Medicine and Health Sciences Commons^™

A Core Outcome Set For Studies Of Gestational Diabetes Mellitus Prevention And Treatment, Aoife M Egan, Delia Bogdanet, Tomás P Griffin, Oratile Kgosidialwa, Mila Cervar-Zivkovic, Eugene Dempsey, John Allotey, Fernanda Alvarado, Cheril Clarson, Shamil D Cooray, Harold W De Valk, Sander Galjaard, Mary R Loeken, Michael J A Maresh, Angela Napoli, Paula M O'Shea, Ewa Wender-Ozegowska, Mireille N M Van Poppel, Shakila Thangaratinam, Caroline Crowther, Linda M Biesty, Declan Devane, Fidelma P Dunne

Paediatrics Publications

AIMS/HYPOTHESIS: The aim of this systematic review was to develop core outcome sets (COSs) for trials evaluating interventions for the prevention or treatment of gestational diabetes mellitus (GDM).

METHODS: We identified previously reported outcomes through a systematic review of the literature. These outcomes were presented to key stakeholders (including patient representatives, researchers and clinicians) for prioritisation using a three-round, e-Delphi study. A priori consensus criteria informed which outcomes were brought forward for discussion at a face-to-face consensus meeting where the COS was finalised.

RESULTS: Our review identified 74 GDM prevention and 116 GDM treatment outcomes, which were presented to stakeholders …

Labour Progression In Obese Women: Are Women With Increased Body Mass Index Having Unnecessary Cesarean Sections?, Caroline Shenouda, Aloka Wijesooriya, Amanda Toufeili, Michael R Miller, Debbie Penava, Barbra De Vrijer

Obstetrics & Gynaecology Publications

OBJECTIVE: This study sought to determine whether obese pregnant women undergo cesarean sections without an adequate trial of labour. This may affect future birth and pregnancy outcomes.

METHODS: A retrospective analysis was done on 526 parturients at Victoria Hospital in London, Ontario. Women were categorized according to parity and pre-pregnancy body mass index (BMI; normal weight, BMI 18.5-24.9 kg/m

RESULTS: Obese class II and III primiparous women required an additional 1.62 and 2.67 hours (P = 0.012), respectively, to reach a dilation of 10 cm compared with their normal weight counterparts; obese class II and III multiparous women required an …

Risk Factors For Poor Birth Outcomes In Moderately Malnourished Pregnant Women In Sierra Leone, Candice A. Rodriguez

Master's Theses

Background: Maternal malnutrition in developing countries is associated with adverse pregnancy and birth outcomes. Malnourished mothers are often faced with additional risk factors as a circumstance of poverty. Supplementary nutrition can improve the outcomes of both mother and infant. Identifying maternal nutritional and socioeconomic risk factors is critical for developing effective interventions.

Objective: A secondary analysis to evaluate maternal risk factors associated with poor birth outcomes including pregnancy loss, low birth weight, stunting, and preterm delivery among moderately malnourished pregnant women in Sierra Leone. Maternal risk factors in the analysis are age, education, parity, BMI, MUAC, gestational weight gain, and …

Characterization Of Urinary Concentrations Of Heavy Metals Among Socioeconomically Disadvantaged Black Pregnant Women, Inkyu Han, Kristina W Whitworth, Xueying Zhang, Masoud Afshar, Pamela D Berens, Elaine Symanski

Faculty, Staff and Student Publications

The objective of this study was to characterize exposures to metals using biological samples collected on socioeconomically disadvantaged black pregnant women. We obtained 131 anonymous urine samples provided by black pregnant women visiting a Medicaid-serving prenatal clinic in Houston, TX, from March 27, 2017 to April 11, 2017. We analyzed urine samples for 15 metals including cadmium (Cd), arsenic (As), lead (Pb), and nickel (Ni) and for creatinine and cotinine. We found that median concentrations of zinc (Zn), selenium (Se), and aluminum (Al) among black pregnant women in this study were 1.5 to 3 times higher than levels reported among …

