Sharon T. Phelan

Nutrition During Pregnancy

Nutritional concerns in pregnancy are gaining increasing importance as problems with obesity, poor nutrition, and improper weight gain during pregnancy have been shown to result in morbidity for mother and infant during the pregnancy. More recent studies show that the impact of poor nutrition in pregnancy extends for decades to follow for the mother and the offspring. Clearly, prevention of problems is the best approach. This article discusses aspects of, and controversies concerning, prenatal weight gain and specific nutrients, and special patient groups who may benefit from intervention by a registered dietitian.

Smoking Cessation in Pregnancy

More than 400,000 deaths occur per year in the United States that are attributable to cigarette smoking; the risks to the general public are widely known. The risk to women, especially those who are pregnant, is less commonly known. During pregnancy, smoking increases the risk of low birth weight infants, placental problems (previa and/or abruption), chronic hypertensive disorders, and fetal death. It is proposed that much of this happens because of vasoconstriction with decreased uterine blood flow from nicotine, carbon monoxide toxicity, and increased cyanide production. Infants of smoking mothers have increased risks, such as sudden infant death syndrome.

Umbilical Cord Prolapse

Umbilical cord prolapse is an obstetric emergency that can have negative outcomes for the fetus. It is diagnosed by a palpable or visible cord and is often accompanied by severe, rapid fetal heart rate decelerations. Cases of cord prolapse should be delivered as soon as possible, usually by cesarean section. While awaiting delivery, the fetal presenting part should be elevated off the cord either manually or by filling the bladder. Although an untreated case of umbilical cord prolapse can lead to severe fetal morbidity and mortality, prompt and appropriate management leads to good overall outcomes.

Improved climate, culture, and communication through multidisciplinary training and instruction

OBJECTIVE The objective of the study was to determine the effectiveness of multidisciplinary team training on organizational culture and team communication. STUDY DESIGN The training included a 6-step protocol: (1) a pretest survey assessing cultural attitudes and perceptions, (2) a baseline high-fidelity simulation session, (3) invitational medical rhetoric instruction, (4) a second high-fidelity simulation session, (5) a posttest survey assessing changed cultural attitudes and perceptions, and (6) a debriefing with participants. Teams of 4 physicians trained together: 2 obstetricians and 2 anesthesiologists. Forty-four physicians completed the training protocol during 2010 and 2011. RESULTS Paired-sample t tests demonstrated significant decreases in autonomous cultural attitudes and perceptions (t = 8.23, P < .001) and significant increases in teamwork cultural attitudes and perceptions (t = -4.05, P < .001). Paired-sample t tests also demonstrated significant increases in communication climate that invited participation and integrated information from both medical services (t = -5.80, P < .001). CONCLUSION The multidisciplinary team training program specified in this report resulted in increased teamwork among obstetricians and anesthesiologists.

The Prenatal Medical Record: Purpose, Organization and the Debate of Print Versus Electronic

The obstetric prenatal record is one of the best, most organized medical record systems currently used in the United States. This has allowed a standardization of care and documentation that has benefited pregnant women over the past two decades. The transition to an electronic record must maintain these advances and, hopefully, strengthen them with the use of electronic prompts, seamless transfer of information, and universal accessibility to the records, regardless of the location of care.

Obesity in Minority Women: Calories, Commerce, and Culture

Obesity is increasing at epidemic rates in all women, but especially in minority women and children. Factors that contribute to this include changes in caloric intake and expenditure (calories), cost and ease of acquiring food along with pressures from the marketplace and media (commerce) and the community response to the increasing prevalence of obesity and sedentary lifestyle (culture).

Promoting Healthy Habits in Pregnancy

Most women have an appreciation of what are generally considered healthy habits including more exercise; eating a healthy diet; avoiding cigarettes, alcohol, and drugs; using seatbelts; and being current on preventive care, such as good dental status. Being pregnant can be a strong motivator to change or modify behavioral choices. This is an optimal time for a provider to build on this potential motivator to effect change. Frequent follow-up visits allow re-enforcement of attempted change. This constant encouragement and support helps to impress on the woman and her family the importance of change.

