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1. Outcomes of induction vs prelabor cesarean delivery at

Author

Bushman, Elisa T., Grobman, William A., Bailit, Jennifer L., Reddy, Uma M., Wapner, Ronald J., Varner, Michael W., Thorp, John M., Jr, Caritis, Steve N., Prasad, Mona, Saade, George R., Sorokin, Yoram, Rouse, Dwight J., Blackwell, Sean C., and Tolosa, Jorge E.

Published
2023
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2. Comparison of Cesarean Deliveries in a Multicenter U.S. Cohort Using the 10-Group Classification System.

Author

Pasko, Daniel N., McGee, Paula, Grobman, William A., Bailit, Jennifer L., Reddy, Uma M., Wapner, Ronald J., Varner, Michael W., Thorp Jr., John M., Caritis, Steve N., Prasad, Mona, Saade, George R., Sorokin, Yoram, Rouse, Dwight J., and Tolosa, Jorge E.

Subjects
CESAREAN section, SECONDARY analysis, DATA analysis, RESEARCH funding, LOGISTIC regression analysis, HOSPITALS, DESCRIPTIVE statistics, INDUCED labor (Obstetrics), STATISTICS, RESEARCH, COMPARATIVE studies, FETAL presentation
Abstract

Objective We sought to (1) use the Robson 10-Group Classification System (TGCS), which classifies deliveries into 10 mutually exclusive groups, to characterize the groups that are primary contributors to cesarean delivery frequencies, (2) describe inter-hospital variations in cesarean delivery frequencies, and (3) evaluate the contribution of patient characteristics by TGCS group to hospital variation in cesarean delivery frequencies. Study Design This was a secondary analysis of an observational cohort of 115,502 deliveries from 25 hospitals between 2008 and 2011. The TGCS was applied to the cohort and each hospital. We identified and compared the TGCS groups with the greatest relative contributions to cohort and hospital cesarean delivery frequencies. We assessed variation in hospital cesarean deliveries attributable to patient characteristics within TGCS groups using hierarchical logistic regression. Results A total of 115,211 patients were classifiable in the TGCS (99.7%). The cohort cesarean delivery frequency was 31.4% (hospital range: 19.1–39.3%). Term singletons in vertex presentation with a prior cesarean delivery (group 5) were the greatest relative contributor to cohort (34.8%) and hospital cesarean delivery frequencies (median: 33.6%; range: 23.8–45.5%). Nulliparous term singletons in vertex (NTSV) presentation (groups 1 [spontaneous labor] and 2 [induced or absent labor]: 28.9%), term singletons in vertex presentation with a prior cesarean delivery (group 5: 34.8%), and preterm singletons in vertex presentation (group 10: 9.8%) contributed to 73.2% of the relative cesarean delivery frequency for the cohort and were correlated with hospital cesarean delivery frequencies (Spearman's rho = 0.96). Differences in patient characteristics accounted for 34.1% of hospital-level cesarean delivery variation in group 2. Conclusion The TGCS highlights the contribution of NTSV presentation to cesarean delivery frequencies and the impact of patient characteristics on hospital-level variation in cesarean deliveries among nulliparous patients with induced or absent labor. Key Points We report on the cesarean delivery frequencies in a multicenter U.S. cohort. NTSV gestations (groups 1 and 2) are a primary driver of cesarean deliveries. Patient characteristics contributed most to hospital variation in cesarean deliveries in group 2. [ABSTRACT FROM AUTHOR]

Published
2024
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3. Association of Maternal Body Mass Index and Maternal Morbidity And Mortality.

Author

Dinsmoor, Mara J., Ugwu, Lynda G., Bailit, Jennifer L., Reddy, Uma M., Wapner, Ronald J., Varner, Michael W., Thorp Jr., John M., Caritis, Steve N., Prasad, Mona, Tita, Alan T.N., Saade, George R., Sorokin, Yoram, Rouse, Dwight J., Blackwell, Sean C., and Tolosa, Jorge E.

Subjects
POISSON distribution, BODY mass index, SECONDARY analysis, RESEARCH funding, HYPERTENSION, SMOKING, MATERNAL mortality, CAUSES of death, MULTIVARIATE analysis, DESCRIPTIVE statistics, DISEASES, LONGITUDINAL method, INTENSIVE care units, PARITY (Obstetrics), CONFIDENCE intervals, OBESITY, REGRESSION analysis, PREGNANCY
Abstract

Objective This study aimed to assess the association of maternal body mass index (BMI) with a composite of severe maternal outcomes. Study Design Secondary analysis of a cohort of deliveries on randomly selected days at 25 hospitals from 2008 to 2011. Data on comorbid conditions, intrapartum events, and postpartum course were collected. The reference group (REF, BMI: 18.5–29.9kg/m 2), obese (OB; BMI: 30–39.9kg/m 2), morbidly obese (MO; BMI: 40–49.9kg/m 2), and super morbidly obese (SMO; BMI ≥ 50kg/m 2) women were compared. The composite of severe maternal outcomes was defined as death, intensive care unit (ICU) admission, ventilator use, deep venous thrombosis/pulmonary embolus (DVT/PE), sepsis, hemorrhage, disseminated intravascular coagulation (DIC), unplanned operative procedure, or stroke. Patients in the REF group were matched 1:1 with those in all other obesity groups based on propensity score using the baseline characteristics of age, race/ethnicity, previous cesarean, preexisting diabetes, chronic hypertension, parity, cigarette use, and insurance status. Multivariable Poisson's regression was used to estimate adjusted relative risks (aRRs) and 95% confidence intervals (CIs) for the association between BMI and the composite outcome. Because cesarean delivery may be in the causal pathway between obesity and adverse maternal outcomes, models were then adjusted for mode of delivery to evaluate potential mediation. Results A total of 52,162 pregnant patients are included in the analysis. Risk of composite maternal outcomes was increased for SMO compared with REF but not for OB and MO [OB: aRR=1.06, 95% CI: 0.99–1.14; MO: aRR=1.10, 95% CI: 0.97–1.25; SMO: aRR=1.32, 95% CI: 1.02–1.70]. However, in the mediation analysis, cesarean appears to mediate 46% (95% CI: 31–50%) of the risk of severe morbidity for SMO compared with REF. Conclusion Super morbid obesity is significantly associated with increased serious maternal morbidity and mortality; however, cesarean appears to mediate this association. Obesity and morbid obesity are not associated with maternal morbidity and mortality. Key Points Super morbid obesity is associated with increased morbidity. Cesarean appears to mediate the association between super morbid obesity and morbidity. Obesity and morbid maternal obesity are not associated with morbidity. [ABSTRACT FROM AUTHOR]

Published
2024
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4. Prediction of Cerebral Palsy or Death among Preterm Infants Who Survive the Neonatal Period.

