Lisa Gittens-Williams

Vitamin Profile of 563 Gravidas during Trimesters of Pregnancy

Objective: Gestation imposes metabolic stress on the mother which heightens as pregnancy progresses. The need for quantifying circulating vitamins is important for identifying pitfalls in metabolic imbalance and nutritional status. For this reason we wanted to analyze blood vitamin concentrations of B12, thiamin, biotin, pantothenate, B6, niacin, riboflavin, folate, vitamins A, C, E and total carotenes to determine if imbalances occur during the trimesters of pregnancy. Methods: We randomly selected 563 gravidas who volunteered for this study from the obstetrical clinic of New Jersey Medical School; 132 were in 1st trimester, 198 were in 2nd trimester, and 233 were in 3rd trimester. All were healthy, taking a good diet and supplemented with vitamins. Blood, from an antecubital vein, was analyzed for thiamin, biotin, B12, B6, pantothenate, riboflavin, nicotinate, folates, vitamins A, E, C and total carotenes. Gravidas were classified as being normovitaminemic, hypervitaminemic or hypovitaminemic compared with blood vitamins seen in healthy non-pregnant, non-vitamin supplemented women. Result: Hypervitaminemic levels of folate, biotin, pantothenate and riboflavin were found during any trimester of pregnancy due to vitamin supplementation. Despite the vitamin supplementation, a high percent of vitamin A, B6, niacin, thiamin and B12 hypovitaminemia was noted during pregnancy trimesters. An especially high percentage of niacin deficiency was seen during the 1st trimester; it worsened in later trimesters; B12 deficits increased during the late trimesters. Combination deficits of niacin, thiamin, vitamins A, B6, B12 were noted in each of the trimesters. Conclusions: Despite vitamin supplementation, a vitamin profile of pregnancy indicates that vitamin deficits exist during the trimesters. Also, combination hypovitaminemias of deficient vitamins were noted; this indicates that a vitamin deficit during pregnancy does not occur in isolation.

Risk factors for hepatitis C infection among sexually transmitted disease-infected, inner city obstetric patients

Objective: To test the hypothesis that our inner city obstetric patients who have been infected with sexually transmitted diseases (STDs) will have a higher prevalence of hepatitis C virus infection than the general population and to identify specific risk factors and high-risk groups. Methods: All patients in our prenatal clinic (July 1997–April 1999) who tested positive for one or more STDs were asked to return for hepatitis C antibody testing. Medical charts of all patients who returned for hepatitis C testing were reviewed. Results: A total of 106 patients with STDs were tested for hepatitis C. Positive screening tests for anti-hepatitis C antibody were found in 6.6% (7/106) of the patients (95% CI = 2.7–13.1%). This frequency is significantly higher than the hepatitis C prevalence (1.8%) in the general United States population (p = 0.006). Multiple logistic regression analysis confirmed only older age (p = 0.016) and positive HIV status (p = 0.023) to be significant predictors of hepatitis C infection. Conclusions: Inner city STD-infected obstetric patients are at high risk for hepatitis C infection compared with the general population. Increasing age and HIV-positive status are risk factors which are significantly associated with hepatitis C infection.

Genital tract GBS and rate of histologic chorioamnionitis in patients with preterm premature rupture of membrane

Abstract Introduction: Histologic chorioamnionitis (HC) is a common finding in the placenta from patients with preterm premature rupture of membranes (PPROM). The purpose of this study is to determine if HC differs based on the Group B streptococcus (GBS) status in patients managed expectantly with PPROM <34 weeks gestation. Methods: A retrospective study was performed of patients admitted with PPROM between 23 0/7 and 33 6/7 weeks from 2003 to 2014 at one institution. Patients were excluded if in labor, evidence of clinical chorioamnionitis, nonreassuring fetal status, multifetal gestation, HIV positive, or if GBS specimens or placental histology were not available. Placental pathology results were compared using Fisher’s exact test. Results: One hundred eighty-one patients met inclusion criteria and 55 (30.3%) were GBS positive. The prevalence of HC did not differ between the GBS positive and GBS negative groups (69 versus 64.2%, respectively; p = .62). Clinical chorioamnionitis, endomyometritis, wound infection, maternal and neonatal sepsis did not differ between the two groups. Conclusions: Vaginal–rectal colonization with GBS on admission does not appear to affect the rate of HC nor neonatal outcome in patients managed conservatively with PPROM <34 weeks gestation.

