RESUMEN
OBJECTIVE: The objective of this study was to examine the influence of gestational weight gain on the development of gestational hypertension/preeclampsia (GHTN/PE) in women with an obese prepregnancy body mass index (BMI). METHODS: Obese women with a singleton pregnancy enrolled at < 20 weeks were studied. Data were classified according to reported gestational weight gain (losing weight, under-gaining, within target, and over-gaining) from the recommended range of 11 to 9.7 kg and by obesity class (class 1 = BMI 30-34.9 kg/m(2), class 2 = 35-39.9 kg/m(2), class 3 = 40-49.9 kg/m(2), and class 4 ≥ 50 kg/m(2)). Rates of GHTN/PE were compared by weight gain group overall and within obesity class using Pearson chi-square statistics. RESULTS: For the 27,898 obese women studied, rates of GHTN/PE increased with increasing class of obesity (15.2% for class 1 and 32.0% for class 4). The incidence of GHTN/PE in obese women was not modified with weight loss or weight gain below recommended levels. Overall for obese women, over-gaining weight was associated with higher rates of GHTN/PE compared with those with a target rate for obesity classes 1 to 3 (each p < 0.001). CONCLUSION: Below recommended gestational weight gain did not reduce the risk for GHTN/PE in women with an obese prepregnancy BMI. These data support a gestational weight gain goal ≤ 9.7 kg in obese gravidas.
Asunto(s)
Índice de Masa Corporal , Hipertensión Inducida en el Embarazo/epidemiología , Obesidad/epidemiología , Aumento de Peso , Adulto , Femenino , Humanos , Incidencia , Preeclampsia/epidemiología , Embarazo , Estados Unidos/epidemiología , Adulto JovenRESUMEN
OBJECTIVE: The aim of the study was to examine pregnancy outcomes of healthy nulliparous women aged ≥ 40 years at delivery. STUDY DESIGN: The study included 53,480 nulliparous women aged 20 to 29 or ≥ 40 years delivering singleton infants, enrolled in a pregnancy risk assessment program between July 1, 2006, and August 1, 2011. Women reporting medical disorders, tobacco use, or conception with assistive reproductive technology were excluded. Data were grouped by body mass (obese or nonobese) and age (20-29 or ≥ 40 years). Pregnancy outcomes were compared within each body mass group for women aged 20 to 29 years versus ≥ 40 years and between obese and nonobese women aged ≥ 40 years. RESULTS: Within each body mass group, nulliparous women aged ≥ 40 years delivered at a significantly lower gestational age and had a greater incidence of cesarean delivery, gestational diabetes, preterm birth, and both low and very low birth weight infants, compared with controls aged 20 to 29 years. For women aged ≥ 40 years, obesity was associated with higher rates of adverse pregnancy outcomes. CONCLUSION: In healthy women, both advanced maternal age and obesity negatively influence pregnancy outcomes. Women who delay pregnancy until age 40+ years may modify their risk for cesarean section, preterm birth, and low-birth-weight infants by reducing their weight to nonobese levels before conception.
Asunto(s)
Índice de Masa Corporal , Diabetes Gestacional/epidemiología , Edad Materna , Obesidad/epidemiología , Resultado del Embarazo , Nacimiento Prematuro/epidemiología , Adulto , Peso Corporal , Cesárea , Femenino , Edad Gestacional , Humanos , Incidencia , Recién Nacido de Bajo Peso , Recién Nacido , Recién Nacido de muy Bajo Peso , Persona de Mediana Edad , Paridad , Embarazo , Estados Unidos/epidemiología , Adulto JovenRESUMEN
OBJECTIVE: To examine the timing of elective delivery and neonatal intensive care unit (NICU) utilization of electively delivered infants from 2008 to 2011. METHODS: Analysis included 42,290 women with singleton gestation enrolled in a pregnancy education program, reporting uncomplicated pregnancies with elective labor induction (ELI) (n = 27,677) or scheduled cesarean delivery (SCD) (n = 14,613) at 37.0-41.9 weeks' gestation. Data were grouped by type and week of delivery (37.0-37.9, 38.0-38.9, and 39.0-41.9 weeks). ELI and SCD for each week of delivery from 2008 to 2011 and nursery utilization by delivery week were compared. RESULTS: During the 2008-2011 timeframe, a shift in timing of ELI and SCD toward ≥39.0 weeks was observed. In 2008, 80.9% of ELI occurred at ≥39.0 weeks versus 92.6% in 2011 (p < 0.001). In 2008, 60.5% of SCD occurred at ≥39.0 weeks versus 78.1% in 2011 (p < 0.001). NICU admission and prolonged nursery stays were highest at 37.0-37.9 weeks for both groups. CONCLUSIONS: We observed a shift toward later gestational age at elective delivery from 2008 to 2011 and increased NICU utilization for neonates born at <39 weeks' gestation.