Medicaid Home Visitation And Maternal And Infant Care And Health: A Reassessment Of Program Effectiveness, Cristian Meghea, Zhiying You, Jennifer E. Raffo, Lee Anne Roman

Michigan Journal of Public Health

Introduction: The Maternal Infant Health Program, MIHP, is Michigan's largest home visiting program for Medicaid-eligible pregnant women and infants. Prior quasi-experimental propensity score matched MIHP evaluations were limited by the possibility of selection bias due to the limited available baseline characteristics. The purpose of this study was to assess the effectiveness of MIHP including previously unobserved baseline characteristics to mitigate the possibility of selection bias.

Methods: We analyzed health care and outcomes of mothers and their infants using linked administrative and screening data. All Medicaid pregnant women with a singleton birth in Michigan between 2009 and 2012 who were prenatally …

Characterizing The Vaccine Knowledge, Attitudes, Beliefs, And Intentions Of Pregnant Women In Georgia And Colorado, Matthew Z. Dudley, Rupali J. Limaye, Saad B. Omer, Sean T. O’Leary, Mallory K. Ellingson, Christine I. Spina, Sarah E. Brewer, Allison T. Chamberlain, Robert A. Bednarczyk, Fauzia Malik, Paula M. Frew, Daniel A. Salmon

School of Public Health Faculty Research

Vaccine coverage for maternal vaccines is suboptimal; only about half of pregnant women received influenza and Tdap vaccines in 2018. We explored knowledge, attitudes, beliefs, intentions, and trust regarding maternal and infant vaccines among pregnant women. Between June 2017 and July 2018, we surveyed 2196 pregnant women recruited from geographically and socio-demographically diverse prenatal care practices in Georgia and Colorado (56% response rate). Fifty-six percent of pregnant women intended to receive both influenza and Tdap vaccines during pregnancy and 68% intended to vaccinate their baby with all recommended vaccines on time. Attitudinal constructs associated with intention to vaccinate include confidence …

Does Gestational Diabetes Mellitus Increases The Risk Of Preeclampsia Among Primigravid Women?, Astha Kakkad

USF Tampa Graduate Theses and Dissertations

Gestational diabetes mellitus (GDM) and preeclampsia are serious complications of pregnancy which are associated with both short- and long-term adverse health outcomes for the mother as well as the fetus. The increase in prevalence of these conditions has become a major public health concern. The purpose of this study is to examine the association and risk imposed by GDM for preeclampsia in primigravid women. This descriptive study was conducted using data retrieved from the electronic medical records of a large integrated health system in Florida. The data for this analysis included pregnancy records for patients at least 18 years of …

Robotic Adrenalectomy For Functional Adenoma In Second Trimester Treats Worsening Hypertension, Courtney Capella, Bs, Joseph Godovchik, Bs, May Jean Counsilman, Md, Thenappan Chandrasekar, Md, Costas D. Lallas, Md, Huda B. Al-Kouatly, Md

Department of Obstetrics and Gynecology Posters

Robotic adrenalectomy is a feasible surgical alternative in the second trimester and can reverse the hypertensive disease and its associated maternal-fetal complications

Evidence Of Increased Hypoxia Signaling In Fetal Liver From Maternal Nutrient Restriction In Mice., Bethany N Radford, Victor K M Han

Paediatrics Publications

BACKGROUND: Intrauterine growth restriction (IUGR) is a pregnancy condition where fetal growth is reduced, and offspring from IUGR pregnancies are at increased risk for type II diabetes as adults. The liver is susceptible to fetal undernutrition experienced by IUGR infants and animal models of growth restriction. This study aimed to examine hepatic expression changes in a maternal nutrient restriction (MNR) mouse model of IUGR to understand fetal adaptations that influence adult metabolism.

