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1.
Am J Perinatol ; 38(5): 414-420, 2021 04.
Article in English | MEDLINE | ID: mdl-32971564

ABSTRACT

OBJECTIVE: Although intrahepatic cholestasis of pregnancy (ICP) remains poorly understood, there are several perinatal complications associated with this condition. This study aimed to examine perinatal outcomes of women with ICP, evaluate outcomes according to severity of disease, and monitor time to symptom improvement following diagnosis. STUDY DESIGN: It involves a prospective, observational study of women with ICP at a single institution. Women with new-onset pruritus without rash were referred to a high-risk obstetrics clinic and evaluated with fasting total bile acids (TBA). Laboratory-confirmed ICP was defined as fasting TBA ≥10 µmol/L. Following diagnosis, a standardized protocol was utilized, including treatment with ursodeoxycholic acid (UDCA). Perinatal outcomes were compared amongst those with and without ICP, and to the general population. Women with ICP were further analyzed based on maximum TBA: 10 to 39, 40 to 99, and ≥100 µmol/L. A Kaplan-Meier survival curve was used to analyze time to symptom improvement. RESULTS: A total of 404 patients were evaluated and 212 (52%) were diagnosed with ICP. The mean gestational age at diagnosis was 34.1 ± 3.3 weeks. When comparing those with ICP to those not confirmed, and to the general population, there were no differences in age, parity, mode of delivery, preeclampsia, or stillbirth (p > 0.05). Preterm birth was significantly associated with ICP (p < 0.01). This relationship was significant across increasing severity of TBA (p < 0.01) and persisted when examining rates of spontaneous preterm birth (p < 0.01). All women with fasting TBA ≥40 µmol/L delivered preterm due to premature rupture of membranes or spontaneous labor. Time to symptom improvement after diagnosis was over 2 weeks on average; however, this time increased with worsening severity of disease. CONCLUSION: Despite treatment with UDCA, women with ICP are at increased risk for spontaneous preterm birth, and this risk significantly increased with severity of disease. Although not significant, a trend exists between increasing time to symptom improvement and worsening severity of disease. KEY POINTS: · Preterm birth is significantly increased in patients diagnosed with intrahepatic cholestasis of pregnancy.. · The risk of preterm birth in women with ICP increases across increasing strata of disease.. · Following initiation of treatment in patients with ICP, symptom improvement takes more than 2 weeks..


Subject(s)
Cholestasis, Intrahepatic/epidemiology , Pregnancy Complications/epidemiology , Premature Birth/epidemiology , Stillbirth/epidemiology , Adolescent , Adult , Bile Acids and Salts , Female , Gestational Age , Humans , Infant, Newborn , Logistic Models , Pregnancy , Pregnancy Outcome/epidemiology , Prospective Studies , Texas/epidemiology , Young Adult
3.
J Perinat Educ ; 26(2): 70-78, 2017.
Article in English | MEDLINE | ID: mdl-30723370

ABSTRACT

To support optimal health outcomes during pregnancy, understanding obstetricians' (OBs) recommendations for and barriers to managing gestational weight gain (GWG) can benefit childbirth educators. This mailed survey examined OBs' practices (n = 63) for managing GWG along with perceived barriers. The most frequent recommendations were (a) increase activity (76.2%), (b) aerobic activity (63.5%), (c) patient education about weight management (61.9%), (d) increase fiber intake (61.3%), and (e) use of guidelines for weight gain (58.7%). Self-tracking weight gain charts were the least used. Greatest barriers to GWG management were (a) patients not interested in changing behavior (77.8%), (b) high relapse rates (66.7%), (c) lack of community resources (60.3%), (d) patients cannot afford referrals (58.7%), and (e) lack of time (53.9%).