Asunto(s)
Parto Obstétrico/efectos adversos , Parto Obstétrico/métodos , Resultado del Embarazo/epidemiología , Nacimiento Prematuro/epidemiología , Nacimiento a Término , Adulto , Cesárea/efectos adversos , Cesárea/estadística & datos numéricos , Parto Obstétrico/estadística & datos numéricos , Procedimientos Quirúrgicos Electivos/efectos adversos , Procedimientos Quirúrgicos Electivos/estadística & datos numéricos , Femenino , Edad Gestacional , Hospitalización/estadística & datos numéricos , Humanos , Recién Nacido , Unidades de Cuidado Intensivo Neonatal/estadística & datos numéricos , Trabajo de Parto Inducido/efectos adversos , Trabajo de Parto Inducido/estadística & datos numéricos , Embarazo , Estudios Retrospectivos , Factores de Tiempo , Adulto JovenRESUMEN
OBJECTIVE: The purpose of this study was to determine the role of previous term delivery on the rate of recurrent preterm birth in women with previous spontaneous preterm delivery (SPTD) who receive 17-alphahydroxyprogesterone caproate (17P) therapy. STUDY DESIGN: Women with singleton gestations who were receiving 17P therapy were studied. Rates of recurrent SPTD were compared for 1 or ≥2 SPTD with and without a previous term delivery. RESULTS: Five thousand one hundred two women had 1 previous SPTD, and 2217 women had ≥2 SPTDs. In women with 1 previous SPTD, a previous term delivery had lower rates of SPTD at <35 weeks (8.4% vs 11.2%; P = .002) and preterm delivery at <32 weeks (4.7% vs 6.2%; P = .027) compared with those women with no such history. No differences were found for SPTD at <35 weeks with ≥2 SPTDs. CONCLUSION: In patients who received 17P therapy with 1 previous SPTD, a previous term delivery confers a reduction in risk of preterm delivery at <37, <35, and <32 weeks' gestation; such reduction is not evident with ≥2 previous SPTDs.
Asunto(s)
Hidroxiprogesteronas/uso terapéutico , Nacimiento Prematuro/prevención & control , Progestinas/uso terapéutico , Caproato de 17 alfa-Hidroxiprogesterona , Adulto , Femenino , Humanos , Recién Nacido , Recien Nacido Prematuro , Embarazo , Estudios Retrospectivos , Riesgo , Prevención Secundaria , Nacimiento a TérminoRESUMEN
OBJECTIVE: We sought to compare rates of recurrent spontaneous preterm birth (SPTB) in women receiving 17-α-hydroxyprogesterone caproate (17P) with prior SPTB due to preterm labor (PTL) vs preterm premature rupture of membranes (PPROM). STUDY DESIGN: Women with singleton gestation having 1 prior SPTB enrolled at 16-24.9 weeks' gestation for weekly outpatient 17P administration were identified from a database. Rates of recurrent SPTB were compared between those with prior SPTB due to PTL or PPROM overall and by gestational age at prior SPTB. RESULTS: Records from 2123 women were analyzed. The prior PTL group vs the prior PPROM group experienced higher rates of recurrent SPTB at <37 weeks (29.7% vs 22.9%, P = .004), <35 weeks (14.0% vs 9.1%, P = .004), and <32 weeks (5.9% vs 3.3%, P = .024), respectively. CONCLUSION: Reason and gestational age of prior SPTB influence the likelihood of recurrent SPTB in women receiving 17P prophylaxis.
