Elizabeth Ramsey Unal

Maternal inflammation in spontaneous term labor

OBJECTIVE The purpose of this study was to examine the association between peripheral markers of maternal inflammation and the onset of term labor. STUDY DESIGN A nested case-control study was performed with serum that had been collected at routine visits from a cohort of 607 term nulliparous women. Cases (n = 20) labored spontaneously within 48 hours of enrollment, and control subjects (n = 80) labored spontaneously ≥14 days after enrollment. Maternal serum cytokines were determined with the use of standard multiplex protocols. Median levels of interleukin-1, -4, -6, -8, and -10, interferon-γ, and tumor necrosis factor-α were compared with the use of the Mann-Whitney U test. Correlations between cytokine levels and maternal factors were performed (Spearmans rho). RESULTS Median interleukin-1 and -6 and tumor necrosis factor-α levels were significantly higher in cases vs control subjects (0.76 vs 0.31 pg/mL [P < .01]; 2.05 vs 0.95 pg/mL [P = .03]; 0.81 vs 0.51 pg/mL [P = .02], respectively). Latency until delivery was inversely correlated with interleukin-1 and tumor necrosis factor-α (-0.28 [P < .01]; -0.246 [P = .01]), but not with interleukin-6. CONCLUSION Maternal proinflammatory markers increase before spontaneous term labor.

Racial disparity in maternal and fetal-cord bisphenol A concentrations.

Objective:To determine if racial disparities exist in maternal and fetal cord serum concentrations of bisphenol A (BPA).Study Design:A nested cross-sectional study was performed from a cohort of 600 term nulliparas. In 27 patients (8 Caucasian, 8 African-American and 11 Hispanic), term pre-labor maternal serum and corresponding fetal-cord serum were analyzed for BPA.Result:African-Americans had the highest maternal serum concentrations, 10-fold higher than Caucasians (30.13 vs 3.14 ng ml−1; P=0.038). Hispanics had intermediate concentrations with a trend towards higher concentrations compared with Caucasians (24.46 vs 3.14 ng ml−1; P=0.051). Overall concentrations were 10-fold higher in maternal samples than fetal samples (14.1 vs 1.3 ng ml−1; P=0.001). Hispanics had higher fetal concentrations than non-Hispanics (2.05 vs 0.35 ng ml−1; P=0.025).Conclusion:We found significant racial/ethnic differences in maternal/fetal BPA concentrations. Further study is needed to determine if these differences reflect disparities in exposure, metabolism or placental transfer.

A cost-effectiveness analysis of anal cancer screening in HIV-positive women.

Objective Anal cancer rates have increased in HIV+ patients. The prevalence of anal intraepithelial neoplasias (AINs) and progression to anal cancer in HIV+ men who have sex with men has been well described, and screening is cost-effective. Our objective was to determine whether anal cancer screening in HIV+ women is cost-effective. Materials and Methods A Markov model analysis of 100 HIV+ women was constructed. All women had a CD4 count less than 200 and were assumed to be on antiretrovirals. Rates of AIN were based on previous studies. Progression rates were extrapolated from previous data on HIV+ men who have sex with men. The 5-year model included 3 screening approaches: none, annual, and biennial. Anoscopy and biopsy were performed after an abnormal cytologic result. Low-grade AIN was followed with repeat cytology, and high-grade AIN was treated surgically. Anal cancer was treated surgically followed by chemotherapy and radiation. Sensitivity analyses (SAs) were performed to account for variable rates of AIN progression, anal cancer mortality, and anal cancer and HIV quality-adjusted life years. Results The incremental cost-effectiveness ratio of biennial anal cancer screening compared to no screening was

Cost-effectiveness of maternal treatment to prevent perinatal hepatitis B virus transmission.

34,763. Cost-effectiveness was maintained across all assumptions in SA except for decreased progression rate of high-grade AIN to anal cancer. Conclusions Biennial anal cancer screening in HIV+ women with CD4 counts less than 200 is cost-effective. Annual screening was not cost-effective, likely because of the slow progression of AIN to anal cancer. Further data on rates of AIN progression in HIV+ women based on CD4 count are needed to determine whether screening is cost-effective in women with higher CD4 counts.

Cost-effectiveness analysis of annual Trichomonas vaginalis screening and treatment in HIV-positive women to prevent HIV transmission.

OBJECTIVE: To estimate the cost-effectiveness of maternal lamivudine or hepatitis B immune globulin (HBIG) treatment, in addition to standard neonatal immunoprophylaxis, for the prevention of perinatal hepatitis B virus transmission. METHODS: A decision-tree model was created to estimate the cost-effectiveness of maternal administration of either lamivudine or HBIG in the third trimester to prevent perinatal hepatitis B transmission compared with no maternal treatment. The model was first estimated for each treatment using overall transmission rates, and then stratified by maternal hepatitis B virus DNA viral load. RESULTS: The model estimated that for each 100 hepatitis B surface antigen positive pregnant women treated with lamivudine, 9.7 cases of chronic hepatitis B virus infections are prevented, with a cost-savings of

The cost of Medicaid savings: the potential detrimental public health impact of neonatal circumcision defunding.

5,184 and 1.3 life-years gained per patient treated. For HBIG, 9.5 cases of chronic hepatitis B virus infections are prevented for each 100 pregnant women treated, with a cost-savings of

Influence of race on prenatal phthalate exposure and anogenital measurements among boys and girls

5,887 and 1.2 life-years gained per patient treated. Under baseline assumptions, lamivudine remains cost-saving unless the reduction in perinatal transmission is less than 18.5%, and HBIG remains cost-saving unless the reduction in perinatal transmission is less than 9.6%. CONCLUSION: In this decision analysis, administration of lamivudine or HBIG to hepatitis B surface antigen positive pregnant women for the prevention of perinatal transmission of hepatitis B is cost-savings across a wide range of assumptions. LEVEL OF EVIDENCE: III

Multiple Gestations: Timing of Indicated Late Preterm and Early-Term Births in Uncomplicated Dichorionic, Monochorionic, and Monoamniotic Twins

Background Because of a high incidence of Trichomonas infection among HIV-positive women, annual screening and treatment are recommended. Trichomonas infection is associated with a 2-fold risk of HIV transmission. The objective of this study was to determine if annual screening is cost-effective for the prevention of new HIV cases in susceptible male partners secondary to Trichomonas infection in HIV-positive women. Methods A decision tree analysis was constructed to model the costs of Trichomonas screening, treatment, and follow-up. 200 women cycled through the model for a period of 12 months. One hundred women were unscreened and 100 were screened and treated per recommendations. Results Annual Trichomonas screening and treatment saves US

Risk of late-preterm stillbirth and neonatal morbidity for monochorionic and dichorionic twins

553 (US

Prevalence and predictors of phthalate exposure in pregnant women in Charleston, SC

475– US