Delivery of the Nondiabetic Macrosomic Infant

The intrapartum management of the fetus with known or suspected macrosomia presents a considerable challenge to the clinician. Risks and complications are reviewed, and management is discussed.

Evaluation of a Multilevel Intervention to Reduce Preterm Birth Among Black Women in Newark, New Jersey: A Controlled Interrupted Time Series Analysis

Objective To evaluate the effectiveness of a multilevel intervention, Healthy Babies are Worth the Wait (HBWW), in reducing preterm birth (PTB) and very preterm birth (VPTB) among black women in Newark, NJ. Methods HBWW is a program linking the local March of Dimes office, providers, community-based organizations, and public health institutions to increase uptake of evidence based preterm birth interventions. We used birth certificate data before (2009–2011) and after (2012–2015) the introduction of HBWW in Newark. We estimated differences in PTB and VPTB between these periods among black women in Newark and compared them to rate differences among black women in the rest of NJ (difference-in-differences). We used interrupted time series analysis (ITSA) to examine declines in PTB and VPTB following the introduction of HBWW controlling for secular trends. All models adjusted for maternal age, education and parity. Results PTB declined in Newark 1.1 case per 100 (95% confidence interval (CI) − 2.3, 0) and in the rest of NJ 0.5 case per 100 (− 1.4, 0.4) (difference-in-differences = 0.6 fewer cases per 100 in Newark, 95% CI − 1.6, 0.3). VPTB declined in both Newark (− 0.6 cases per 100, 95% CI − 1.0, 0) and the rest of NJ (− 0.2 cases per 100, 95% CI − 0, 0.3) (difference-in-differences = 0.4 fewer cases per 100 in Newark, 95% CI − 0.9, 0). However, using ITSA the downward VPTB trend in Newark was not different from the rest of NJ or pre-intervention trends. Conclusions for Practice Our study supports the importance of critically evaluating and advancing complex interventions to reduce PTB among black women.

Is Obesity Protective in Pyelonephritis in Pregnancy? [17J]

INTRODUCTION: Acute pyelonephritis is a major cause of infectious morbidity and ICU admissions in pregnancy. In the non-obstetric critical care literature, an “obesity paradox” has been described where increasing Body Mass Index (BMI) is associated with decreased mortality in septic patients admitted to the ICU. Here we study the association between BMI, pyelonephritis in pregnancy, and ICU admission. METHODS: A retrospective cohort study was performed on all pregnant patients admitted with pyelonephritis for the past 5 years. Data was collected on BMI at presentation, BMI postpartum, disease severity (SIRS, sepsis, or septic shock), and ICU admission. To define the distribution of BMI in our general obstetric population, BMI was recorded for all patients delivering at our institution over a one year period. Patients were grouped by BMI category: normal weight (18.5–24.99 kg/m2), overweight (25–29.99 kg/m2), or obese (greater than 30 kg/m2), and distributions compared by Chi-square test. RESULTS: The distribution of BMIs in patients with pyelonephritis (n=89) versus general obstetric patients (n=1,076) was significantly different (P<.0001) with 43% versus 11% normal weight, 34% versus 28% overweight, and 23% versus 61% obese, respectively. Postpartum BMIs in patients with pyelonephritis were increased but still significantly different from the general obstetric population (P=.0018). Among patients with pyelonephritis, the odds ratio for ICU admission/shock was 0.25 for obese versus normal/overweight (not significant at P=.2). CONCLUSION: In this obstetric population, obesity was associated with a decreased incidence of pyelonephritis and a trend towards decreased disease severity suggesting a role for the “obesity paradox” in pregnancy.