Asunto(s)
Rotura Prematura de Membranas Fetales/prevención & control , Edad Gestacional , Hidroxiprogesteronas/uso terapéutico , Nacimiento Prematuro/prevención & control , Progestinas/uso terapéutico , Caproato de 17 alfa-Hidroxiprogesterona , Adulto , Factores de Edad , Femenino , Rotura Prematura de Membranas Fetales/tratamiento farmacológico , Rotura Prematura de Membranas Fetales/etiología , Humanos , Recién Nacido , Recien Nacido Prematuro , Embarazo , Nacimiento Prematuro/tratamiento farmacológico , Nacimiento Prematuro/etiología , Prevención SecundariaRESUMEN
In 2009, the Institute of Medicine (IOM) revised their pregnancy weight gain guidelines, recommending gestational weight gain of 11-20 pounds for women with prepregnancy BMI >30 kg/m(2). We investigated the potential influence of the new guidelines on perinatal outcomes using a retrospective analysis (n = 691), comparing obese women who gained weight during pregnancy according to the new guidelines to those who gained weight according to traditional recommendations (25-35 pounds). We found no statistical difference between the two weight gain groups in infant birth weight, cesarean delivery rate, pregnancy-related hypertension, low birth weight infants, macrosomia, neonatal intensive care unit admissions, or total nursery days. Despite showing no evidence of other benefits, our data suggest that obese women who gain weight according to new IOM guidelines are no more likely to have low birth weight infants. In the absence of national consensus on appropriate gestational weight gain guidelines, our data provide useful data for clinicians when providing evidence-based weight gain goals for their obese patients.
Asunto(s)
Peso al Nacer , Recién Nacido de Bajo Peso , Obesidad/fisiopatología , Guías de Práctica Clínica como Asunto , Complicaciones del Embarazo/fisiopatología , Resultado del Embarazo , Aumento de Peso , Adulto , Índice de Masa Corporal , Cesárea/estadística & datos numéricos , Femenino , Macrosomía Fetal/etiología , Objetivos , Humanos , Hipertensión/etiología , Recién Nacido , Unidades de Cuidado Intensivo Neonatal , Embarazo , Estudios RetrospectivosRESUMEN
OBJECTIVE: To examine the frequency of elective delivery and neonatal outcomes in women with stable mild gestational hypertension delivering late preterm. STUDY DESIGN: The frequency of elective delivery between 1995 and 2007 at gestational age of 34°(/)7-366(/)7 weeks (late preterm), 37°(/)7-376(/)7 weeks, and ≥38°(/)7 weeks, as well as neonatal outcomes, were studied in singleton gestation with mild gestational hypertension without proteinuria from a large national database. RESULTS: One thousand eight hundred fifty-eight patients were studied: 607 (33%) were delivered for maternal/fetal reasons and 1251 (67%) were electively delivered. Among the 1251 women delivered electively, 25.5% were late preterm, 24.4% at 37°(/)7-376(/)7 weeks and 50.1% at ≥38°(/)7 weeks' gestation. Neonatal intensive care unit admission, ventilatory assistance, and respiratory distress syndrome were more common in late-preterm infants. There was no maternal/perinatal mortality. CONCLUSION: We found that 25.5% of patients with stable mild gestational hypertension, without any maternal or fetal complication, had iatrogenic elective late-preterm delivery. This practice also was associated with increased rates of neonatal complications and neonatal length of stay.