METHODS: Liver samples of male offspring from MNR (70% of ad libitum starting at E6.5) or control pregnancies were obtained at E18.5 and differential expression was assessed by …

Preconception Nutrition Intervention Improved Birth Length And Reduced Stunting And Wasting In Newborns In South Asia: The Women First Randomized Controlled Trial., Sangappa M Dhaded, K. Michael Hambidge, Sumera Aziz Ali, Manjunath Somannavar, Sarah Saleem, Omrana Pasha, Umber Khan, Veena Herekar, Sunil Vernekar, S. Yogesh Kumar, Jamie E. Westcott, Vanessa R. Thorsten, Amaanti Sridhar, Abhik Das, Elizabeth Mcclure, Richard J. Derman, Robert L. Goldenberg, Marion Koso-Thomas, Shivaprasad S. Goudar, Nancy F. Krebs

Global Health Articles

South Asia has >50% of the global burden of low birth weight (LBW). The objective was to determine the extent to which maternal nutrition interventions commenced before conception or in the 1st trimester improved fetal growth in this region. This was a secondary analysis of combined newborn anthropometric data for the South Asian sites (India and Pakistan) in the Women First Preconception Maternal Nutrition Trial. Participants were 972 newborn of mothers who were poor, rural, unselected on basis of nutritional status, and had been randomized to receive a daily lipid-based micronutrient supplement commencing ≥3 months prior to conception (Arm 1), …

Marijuana Use In Pregnancy And The Effects On The Fetus/Infant, Amy Rebecca Hurst, Malia Smylie

All Electronic Theses and Dissertations

The purpose of this paper is to critically examine the literature and evidence that is available surrounding pre-pregnancy and prenatal use of marijuana and the effects it has on the developing fetus/infant. It was found that across most findings that further research needs to be done on the use of marijuana prior to pregnancy, during pregnancy, and postpartum. It has also been found that screening and counseling needs to be done and focused on prior to pregnancy and during pregnancy and postpartum. Healthcare professionals have the opportunity to establish a trusting relationship with their patients and to be able to …

Predictors Of Gestational Weight Gain In A Low-Income Hispanic Population: Sociodemographic Characteristics, Health Behaviors, And Psychosocial Stressors, C. D. Dolin, R. S. Gross, A. L. Deierlein, L. T. Berube, M. Katzow, Y. Yaghoubian, S. G. Brubaker, M. J. Messito

Journal Articles

No abstract provided.

Prenatal Perception Of Wic Breastfeeding Recommendation Affects First Month Postpartum Breastfeeding Outcomes, Qi Zhang, Lamichhane Rajan, Joanne Guthrie

Community & Environmental Health Faculty Publications

No abstract provided.

The Effectiveness Of Exercise In The Prevention Of Gestational Diabetes: A Systematic Review, Gabrielle Freed Spt, Amanda Sheehan Spt, Amy Sokol Spt, Haley Stack Spt

Student Research Poster Presentations 2020

Background: Gestational diabetes develops during pregnancy and can cause complications for the mother and baby. Poor management of gestational diabetes can lead to a large sized baby, Cesarean section at delivery, preeclampsia, or hypoglycemia in the baby at birth. Physicians advise women, pre-conception and post-conception, to follow a diet and exercise plan in order to decrease the chances of developing gestational diabetes. Studies have been done to determine the effectiveness of proper diet and exercise prior to conception and during pregnancy in the prevention of gestational diabetes.

Purpose: The purpose of the review was to evaluate the role of exercise …

The Utility Of Performing Cervical Length Follow-Up In Lower Risk Singleton, Varsha Kripalu, Rupsa Boelig, Md

Phase 1

Introduction: Short cervical length (<25 mm) during pregnancy is known to be an increased risk factor for preterm birth (<37 weeks). While interventions exist for women who have had prior preterm births, it is important to investigate the cost effectiveness of screening low risk women with an intermediate cervical length (26-29 mm).

Objective: To quantify the association between change in cervical length on follow up and the incidence of preterm birth in otherwise low risk women with an initial intermediate cervical length.

