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Every pregnant woman in the United States is exposed to many and varied environmental chemicals. Rapidly accumulating scientific evidence documents that widespread exposure to environmental chemicals at levels that are encountered in daily life can impact reproductive and developmental health adversely. Preconception and prenatal exposure to environmental chemicals are of particular importance because they may have a profound and lasting impact on health across the life course. Thus, prevention of developmental exposures to environmental chemicals would benefit greatly from the active participation of reproductive health professionals in clinical and policy arenas. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this study was to determine whether rates of hypertensive disorders of pregnancy increase beyond 37 weeks of gestation and to address how best to analyze these rates.Study Design: This was a retrospective cohort study of all women delivered beyond 37 weeks' gestational age from 1995 to 1999 at all Kaiser Permanente Medical Care Program delivery hospitals in Northern California. Rates of gestational hypertension, preeclampsia, and eclampsia were calculated by use of both pregnancy delivered (PD) and ongoing pregnancy (OP) as the denominator. Bivariate and multivariate analyses were conducted with use of P<.05 to indicate statistical significance.Results: Among the 135,560 women in this cohort, the rates of gestational hypertension, preeclampsia, and eclampsia were the same or decreased from 37 to 43 weeks' gestation using PD, but all three increased when calculated according to OP (P<.01).Conclusion: We found that among complications of pregnancy that are diagnosed ante partum, use of a different denominator led to contradictory conclusions. When hypertensive disorders of pregnancy are analyzed, ongoing pregnancies should be used as the denominator. [ABSTRACT FROM AUTHOR]

OBJECTIVE: The study was undertaken to assess attitudes and behavior of newer obstetricians/gynecologists in depression care. STUDY DESIGN: One thousand randomly selected physicians in their final year of training or recent practice received a survey about depression: training; related attitudes, responsibility, confidence; and self-reported care for the last depressed patient. RESULTS: Of those eligible, 437 (64%) returned the survey. Current residents reported more didactic mental health training, but practice patterns were similar to recent graduates. Overall, 94% felt responsible for recognition, whereas about half indicated asking about substance abuse, sexual abuse, or physical abuse, 37% expressed confidence in their ability to treat with medications, and 22% felt confident in their ability to manage depression overall. CONCLUSION: Residents are receiving more didactic mental health training, yet changes in training are not yet reflected in reported practice patterns or confidence. The use of antidepressant medications and assessment of contributing conditions such as abuse deserve more emphasis in training. [ABSTRACT FROM AUTHOR]

OBJECTIVE: The purpose of this study was to compare four strategies for treating patients with a previous classic cesarean delivery by medical outcomes and quality-adjusted life years. STUDY DESIGN: A decision tree was designed that compared four strategies for a hypothetical cohort of 10,000 women with a previous classic cesarean delivery: (1) delivery at 39 weeks of gestation, (2) delivery at 36 weeks of gestation without amniocentesis, (3) amniocentesis at 36 weeks of gestation with delivery if the fetus was mature and antenatal corticosteroids if the fetus was immature, and (4) weekly amniocentesis starting at 36 weeks of gestation with delivery when mature. RESULTS: Strategy 2 provided the greatest maternal quality-adjusted life years. Comparing strategy 1 with strategy 2, it was determined that 27 cesarean deliveries must be performed at 36 weeks of gestation with one associated case of respiratory distress syndrome to prevent one case of uterine rupture. Sensitivity analysis revealed that the uterine rupture rate must be below 0.36% for any strategy to surpass strategy 2 (elective cesarean delivery at 36 weeks of gestation without amniocentesis). CONCLUSION: A 36-week delivery may be preferable because it provides a lower risk of severe adverse outcomes and higher maternal quality of life. [ABSTRACT FROM AUTHOR]

To estimate when rates of maternal pregnancy complications increase beyond 37 weeks' gestation, investigators examined rates of mode of delivery and maternal complications of labor and delivery by gestational age in a 5-year retrospective cohort study of low-risk women. [ABSTRACT FROM AUTHOR]