Asunto(s)
Parto Obstétrico/métodos , Hipertensión Inducida en el Embarazo , Nacimiento Prematuro , Adolescente , Adulto , Parto Obstétrico/efectos adversos , Femenino , Edad Gestacional , Humanos , Recién Nacido , Recien Nacido Prematuro , Unidades de Cuidado Intensivo Neonatal , Persona de Mediana Edad , Embarazo , Respiración Artificial/estadística & datos numéricos , Síndrome de Dificultad Respiratoria del Recién Nacido/etiología , Estudios Retrospectivos , Adulto JovenRESUMEN
OBJECTIVE: We sought to examine if 17-alpha-hydroxyprogesterone caproate (17OHPC) effectiveness is dependent on the earliest gestational age (GA) at prior spontaneous preterm birth (SPTB) when administered in the clinical setting. STUDY DESIGN: Women enrolled for outpatient services with current singleton gestation and > or =1 prior SPTB between 20-36.9 weeks were identified. Data were divided into 3 groups according to earliest GA of prior SPTB (20-27.9, 28-33.9, and 34-36.9 weeks). We compared GA at delivery of current pregnancy and incidence of recurrent SPTB between women enrolled in outpatient 17OHPC administration program (n = 2978) and women receiving other outpatient services without 17OHPC (n = 1260). RESULTS: Rates of recurrent SPTB for those with and without 17OHPC prophylaxis, respectively, according to GA at earliest SPTB were: 20-27.9 weeks at earliest SPTB, 32.2% vs 40.7%, P = .025; 28-33.9 weeks at earliest SPTB, 34.1% vs 45.5%, P < .001; and 34-36.9 weeks at earliest SPTB, 29.3% vs 38.8%, P < .001. CONCLUSION: 17OHPC given to prevent recurrent SPTB is effective regardless of GA at earliest SPTB.
Asunto(s)
17-alfa-Hidroxiprogesterona/uso terapéutico , Edad Gestacional , Nacimiento Prematuro/epidemiología , Nacimiento Prematuro/prevención & control , Adulto , Femenino , Humanos , Embarazo , Embarazo de Alto Riesgo , Estudios Retrospectivos , Prevención SecundariaRESUMEN
OBJECTIVE: Evaluation of an outpatient 17 α-hydroxyprogesterone caproate (17P) administration programme. METHODS: A retrospective analysis of data collected from patients with a history of preterm birth (PTB) and current singleton gestation enrolled between 16.0 and 20.9 weeks' gestational age (GA) for weekly outpatient 17P administration and nursing assessment between 7/2004 and 12/2007 was conducted (n=3139). RESULTS: The population was mostly white (50.3%), 18-35 years old (77.7%), and married (67.0%). Median GA at 17P initiation and stop was 17.4 (16.0, 20.9) weeks and 35.1 (18.6, 37.4) weeks. Mean injections per patient were 16.5±4.9, at an interval of 7.2 days. Median GA at delivery was 37.3 (18.6, 44.0) weeks. Rate of recurrent spontaneous PTB was 29.8%, with 15.5% and 7.0% with PTB at <35 and <32 weeks. CONCLUSIONS: This represents the largest cohort reported to date of patients prescribed 17P therapy in clinical practice to prevent recurrent spontaneous PTB.
Asunto(s)
Servicios de Atención de Salud a Domicilio , Hidroxiprogesteronas/administración & dosificación , Trabajo de Parto Prematuro/tratamiento farmacológico , Nacimiento Prematuro/prevención & control , Progestinas/administración & dosificación , Caproato de 17 alfa-Hidroxiprogesterona , Adolescente , Adulto , Estudios de Cohortes , Femenino , Humanos , Inyecciones Intramusculares , Educación del Paciente como Asunto , Satisfacción del Paciente , Embarazo , Atención Prenatal , Adulto JovenRESUMEN
We sought to identify maternal or clinical characteristics of women likely to develop preterm labor (PTL) at <34 weeks' gestation while receiving 17 alpha-hydroxyprogesterone caproate (17P) prophylaxis. Current singleton gestations with prior preterm delivery enrolled for outpatient 17P administration at <27 weeks' gestation were identified ( N = 1177). Maternal and clinical characteristics were compared between women hospitalized and diagnosed with PTL at <34 weeks' gestation (PTL group, N = 270) and those without PTL (No PTL group, N = 660). PTL at <34 weeks' gestation occurred in 270/1177 (22.9%) of patients receiving 17P prophylaxis (mean gestational age at diagnosis was 28.3 +/- 4.0 weeks). Recurrent preterm delivery occurred in 73.3% of women with PTL at <34 weeks. Maternal age, marital status, race, tobacco use, cerclage, gestational age at start of 17P, and Medicaid status were similar between the groups. Women developing PTL at <34 weeks were more likely to have >1 prior preterm delivery than those without PTL (35.2% versus 25.9%, P = 0.006, odds ratio [95% confidence interval] 1.5 [1.1, 2.1]). Women receiving 17P prophylaxis remain at increased risk for PTL and preterm birth. Patient education and surveillance for PTL symptoms may be warranted in women with a history of more than one prior preterm delivery.