Methods: A retrospective cohort study was conducted, reviewing 108 charts of women who had an initial screening between 26 and 29 mm. Charts were reviewed for whether or not a follow-up ultrasound was recommended, whether or not the follow-up was performed, and the outcome of their deliveries.

Results: 93.5% (N=101) of women were recommended to get a follow-up ultrasound and 84% (N=85) completed their follow-up. …

The Experience Of Intimate Partner Violence Among Pregnant Women Seeking Treatment For Opioid Use Disorder, Julia Dewey, Diane Abatemarco, Phd, Msw

Phase 1

Introduction: Intimate partner violence (IPV) is a major health issue among those with substance use disorder. A history of partner violence is associated with increased health problems and less improvement in treatment. The perinatal period is a time of increased risk of IPV for women, as well as a key opportunity for opioid use disorder treatment intervention. The purpose of this study is to characterize the experience of partner violence and evaluate the typology of sequelae associated with it in a population of pregnant women seeking medication assisted treatment for opioid use disorder.

Methods: The population of interest in this …

Diffuse Intrasinusoidal Hepatic Metastasis From Breast Cancer Presenting As Liver Failure: Effective And Rapid Treatment With Weekly Low-Dose Adriamycin, Thanh-Phuong N. Afiat, Timothy N. Hembree, Erin A. Dean, Cyrillo Araujo, Luis R. Pena, Marilin Rosa, Hyo S. Han, Kaitlin Hendrix, Asha Ramsakal

Oncologic Sciences Faculty Publications

Background: Hepatic metastasis is well known in breast cancer. Approximately 12–20% of breast cancer patients will develop liver metastasis, which usually presents as discrete mass lesions. Rarely, metastatic spread can be so diffuse that it is unidentifiable on imaging but can progress to fulminant hepatic failure. Our case report suggests that clinicians need to have a high index of suspicion when patients present with rapidly decompensating liver failure in the absence of discrete radiologic hepatic lesions, and that weekly Adriamycin should be considered as a first-line therapeutic option.

Case Report: A 28-year-old African American woman with a history of locally …

Down Regulation With Luteal Gnrh Agonist Therapy In Euploid Embryo Transfers Does Not Impact Pregnancy Rates, Isabelle Levin, Keri Bergin, Md, Dmitry Gounko, Joseph Lee, Alan Copperman, Md

Phase 1

Introduction : Gonadotropin-releasing hormone (GnRH) agonists have been used during assisted reproductive technology (ART) treatment for pituitary suppression and stimulation. Currently, clinical opinion is divided about whether GnRH agonist therapy improves pregnancy rates when used for luteal down-regulation in a frozen euploid embryo transfer (FET). This study evaluated the clinical utility of GnRH agonist down-regulation in single, euploid FET cycles.

Methods : A retrospective analysis was performed, using data from patients who underwent a single, euploid FET cycle from 2012 to 2019. Patients were segregated into two cohorts: Group A: single, euploid FET with down-regulation using GnRH agonist; Group B: …

Cardiac Effects Of Obesity During Pregnancy In C57bl/6j Mice, Kayla Lynn Dudick

Theses and Dissertations--Nutrition and Food Systems

Objective: Pregnancy requires profound cardiac and metabolic adaptation. Left ventricular (LV) mass is increased in response to pregnancy, but is not associated with cardiac damage. In contrast, obesity-mediated cardiac hypertrophy is pathological. Data from animal studies indicate dietary fatty acid composition may have a protective effect during states of extreme cardiac physiological adaptation. In contrast, aberrant cardiac metabolism is a hallmark of disease. Over a third of reproductive-age women in the United States are obese, but there is a paucity of data describing the effect of obesity on maternal cardiac adaptation to pregnancy. The objective of this study was to …

The Association Of Maternal Sociodemographic Factors With Stress In Pregnancy, Maheshwari Andhavarapu