Periconceptional binge drinking and acculturation among pregnant Latinas in New Mexico

Binge drinking during pregnancy might lead to the development of Fetal Alcohol Spectrum Disorders in the offspring. Latinas are often considered a low-risk group for alcohol abuse, although recent reports indicate that the prevalence of alcohol consumption in this group is increasing due to changing cultural norms. The predictors of alcohol consumption during pregnancy among Latinas are largely unknown. We explored predictors of periconceptional drinking among Latinas (n=155) recruited into an ongoing cohort study at the University of New Mexico. Women were interviewed by a bilingual trained interviewer about any episodes of binge drinking (>or=4 drinks/occasion) a month around their last menstrual period (LMP) and were administered a TWEAK questionnaire. Sociodemographic, lifestyle, and reproductive health characteristics were also ascertained. Predictors of binge drinking were identified by Chi-square test and logistic regression in univariate and multivariable analyses, respectively. Backward selection procedure was used to identify covariates that were independently associated with binge drinking in the final model. The mean age of participants was 27.0+/-5.8 years and 69% were foreign born. In the entire sample, 17.4% of pregnant Latinas admitted at least one binge-drinking episode in the month around their LMP. Results of multivariate analysis indicate that Latinas born in the United States have a much greater risk of binge drinking in the periconceptional period (odds ratio [OR]=3.2; 95% confidence interval [CI]: 1.2, 8.9) compared with foreign-born Latinas. Similarly, Latinas who primarily speak English at home were at much greater risk (OR=3.6; 95% CI: 1.3, 10.5) compared with primarily Spanish-speaking women. No other variables were identified as significant predictors in multivariable models. Our results indicate that more acculturated Latinas are at much greater risk of binge drinking before conception and in early pregnancy compared with less acculturated Latinas. Culturally sensitive interventions should be developed to address risky alcohol consumption among Latinas of reproductive age.

Promotion rates for assistant and associate professors in obstetrics and gynecology.

OBJECTIVE: To estimate promotion rates of physician faculty members in obstetrics and gynecology during the past 30 years METHODS: Data were collected annually by the Association of American Medical Colleges from every school between 1980 and 2009 for first-time assistant and associate professors to determine whether and when they were promoted. Data for full-time physician faculty were aggregated by decade (1980–1989, 1990–1999, 2000–2009). Faculty were included if they remained in academia for 10 years after beginning in rank. Data were analyzed by constructing estimated promotion curves and extracting 6-year and 10-year promotion rates. RESULTS: The 10-year promotion rates (adjusted for attrition) declined significantly for assistant professors from 35% in 1980–1989 to 32% in 1990–1999 to 26% in 2000–2009 (P<.001), and for associate professors from 37% to 32% to 26%, respectively (P<.005). These declines most likely resulted from changes in faculty composition. The most recent 15 years saw a steady increase in the proportion of entry-level faculty who were women (now 2:1) and primarily on the nontenure track. The increasing number of faculty in general obstetrics and gynecology had lower promotion probabilities than those in the subspecialties (odds ratio 0.16; P<.001). Female faculty on the nontenure track had lower promotion rates than males on the nontenure track, males on the tenure track, and females on the tenure track (odds ratio 0.8 or less; P<.01). CONCLUSION: A decline in promotion rates during the past 30 years may be attributable to changes in faculty composition. LEVEL OF EVIDENCE: II

Fads and fashions: the price women pay

Abstract Over the past 100 years, women’s fashions have undergone great change but rarely have been practical or logical, whether they consist of the tight corset, platform shoes, or the deep golden tan. The principle behind fashions is that the current “look” makes a statement of what society wants a woman to be and establishes the social hierarchy. Each of the fashion trends serves a cultural purpose, but also may have a price for the women who try to achieve the fashionable look. Health care providers for women need to be aware of fashion trends and adjust health screening and counseling appropriately.