Author

Peaceman, Alan M., Mele, Lisa, Rouse, Dwight J., Leveno, Kenneth J., Mercer, Brian M., Varner, Michael W., Reddy, Uma M., Wapner, Ronald J., Sorokin, Yoram, Thorp, John M., Ramin, Susan M., Malone, Fergal D., O'Sullivan, Mary J., Dudley, Donald J., and Caritis, Steve N.

Subjects
CEREBRAL palsy prevention, RISK assessment, DEATH, SECONDARY analysis, MAGNESIUM sulfate, PREDICTION models, DELIVERY (Obstetrics), RECEIVER operating characteristic curves, RESEARCH funding, SEX distribution, QUESTIONNAIRES, CEREBRAL palsy, PREGNANCY outcomes, DISCHARGE planning, BRAIN diseases, DISEASES, ODDS ratio, GESTATIONAL age, APGAR score, CONFIDENCE intervals, PREGNANCY complications, CEREBRAL hemorrhage, DISEASE risk factors, DISEASE complications, CHILDREN
Abstract

Objective To assess whether neonatal morbidities evident by the time of hospital discharge are associated with subsequent cerebral palsy (CP) or death. Study Design This is a secondary analysis of data from a multicenter placebo-controlled trial of magnesium sulfate for the prevention of CP. The association between prespecified intermediate neonatal outcomes (n = 11) and demographic and clinical factors (n = 10) evident by the time of discharge among surviving infants (n = 1889) and the primary outcome of death or moderate/severe CP at age 2 (n = 73) was estimated, and a prediction model was created. Results Gestational age in weeks at delivery (odds ratio [OR]: 0.74, 95% confidence interval [CI]: 0.67–0.83), grade III or IV intraventricular hemorrhage (IVH) (OR: 5.3, CI: 2.1–13.1), periventricular leukomalacia (PVL) (OR: 46.4, CI: 20.6–104.6), and male gender (OR: 2.5, CI: 1.4–4.5) were associated with death or moderate/severe CP by age 2. Outcomes not significantly associated with the primary outcome included respiratory distress syndrome, bronchopulmonary dysplasia, seizure, necrotizing enterocolitis, neonatal hypotension, 5-minute Apgar score, sepsis, and retinopathy of prematurity. Using all patients, the receiver operating characteristic curve for the final prediction model had an area under the curve of 0.84 (CI: 0.78–0.89). Using these data, the risk of death or developing CP by age 2 can be calculated for individual surviving infants. Conclusion IVH and PVL were the only neonatal complications evident at discharge that contributed to an individual infant's risk of the long-term outcomes of death or CP by age 2. A model that includes these morbidities, gestational age at delivery, and gender is predictive of subsequent neurologic sequelae. Key Points Factors known at hospital discharge are identified which are independently associated with death or CP by age 2. A model was created and validated using these findings to counsel parents. The risk of death or CP can be calculated at the time of hospital discharge. [ABSTRACT FROM AUTHOR]

Published
2024
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5. Cord Blood Haptoglobin, Cerebral Palsy and Death in Infants of Women at Risk for Preterm Birth: A Secondary Analysis of a Randomised Controlled Trial

Author

Buhimschi, Catalin S., Jablonski, Kathleen A., Rouse, Dwight J., Varner, Michael W., Reddy, Uma M., Mercer, Brian M., Leveno, Kenneth J., Wapner, Ronald J., Sorokin, Yoram, Thorp, John M., Jr, Ramin, Susan M., Malone, Fergal D., Carpenter, Marshall W., O'Sullivan, Mary J., Peaceman, Alan M., Saade, George R., Dudley, Donald, Caritis, Steve N., and Buhimschi, Irina A.

Published
2019
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6. Fetal Tachycardia in the Setting of Maternal Intrapartum Fever and Perinatal Morbidity.

Author

Tita, Alan T. N., McGee, Paula L., Reddy, Uma M., Bloom, Steven L., Varner, Michael W., Ramin, Susan M., Caritis, Steve N., Peaceman, Alan M., Sorokin, Yoram, Sciscione, Anthony, Carpenter, Marshall W., Mercer, Brian M., Thorp, John M., Malone, Fergal D., and Buhimschi, Catalin

Subjects
RESEARCH, FETAL heart rate, FEVER, CARDIOVASCULAR diseases in pregnancy, DISEASES, PREGNANT women, FETAL diseases, RISK assessment, COMPARATIVE studies, TACHYCARDIA, DESCRIPTIVE statistics, RESEARCH funding, APGAR score, ODDS ratio, PERINATAL period, INTRAPARTUM care, SECONDARY analysis, TRACHEA intubation, DISEASE risk factors
Abstract