Master of Medicine in Obstetrics and Gynecology

Introduction: Antenatal stress has been linked to maternal morbidity and preterm birth (PTB). One of the pathophysiological processes leading to PTB is thought to be via activation of the hypothalamus-pituitary-adrenal axis resulting in cortisol production. Hair cortisol has recently been shown to be a stress marker in the pregnant and non-pregnant population. Some determinants of hair cortisol have also been studied but more research is needed in this area, especially in pregnancy. Understanding the risk factors of antenatal stress may guide institution of preventative or screening measures to reduce the risk of adverse birth outcomes. As the effect of stress …

Effects Of Centeringpregnancy On Pregnancy Outcomes And Health Disparities In Racial Groups Versus Traditional Prenatal Care, Adrianne M. Smith, Mehak Zainab, Brad Lian

Journal of the Georgia Public Health Association

Background: Group prenatal care has been shown to be effective in reducing health disparities in pregnancy outcomes between racial/ethnic groups. Here, we assess the effectiveness of CenteringPregnancy, a group prenatal care program offered as an alternative to traditional prenatal care.

Purpose: Our multidisciplinary team assessed the effectiveness of an innovative prenatal program intended to improve health outcomes for infants and mothers and reduce health disparities among populations.

Methods: A retrospective cohort study was conducted to examine differences with respect to several pregnancy outcomes such as low birth weight

Results: There were no statistically significant differences between the groups on pregnancy …

Identifying Protective Factors In Response To Discriminatory Experiences Among Pregnant African American Woman, Effie Mathew, Krys Foster, Md

Phase 1

Adverse maternal-fetal health outcomes, such as low birth weight and preterm delivery, are disproportionately more likely among African-Americans than Non-Hispanic Whites. Experiences of discrimination have been hypothesized as a contributing factor to the large discrepancies in maternal-fetal health outcomes. It is well understood that with increased levels of self-reported discrimination, there are lower ratings of physical and mental health, and higher reporting rates of depressive symptoms; this relationship is stronger in women. In addition to this, skin tone has long been a marker for social class and opportunity, but research on skin tone as a risk factor for African Americans …

A Needs Assessment Of Screening Of Non-Communicable Diseases In Prenatal Care At Chuk And Muhima District Hospital, Vaishali Mehta, Ilana Porges, Kaitlin Demarest, Alex Rugamba, Kelly Kaneza, Magnifique Irakoze, Md

Phase 1

Introduction: There has been a recent trend of women experiencing delays in management for high-risk pregnancies in Kigali, Rwanda. Physicians at the University Teaching Hospital of Kigali (CHUK) have observed a high incidence of women receiving obstetric care that were not screened appropriately. This points to an inconsistent screening method for non-communicable diseases (NCDs) prior to delivery and lack of streamlined care. The objective of this study is to assess the need for more robust screening of maternal NCDs.

Methods: This study, between June 2018-19, is a needs-assessment for the screening of NCDs among pregnant women (n=255) at CHUK. It …

A Needs Assessment Of Screening Of Non-Communicable Diseases In Prenatal Care At Chuk And Muhima District Hospital, Ilana Porges, Vaishali Mehta, Kaitlin Demarest, Alex Rugamba, Kelly Kaneza, Magnifique Irakoze, Md

Phase 1

Introduction: Delays in management of high risk pregnancies can result in significant morbidity for women seeking obstetric care. A trend of high incidence of pregnancy complications has been observed among women with non-communicable diseases (NCDs) receiving care at the University Teaching Hospital of Kigali (CHUK), which may suggest the need for more consistent screening of NCDs among pregnant women, and more streamlined care for those identified to be at highest risk for complications.

Methods: This study utilized a mixed method design to assess the need for screening of NCDs among pregnant women (n=255) who received obstetric care at CHUK between …

From The Legal Literature: If The Fetus Is A Person—Is It Relevant? An Argument On The Rights Of Pregnant Women, Francesca Laguardia

Department of Justice Studies Faculty Scholarship and Creative Works

No abstract provided.

