Donna Halloran

Maternal superobesity and perinatal outcomes

OBJECTIVE The purpose of this study was to determine the effect of maternal superobesity (body mass index [BMI], ≥ 50 kg/m(2)) compared with morbid obesity (BMI, 40-49.9 kg/m(2)) or obesity (BMI, 30-39.9 kg/m(2)) on perinatal outcomes. STUDY DESIGN We conducted a retrospective cohort study of birth records that were linked to hospital discharge data for all liveborn singleton term infants who were born to obese Missouri residents from 2000-2006. We excluded major congenital anomalies and women with diabetes mellitus or chronic hypertension. RESULTS There were 64,272 births that met the study criteria, which included 1185 superobese mothers (1.8%). Superobese women were significantly more likely than obese women to have preeclampsia (adjusted relative risk [aRR], 1.7; 95% confidence interval [CI], 1.4-2.1), macrosomia (aRR, 1.8; 95% CI, 1.3-2.5), and cesarean delivery (aRR, 1.8; 95% CI, 1.5-2.1). Almost one-half of all superobese women (49.1%) delivered by cesarean section, and 33.8% of superobese nulliparous women underwent scheduled primary cesarean delivery. CONCLUSION Women with a BMI of ≥ 50 kg/m(2) are at significantly increased risk for perinatal complications compared with obese women with a lower BMI.

Effect of maternal weight on postterm delivery.

Objective:Examine the effect of prepregnancy weight and maternal gestational weight gain on postterm delivery rates.Study Design:This was a retrospective cohort study of term, singleton births (N=375 003). We performed multivariable analyses of the association between postterm pregnancy and both prepregnancy body mass index (BMI) and maternal weight gain.Result:Prolonged or postterm delivery (41 or 42 weeks) was increasingly common with increasing prepregnancy weight (P<0.001) and increasing maternal weight gain (P<0.001). Underweight women were 10% less likely to deliver postterm than normal weight women who gain within the recommendations (adjusted odds ratio 0.90 (95% confidence interval 0.83, 0.97)). Overweight women who gain within or above recommendations were also at increased risk of a 41-week delivery. Finally, obese women were at increased risk of a 41-week delivery with increasing risk with increasing weight (below, within and above recommendations adjusted odds ratios 1.19, 1.21, and 1.27, respectively).Conclusion:Elevated prepregnancy weight and maternal weight gain both increase the risk of a postterm delivery. Although most women do not receive preconceptional care, restricting weight gain to the within the recommended range can reduce the risk of postterm pregnancy in normal, overweight and obese women.

Racial disparities in pregnancy outcomes in obese women.

Abstract Objective: To estimate the effect of race on perinatal outcomes in obese women. Methods: Retrospective cohort study of birth records linked to hospital discharge data for all live born singleton infants ≥37 weeks gestation born to African-American or Caucasian Missouri residents from 2000 to 2006. We excluded major congenital anomalies and women with diabetes or chronic hypertension. Obesity was defined as pre-pregnancy body mass index ≥30 kg/m2. Results: There were 312 412 births meeting study criteria. 27.1% (11 776) of African-American mothers and 19.1% (49 415) of Caucasian mothers were obese. There were no differences in cesarean delivery or preeclampsia between obese African-American and obese Caucasian women. Infants of obese African-American women were significantly less likely to be macrosomic (0.9% vs. 2.2%, adjusted odds ratio [aOR] 0.5, 95% confidence interval [CI] 0.4 0.6) and more likely to be low birth weight (3.4% vs. 1.8%, aOR 1.9, 95% CI 1.7, 2.2) compared to infants of obese Caucasian women. Compared to their normal weight peers, obese Caucasian women had a greater relative risk of developing preeclampsia (aOR 3.1, 95% CI 2.9, 3.2) than obese African-American women (aOR 2.1, 95% CI 1.9, 2.4). Conclusion: Racial disparities impact obesity-related maternal and neonatal complications of pregnancy.

Validity of pure-tone hearing screening at well-child visits.

OBJECTIVE To estimate the sensitivity and specificity of pure-tone audiometry hearing screening in the primary care setting. DESIGN Prospective cohort study. SETTING Eight academic and private pediatric practices. PARTICIPANTS A subset of children from a convenience sample of 1061 children between 3 and 19 years of age were screened for hearing loss using pure-tone audiometry. Intervention Formal audiologic evaluations (gold standard) for those children referred by their primary care physician (28 children) and for a random sample of children not referred (102 children). Main Exposure Pure-tone audiometry screening. MAIN OUTCOME MEASURES Audiologic evaluations. RESULTS A total of 28 children were referred to an audiologist for formal hearing testing after pure-tone audiometry screening during a well-child visit, at which 25 children did not pass the initial screening and 3 could not complete the screening. Of the 25 children, only 7 were evaluated by an audiologist, for a follow-up rate of 25%. One child was diagnosed as having hearing loss. Formal audiologic assessment was also performed on a random sample of 102 children who were not referred to the audiologist. For the random sample, hearing loss was identified in 2 of 76 (3%) children who passed and 1 of 16 (6%) children who did not pass pure tone audiometry screening. The sensitivity and specificity of pure-tone audiometry were 50% and 78%, respectively. CONCLUSION In light of the increasing burden on physicians to provide preventive care, this study calls into question the value of hearing screening using pure-tone audiometry during well-child visits given the lack of follow-up after referral and the poor sensitivity.