Asunto(s)
17-alfa-Hidroxiprogesterona/administración & dosificación , Trabajo de Parto Prematuro/inducido químicamente , Resultado del Embarazo , Embarazo de Alto Riesgo , Nacimiento Prematuro/prevención & control , Adulto , Estudios de Cohortes , Relación Dosis-Respuesta a Droga , Esquema de Medicación , Femenino , Monitoreo Fetal/métodos , Estudios de Seguimiento , Edad Gestacional , Humanos , Recién Nacido , Trabajo de Parto Prematuro/epidemiología , Trabajo de Parto Prematuro/prevención & control , Embarazo , Probabilidad , Recurrencia , Estudios Retrospectivos , Medición de RiesgoRESUMEN
We evaluated uterine contraction frequency in women receiving 17 alpha-hydroxyprogesterone caproate (17-OHP-C) for the prevention of preterm delivery. Women with singleton pregnancies and receiving weekly 17-OHP-C and outpatient tococardiography were identified from a database. The mean and maximum contraction frequencies per hour were compared from 3 days before to 3 days after 17-OHP-C dosing. McNemar chi(2), Mann-Whitney U, and Friedman test statistics were used for analysis. Data were obtained from 388 women. Median contraction frequency was greater for women with subsequent preterm birth versus those delivering at term (1.5 [range 0, 14.5] versus 1.2 [range 0, 21.0] contractions per hour, P < 0.001). No reduction in contraction frequency was observed after 17-OHP-C administration, and in fact, the converse was observed for the average contractions 3 days prior compared with 3 days posttreatment ( P < 0.001). In the subgroup of women with a subsequent spontaneous preterm, the proportion who had an average contraction frequency of more than five per hour 1 day preinjection versus 1 day postinjection was not significantly different (2.6% versus 3.0%, P = 1.0). Administration of 17-OHP-C was not associated with a reduction in contraction frequency. To be effective, this drug likely has effects by mechanisms other than tocolysis. Although a statistically significant increase in contractions was identified posttherapy versus pretherapy, the clinical importance of this observation is unknown.
Asunto(s)
Hidroxiprogesteronas/uso terapéutico , Nacimiento Prematuro/prevención & control , Progestinas/uso terapéutico , Contracción Uterina/efectos de los fármacos , Caproato de 17 alfa-Hidroxiprogesterona , Adulto , Femenino , Humanos , Inyecciones , Embarazo , Estudios RetrospectivosRESUMEN
OBJECTIVE: To compare the incidence of spontaneous recurrent preterm delivery (SPTD) between women receiving 17 alpha-hydroxyprogesterone caproate (17P) and women receiving daily perinatal nursing surveillance (dPNS) with home uterine activity monitoring. STUDY DESIGN: Women enrolled for dPNS or weekly nursing visits with 17P injection were eligible. Included were singletons with previous SPTD, without preterm labor (PTL), cerclage or vaginal bleeding and < 27 weeks at enrollment. 17P and dPNS patients were matched 1:1 by race, marital status, tobacco use and number of SPTDs. Primary study outcome was incidence of spontaneous PTD. RESULTS: Data from 342 matched pairs were compared. Diagnosis of PTL (39.2% vs. 60.8%) and tocolytic use (12.9% vs. 49.7%) was decreased with 17P vs. dPNS (p < 0.001). The incidences of spontaneous PTD at < 32, 35 and 37 weeks were similar between the groups. CONCLUSION: There was no difference in recurrent SPTD between women treated with 17P and those receiving dPNS.
