The utility of an obesity-specific small for gestational age standard for pregnancies complicated by maternal obesity.

INTRODUCTION: An obesity-specific standard for small for gestational age (SGA) pregnancies may help identify additional at risk pregnancies. METHODS: This was a retrospective cohort study of all non-anomalous singleton neonates born in Texas from 2006-2011. Analysis was limited to births between 34 and 42 weeks gestation. Two SGA birth weight standards (birth weight ≤10th centile) were generated, one using the entire population (SGApop) and another using obese pregnancies (SGAcust). The outcomes of interest included: risks of stillbirth, neonatal death, 5-minute Apgar score below 7, NICU admission, and assisted ventilation >6 h. RESULTS: Using the population standard, the prevalence of SGA complicated by obesity was 8.1%, compared with 10.3% using the obesity-specific standard. 10,457 additional pregnancies were identified as SGA. Compared to obese AGA pregnancies, the aHR for stillbirth was 5.45 [4.28, 6.94] for SGApop, and 1.21 [0.54, 2.74] for SGAcust-pop. The risks for the following neonatal complications were slightly higher for SGAcust-pop group compared to AGA group: neonatal death aOR 1.40 [1.05, 1.87], low 5-minute Apgar 1.31 [1.09, 1.57], and NICU admission 1.13 [1.03, 1.25]. These risks were lower than SGApop. CONCLUSIONS: Using an obesity-specific SGA standard, a subgroup of pregnancies with marginally increased risk for neonatal complications was identified.

The association between gestational weight gain and risk of stillbirth: a population-based cohort study.

PURPOSE: To estimate the risk of stillbirth associated with excessive and inadequate weight gain during pregnancy. METHODS: Retrospective cohort study using the Texas vital records database between 2006 and 2011, with 2,230,310 births (5502 stillbirths) was included for analysis. Pregnancies were categorized as adequate weight gain, excessive weight gain, inadequate weight gain, or weight loss based on the Institute of Medicine 2009 recommendations. Hazard ratios (HRs) for stillbirth were estimated for each gestational weight-gain stratum using adequate weight gain as the comparison group. The analysis was performed separately for each body mass index (BMI) class. RESULTS: Both inadequate weight gain and weight loss were associated with an increased risk of stillbirth for all BMI classes except the morbidly obese group. Highest risk was seen in weight-loss groups after 36 completed weeks (normal weight: HR = 18.85 [8.25-43.09]; overweight: HR = 5.87 [2.99-11.55]; obese: HR = 3.44 [2.34-5.05]). Weight loss was associated with reduced stillbirth risk in morbidly obese women between 24 and 28 weeks (HR = 0.56 [0.34-0.95]). Excess weight gain was associated with an increased risk of stillbirth among obese and morbidly obese women, with highest risk after 36 completed weeks (obese: HR = 2.00 [1.55-2.58]; morbidly obese: HR = 3.16 [2.17-4.62]). In contrast, excess weight gain was associated with reduced risk of stillbirth in normal-weight women between 24 and 28 weeks (HR = 0.57 [0.44-0.70]) and in overweight women between 29 and 33 weeks (HR = 0.62 [0.45-0.85]). Analysis for the underweight group was limited by sample size. Both excessive weight gain and inadequate weight gain were not associated with stillbirth in this group. CONCLUSIONS: Stillbirth risk increased with inadequate weight gain and weight loss in all BMI classes except the morbidly obese group, where weight demonstrated a protective effect. Conversely, excessive weight gain was associated with higher risk of stillbirth among obese and morbidly obese women but was protective against stillbirth in lower weight women.

Acute hemorrhage related to a residual cervical pregnancy: management with curettage, tamponade, and cerclage.

Cervical ectopic pregnancy is uncommon, with no universally accepted protocol for conservative management of acute hemorrhage due to residual cervical ectopic pregnancy. Herein is presented the case of a 33-year-old woman with profuse vaginal bleeding 3 months after receiving treatment including intraamniotic potassium chloride injection, systemic methotrexate, and uterine artery embolization because of a cervical ectopic pregnancy. A residual cervical pregnancy was suspected. Hemorrhage was controlled using curettage, tamponade with a Bakri balloon, and cerclage. The balloon and cerclage were removed on postoperative day 2, with no recurrence of symptoms. Our experience suggests that a combination of curettage, balloon tamponade, and cerclage may be considered in the management of cervical ectopic pregnancies with acute hemorrhage, in particular in patients desiring future childbearing.

Longitudinal retention of families in the assessment of a prevention program targeting adolescent alcohol and tobacco use: the utility of an ecological systems framework.

This study examined the association between ecological context (extrafamilial, familial, child factors) at baseline and longitudinal retention of families in the 36-month assessment of an adolescent alcohol and tobacco use prevention program that was conducted within a pediatric primary care setting. A total of 1,780 families were enrolled at baseline when the youth were in the fifth and sixth grades, and 1,220 of these families participated in the 36-month assessment. Findings indicated that familial and child, but not extrafamilial, factors were associated with the participation of families in the 36-month assessment. Clinical implications and future research directions are discussed.

Family socialization of adolescent's self-reported cigarette use: the role of parents' history of regular smoking and parenting style.

OBJECTIVE: To examine the main and interactive effects of parental history of regular cigarette smoking and parenting style on adolescent self-reported cigarette use. METHODS: Predictors of adolescent self-reported cigarette use, including parents' history of regular cigarette smoking and two dimensions of parenting behavior, were analyzed in a sample of 934 predominately Caucasian (96.3%) parent-adolescent dyads. Families were drawn from the control group of a randomized control trial aimed at preventing adolescent substance use. RESULTS: In addition to the main effects of parents' history of regular smoking and parental warmth, logistic regression analysis revealed that the interaction of these two variables was associated with adolescent self-reported cigarette use. Parental warmth was associated with a decreased likelihood of the adolescent ever having smoked a cigarette; however, this was true only if neither parent had a history of regular cigarette smoking. CONCLUSIONS: Findings suggest that adolescent smoking prevention programs may be more efficacious if they address both parental history of regular smoking and parenting behavior.

Knowledge of maternal HIV/AIDS and child adjustment: the moderating role of children's relationships with their mothers.

The current study examined whether child-reported maternal warmth and support moderated the association between knowledge of maternal illness and child psychosocial adjustment among 86 low-income, African American mothers with HIV/AIDS and their non-infected children. Mother-child relationship quality moderated the association between children's knowledge of maternal HIV/AIDS and children's externalizing, but not internalizing, difficulties. Consistent with the stress-buffering hypothesis, a warm and supportive mother-child relationship afforded a more robust buffer against externalizing difficulties for children who knew of their mother's illness than for children who did not. Clinical implications and future directions are discussed.

Self-reported health in HIV-positive African American women: the role of family stress and depressive symptoms.

This prospective study examined the association between stressful life events and self-reported health in 72 inner-city, low-income African American women with HIV. Depressive symptoms were examined as a potential mediator of this association. Findings indicated that family stressors predicted deterioration in self-reported health status over the 15-month assessment period. Additionally, the association between family stress and self-reported physical health was mediated by depressive symptoms such that the strength of the association between family stress and self-reported health was no longer statistically significant after depressive symptoms were entered in the model. This study suggests a potentially important target for prevention and intervention efforts aimed at enhancing the quality of life of women with HIV.