Objective The fetal consequences of intrapartum fetal tachycardia with maternal fever or clinical chorioamnionitis are not well studied. We evaluated the association between perinatal morbidity and fetal tachycardia in the setting of intrapartum fever. Study Design Secondary analysis of a multicenter randomized control trial that enrolled 5,341 healthy laboring nulliparous women ≥36 weeks' gestation. Women with intrapartum fever ≥ 38.0°C (including those meeting criteria for clinical chorioamnionitis) after randomization were included in this analysis. Isolated fetal tachycardia was defined as fetal heart rate (FHR) ≥160 beats per minute for at least 10 minutes in the absence of other FHR abnormalities. FHR abnormalities other than tachycardia were excluded from the analysis. The primary outcome was a perinatal composite (5-minute Apgar's score ≤3, intubation, chest compressions, or mortality). Secondary outcomes included low arterial cord pH (pH < 7.20), base deficit ≥12, and cesarean delivery. Results A total of 986 (18.5%) of women in the trial developed intrapartum fever, and 728 (13.7%) met criteria to be analyzed; of these, 728 women 336 (46.2%) had maternal-fetal medicine (MFM) reviewer-defined fetal tachycardia, and 349 of the 550 (63.5%) women during the final hour of labor had validated software (PeriCALM) defined fetal tachycardia. After adjusting for confounders, isolated fetal tachycardia was not associated with a significant difference in the composite perinatal outcome (adjusted odds ratio [aOR] = 3.15 [0.82–12.03]) compared with absence of tachycardia. Fetal tachycardia was associated with higher odds of arterial cord pH <7.2, aOR = 1.48 (1.01–2.17) and of infants with a base deficit ≥ 12, aOR = 2.42 (1.02–5.77), but no significant difference in the odds of cesarean delivery, aOR = 1.33 (0.97–1.82). Conclusion Fetal tachycardia in the setting of intrapartum fever or chorioamnionitis is associated with significantly increased fetal acidemia defined as a pH <7.2 and base excess ≥12 but not with a composite perinatal morbidity. Key Points The perinatal outcomes associated with fetal tachycardia in the setting of maternal fever are undefined. Fetal tachycardia was not significantly associated with perinatal morbidity although the sample size was limited. Fetal tachycardia was associated with an arterial cord pH <7.2 and base deficit of 12 or greater. [ABSTRACT FROM AUTHOR]

Published
2024
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10. Risk-adjusted models for adverse obstetric outcomes and variation in risk-adjusted outcomes across hospitals

Author

Bailit, Jennifer L, Grobman, William A, Rice, Madeline Murguia, Spong, Catherine Y, Wapner, Ronald J, Varner, Michael W, Thorp, John M, Leveno, Kenneth J, Caritis, Steve N, Shubert, Phillip J, Tita, Alan T, Saade, George, Sorokin, Yoram, Rouse, Dwight J, Blackwell, Sean C, Tolosa, Jorge E, Van Dorsten, J Peter, and Network, Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal–Fetal Medicine Units

Subjects
Reproductive Medicine, Biomedical and Clinical Sciences, Good Health and Well Being, Adult, Cohort Studies, Delivery, Obstetric, Female, Hospitals, Humans, Infant, Newborn, Lacerations, Models, Statistical, Multivariate Analysis, Obstetric Labor Complications, Outcome Assessment, Health Care, Perineum, Peripartum Period, Postpartum Hemorrhage, Pregnancy, Pregnancy Complications, Cardiovascular, Pregnancy Complications, Infectious, Puerperal Infection, Quality Improvement, Risk Adjustment, United States, Venous Thromboembolism, Young Adult, obstetrics, performance improvement, quality, risk adjustment, Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal–Fetal Medicine Units Network, Paediatrics and Reproductive Medicine, Obstetrics & Reproductive Medicine, Reproductive medicine
Abstract

ObjectiveRegulatory bodies and insurers evaluate hospital quality using obstetrical outcomes, however meaningful comparisons should take preexisting patient characteristics into account. Furthermore, if risk-adjusted outcomes are consistent within a hospital, fewer measures and resources would be needed to assess obstetrical quality. Our objective was to establish risk-adjusted models for 5 obstetric outcomes and assess hospital performance across these outcomes.Study designWe studied a cohort of 115,502 women and their neonates born in 25 hospitals in the United States from March 2008 through February 2011. Hospitals were ranked according to their unadjusted and risk-adjusted frequency of venous thromboembolism, postpartum hemorrhage, peripartum infection, severe perineal laceration, and a composite neonatal adverse outcome. Correlations between hospital risk-adjusted outcome frequencies were assessed.ResultsVenous thromboembolism occurred too infrequently (0.03%; 95% confidence interval [CI], 0.02-0.04%) for meaningful assessment. Other outcomes occurred frequently enough for assessment (postpartum hemorrhage, 2.29%; 95% CI, 2.20-2.38, peripartum infection, 5.06%; 95% CI, 4.93-5.19, severe perineal laceration at spontaneous vaginal delivery, 2.16%; 95% CI, 2.06-2.27, neonatal composite, 2.73%; 95% CI, 2.63-2.84). Although there was high concordance between unadjusted and adjusted hospital rankings, several individual hospitals had an adjusted rank that was substantially different (as much as 12 rank tiers) than their unadjusted rank. None of the correlations between hospital-adjusted outcome frequencies was significant. For example, the hospital with the lowest adjusted frequency of peripartum infection had the highest adjusted frequency of severe perineal laceration.ConclusionEvaluations based on a single risk-adjusted outcome cannot be generalized to overall hospital obstetric performance.