Cardiovascular Tissue Remodeling Of Preeclampsia, Rachel Metz

Williams Honors College, Honors Research Projects

Preeclampsia is a hypertensive disorder of pregnancy that leads to a multitude of problems for the mother and fetus during and after pregnancy. While the effects on the mother's body after pregnancy are often overlooked, preeclamptic mothers are prone to cardiovascular diseases from the great deal of stress experienced through the duration of a preeclamptic pregnancy. The associated high blood pressure causes cardiac muscle to work a great deal harder in an attempt to successfully perfuse tissues adequately. This increase in prolonged stress leads to remodeling of the cardiovascular tissues-significantly increasing the risk of heart issues in life beyond the …

Non-Pharmacological Interventions For Alcohol, Marijuana, And Opioid Use During Pregnancy: A Systematic Review, Hannah Safranek, Madeline Frausto, Amy King, Stoneking Madison

Williams Honors College, Honors Research Projects

The purpose of this review is to analyze evidence on prevalence of opioid, alcohol and marijuana use during pregnancy and answer the PICOT question: In pregnant women addicted to or using marijuana, opioids, and alcohol, how do non-pharmacological interventions, compared to standard care of pharmacological interventions alone, affect health outcomes in mothers and neonates between birth to hospital discharge? Diagnosis of substance use disorder is increasing and with it comes increased risk of complications to mother and neonate including neonatal abstinence syndrome (NAS), fetal alcohol syndrome (FAS) and other negative neonatal and maternal outcomes. Evidence was identified on the online …

Prevalence Of Illicit Tobacco Use And Tobacco Tax Avoidance In Pregnancy, Brendan P. Mcdonnell, Robert Mccausland, Sheila Keogan, Luke Clancy, Carmen Regan

Articles

Background Smoking during pregnancy is associated with adverse maternal and fetal outcomes. Tobacco tax avoidance and tax evasion undermine the effectiveness of tobacco tax policies, resulting in cheaper prices for smokers and increased tobacco usage. Aims The purpose of this study was to explore the purchasing habits of pregnant smokers with regard to tobacco expenditure and
use of illicit tobacco. Methods Prospective cohort study. Face to face interviews were conducted with 90 attendees (age range 18–42 years; mean age
28 years) of a smoking cessation antenatal clinic in a large Irish tertiary level maternity hospital. Information regarding smoking habits, quantity …

Impact Of Lifestyle Factors On Group B Streptococcus Colonization During Pregnancy, Myra Joy Quilatan

Theses

Background: Group B Streptococcus (GBS) colonization in the genital tract of pregnant women is a known contributory factor for infection in the neonate, having an impact on morbidity and mortality especially if unrecognized and untreated prior to vaginal delivery. An understanding on how certain lifestyle factors contribute to the development of GBS colonization during pregnancy will assist in aiding a modification of behavior to promote prevention and improve general health.

Aim: The aim of this study was to investigate the effect of various lifestyle factors in isolation or combination on GBS colonization during pregnancy.

Methods: A cross-sectional survey research design …

Examining The Associations Between Addiction Severity And Prior Adverse Childhood Experiences In Pregnant Women Receiving Treatment For Opioid Addiction, Julia Gong, Diane Abatemarco, Phd, Msw

Phase 1

Introduction: Opioid use during pregnancy poses risk to both the mother and fetus, including fetal loss and pre-term birth. Prior research suggests that adverse childhood experiences (ACEs) are a plausible antecedent to opioid abuse. However, there is insufficient understanding of the association between prior ACEs, familial history of substance use, and treatment outcomes in pregnant women receiving treatment for opioid addiction.

Methods: A retrospective chart review will be used to review data from 167 MATER patients who entered treatment between 1997 and 2017. Descriptive statistics will be utilized to characterize the study population. Regression and chi-square analyses will be conducted …