Asunto(s)
Caproato de Gestonorona/administración & dosificación , Monitoreo Ambulatorio , Trabajo de Parto Prematuro/diagnóstico , Trabajo de Parto Prematuro/prevención & control , Progestinas/administración & dosificación , Adulto , Femenino , Servicios de Atención de Salud a Domicilio , Humanos , Inyecciones Intramusculares , Trabajo de Parto Prematuro/enfermería , Embarazo , Nacimiento Prematuro/prevención & control , Estudios Retrospectivos , Adulto JovenRESUMEN
We compared neonatal outcomes from singleton pregnancies in women hospitalized with preterm labor (PTL) at 32 0/7 to 34 6/7 weeks managed with and without acute tocolysis. Women enrolled for outpatient surveillance who were hospitalized and diagnosed with PTL between 32 0/7; to 34 6/7 weeks' gestation without conditions necessitating interventional delivery during hospitalization were identified ( N = 2921). Patients with contraindications to pregnancy prolongation were excluded ( N = 168). Data were compared between patients whose clinical management included tocolysis ( N = 2342) and patients in whom tocolysis was not utilized ( N = 411). The incidence of preterm birth (77.9% versus 48.1%), low birth weight (48.9% versus 16.7%), neonatal intensive care unit admission (41.4% versus 16.2%), and nursery length of stay > 7 days (28.0% versus 9.7%) were all higher in women not receiving acute tocolysis compared with the acute tocolysis group (all P < 0.001). Using acute tocolysis to prolong pregnancy in patients hospitalized with PTL at 32 0/7 to 34 6/7 weeks' gestation is associated with improved neonatal outcomes.
Asunto(s)
Trabajo de Parto Prematuro/epidemiología , Trabajo de Parto Prematuro/prevención & control , Resultado del Embarazo , Tocólisis , Adolescente , Adulto , Femenino , Edad Gestacional , Humanos , Incidencia , Recién Nacido , EmbarazoRESUMEN
We examined outcomes of twin pregnancies complicated by recurrent preterm labor receiving nifedipine tocolysis. In a retrospective study design, twin pregnancies receiving outpatient preterm labor surveillance services and oral nifedipine tocolysis following a diagnosis of preterm labor were identified from a database ( N = 1421). Eligible for inclusion were patients subsequently rehospitalized with recurrent preterm labor symptoms ( N = 862). Included were patients at < 35 weeks' gestation, having intact membranes, and remaining undelivered for > 48 hours after recurrent preterm labor ( N = 656). Pregnancy outcomes of women resuming nifedipine tocolysis ( N = 418) following hospitalization were compared with those having an alteration in treatment ( N = 238) to continuous subcutaneous terbutaline. Alteration of tocolytic treatment versus resuming nifedipine resulted in increased pregnancy prolongation (34.7 +/- 18.8 days versus 27.5 +/- 19.9 days, P < 0.001), with delivery of fewer low birth weight (67.2% versus 78.3%, P < 0.001) and very low birth weight infants (6.5% versus 15.0%, P < 0.001) and a decreased incidence of neonatal intensive care unit admission (44.7% versus 52.9%, P = 0.005). In twin pregnancies receiving nifedipine tocolysis, alteration of tocolytic treatment to subcutaneous terbutaline following hospitalization for recurrent preterm labor symptoms had a positive impact on pregnancy prolongation and neonatal outcomes.
Asunto(s)
Nifedipino/uso terapéutico , Trabajo de Parto Prematuro/tratamiento farmacológico , Resultado del Embarazo , Embarazo Múltiple , Terbutalina/uso terapéutico , Tocolíticos/uso terapéutico , Administración Oral , Relación Dosis-Respuesta a Droga , Esquema de Medicación , Femenino , Edad Gestacional , Humanos , Inyecciones Subcutáneas , Trabajo de Parto Prematuro/prevención & control , Embarazo , Probabilidad , Sistema de Registros , Estudios Retrospectivos , Medición de Riesgo , Prevención Secundaria , Nacimiento a Término , Tocólisis/métodos , Resultado del Tratamiento , GemelosRESUMEN
OBJECTIVE: To identify characteristics indicative of subsequent requirement of insulin in patients with gestational diabetes (GDM). METHODS: Identified from a database were patients with GDM not receiving insulin or oral hypoglycemic agents at enrollment for outpatient education and surveillance. Maternal characteristics were compared between patients achieving glycemic control with diet and those requiring insulin. Cox proportional hazards regression was used to assess multiple effects of significant univariate factors. RESULTS: Data from 2365 patients were analyzed. Patients requiring insulin were more likely to be multiparous, obese, have a history of GDM, be diagnosed at <28 weeks of gestation, and have a fasting blood glucose of >95 mg/dL, a glucose tolerance test 3-hour blood glucose of >140 mg/dL, and a glycosylated hemoglobin (A1c) of >or=6% at diagnosis of GDM. CONCLUSIONS: Laboratory values at diagnosis of GDM were the strongest indicators of subsequent need for insulin treatment. Patients with fasting blood glucose of >95 mg/dL and A1c values >or=6% at diagnosis of GDM should receive close surveillance of daily blood glucose.
