harper LM. 817 Utility of ultrasound and antenatal testing in women undergoing outpatient cervical ripening. Am J Obstet Gynecol 2021. [DOI: 10.1016/j.ajog.2020.12.840] [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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45
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Jaber S, Blanchard CT, Lu MY, Oglesby KR, Page MR, Lazenby AJ, Ausbeck EB, Cozzi GD, Muñoz Rogers RD, Bushman ET, Kaplan ER, Ruzic MF, Mahalingam M, Dunk SA, Champion ML, Casey BM, Tita A, Kim DJ, Szychowski JM, Subramaniam A. 510 Contemporary trends in cesarean delivery rates and indications. Am J Obstet Gynecol 2021. [DOI: 10.1016/j.ajog.2020.12.531] [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: 11/25/2022]
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Becker DA, Blanchard CT, Szychowski JM, Rogers SL, Brumfield CG, Subramaniam A. Resident Operative Vaginal Delivery Volume after Educational Curriculum Implementation. Am J Perinatol 2020; 37:1296-1300. [PMID: 32455468 DOI: 10.1055/s-0040-1710543] [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: 01/16/2023]
Abstract
OBJECTIVE The percentage of operative vaginal deliveries (OVDs) in the United States has sharply declined. In May 2016, our institution's obstetrics and gynecology (OB/GYN) residency program implemented a twice-yearly OVD curriculum consisting of didactics and simulation. We sought to evaluate the impact of this curriculum. STUDY DESIGN We performed a retrospective cohort study of all deliveries at our institution from July 2011 to May 2018. Deliveries were evaluated quarterly for the pre- (July 2011-April 2016) and postcurriculum (July 2016-May 2018) periods. Forceps-assisted vaginal delivery (FAVD), vacuum-assisted vaginal delivery (VAVD), and total OVD percentages, and the ratio of forceps to vacuums were calculated. Pre- and postcurriculum percentages were compared using Wilcoxon's rank-sum test. Cubic regression curves were fit to quarterly percentages to illustrate trends over time. RESULTS The quarterly OVD percentage was unchanged following curriculum implementation (mean 3.2% [Q1-Q3: 2.6-3.5%] pre- vs. 3.1% [2.5-3.8%] post-, p > 0.99). The FAVD percentage was increased (1.2% [0.8-1.5%] vs. 2.0% [1.4-2.6%], p = 0.027) and the VAVD percentage was decreased (2.0% [1.6-2.2%] vs. 1.2% [0.9-1.3%], p < 0.001). This was accompanied by an increase in the ratio of FAVD to VAVD (0.6 [0.4-0.8] vs. 1.7 [1.3-2.2], p < 0.001). FAVD percentage (3.1%) was higher in the last quarter than any other quarter in the 7-year study period, and total OVD percentage (3.9%) was higher in 2018 than any other calendar year. CONCLUSION The implementation of an OVD curriculum in our OB/GYN residency program resulted in an increase in the percentage of FAVD and the ratio of FAVD to VAVD. KEY POINTS · OVD utilization in the United States continues to decline.. · We demonstrate real-world impact of an OVD curriculum.. · OVD curriculum implementation increases usage of FAVD..
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Affiliation(s)
- David A Becker
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Center for Women's Reproductive Health, The University of Alabama at Birmingham, Birmingham, Alabama
| | - Christina T Blanchard
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Center for Women's Reproductive Health, The University of Alabama at Birmingham, Birmingham, Alabama
| | - Jeff M Szychowski
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Center for Women's Reproductive Health, The University of Alabama at Birmingham, Birmingham, Alabama
| | - Sharee L Rogers
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Center for Women's Reproductive Health, The University of Alabama at Birmingham, Birmingham, Alabama
| | - Cynthia G Brumfield
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Center for Women's Reproductive Health, The University of Alabama at Birmingham, Birmingham, Alabama
| | - Akila Subramaniam
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Center for Women's Reproductive Health, The University of Alabama at Birmingham, Birmingham, Alabama
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Hoke TP, Meyer I, Blanchard CT, Szychowski JM, Richter HE. Characterization of symptom severity and impact on four fecal incontinence phenotypes in women presenting for evaluation. Neurourol Urodyn 2020; 40:237-244. [PMID: 33080084 DOI: 10.1002/nau.24541] [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: 05/10/2020] [Revised: 07/29/2020] [Accepted: 10/05/2020] [Indexed: 12/17/2022]
Abstract
AIM To characterize symptom-specific distress and impact on quality of life (QOL) among women with urge, passive, and combined urge/passive fecal incontinence (FI) phenotypes. A secondary aim was to characterize FI symptom-specific distress and impact on women with a novel fourth phenotype, stress FI. METHODS Women with at least monthly FI from 2003 to 2017 were included. Participants completed the Modified Manchester Health Questionnaire (MMHQ) including MHQ and Fecal Incontinence Severity Index (FISI). Anorectal manometry (ARM) and endoanal ultrasound (EAUS) testing was performed. Total MHQ and FISI scores were compared across FI subtypes controlling for pertinent baseline covariates. RESULTS The cohort included 404 subjects, 220 meeting criteria for urge FI, 67 passive FI, and 117 combined urge/passive FI. On MHQ, women with combined urge/passive FI were most impacted (p < 0.01). FISI scores were significantly different from combined urge/passive FI having the greatest impact (38.1 ± 12.5) and urge FI (31.1 ± 11.3), p < 0.01 having the least. No differences were observed in ARM measurements or anal sphincter defects among the three groups (all p > 0.05). Twenty-nine subjects were identified with stress FI. There were no differences in overall MHQ or FISI scores or anal sphincter evaluation among the urge, passive, and stress FI groups (all p > 0.05). CONCLUSION Women with combined urge/passive FI have higher symptom distress and impact on QOL than urge or passive FI alone. Further research is needed to determine the significance of stress FI as a subtype and response to treatment.