Published
2013

12. Thyroid function in neonates of women with subclinical hypothyroidism or hypothyroxinemia

Author

Varner, Michael W., Mele, Lisa, Casey, Brian M., Peaceman, Alan M., Sorokin, Yoram, Reddy, Uma M., Wapner, Ronald J., Thorp, John M., Saade, George R., Tita, Alan T. N., Rouse, Dwight J., Sibai, Baha, Iams, Jay D., Mercer, Brian M., Tolosa, Jorge, Caritis, Steve N., and for the Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network

Published
2018
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15. Short term neonatal outcomes of pregnancies complicated by maternal obesity

Author

DINSMOOR, Mara J., primary, UGWU, Lynda G., additional, BAILIT, Jennifer L., additional, REDDY, Uma M., additional, WAPNER, Ronald J., additional, VARNER, Michael W., additional, THORP, John M., additional, CARITIS, Steve N., additional, PRASAD, Mona, additional, TITA, Alan T.N., additional, SAADE, George R., additional, SOROKIN, Yoram, additional, ROUSE, Dwight J., additional, BLACKWELL, Sean C., additional, and TOLOSA, Jorge E., additional

Published
2023
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16. Antenatal Magnesium and Cerebral Palsy in Preterm Infants

Author

Hauth, John C., Todd, Allison, Hill, Tawanda, Harris, Stacy, Nelson, Kathleen G., Biasini, Fred J., Anderson, Kristine, Jensen, Marla K., Williams, Lori A., Fullmer, Lisa H., Guzman, Anna M., Collin, Marc, VanBuren, George, Milluzzi, Cynthia, Fundzak, Monica, Santori, Cathy, Johnson, Francee, Landon, Mark B., Latimer, Cheryl, Curry, Valerie, Meadows, Sandra, Sciscione, Anthony, DiVito, Michelle, Talucci, Mary, Desai, Shobhana A., Paul, David A., Sibai, Baha M., Ramsey, Risa D., Mabie, William C., Kao, Lu, Cassie, Melanie, Norman, Gwendolyn S., Driscoll, Debra, Steffy, Barbara, Dombrowski, Mitchell P., Meis, Paul J., Swain, Melissa, Klinepeter, Kurt, O'Shea, T. Michael, Steele, Linda, Moise, Kenneth J., Jr., Brody, Seth, Bernhardt, Janice, Dorman, Karen, Gilstrap, Larry C., III, Day, Mary-Clare, Flinn-Gildersleeve, Erin, Ortiz, Felecia, Kerr, Marcia, Pemberton, Victoria, Paley, Lisa, Paley, Charles, Bousleiman, Sabine, Carmona, Vilmarie, Tillinghast, JoAnn, Allard, Donna, Vohr, Betty, Noel, Lucy, McCarten, Kathleen, Miodovnik, Menachem, Elder, Nancy, Girdler, Wendy, Gratton, Teresa L., Moawad, Atef, Lindheimer, Marshall, Jones, Phyllis L., Doyle, Faith, Alfonso, Carmen, Scott, May, Washington, Ramona, Mallett, Gail, Ramos-Brinson, Mercedes, Simon, Paula, Wen, Tony, Goodrum, Linda A., Saade, George R., Olson, Gayle L., Harirah, Hassan M., Martin, Elizabeth, Xenakis, Elly M.-J., Conway, Deborah L., Berkus, Michael, Kamon, Theresa M., Cotroneo, Margaret, Milford, Cheryl A., Sherman, M. Lynne, Dax, Jody S., Fay-Randall, Lisa, Melton, Carla F., Flores, Ester, Thom, Elizabeth, Jones-Binns, Barbara, Cooney, Maureen, Fischer, Molly L., McLaughlin, Sarah, Brunette, Kimberly, Fricks, Elizabeth, Spong, Catherine Y., Tolivaisa, Susan, McNellis, Donald, Catz, Charlotte, Howell, Kimberly, Nelson, Karin B., Roberts, James M., Hirtz, Deborah G., Weiner, Steven J., Bulas, Dorothy, DiPietro, Michael, Seibert, Joanna, Rouse, Dwight J., Mercer, Brian M., Varner, Michael W., Reddy, Uma M., Iams, Jay D., Wapner, Ronald J., Sorokin, Yoram, Thorp, John M., Jr., Ramin, Susan M., Malone, Fergal D., Carpenter, Marshall W., O'Sullivan, Mary J., Peaceman, Alan M., Hankins, Gary D.V., Dudley, Donald, and Caritis, Steve N.

Published
2015
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17. Defining failed induction of labor

Author

Grobman, William A., Bailit, Jennifer, Lai, Yinglei, Reddy, Uma M., Wapner, Ronald J., Varner, Michael W., Thorp, John M., Jr., Leveno, Kenneth J., Caritis, Steve N., Prasad, Mona, Tita, Alan T.N., Saade, George, Sorokin, Yoram, Rouse, Dwight J., Blackwell, Sean C., and Tolosa, Jorge E.

Published
2018
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19. Association of Gestational Diabetes Mellitus With Neonatal Respiratory Morbidity

Author

Werner, Erika F., Romano, Megan E., Rouse, Dwight J., Sandoval, Grecio, Gyamfi-Bannerman, Cynthia, Blackwell, Sean C., Tita, Alan T.N., Reddy, Uma M., Jain, Lucky, Saade, George R., Iams, Jay D., Clark, Erin A.S., Thorp, John M., Jr, Chien, Edward K., Peaceman, Alan M., Swamy, Geeta K., Norton, Mary E., Casey, Brian M., Caritis, Steve N., Tolosa, Jorge E., and Sorokin, Yoram

Published
2019
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25. The association among cytochrome P450 3A, progesterone receptor polymorphisms, plasma 17-alpha hydroxyprogesterone caproate concentrations, and spontaneous preterm birth

Author

Bustos, Martha L., Caritis, Steve N., Jablonski, Kathleen A., Reddy, Uma M., Sorokin, Yoram, Manuck, Tracy, Varner, Michael W., Wapner, Ronald J., Iams, Jay D., Carpenter, Marshall W., Peaceman, Alan M., Mercer, Brian M., Sciscione, Anthony, Rouse, Dwight J., and Ramin, Susan M.

Published
2017
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30. Racial and Ethnic Disparities in Adverse Perinatal Outcomes at Term.

Author

Parchem, Jacqueline G., Rice, Madeline Murguia, Grobman, William A., Bailit, Jennifer L., Wapner, Ronald J., Debbink, Michelle P., Thorp Jr, John M., Caritis, Steve N., Prasad, Mona, Tita, Alan T.N., Saade, George R., Sorokin, Yoram, Rouse, Dwight J., and Tolosa, Jorge E.