Asunto(s)
Glucemia/análisis , Diabetes Gestacional/dietoterapia , Diabetes Gestacional/tratamiento farmacológico , Dieta para Diabéticos , Hipoglucemiantes/uso terapéutico , Insulina/uso terapéutico , Adulto , Bases de Datos Factuales , Diabetes Gestacional/sangre , Dieta para Diabéticos/estadística & datos numéricos , Femenino , Georgia , Humanos , Obesidad , Paridad , EmbarazoRESUMEN
Our objective was to compare the incidence of recurrent spontaneous preterm delivery (SPTD) in patients with cervical cerclage treated with weekly 17 alpha-hydroxyprogesterone caproate (17P) injections versus daily outpatient nursing surveillance (ONS) without 17P. Included in this retrospective cohort study were singleton gestations with cerclage placed at the discretion of the provider due to prior SPTD, delivering between January 1, 2004 and May 1, 2006. The study group (n = 232) consisted of women receiving once-weekly nursing visit and 17P injection. The control group (n = 1650) consisted of women enrolled for ONS (twice-daily electronic uterine contraction monitoring and nursing assessment). Data were further stratified by the number of prior preterm deliveries (1, > 1). Primary study outcome was the incidence of SPTD. No difference in rates of recurrent SPTD at < 37 or < 35 weeks were observed between the study and control groups. Study patients were less likely to be diagnosed with preterm labor (PTL) than controls (45.7% versus 70.8%, respectively; P < 0.001). The incidence of preterm premature rupture of membranes was similar between the groups (8.6% versus 8.1%; P = 0.770). We concluded that the incidence of recurrent SPTD was similar in women with cerclage treated with 17P or ONS, although women receiving 17P had a lower incidence of PTL. This benefit of 17P should be considered when managing patients with prior SPTD and cerclage.
Asunto(s)
Cerclaje Cervical , Antagonistas de Estrógenos/uso terapéutico , Hidroxiprogesteronas/uso terapéutico , Trabajo de Parto Prematuro/prevención & control , Caproato de 17 alfa-Hidroxiprogesterona , Adulto , Estudios de Cohortes , Femenino , Edad Gestacional , Humanos , Atención de Enfermería , Embarazo , Resultado del Embarazo , Estudios RetrospectivosRESUMEN
OBJECTIVE: This study evaluated the association of maternal factors known to influence outcomes of triplets, different discordance levels (-25, 25.1-35, and )35%), and three types (according to the birth weight of the middle-sized triplet) of birth weight discordance in triplets. METHODS: We used data collected by the Women's Health Division of Matria Healthcare, Inc. (Marietta, GA). We analyzed a cohort of 2706 triplet sets, to calculate the frequencies of different levels and types of birth weight discordance by maternal age, parity, weight, height, body mass index and weight gain at 24 weeks of gestation. RESULTS: We found a positive association between maternal parity and birth weight discordance level but no clear association between the other maternal factors and the level of discordance as well as the type of discordance. However, a trend was seen whereby overweight women had a trend towards the low-skew (a set comprising one large and two small triplets) type of birth weight discordance and an opposite trend in underweight women. CONCLUSIONS: These results corroborate previous findings that nulliparity is associated with aberrant growth in triplet pregnancies.
