Luisa Wetta

Is midtrimester vitamin D status associated with spontaneous preterm birth and preeclampsia

OBJECTIVE The objective of this study is to evaluate whether midtrimester maternal vitamin D is associated with preeclampsia < 37 weeks or spontaneous preterm birth (SPTB) < 35 weeks. STUDY DESIGN Nested case-control comprising two case subsets: (1) 100 women with preeclampsia < 37 weeks and (2) 100 women with SPB < 35 weeks. Controls consisted of 200 women delivered between 39 and 40 weeks. Stored maternal serum obtained between 15 and 21 weeks was tested for total 25-hydroxy vitamin D (25-OH D) levels using liquid chromatography-tandem mass spectrometry. Mean 25-OH D levels and prevalence of vitamin D insufficiency (25-OH D < 30 ng/mL) and deficiency (25-OH D < 15 ng/mL) were compared. RESULTS In this study, 89 preeclampsia, 90 SPTB cases, and 177 controls had valid measurements. Mean midtrimester vitamin D was not significantly different between women with preeclampsia (27.4 ng/mL ± 14.4) and controls (28.6 ± 12.6) (p = 0.46), or SPTB (28.8 ± 13.2) and controls (p = 0.92). After adjusting for potential cofounders, neither vitamin D insufficiency (adjusted odds ratio [OR], 1.1; 95% confidence interval [CI], 0.6-2.0) nor deficiency (adjusted OR, 1.4; 95% CI, 0.7-3.0) was significantly associated with preeclampsia. Likewise, SPTB was not significantly associated with either vitamin D insufficiency or deficiency (adjusted OR, 0.8; 95% CI, 0.4-1.4, adjusted OR, 1.3 or 95% CI, 0.6-3.0, respectively). CONCLUSION Midtrimester maternal vitamin D was not significantly associated with preeclampsia < 37 weeks or SPTB < 35 weeks.

Selective uptake of influenza vaccine and pregnancy outcomes

Abstract Objective: To describe the characteristics of pregnant women who accept the influenza vaccine and evaluate the relationship between vaccination and adverse pregnancy outcomes. Methods: Retrospective cohort study of women receiving prenatal care during the 2009–2011 influenza seasons. Vaccination status was ascertained through our perinatal record system and clinic vaccination logs. Pregnancy outcomes included a primary composite of miscarriage, fetal demise, preterm birth (PTB) <37 weeks and neonatal demise. Stratification and logistic regression were used to adjust for potential confounders. Results: Of 3104 eligible pregnant women, 1094 (35%) received the influenza vaccine. Women vaccinated were more likely to be older, obese, primiparae, and have medical complications or a prior PTB. In univariable analyses, flu vaccination was associated with increased adverse composite outcome and PTB. After multivariable adjustments, vaccination was no longer associated with adverse outcomes in women with medical complications but remained associated with adverse outcomes among those without known co-morbidity. Conclusions: Vaccination was associated with an increased adverse composite outcome in pregnant women without identified co-morbidity but not those with co-morbidities. This association is likely due to selection bias, which should be considered in planning of observational studies of the impact of vaccination on pregnancy outcomes.

Early Term Births: Considerations in Management

The frequency of early term birth varies depending on patient, provider, and system characteristics. Early term deliveries are associated with suboptimal neonatal outcomes without evidence of maternal benefit. Some early term births are either unavoidable or absolutely indicated for maternal and/or fetal benefit in the setting of medical or obstetric risks. Demonstrated fetal lung maturity before early term birth reduces the risk of respiratory and other morbidities relative to gestational age-matched counterparts but may not reduce the risks to the low levels at 39 to 40 weeks. For some risk situations, it remains controversial whether earlier delivery is beneficial. The assessment of the provider and patient’s desires should direct care. In the absence of any obstetric or medical risks, early term delivery should be avoided. A simple intervention that includes administrative support, review of indications, and feedback to providers can dramatically reduce the frequency of early term births over time.