Subjects
PERINATAL death, RESEARCH, SCIENTIFIC observation, CONFIDENCE intervals, RACE, PREGNANT women, ACQUISITION of data, PREGNANCY complications, MEDICAL records, DESCRIPTIVE statistics, SECONDARY analysis, DISEASE risk factors
Abstract

Objective This study aimed to evaluate whether racial and ethnic disparities in adverse perinatal outcomes exist at term. Study Design We performed a secondary analysis of a multicenter observational study of 115,502 pregnant patients and their neonates (2008–2011). Singleton, nonanomalous pregnancies delivered from 37 to 41 weeks were included. Race and ethnicity were abstracted from the medical record and categorized as non-Hispanic White (White; referent), non-Hispanic Black (Black), non-Hispanic Asian (Asian), or Hispanic. The primary outcome was an adverse perinatal composite defined as perinatal death, Apgar score < 4 at 5 minutes, ventilator support, hypoxic–ischemic encephalopathy, subgaleal hemorrhage, skeletal fracture, infant stay greater than maternal stay (by ≥ 3 days), brachial plexus palsy, or facial nerve palsy. Results Of the 72,117 patients included, 48% were White, 20% Black, 5% Asian, and 26% Hispanic. The unadjusted risk of the primary outcome was highest for neonates of Black patients (3.1%, unadjusted relative risk [uRR] = 1.16, 95% confidence interval [CI]: 1.04–1.30), lowest for neonates of Hispanic patients (2.1%, uRR = 0.80, 95% CI: 0.71–0.89), and no different for neonates of Asian (2.6%), compared with those of White patients (2.7%). In the adjusted model including age, body mass index (BMI), smoking, obstetric history, and high-risk pregnancy, differences in risk for the primary outcome were no longer observed for neonates of Black (adjusted relative risk [aRR] = 1.06, 95% CI: 0.94–1.19) and Hispanic (aRR = 0.92, 95% CI: 0.81–1.04) patients. Adding insurance to the model lowered the risk for both groups (aRR = 0.85, 95% CI: 0.75–0.96 for Black; aRR = 0.68, 95% CI: 0.59–0.78 for Hispanic). Conclusion Although neonates of Black patients have the highest frequency of adverse perinatal outcomes at term, after adjustment for sociodemographic factors, this higher risk is no longer observed, suggesting the importance of developing strategies that address social determinants of health to lessen extant health disparities. Key Points Term neonates of Black patients have the highest crude frequency of adverse perinatal outcomes. After adjustment for confounders, higher risk for neonates of Black patients is no longer observed. Disparities in outcomes are strongly related to insurance status. [ABSTRACT FROM AUTHOR]

Published
2023
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31. Evaluation of Hypoglycemia in Neonates of Women at Risk for Late Preterm Delivery: An Antenatal Late Preterm Steroids Trial Cohort Study.

Author

Gyamfi-Bannerman, Cynthia, Jablonski, Kathleen A., Blackwell, Sean C., Tita, Alan T. N., Reddy, Uma M., Jain, Lucky, Saade, George R., Rouse, Dwight J., Clark, Erin A. S., Thorp Jr., John M., Chien, Edward K., Peaceman, Alan M., Gibbs, Ronald S., Swamy, Geeta K., Norton, Mary E., Casey, Brian M., Caritis, Steve N., Tolosa, Jorge E., Sorokin, Yoram, and VanDorsten, J. Peter

Subjects
HYPOGLYCEMIA treatment, RELATIVE medical risk, PREMATURE infants, CONFIDENCE intervals, BETAMETHASONE, COMPARATIVE studies, HYPOGLYCEMIA, PREGNANCY complications, DESCRIPTIVE statistics, RESEARCH funding, RESPIRATORY distress syndrome, SECONDARY analysis, LONGITUDINAL method, CHILDREN
Abstract

Objective In the antenatal late preterm steroids (ALPS) trial betamethasone significantly decreased short-term neonatal respiratory morbidity but increased the risk of neonatal hypoglycemia, diagnosed only categorically (<40 mg/dL). We sought to better characterize the nature, duration, and treatment for hypoglycemia. Study Design Secondary analysis of infants from ALPS, a multicenter trial randomizing women at risk for late preterm delivery to betamethasone or placebo. This study was a reabstraction of all available charts from the parent trial, all of which were requested. Unreviewed charts included those lost to follow-up or from sites not participating in the reabstraction. Duration of hypoglycemia (<40 mg/dL), lowest value and treatment, if any, were assessed by group. Measures of association and regression models were used where appropriate. Results Of 2,831 randomized, 2,609 (92.2%) were included. There were 387 (29.3%) and 223 (17.3%) with hypoglycemia in the betamethasone and placebo groups, respectively (relative risk [RR]: 1.69, 95% confidence interval [CI]: 1.46–1.96). Hypoglycemia generally occurred in the first 24 hours in both groups: 374/385 (97.1%) in the betamethasone group and 214/222 (96.4%) in the placebo group (p = 0.63). Of 387 neonates with hypoglycemia in the betamethasone group, 132 (34.1%) received treatment, while 73/223 (32.7%) received treatment in placebo group (p = 0.73). The lowest recorded blood sugar was similar between groups. Most hypoglycemia resolved by 24 hours in both (93.0 vs. 89.3% in the betamethasone and placebo groups, respectively, p = 0.18). Among infants with hypoglycemia in the first 24 hours, the time to resolution was shorter in the betamethasone group (2.80 [interquartile range: 2.03–7.03) vs. 3.74 (interquartile range: 2.15–15.08) hours; p = 0.002]. Persistence for >72 hours was rare and similar in both groups, nine (2.4%, betamethasone) and four (1.9%, placebo, p = 0.18). Conclusion In this cohort, hypoglycemia was transient and most received no treatment, with a quicker resolution in the betamethasone group. Prolonged hypoglycemia was uncommon irrespective of steroid exposure. Key Points Hypoglycemia was transient and approximately two-thirds received no treatment. Neonates in the ALPS trial who received betamethasone had a shorter time to resolution than those with hypoglycemia in the placebo group. Prolonged hypoglycemia occurred in approximately 2 out of 100 late preterm newborns, irrespective of antenatal steroid exposure. [ABSTRACT FROM AUTHOR]