Prevalence of atopic disorders and immunodeficiency in patients with ectodermal dysplasia syndromes

BACKGROUND Ectodermal dysplasia (ED) syndromes are a diverse group of disorders that affect multiple ectodermally derived tissues. Small studies and case reports suggest an increase in atopy and primary immunodeficiencies (PIDs) among patients with ED syndromes. OBJECTIVE To determine the prevalence of clinical symptoms suggestive of atopy or immunodeficiency among a large cohort of children with ED syndromes. METHODS A 9-page questionnaire was mailed to families who were members of the National Foundation for Ectodermal Dysplasias. The surveys were completed by parents of children younger than 18 years with a diagnosis of an ED syndrome or carrier state. Portions of the questionnaire were adapted from previously validated questionnaires developed by the International Study of Asthma and Allergies in Childhood (ISAAC). RESULTS We received 347 completed questionnaires (41%). When compared with the 13- to 14-year-old children surveyed by ISAAC, we found both all-aged and age-matched children with ED syndromes, respectively, had significantly higher rates of asthma (32.2% and 37.2% vs 16.4%), rhinitis symptoms (76.1% and 78.3% vs 38.9%), and eczema (58.9% and 48.9% vs 8.2%). The prevalence of physician-diagnosed food allergies (20.7%) and PIDs (6.1%) in these ED patients also exceeded known rates in the general pediatric population. CONCLUSION This large-scale, retrospective study demonstrates a greater reported prevalence of symptoms suggestive of atopic disorders and PIDs among children with ED syndromes than the general pediatric population. A combination of genetic and environmental factors in ED syndromes may contribute to breaches of skin and mucosal barriers, permitting enhanced transmission and sensitization to irritants, allergens, and pathogens.

Obesity trends and perinatal outcomes in black and white teenagers.

OBJECTIVE Our objective was to explore the trends in prepregnancy body mass index (BMI) for black and white teenagers over time and the association between elevated BMI and outcomes based on race. STUDY DESIGN This was a retrospective cohort study of singleton infants (n = 38,158) born to black (34%) and white (66%) teenagers (<18 years of age). We determined the prevalence of elevated prepregnancy BMI between 1993 and 2006 and the association between elevated prepregnancy BMI (primary exposure) and maternal and perinatal outcomes based on race (2000-2006). RESULTS The percentage of white teenagers with elevated prepregnancy BMI increased significantly from 17-26%. White and black overweight and obese teenagers were more likely to have pregnancy-related hypertension than normal-weight teenagers; postpartum hemorrhage was increased only in obese black teenagers, and infant complications were increased only in overweight and obese white teenagers. CONCLUSION Because the percentage of elevated prepregnancy BMI has increased in white teenagers, specific risks for poor maternal and perinatal outcomes in the overweight and obese teenagers varies by race.

Effect of revised IOM weight gain guidelines on perinatal outcomes

Objective. We sought to examine perinatal outcomes in women with a body mass index (BMI) of 25 kg/m2 comparing those whose weight gain met 2009 IOM guidelines to women meeting 1990 IOM guidelines. Methods. This is a retrospective cohort study utilizing birth records linked to hospital discharge data for all term, singleton infants born to overweight, Missouri residents (2000–2006) with a BMI of 25 kg/m2. We excluded congenital anomalies, mothers with diabetes, hypertension, or previous cesarean delivery. Results. Fourteen thousand nine hundred fifty-five women gained 25–35 lbs (1990 guidelines); 1.6% delivered low birth weight (LBW) infants and 1.1% delivered macrosomic infants. Eight thousand three hundred fifty women gained 15–25 lbs (2009 guidelines); 3.4% delivered LBW infants and 0.6% delivered macrosomic infants. Women who gained 15–25 lbs were 1.99 (95% CI 1.67, 2.38) times more likely to have a LBW infant and 0.59 (95% CI 0.40, 0.76) times less likely to deliver a macrosomic infant. Conclusion. Limiting weight gain in women with a BMI of 25 kg/m2, per the 2009 guidelines, increases the risk of LBW deliveries and decreases the risk of macrosomia but does not reduce associated adverse perinatal outcomes. Further studies should explore the optimal weight gain to reduce these outcomes.

Multiple Psychiatric Diagnoses Common in Privately Insured Children on Atypical Antipsychotics

Objective. To evaluate the prevalence of atypical antipsychotic use in privately insured children and the diagnoses associated with treatment. Study design. Claims were used to conduct a retrospective cohort study of children aged 2 through 18 years in the Midwest, covered by private insurance between 2002 and 2005 (n = 172 766). The 1-year prevalence of children receiving atypical antipsychotics was determined along with associated diagnoses. Results. The 1-year prevalence of atypical antipsychotics ranged from 7.9 per 1000 in 2002 to 9.0 in 2005. The leading diagnoses were disruptive behavior disorders (67%), mood disorders (65%), and anxiety disorders (43%).The authors found that 75% of children on atypical antipsychotics had more than one psychiatric diagnosis. Conclusions. Atypical antipsychotic use is primarily seen in children who have multiple psychiatric diagnoses. Studies are needed to assess the long-term safety and effectiveness in such patients with multiple diagnoses.