Antibiotic prophylaxis for cesarean delivery: survey of maternal-fetal medicine physicians in the U.S.

Objective: To describe practices concerning antibiotic prophylaxis for cesarean delivery among maternal-fetal medicine (MFM) physicians in the United States. Methods: A 10-item self-administered survey about their routine use of antibiotics for cesarean delivery was mailed once only to a random sample of 1000 US-based fellows of the Society of Maternal-Fetal Medicine in November 2009. Results: There were a total of 250 respondents from 40 US states between 10/09 and 4/2010, corresponding to a response rate of 25%. Among respondents, 95.5% reported routine use of a cephalosporin only (including 84.4% who reported use of cefazolin) as antibiotic prophylaxis for cesarean delivery; less than 3% reported use of an extended spectrum regimen such as cefazolin + azithromycin. Preoperative administration of antibiotic prophylaxis was reported by 84.6% compared to 15.0% who reported giving antibiotic prophylaxis after umbilical cord clamping. Administration of a single dose of antibiotic was reported by 96%. Conclusion: The majority of MFM specialists in the US report routine and preoperative use of a single prophylactic dose of a 1st generation cephalosporin for cesarean delivery.

Use of ethnic‐specific medians for Hispanic patients reduces ethnic disparities in multiple marker screening

To estimate whether midtrimester maternal serum analyte concentrations differ between Caucasian and Hispanic women and whether using ethnic‐specific medians affects quad screen performance.

Low-Dose Aspirin, Smoking Status, and the Risk of Spontaneous Preterm Birth

OBJECTIVE We evaluated the relationship between aspirin supplementation and perinatal outcomes for potential effect modification by smoking status. STUDY DESIGN A secondary analysis of two multicenter trials for which prophylactic aspirin supplementation was given to either low- or high-risk women for prevention of preeclampsia (PE). We examined the effect of aspirin by smoking status using the Breslow-Day test. Primary outcomes for this analysis were PE and preterm birth (PTB) < 37 weeks. We also examined PTB subtypes, small for gestational age (SGA), and neonatal intensive care unit (NICU) admission. RESULTS The effect of prenatal aspirin on the risk of PE did not differ by smoking status (relative risk [RR] 95% confidence interval [CI] for smokers; RR 95% CI for nonsmokers) in low-risk (Breslow-Day p = 0.32) or high-risk (RR 95% CI for smokers; RR 95% CI for nonsmokers) (Breslow-Day p = 0.58) women. Among women at low risk for PE, the effect of aspirin supplementation on PTB was not different for nonsmokers (RR 1.00 [95% CI 0.8-1.3]) or smokers (RR 0.80 [95% CI 0.4-1.7]), (Breslow-Day p = 0.54). Aspirin was protective for PTB in nonsmokers (RR 0.80 [95% CI 0.7-0.9]), but not in smokers (RR 1.1 [95% CI 0.9-1.4]) in the high-risk group (Breslow-Day p = 0.03). Aspirin was also associated with increased spontaneous and early PTB and NICU admission in smokers and not nonsmokers in the high-risk group only. CONCLUSION Aspirin supplementation was associated with worse outcomes related to preterm birth in smokers in a high-risk but not low-risk cohort.

Discussion: 'Infant death among Ohio residents' by Donovan et al.

In the roundtable that follows, clinicians discuss a study published in this issue of the Journal in light of its methodology, relevance to practice, and implications for future research.

Discussion: ‘Physician gender, specialty, and hysterectomy utilization’ by Gretz et al

In the roundtable that follows, clinicians discuss a study published in this issue of the Journal in light of its methodology, relevance to practice, and implications for future research. Article discussed: Gretz H, Bradley WH, Zakashansky K, et al. Effect of physician gender and specialty on utilization of hysterectomy in New York, 2001-2005. Am J Obstet Gynecol 2008;199:347.e1-347.e6.