Published
2023
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33. Timing of treatment initiation for mild gestational diabetes mellitus and perinatal outcomes

Author

Palatnik, Anna, Mele, Lisa, Landon, Mark B., Reddy, Uma M., Ramin, Susan M., Carpenter, Marshall W., Wapner, Ronald J., Varner, Michael W., Rouse, Dwight J., Thorp, John M., Jr., Sciscione, Anthony, Catalano, Patrick, Saade, George R., Caritis, Steve N., Sorokin, Yoram, Peaceman, A., Simon, P., Mallett, G., Casey, B., Leveno, K., Moseley, L., Gold, J., Bradford, D., Fay, L., Garcia, M., Capellan, F., Miodovnik, M., Malone, F., Bousleiman, S., Husami, H., Carmona, V., Fredericks, N., Gantioqui, E., Greenspan, B., Williams, M., Anderson, K., Ashby, P., McAllister, S., Quinn, S., Castinella, F., Guzman, A., Steiner, J., Parker, J., Sheppard, J., Tisdale, J., Northen, A., Andrews, W., Catlow, D., Allard, D., Seebeck, M., Tillinghast, J., Iams, J., Johnson, F., Latimer, C., Weinandy, E., Maselli, B., Dorman, K., Brody, S., Timlin, S., Bernhardt, J., Hoffman, M., Guzman, E., Talucci, M., Grossman, T., Perez, C., Zeghibe, L., Tabangin, P., Mercer, B., Stetzer, B., Milluzzi, C., Dalton, W., Pichette, S., Harper, M., Swain, M., Meis, P., White, J., Gilstrap, L., Cannon, K., Martinez, J., Dusek, D., Moss, J., Brandon, J., Jackson, A., Hankins, G., Sharp, D., Bickus, M., Birkland, H., Cotroneo, M., Cuddy, N., Norman, G., Lockhart, P., Blackwell, S., Quast, L., Tolosa, J., Davis, L., Lairson, E., Cromett, C., Naze, C., Blaser, M., Thom, E., Zachary, J., Getachew, B., Cobb, C., Leuchtenburg, L., Gilbert, S., Spangler, T., Spong, C., Tolivaisa, S., Howell, K., and Anderson, G. D.

Published
2015
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34. Serious maternal complications after early preterm delivery (24-33 weeks’ gestation)

Author

Reddy, Uma M., Rice, Madeline Murguia, Grobman, William A., Bailit, Jennifer L., Wapner, Ronald J., Varner, Michael W., Thorp, John M., Jr., Leveno, Kenneth J., Caritis, Steve N., Prasad, Mona, Tita, Alan T.N., Saade, George R., Sorokin, Yoram, Rouse, Dwight J., Blackwell, Sean C., Tolosa, Jorge E., Spong, C., Tolivaisa, S., Talucci, M., Zylfijaj, M., Reid, Z., Leed, R., Benson, J., Forester, S., Kitto, C., Davis, S., Falk, M., Perez, C., Hill, K., Sowles, A., Postma, J., Alexander, S., Andersen, G., Scott, V., Morby, V., Jolley, K., Miller, J., Berg, B., Dorman, K., Mitchell, J., Kaluta, E., Clark, K., Spicer, K., Timlin, S., Wilson, K., Moseley, L., Santillan, M., Price, J., Buentipo, K., Bludau, V., Thomas, T., Fay, L., Melton, C., Kingsbery, J., Benezue, R., Simhan, H., Bickus, M., Fischer, D., Kamon, T., DeAngelis, D., Mercer, B., Milluzzi, C., Dalton, W., Dotson, T., McDonald, P., Brezine, C., McGrail, A., Latimer, C., Guzzo, L., Johnson, F., Gerwig, L., Fyffe, S., Loux, D., Frantz, S., Cline, D., Wylie, S., Iams, J., Wallace, M., Northen, A., Grant, J., Colquitt, C., Rouse, D., Andrews, W., Mallett, G., Ramos-Brinson, M., Roy, A., Stein, L., Campbell, P., Collins, C., Jackson, N., Dinsmoor, M., Senka, J., Paychek, K., Peaceman, A., Moss, J., Salazar, A., Acosta, A., Hankins, G., Hauff, N., Palmer, L., Lockhart, P., Driscoll, D., Wynn, L., Sudz, C., Dengate, D., Girard, C., Field, S., Breault, P., Smith, F., Annunziata, N., Allard, D., Silva, J., Gamage, M., Hunt, J., Tillinghast, J., Corcoran, N., Jimenez, M., Ortiz, F., Givens, P., Rech, B., Moran, C., Hutchinson, M., Spears, Z., Carreno, C., Heaps, B., Zamora, G., Seguin, J., Rincon, M., Snyder, J., Farrar, C., Lairson, E., Bonino, C., Smith, W., Beach, K., Van Dyke, S., Butcher, S., Thom, E., Zhao, Y., McGee, P., Momirova, V., Palugod, R., Reamer, B., Larsen, M., Spangler, T., Bhandaru, V., and VanDorsten, J. P.

Published
2015
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36. Treatment of Subclinical Hypothyroidism or Hypothyroxinemia in Pregnancy

Author

Casey, Brian M., Thom, Elizabeth A., Peaceman, Alan M., Varner, Michael W., Sorokin, Yoram, Hirtz, Deborah G., Reddy, Uma M., Wapner, Ronald J., Thorp, John M., Jr., Saade, George, Tita, Alan T.N., Rouse, Dwight J., Sibai, Baha, Iams, Jay D., Mercer, Brian M., Tolosa, Jorge, Caritis, Steve N., and VanDorsten, Peter J.

