Social Contributors to Glycemic Control in Gestational Diabetes Mellitus.

OBJECTIVE: To evaluate the association of social factors with glycemic control in women with gestational diabetes mellitus (GDM). METHODS: A survey instrument assessing social support, access to healthy food, cooking and meal preparation, chaotic lifestyle, employer support, and physical and emotional responses to food was developed and administered to women with GDM at maternal-fetal medicine office visits. Validated scales were used to measure social support and life chaos (defined as organization, instability, and the ability to plan and prepare for the future). Glycemic control and pregnancy outcome were ascertained by chart review. Multivariable logistic regression was used to quantify the association of these factors with the primary outcome of satisfactory glycemic control, defined as greater than 70% of blood sugars within goal. RESULTS: We approached 145 women, of whom 111 agreed to participate (76.5%). Seventy-seven percent of patients (86/111) achieved satisfactory glycemic control. Chaotic lifestyle (Confusion, Hubbub and Order Scale score 12.5±2.9 for those with good control, 16.3±3.9 for poor control; odds ratio [OR] 0.71, 95% confidence interval [CI] 0.59-0.85) and receipt of food stamps (11/86 [12.9%] for good control and 10/25 [40%] for poor control; OR 0.22, 95% CI 0.08-0.62) were associated with decreased likelihood of achieving glycemic control. Being married (67/86 [77.9%] for good control and 12/25 [48.0%] for poor control; OR 3.82, 95% CI 1.49-9.74) and regular exercise (49/86 [57.0%] for good control and 5/25 [20.0%] for poor control; OR 5.03, 95% CI 1.72-14.72) increased the likelihood of achieving glycemic control. Transportation time to food stores, home cooking, and social support were not associated with glycemic control or pregnancy outcomes. CONCLUSION: Social factors are associated with glycemic control in GDM and may be modifiable to improve glucose control.

Patient-Health Care Provider Conversations About Prenatal Genetic Screening: Recommendation or Personal Choice.

OBJECTIVE: To assess how obstetric health care providers counsel patients regarding prenatal genetic screening and how these conversations influence patients' screening decisions. METHODS: This cohort study analyzed transcripts and audio recordings of 210 first prenatal visits collected as part of a larger study on patient-provider communication. Conversations were coded in an iterative process to determine compliance with American College of Obstetricians and Gynecologists (College) prenatal genetic screening recommendations and to identify recurrent themes. χ, nonparametric tests, and logistic regression were used to determine the effects of discussion elements on screening decisions. Qualitative analysis was performed for genetic screening content. RESULTS: The study included 210 patients and 45 health care providers. Health care providers offered genetic screening at 90% of visits; 78% of women chose genetic screening. Few conversations (1.5%) included all College-recommended topics. Inclusion of College-recommended topics did not affect women's screening choices. Conversations about screening for fetal aneuploidy lasted 1.5 minutes on average (range 0.12-7.05 minutes). Recurrent themes identified included clarifying that screening results are not diagnostic (51% of conversations), emphasizing that screening is a personal choice (45% of conversations), and discussing how a woman might use genetic screening results to guide decisions about diagnostic testing or termination (37% of conversations). Health care providers described screening results as "high or low risk" in 67% of conversations discussing risk and quantitatively (ie, 1 in 100 [1%]) in 33%. CONCLUSION: Although the majority of patients were offered and underwent screening, most health care providers' counseling did not adhere to College recommendations.

Optimizing Subsequent Pregnancy Outcomes for Women with a Prior Preterm Birth.

Women with a prior preterm birth are at increased risk of recurrent preterm delivery in a subsequent pregnancy. Interventions during the preconception and prenatal periods can decrease this risk. Review of the circumstances of the prior delivery can elucidate whether delivery was spontaneous or indicated, anticipate recurrence risk, and guide management in a subsequent pregnancy. Preconception interventions for women with prior preterm birth should include cessation of tobacco and substance abuse, control of underlying maternal comorbidities, and encouraging a healthy body mass index. Effective contraception, including use of long-acting reversible methods, should be encouraged to facilitate planned pregnancies with optimal interpregnancy intervals. Interventions during prenatal care include screening and treatment of infections, nutritional supplementation, and enhanced prenatal care. Women with prior spontaneous preterm birth may benefit from progesterone supplementation and serial cervical length screening, while women with prior indicated preterm birth may benefit from daily aspirin.

Efficiency of Screening for the Recurrence of Antenatal Group B Streptococcus Colonization in a Subsequent Pregnancy: A Systematic Review and Meta-analysis with Independent Patient Data.

OBJECTIVE: The objective of this study was to evaluate the risk of recurrent group B streptococcus (GBS) colonization in a subsequent pregnancy and to assess clinical characteristics that influence this risk. STUDY DESIGN: A systematic review and meta-analysis was performed. Databases were searched from inception through June 2015 using PubMed, Embase, Scopus, Central, and ClinicalTrials.gov. Studies were eligible if they assessed antenatal GBS colonization in two successive pregnancies. The quality of included studies was evaluated. Independent patient data was requested from the authors of the included trials. Unadjusted odds ratios (OR) were pooled using the Mantel-Haenszel fixed effect model. RESULTS: In the five studies identified, two studies lacked a nonexposed cohort. GBS colonization in the index pregnancy was associated with a higher risk of recurrence of GBS colonization in a subsequent pregnancy (three studies: 50.2 compared with 14.1%; pooled fixed effects OR, 6.05; 95% confidence interval [CI], 4.84-7.55). When heavy colonization with GBS was compared with colonization by vaginal culture only, an increased risk of recurrence was shown (four studies: 52.0 compared with 45.1%, pooled fixed effects OR, 1.54; 95% CI, 1.02-2.31). CONCLUSION: Women colonized with GBS are at significantly higher odds for recurrent colonization in a subsequent pregnancy when compared with women who were not colonized in an index pregnancy. If the individual is considered heavily colonized with GBS, there appears to be an association with an increased risk compared with conventional culture. Subgroup analysis of the variables time interval ≤ 12 months between subsequent pregnancies, body mass index ≥ 30 kg/m(2), race, ethnicity, and primiparous in the subsequent pregnancy showed no effect.