Kelly S. Gibson

Maternal Weight Gain in Women Who Develop Gestational Diabetes Mellitus

OBJECTIVE: To assess maternal weight gain before 24 weeks in women developing gestational diabetes mellitus (GDM) compared with controls with normal glucose tolerance. METHODS: This was a retrospective cohort study of maternal weight gain. Women developing GDM were matched to three controls by self-reported prepregnancy body mass index (BMI), maternal age, race, and parity. Women without documented pregravid or 22- to 24-week weights and multiple gestations were excluded. The primary outcome was weight gain through 24 weeks of gestation. RESULTS: Six hundred fifty-two women (163 in the GDM group and 489 controls) underwent chart review. There were no significant differences in race (36% compared with 36% African American, P=.99), age (28.7±6.3 years compared with 29.4±6.9 years, P=.26) or prepregnancy BMI (31.7±8.2 compared with 31.8±8.6, P=.88). Maternal weight gain was higher in the GDM group than in the control group (14.8 compared with 11.2 lb, P<.001). When controlling for prepregnancy BMI, overweight (18.6 compared with 12.9 lb, P<.004), and obese (12.6 compared with 8.8 lb, P<.008), GDM participants gained significantly more weight by 24 weeks. Both diet-controlled (A1) and insulin-requiring (A2) GDM had higher weight gain compared with controls (control compared with A1: 11.2 compared with 15.3 lb, P=.029; control compared with A2: 11.2 compared with 14.6 lb, P=.018. No difference was found between A1 and A2 patients (P=.942). CONCLUSION: Women who develop GDM have higher gestational weight gain through 24 weeks. Gestational weight gain is a significant risk factor for GDM in the overweight or obese patient but not in patients who were underweight or had a normal BMI before pregnancy. LEVEL OF EVIDENCE: II

Comparison of 2- and 3-Dimensional Sonography for Estimation of Birth Weight and Neonatal Adiposity in the Setting of Suspected Fetal Macrosomia

To compare the accuracy of 2‐dimensional (2D) and 3‐dimensional (3D) fetal measurements for prediction of birth weight Z score and neonatal adiposity (percent body fat) in the setting of suspected fetal macrosomia.

Measures of success: Prediction of successful labor induction

Ideally, all pregnant women would enter labor spontaneously at the safest time to yield the best health outcomes for both themselves and their newborns. Unfortunately, this does not always happen and leaves obstetric providers weighing the maternal and fetal risks of continued expectant management versus labor induction. Several elements have been reported to affect the success rate of an induction, including the Bishop score, maternal parity, body mass index (BMI), age, medical comorbidities, fetal gestational age, and estimated weight, as well as the hospital site and provider practice. Recent data suggest that the decision to induce or continue expectant management in anticipation of labor is an important variable in determining whether a woman has a safe and successful delivery.

Cesarean delivery as a marker for obstetric quality.

Cesarean delivery is a frequent, easily obtainable, and meaningful event in obstetrics that has frequently been used as a quality indicator. However, its utility as a widespread marker of quality has several limitations. The cesarean delivery rate does not account for variation in levels of maternal care with varying maternal and fetal conditions. Attempts to risk adjust with the nulliparous, singleton, term, vertex cesarean, or the vaginal birth after cesarean rates fall short as, in obstetrics, it is the outcome of 2 patients, the mother and the infant, that ultimately matters. Newer and more sophisticated measures are increasingly available and offer greater potential to improve care for mothers and babies. However, much work is needed to create better quality metrics for obstetric care that can be measured and validated to truly reflect the quality of care women are receiving.

Medical and Surgical Interventions Available Before a Periviable Birth

Periviable birth contributes disproportionately to perinatal morbidity and mortality. By analyzing the most relevant outcomes after a preterm birth some information can be provided on the potential benefit of interventions. This article discusses surgical and medical interventions that may offer neonatal benefit including cerclage, amniocentesis, progesterone, antenatal corticosteroids, magnesium sulfate for neuroprotection, and tocolysis. Cervical cerclage has the greatest promise at reducing morbidity and mortality related to periviable birth even though it may not reduce the overall preterm birth rate. The use of antenatal corticosteroids, magnesium sulfate, progesterone, and tocolytics may also improve outcome. Studies specifically evaluating these interventions are needed.

Maternal and neonatal outcomes in nulliparous women undergoing non-medically indicated induction of labour or expectant management at 38–41 weeks gestation

Commentary on : Bailit JL, Grobman W, Zhao Y, et al, ; Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units (MFMU) Network. Nonmedically indicated induction vs expectant treatment in term nulliparous women. Am J Obstet Gynecol 2015;212:103.e1–7[OpenUrl][1][CrossRef][2]. In the last decade, our understanding of the associations connected with induction of labour have greatly improved as the conventional comparisons with spontaneous labour have been replaced with the appropriate alternative of expectant management.1 Starting with smaller single site studies,2 followed by administrative databases3 ,4 and with validated databases now abstracted directly from medical records,5 multiple studies showed no association or a decrease in caesarean delivery with induction, as well as a decreased risk for some … [1]: {openurl}?query=rft.jtitle%253DAm%2BJ%2BObstet%2BGynecol%26rft.volume%253D212%26rft.spage%253D103.e1%26rft_id%253Dinfo%253Adoi%252F10.1016%252Fj.ajog.2014.06.054%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [2]: /lookup/external-ref?access_num=10.1016/j.ajog.2014.06.054&link_type=DOI