4.
Biol Res Nurs ; 15(1): 78-85, 2013 Jan.
Article in English | MEDLINE | ID: mdl-21821641

ABSTRACT

OBJECTIVE: Among Hispanics living in the United States, acculturation is associated with an increased risk for preterm birth. Inflammatory pathways are also associated with preterm birth. As such, the current study sought to investigate the potential relationships among preterm birth, acculturation of Hispanic women, and inflammatory markers. STUDY DESIGN: The authors performed an observational study on pregnant Hispanic women in Texas at 22-24 weeks' gestation (n = 470). The authors obtained demographic data prenatally as well as birth outcome data from the medical chart after delivery. The authors obtained venous blood and used plasma to assay interleukin-1 receptor antagonist (IL-1RA), interleukin-6 (IL-6), and interleukin-10 (IL-10). The authors used logistic regression to understand whether the presence or the absence of IL-10 levels was related to acculturation and the risk of preterm birth. RESULTS: The authors observed interactions between undetectable IL-10 levels and years in the United States and undetectable IL-10 levels and being born in the United States in models predicting preterm birth. Follow-up probes of these interactions suggested that when IL-10 was undetectable, preterm birth became more likely as time living in the United States increased, χ(2) = 5.15 (1, 416), p = .020, odds ratio (OR) = 3.17, and was more likely in participants born in the United States than in those born elsewhere, χ(2) = 5.35 (1, 462), p = .020, OR = 16.78. The authors observed no interactions among acculturation, preterm birth, and IL-1RA and IL-6 levels. CONCLUSION: Acculturated Hispanics who lack the protective effects of IL-10 experience a markedly higher risk of preterm birth than nonacculturated Hispanics.


Subject(s)
Acculturation , Hispanic or Latino , Interleukin-10/blood , Premature Birth , Adolescent , Adult , Cross-Sectional Studies , Female , Humans , Pregnancy , Texas , Young Adult
5.
Arch Womens Ment Health ; 15(1): 57-67, 2012 Feb.
Article in English | MEDLINE | ID: mdl-22277971

ABSTRACT

We examined the effects of acculturation, depressive symptoms, progesterone, and estriol (E3) as predictors of preterm birth (PTB) in pregnant Hispanic women. This cross-sectional study recruited a sample of 470 Hispanic women between 22- and 24-week gestation from physician practices and community clinics. We used the CES-D to measure maternal depressive symptoms. We measured acculturation by English proficiency on the Bidimensional Acculturation Scale, residence index by years in the USA minus age, nativity, and generational status. Serum progesterone and E3 were analyzed by EIA. Ultrasound and medical records determined gestational age after delivery. In χ (2) analysis, there were a significantly greater percentage of women with higher depressive scores if they were born in the USA. In a structural equation model (SEM), acculturation (English proficiency, residence index, and generational status) predicted the estriol/progesterone ratio (E/P), and the interaction of depressive symptoms with the E/P ratio predicted PTB. Undiagnosed depressive symptoms during pregnancy may have biological consequences increasing the risk for PTB.


Subject(s)
Acculturation , Depressive Disorder/ethnology , Hispanic or Latino/psychology , Hispanic or Latino/statistics & numerical data , Premature Birth/etiology , Adolescent , Adult , Cross-Sectional Studies , Depressive Disorder/psychology , Estriol/blood , Female , Humans , Pregnancy , Premature Birth/ethnology , Progesterone/blood , Risk Factors , Texas/epidemiology , Young Adult
6.
Am Fam Physician ; 79(2): 117-23, 2009 Jan 15.
Article in English | MEDLINE | ID: mdl-19178062