Mercury exposure during pregnancy can have serious health effects for a developing fetus including impacting the child's neurologic and cognitive development. Through biomonitoring in a low-income Latina population in California, we identified a patient with high levels of mercury and traced the source to face creams purchased in a pharmacy in Mexico. [Copyright &y& Elsevier]

Objective: The objective of the study was to examine the rates of gestational diabetes mellitus (GDM) associated with both maternal and paternal race/ethnicity. Study Design: This was a retrospective cohort study of all women delivered within a managed care network. Rates of GDM were calculated for maternal, paternal, and combined race/ethnicity. Results: Among the 139,848 women with identified race/ethnicity, Asians had the highest rate (P < .001) of GDM (6.8%) as compared with whites (3.4%), African Americans (3.2%), and Hispanics (4.9%). When examining race/ethnicity controlling for potential confounders, we found that the rates of GDM were higher among Asian (adjusted odds ratio [aOR], 1.5; 95% confidence interval [CI], 1.4–1.6) and Hispanic (aOR, 1.2; 95% CI, 1.1–1.4) women as well as Asian (aOR, 1.4; 95% CI, 1.3–1.5) and Hispanic (aOR, 1.3; 95% CI, 1.2–1.4) men as compared with their white counterparts. Conclusion: We found that rates of GDM are affected by both maternal and paternal race/ethnicity. In both Asians and Hispanics, maternal and paternal race are equally associated with an increase in GDM. These differences may inform further investigation of the pathophysiology of GDM. [Copyright &y& Elsevier]

Objective: The objective of the study was to examine risk factors for postterm (gestational age ≥ 42 weeks) or prolonged (gestational age ≥ 41 weeks) pregnancy. Study Design: We conducted a retrospective cohort study of all term, singleton pregnancies delivered at a mature, managed care organization. The primary outcome measures were the rates of pregnancies greater than 41 or 42 weeks'' gestation. Multivariable logistic regression models were used to control for potential confounding and interaction. Results: Specific risk factors for pregnancy beyond 41 weeks of gestation include obesity (adjusted odds ratio [aOR], 1.26; 95% confidence interval [CI], 1.16-1.37), nulliparity (aOR, 1.46; 95% CI 1.42-1.51), and maternal age 30-39 years (aOR, 1.06; 95% CI, 1.02-1.10) and 40 years or older (aOR, 1.07; 95% CI, 1.02-1.12). Additionally, African American, Latina, and Asian race/ethnicity were all associated with a lower risk of reaching 41 or 42 weeks of gestation. Conclusion: Our findings suggest that there may be biological differences that underlie the risk for women to progress to 41 or 42 weeks of gestation. In particular, obesity is a modifiable risk factor and could potentially be prevented with prepregnancy or interpregnancy interventions. [Copyright &y& Elsevier]

Objective: The purpose of this study was to examine the relationship between prepregnancy body mass index (BMI) and length of gestation at term. Study Design: This was a retrospective study of 9336 births at the University of California, San Francisco, at ≥37 weeks’ gestation. We performed univariate and multivariable analyses of the associations between prepregnancy BMI and length of gestation (≥40, ≥41, and ≥42 weeks’ gestation). Results: Overweight women were more likely to deliver at ≥40, ≥41, and ≥42 weeks’ gestation than were women who were underweight or normal weight. In multivariable analyses, higher prepregnancy BMI was associated with higher risk of progressing past 40 weeks. Obese women had 69% higher adjusted odds of reaching 42 weeks’ gestation, compared with women of normal prepregnancy BMI (adjusted odds ratio, 1.69; 95% confidence interval, 1.23-2.31). Conclusion: Higher BMI is associated with prolonged gestation at term. Achieving optimal BMI before conception may reduce the risk of postterm pregnancy and its associated complications. [Copyright &y& Elsevier]