Published
2017
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39. Association between hypertensive disorders of pregnancy and long-term neurodevelopmental outcomes in the offspring

Author

Palatnik, Anna, Mele, Lisa, Casey, Brian M, Varner, Michael W, Sorokin, Yoram, Reddy, Uma M, Wapner, Ronald J, Thorp, John M, Saade, George R, Tita, Alan TN, Rouse, Dwight J, Sibai, Baha, Costantine, Maged M, Mercer, Brian M, Tolosa, Jorge E., and Caritis, Steve N

Subjects
Gestational hypertension, Pediatrics, medicine.medical_specialty, Offspring, Article, Pre-Eclampsia, Pregnancy, Medicine, Humans, Language Development Disorders, Child Behavior Checklist, Subclinical infection, Intelligence quotient, business.industry, Infant, Newborn, Obstetrics and Gynecology, Odds ratio, Hypertension, Pregnancy-Induced, medicine.disease, Thyroxine, Pediatrics, Perinatology and Child Health, Cohort, Premature Birth, Female, business
Abstract

Objective The long-term impact of hypertensive disorders of pregnancy (HDP) exposure on offspring health is an emerging research area. The objective of this study was to evaluate the association between a maternal diagnosis of HDP (gestational hypertension and preeclampsia) and adverse neurodevelopmental outcomes in the offspring. Study Design This was a secondary analysis of two parallel multicenter clinical trials of thyroxine therapy for subclinical hypothyroid disorders in pregnancy. Women with singleton nonanomalous gestations diagnosed with subclinical hypothyroidism or hypothyroxinemia were randomized to thyroxine therapy or placebo. The primary outcome was child intelligence quotient (IQ) at 5 years of age. Secondary outcomes included several neurodevelopmental measures, including the Bayley-III cognitive, motor, and language scores at 12 and 24 months, Differential Ability Scales-II (DAS-II) scores at 36 months, the Conners' rating scales-revised at 48 months, and scores from the Child Behavior Checklist at 36 and 60 months. Thyroxine therapy did not influence neurodevelopment in either of the primary studies. Associations between neurodevelopment outcomes and maternal HDP were examined using univariable and multivariable analyses. Results A total of 112 woman–child dyads with HDP were compared with 1,067 woman–child dyads without HDP. In univariable analysis, mean maternal age (26.7 ± 5.9 vs. 27.8 ± 5.7 years, p = 0.032) and the frequency of nulliparity (45.5 vs. 31.0%, p = 0.002) differed significantly between the two groups. Maternal socioeconomic characteristics did not differ between the groups. After adjusting for potential confounders, there were no significant differences in any primary or secondary neurodevelopment outcome between offspring exposed to HDP and those unexposed. However, when dichotomized as low or high scores, we found higher rates of language delay (language scores Conclusion In this cohort of pregnant women, HDP diagnosis was associated with language delay at 2 years of age. However, other long-term neurodevelopmental outcomes in offspring were not associated with HDP. Key Points

Published
2021

40. Does the presence of a condition-specific obstetric protocol lead to detectable improvements in pregnancy outcomes?

Author

Bailit, Jennifer L., Grobman, William A., McGee, Paula, Reddy, Uma M., Wapner, Ronald J., Varner, Michael W., Thorp, John M., Leveno, Kenneth J., Iams, Jay D., Tita, Alan T.N., Saade, George, Sorokin, Yoram, Rouse, Dwight J., Blackwell, Sean C., Mercer, B., Milluzzi, C., Dalton, W., Dotson, T., McDonald, P., Brezine, C., McGrail, A., Mallett, G., Ramos-Brinson, M., Roy, A., Stein, L., Campbell, P., Collins, C., Jackson, N., Dinsmoor, M., Senka, J., Paychek, K., Peaceman, A., Talucci, M., Zylfijaj, M., Reid, Z., Leed, R., Benson, J., Forester, S., Kitto, C., Davis, S., Falk, M., Perez, C., Hill, K., Sowles, A., Postma, J., Alexander, S., Andersen, G., Scott, V., Morby, V., Jolley, K., Miller, J., Berg, B., Dorman, K., Mitchell, J., Kaluta, E., Clark, K., Spicer, K., Timlin, S., Wilson, K., Moseley, L., Santillan, M., Price, J., Buentipo, K., Bludau, V., Thomas, T., Fay, L., Melton, C., Kingsbery, J., Benezue, R., Caritis, S., Simhan, H., Bickus, M., Fischer, D., Kamon, T., DeAngelis, D., Shubert, P., Latimer, C., Guzzo, L., Johnson, F., Gerwig, L., Fyffe, S., Loux, D., Frantz, S., Cline, D., Wylie, S., Iams, J., Wallace, M., Northen, A., Grant, J., Colquitt, C., Moss, J., Salazar, A., Acosta, A., Hankins, G., Hauff, N., Palmer, L., Lockhart, P., Driscoll, D., Wynn, L., Sudz, C., Dengate, D., Girard, C., Field, S., Breault, P., Smith, F., Annunziata, N., Allard, D., Silva, J., Gamage, M., Hunt, J., Tillinghast, J., Corcoran, N., Jimenez, M., Ortiz, F., Givens, P., Rech, B., Moran, C., Hutchinson, M., Spears, Z., Carreno, C., Heaps, B., Zamora, G., Tolosa, J., Seguin, J., Rincon, M., Snyder, J., Farrar, C., Lairson, E., Bonino, C., Smith, W., Beach, K., Van Dyke, S., Butcher, S., Thom, E., Rice, M., Zhao, Y., McGee, P., Momirova, V., Palugod, R., Reamer, B., Larsen, M., Williams, T., Spong, C., Tolivaisa, S., and Van Dorsten, J. P.