Asunto(s)
Peso al Nacer , Paridad , Trillizos , Adulto , Factores de Edad , Estatura , Índice de Masa Corporal , Femenino , Edad Gestacional , Humanos , Recién Nacido , Embarazo , Resultado del EmbarazoRESUMEN
OBJECTIVE: The purpose of this study was to determine effectiveness of 17 alpha-hydroxyprogesterone caproate (17 P) prophylaxis by gestational age (GA) at 17 P initiation. STUDY DESIGN: Singleton gestations with > or = 1 preterm birth (PTB) treated with 17 P prophylaxis for recurrent preterm birth before 27 weeks were identified from a data base. Data were stratified by GA at 17 P initiation (16-20.9 [n = 599] weeks and 21-26.9 [n = 307] weeks) and number of PTB (1, 2, > 2). Outcome variables were PTB at < 37, < 35, and < 32 weeks. RESULTS: No significant differences were found in gestational age at delivery or rates of recurrent PTB < 37, < 35, and < 32 weeks between those women initiating 17 P at 16-20.9 weeks or 21-26.9 weeks, or when stratified by number of prior preterm deliveries. CONCLUSION: Initiation of 17 P prophylaxis at 21-26.9 weeks is as effective as initiation at 16-20.9 weeks of gestation.
Asunto(s)
Hidroxiprogesteronas/uso terapéutico , Trabajo de Parto Prematuro/prevención & control , Nacimiento Prematuro/prevención & control , Tocolíticos/uso terapéutico , Caproato de 17 alfa-Hidroxiprogesterona , Adolescente , Adulto , Femenino , Edad Gestacional , Humanos , Embarazo , Recurrencia , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
OBJECTIVE: Progesterone has a known diabetogenic effect. We sought to determine whether the incidence of gestational diabetes mellitus (GDM) is altered in women receiving weekly 17alpha-hydroxyprogesterone caproate (17P) prophylaxis for the prevention of recurrent preterm birth. RESEARCH DESIGN AND METHODS: Singleton gestations in women having a history of preterm delivery were identified from a database containing prospectively collected information from women receiving outpatient nursing services related to a high-risk pregnancy. Included were patients enrolled for outpatient management at <27 weeks' gestation with documented pregnancy outcome and delivery at >28 weeks. Patients with preexisting diabetes were excluded. The incidence of GDM was compared between patients who received prophylactic intramuscular 17P (250-mg weekly injection initiated between 16.0 and 20.9 weeks' gestation) and those who did not. RESULTS: Maternal BMI and age were similar. The incidence of GDM was 12.9% in the 17P group (n = 557) compared with 4.9% in control subjects (n = 1,524, P < 0.001; odds ratio 2.9 [95% CI 2.1-4.1]). CONCLUSIONS: The use of 17P for the prevention of recurrent preterm delivery is associated with an increased risk of developing GDM. Early GDM screening is appropriate for women receiving 17P prophylaxis.
Asunto(s)
17-alfa-Hidroxiprogesterona/efectos adversos , Diabetes Gestacional/inducido químicamente , Nacimiento Prematuro/prevención & control , Tocolíticos/efectos adversos , 17-alfa-Hidroxiprogesterona/administración & dosificación , 17-alfa-Hidroxiprogesterona/uso terapéutico , Adolescente , Adulto , Caproatos , Diabetes Gestacional/epidemiología , Femenino , Humanos , Incidencia , Inyecciones Intramusculares , Embarazo , Recurrencia , Tocolíticos/administración & dosificación , Tocolíticos/uso terapéuticoRESUMEN
OBJECTIVE: To evaluate whether triplet- or singleton-specific growth standards should be used to define the growth restricted triplet fetus/neonate. STUDY DESIGN: We retrospectively compared the predictive values of singleton vs. triplet-specific "growth" standards using the neonatal ponderal index as reference for growth restriction. RESULTS: A ponderal index <1 SD from the mean was found in 356 (14.4%) of 2477 triplet infants. A total of 686 (27.7%) infants were small for gestational age (SGA) by singleton standards, but only 168 (6.8%) by triplet standards. After 31 weeks' gestation, triplet standards are significantly better associated with a low ponderal index (OR 2.0, 95% CI 1.1, 3.4 at 32 weeks to OR 4.1, 95% CI 2.8, 6.3 at 36-37 weeks), resulting in better positive predictive value and higher specificity of triplet standards in predicting a low ponderal index. CONCLUSION: Triplet birth weight standards are better than singleton standards at >31 but not at < or =31 weeks' gestation in predicting a low neonatal ponderal index.