ABSTRACT

Pregnant women of all ages should be offered screening and invasive diagnostic testing for chromosomal abnormalities before 20 weeks' gestation. New developments in screening methods have increased the number of options for patients. Diagnostic options include chorionic villus sampling in the first trimester and amniocentesis in the second trimester. Screening options in the first trimester include nuchal translucency testing in combination with measurement of pregnancy-associated plasma protein A and human chorionic gonadotropin. Nuchal translucency testing alone is not as effective. Screening options in the second trimester include serum screening using triple or quadruple screening, and ultrasonography. Patients may also choose a combination of first- and second-trimester screening in an integrated, stepwise sequential, or contingent sequential fashion. These options include an analysis of pregnancy-associated plasma protein A, with or without nuchal translucency testing, in combination with quadruple screening. An integrated test with nuchal translucency testing is the most effective method for women who present in the first trimester. If nuchal translucency testing is unavailable, the maternal serum-integrated test is safest and most effective. For women who do not present until the second trimester, the quadruple screen is recommended. Comprehensive counseling should be available to all pregnant women. Specific screening tests will depend on availability of the procedure and patient preference.


Subject(s)
Chromosome Aberrations/embryology , Prenatal Diagnosis/methods , Amniocentesis , Chorionic Villi Sampling , Female , Humans , Pregnancy , Pregnancy Trimester, Second , Pregnancy-Associated Plasma Protein-A/analysis , Ultrasonography, Prenatal
7.
Obstet Gynecol ; 111(2 Pt 1): 309-16, 2008 Feb.
Article in English | MEDLINE | ID: mdl-18238967

ABSTRACT

OBJECTIVE: To examine the Hispanic acculturation paradox by identifying the effect of acculturation on serum progesterone and estriol levels, the progesterone/estriol ratio, and preterm birth. METHODS: We used an observational, prospective design with 468 self-identified, low-income, pregnant Hispanic women. We used the Language Proficiency Subscale (from the Bidimensional Acculturation Scale for Hispanics) to measure acculturation. We measured progesterone and estriol in maternal serum at 22-24 weeks of pregnancy. We defined preterm birth as birth before 37 weeks of gestation. Statistical analysis was by Wilcox-Mann-Whitney and Kruskal-Wallis tests, analysis of variance, t tests, logistic regression, and structural equation modeling. RESULTS: English proficiency had an adjusted odds ratio of 4.03 (95% confidence interval 1.44-11.25), P<.001, and the lowest quartile of the progesterone/estriol ratio had an adjusted odds ratio of 2.93 (95% confidence interval 1.25-6.89), P<.001, to predict preterm birth. English proficiency was associated with a decrease in progesterone/estriol ratio and an increase in preterm birth. In structural equation modeling, the progesterone/estriol ratio mediated the relationship between acculturation and preterm birth. CONCLUSION: Hispanic woman have four times the risk of a preterm birth if they are more acculturated (ie, proficient in English). These findings demonstrate another possible aspect of obstetric risk, that of acculturation. Further refinement of the risk of acculturation is essential to clarify how we can adjust our clinical care to prevent increasing preterm birth with the increasing Hispanic population. LEVEL OF EVIDENCE: III.


Subject(s)
Acculturation , Estriol/blood , Hispanic or Latino , Premature Birth/ethnology , Progesterone/blood , Adolescent , Adult , Analysis of Variance , Female , Gestational Age , Hispanic or Latino/psychology , Hispanic or Latino/statistics & numerical data , Humans , Infant, Newborn , Infant, Premature , Logistic Models , Poverty , Pregnancy , Pregnancy Outcome , Premature Birth/blood , Premature Birth/epidemiology , Prospective Studies , Statistics, Nonparametric , Stress, Psychological/blood , Stress, Psychological/epidemiology , Stress, Psychological/ethnology , United States/epidemiology
8.
J Obstet Gynecol Neonatal Nurs ; 33(4): 446-54, 2004.
Article in English | MEDLINE | ID: mdl-15346670