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Affiliation(s)
- Tanya P Hoke
- Division of Urogynecology and Pelvic Reconstructive Surgery, Department Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Isuzu Meyer
- Division of Urogynecology and Pelvic Reconstructive Surgery, Department Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Christina T Blanchard
- Department of Obstetrics and Gynecology, Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Jeff M Szychowski
- Department of Obstetrics and Gynecology, Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, Alabama, USA.,Department of Biostatistics, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Holly E Richter
- Division of Urogynecology and Pelvic Reconstructive Surgery, Department Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama, USA
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48
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Robbins LS, Blanchard CT, Biasini FJ, Powell MF, Casey BM, Tita AT, Harper LM. General anesthesia for cesarean delivery and childhood neurodevelopmental and perinatal outcomes: a secondary analysis of a randomized controlled trial. Int J Obstet Anesth 2020; 45:34-40. [PMID: 33121885 DOI: 10.1016/j.ijoa.2020.08.007] [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] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 07/20/2020] [Accepted: 08/17/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND In 2016, the U.S. Food and Drug Administration expressed concern that neurodevelopment may be negatively affected by anesthesia or sedation exposure in pregnancy or before three years of age. We examined the association between general anesthesia at the time of cesarean delivery and early childhood neurodevelopment. METHODS A secondary analysis of a multicenter randomized controlled trial assessing magnesium for prevention of cerebral palsy in infants at risk for preterm delivery. Exposure was general compared to neuraxial anesthesia. The primary outcome was motor or mental delay at two years of age, assessed by Bayley Scales of Infant Development II (BSIDII). Secondary outcomes included BSIDII subdomains and perinatal outcomes. Multivariable logistic regression models were performed to control for confounders. RESULTS Of 557 women undergoing cesarean delivery, 119 (21%) received general anesthesia. There were no differences in the primary composite outcome of developmental delay (aOR 0.93, 95% CI 0.61 to 1.43) or the BSIDII subdomains of mild, moderate, or severe mental delay, or mild or moderate motor delay. Severe motor delay was more common among infants exposed to general anesthesia (aOR 1.98, 95% CI 1.06 to 3.69). Infants exposed to general anesthesia had longer neonatal intensive care stays (51 vs 37 days, P=0.010). CONCLUSIONS General anesthesia for cesarean delivery was not associated with overall neurodevelopmental delay at two years of age, except for greater odds of severe motor delay. Future studies should evaluate this finding, as well as the impact on neurodevelopment of longer or multiple anesthetic exposures across all gestational ages.
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Affiliation(s)
- L S Robbins
- Center for Women's Reproductive Health, University of Alabama at Birmingham, USA; Department of Obstetrics and Gynecology, University of Alabama at Birmingham, USA.
| | - C T Blanchard
- Center for Women's Reproductive Health, University of Alabama at Birmingham, USA
| | - F J Biasini
- Department of Psychology, University of Alabama at Birmingham, USA
| | - M F Powell
- Center for Women's Reproductive Health, University of Alabama at Birmingham, USA; Department of Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham, USA
| | - B M Casey
- Center for Women's Reproductive Health, University of Alabama at Birmingham, USA; Department of Obstetrics and Gynecology, University of Alabama at Birmingham, USA
| | - A T Tita
- Center for Women's Reproductive Health, University of Alabama at Birmingham, USA; Department of Obstetrics and Gynecology, University of Alabama at Birmingham, USA
| | - L M Harper
- Center for Women's Reproductive Health, University of Alabama at Birmingham, USA; Department of Obstetrics and Gynecology, University of Alabama at Birmingham, USA
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49
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Bushman ET, Blanchard CT, stacy harris, Casey BM, Tita AT, Harper LM. 669: Head circumference within the normal range and neurodevelopment in preterm infants. Am J Obstet Gynecol 2020. [DOI: 10.1016/j.ajog.2019.11.684] [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: 11/29/2022]
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50
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Cozzi GD, Blanchard CT, Champion ML, Todd A, Davis M, Chandler-Laney P, Casazza K, Casey BM, Tita AT, Subramaniam A. 748: Factors associated with appropriate gestational weight gain among obese women. Am J Obstet Gynecol 2020. [DOI: 10.1016/j.ajog.2019.11.762] [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: 11/29/2022]
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