Published
2015
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43. The association among cytochrome P450 3A, progesterone receptor polymorphisms, plasma 17-alpha hydroxyprogesterone caproate concentrations, and spontaneous preterm birth

Author

Luce, M., Cotroneo, M., Venkataramanan, R., Zhao, W., Harper, M., Meis, P., Swain, M., Scott, B., Leftwich, C., Norman, G., Driscoll, D., Sudz, C., Wynn, L., Blackwell, S., Thorp, J., Dorman, K., Prata, E., Hamden, K., Anderson, K., Bonnemort, S., Lund, D., Russell, J., Parsons, J., Bousleiman, S., South, S., Carmona, V., Husami, H., Lankford, C., Perez, C., Johnson, F., Landon, M., Cline, D., Walker, H., Allard, D., Tillinghast, J., Dinsmoor, M., Simon, P.J., Huntley, M., Whitaker-Carr, C., Ramos-Brinson, M., Mallett, G., Milluzzi, C., Hunter, J., Dalton, W., Ehrenberg, H., Stetzer, B., Hoffman, M., Talucci, M., Tocci, C., Wilson, S., Lake, M., Andrews, W.W., Northen, A., Parks, M., Files, P. Blake, Gilstrap, L.C., Glenn-Cole, B., Cannon, K., Thom, E., Zachary, J., Palugod, R., Leuchtenburg, L., Spong, C., Klebanoff, M., Tolivaisa, S., Anderson, G., Bustos, Martha L., Caritis, Steve N., Jablonski, Kathleen A., Reddy, Uma M., Sorokin, Yoram, Manuck, Tracy, Varner, Michael W., Wapner, Ronald J., Iams, Jay D., Carpenter, Marshall W., Peaceman, Alan M., Mercer, Brian M., Sciscione, Anthony, Rouse, Dwight J., and Ramin, Susan M.

Published
2017
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44. Differences in obstetrical care and outcomes associated with the proportion of the obstetrician’s shift completed

Author

Yee, Lynn M., primary, McGee, Paula, additional, Bailit, Jennifer L., additional, Wapner, Ronald J., additional, Varner, Michael W., additional, Thorp, John M., additional, Caritis, Steve N., additional, Prasad, Mona, additional, Tita, Alan T.N., additional, Saade, George R., additional, Sorokin, Yoram, additional, Rouse, Dwight J., additional, Blackwell, Sean C., additional, Tolosa, Jorge E., additional, Mallett, G., additional, Grobman, W., additional, Ramos-Brinson, M., additional, Roy, A., additional, Stein, L., additional, Campbell, P., additional, Collins, C., additional, Jackson, N., additional, Dinsmoor, M., additional, Senka, J., additional, Paychek, K., additional, Peaceman, A., additional, Talucci, M., additional, Zylfijaj, M., additional, Reid, Z., additional, Leed, R., additional, Benson, J., additional, Forester, S., additional, Kitto, C., additional, Davis, S., additional, Falk, M., additional, Perez, C., additional, Hill, K., additional, Sowles, A., additional, Postma, J., additional, Alexander, S., additional, Andersen, G., additional, Scott, V., additional, Morby, V., additional, Jolley, K., additional, Miller, J., additional, Berg, B., additional, Dorman, K., additional, Mitchell, J., additional, Kaluta, E., additional, Clark, K., additional, Spicer, K., additional, Timlin, S., additional, Wilson, K., additional, Moseley, L., additional, Leveno, K., additional, Santillan, M., additional, Price, J., additional, Buentipo, K., additional, Bludau, V., additional, Thomas, T., additional, Fay, L., additional, Melton, C., additional, Kingsbery, J., additional, Benezue, R., additional, Simhan, H., additional, Bickus, M., additional, Fischer, D., additional, Kamon, T., additional, DeAngelis, D., additional, Mercer, B., additional, Milluzzi, C., additional, Dalton, W., additional, Dotson, T., additional, McDonald, P., additional, Brezine, C., additional, McGrail, A., additional, Latimer, C., additional, Guzzo, L., additional, Johnson, F., additional, Gerwig, L., additional, Fyffe, S., additional, Loux, D., additional, Frantz, S., additional, Cline, D., additional, Wylie, S., additional, Iams, J., additional, Wallace, M., additional, Northen, A., additional, Grant, J., additional, Colquitt, C., additional, Rouse, D., additional, Andrews, W., additional, Moss, J., additional, Salazar, A., additional, Acosta, A., additional, Hankins, G., additional, Hauff, N., additional, Palmer, L., additional, Lockhart, P., additional, Driscoll, D., additional, Wynn, L., additional, Sudz, C., additional, Dengate, D., additional, Girard, C., additional, Field, S., additional, Breault, P., additional, Smith, F., additional, Annunziata, N., additional, Allard, D., additional, Silva, J., additional, Gamage, M., additional, Hunt, J., additional, Tillinghast, J., additional, Corcoran, N., additional, Jimenez, M., additional, Ortiz, F., additional, Givens, P., additional, Rech, B., additional, Moran, C., additional, Hutchinson, M., additional, Spears, Z., additional, Carreno, C., additional, Heaps, B., additional, Zamora, G., additional, Seguin, J., additional, Rincon, M., additional, Snyder, J., additional, Farrar, C., additional, Lairson, E., additional, Bonino, C., additional, Smith, W., additional, Beach, K., additional, Van Dyke, S., additional, Butcher, S., additional, Thom, E., additional, Rice, M., additional, Zhao, Y., additional, Momirova, V., additional, Palugod, R., additional, Reamer, B., additional, Larsen, M., additional, Spong, C., additional, Tolivaisa, S., additional, and VanDorsten, J.P., additional

Published
2021
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47. Antenatal Betamethasone for Women at Risk for Late Preterm Delivery

Author

Gyamfi-Bannerman, Cynthia, Thom, Elizabeth A., Blackwell, Sean C., Tita, Alan T.N., Reddy, Uma M., Saade, George R., Rouse, Dwight J., McKenna, David S., Clark, Erin A.S., Thorp, John M., Jr., Chien, Edward K., Peaceman, Alan M., Gibbs, Ronald S., Swamy, Geeta K., Norton, Mary E., Casey, Brian M., Caritis, Steve N., Tolosa, Jorge E., Sorokin, Yoram, VanDorsten, Peter J., and Jain, Lucky

Published
2016
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