ABSTRACT

OBJECTIVE: To determine the sensitivity, specificity, and positive predictive value (PPV) of fetal fibronectin (fFN) and to determine its usefulness, in conjunction with selected other clinical assessment measures, in the prediction of preterm birth for women with twin gestations. DESIGN: A prospective, descriptive, longitudinal design. SETTING: An obstetrical high-risk clinic that received patient referrals from several surrounding communities in central Texas. PATIENTS/PARTICIPANTS: Forty-eight women identified with twin gestations prior to the 22nd week of pregnancy; primarily of Hispanic ethnicity. MAIN OUTCOME MEASURES: A substantial number of outcome variables were assessed in this study. In the present report, data derived from weekly assessments for the identification of the presence of fFN, the diagnosis of bacterial vaginosis, and the measurement of cervical length were reviewed for their relationship to prematurity, birth weight, birth weight discordancy and placental chorionicity. RESULTS: The relative risk of birth prior to 35 weeks gestation, fetal death, or discordance of twin birth weights of greater than 20% was 2.22 (CI: 1.09, 4.55, P < 0.015) when fFN was found to be positive at any weekly testing after 22 to 24 weeks gestation (sensitivity 76.82%, specificity 58.33%, PPV 66.7%). The presence of fFN was most highly predictive of preterm birth when performed during the 24th to 28th gestational week. Shorter cervical lengths were highly correlated with preterm birth (r = -0.6). An association between bacterial vaginosis and preterm birth was not demonstrated in this sample. CONCLUSION: Sampling for the presence of fetal fibronectin can be easily accomplished by RNs in labor triage units and by advanced practice nurses in outpatient settings. The identification of fFN, particularly during the 24 to 28 weeks gestational time frame, is highly predictive of preterm birth, and particularly so for women with twin gestations.


Subject(s)
Cervix Uteri/chemistry , Fibronectins , Glycoproteins/analysis , Obstetric Labor, Premature/diagnosis , Twins , Vaginal Smears/standards , Adolescent , Adult , Anthropometry/methods , Birth Weight , Cervix Uteri/pathology , Enzyme-Linked Immunosorbent Assay/methods , Enzyme-Linked Immunosorbent Assay/standards , Female , Gestational Age , Hispanic or Latino , Humans , Nurse's Role , Obstetric Labor, Premature/ethnology , Obstetric Labor, Premature/etiology , Predictive Value of Tests , Pregnancy , Pregnancy Outcome , Pregnancy, High-Risk , Prospective Studies , Risk , Texas/epidemiology , Vaginal Smears/methods , Vaginosis, Bacterial/complications
9.
Biol Res Nurs ; 4(1): 54-64, 2002 Jul.
Article in English | MEDLINE | ID: mdl-12363283

ABSTRACT

The relationships and predictive abilities of perceived stress, selected clinical risk factors, and corticotropin-releasing hormone (CRH) levels in maternal plasma were investigated for their association with preterm labor (PTL), preterm birth, and gestational age at delivery. An exploratory, prospective, longitudinal research design was used to measure CRH 4 times over pregnancy, perceived stress at 24 and 32 weeks of pregnancy, clinical risk factors, and genitourinary infections in low-income women. Multiple regression analyses revealed that a model of measurement ofperceived stress at 24 or 32 weeks, CRH at 24 or 32 weeks, and PTL (indicated by a diagnosis by the physicians on the medical record and greater than 5 contractions per hour on the fetal monitor) was predictive of as much as 0.23 to 0.27 of the variance in gestational age at birth. Entering ethnicity as a variable into a model did not improve the predictive value. An analysis of variance between Caucasian and Hispanic ethnic groups revealed differences in CRH levels. However, simple regression analysis of ethnicity as a predictor showed a weak r2 with no significance for prediction. There was some evidence of an association of smoking with stress and both PTL and preterm birth. The measurement of stress combined with the measurement of CRHfrom maternal plasma may improve the prediction of which pregnant women are at riskfor pretern birth. The measurement of CRH has potential as an early biological marker of preterm birth.


Subject(s)
Biomarkers/analysis , Corticotropin-Releasing Hormone/analysis , Obstetric Labor, Premature/etiology , Stress, Psychological/complications , Adult , Ethnicity , Female , Forecasting , Humans , Poverty , Pregnancy , Prospective Studies , Regression Analysis , Risk Factors , Urinary Tract Infections/complications
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