Veronica Maria Pimentel

Vitamin A and β-carotene in pregnant and breastfeeding post-bariatric women in an urban population

Abstract Background As breastfeeding awareness and social acceptance are increased, maternal nutritional deficiency requires more investigation. Methods A prospective cohort study was conducted to determine if vitamin A deficiency is more common in pregnant, lactating post-bariatric surgery women in an inner city population. Antepartum, women after bariatric surgery and controls with no history of malabsorption were recruited. Third trimester, postpartum maternal blood and cord blood were collected as well as three breast milk samples: colostrum, transitional and mature milk. A nutritional survey of diet was completed. Each serum sample was analyzed for total retinol and β-carotene; breast milk samples were analyzed for retinol and retinyl esters, total retinol and β-carotene. Results Fifty-three women after bariatric surgery and 66 controls were recruited. Postpartum serum retinol was significantly higher in women after bariatric surgery in the univariate analysis (P<0.0001) and confirmed in the multiple linear mixed model (P=0.0001). Breast milk colostrum retinol and transitional milk total retinol were significantly greater in the bariatric surgery group in the univariate analysis (P=0.03 and P=0.02, respectively), but not after adjusting for confounders. Serum β-carotene in the third trimester and postpartum were lower (P<0.0001 and P=0.003, respectively) in the bariatric surgery group but not after adjusting for confounders. Vitamin A deficiency was high in both groups in serum and breast milk samples. Conclusion Nutritional deficiencies in breastfeeding women after bariatric surgeries may in fact be less common than in control women in an inner city.

Induction of labor using one dose vs multiple doses of misoprostol: a randomized controlled trial

Background Misoprostol is a common agent that is used to ripen the cervix and induce labor, yet there is no clear evidence of the optimal number of doses needed to achieve a higher rate of vaginal delivery. Objective Our primary objective was to compare the rate of vaginal delivery within 24 hours between a 1‐dose and a multiple‐dose regimen of misoprostol for the induction of labor. Study Design A randomized controlled trial was conducted from March 2016 to March 2017 that compared a single dose to up to 4 doses of misoprostol. Randomization was stratified by parity. Women with a singleton pregnancy ≥37 weeks gestation with intact membranes who had been admitted for labor induction with a Bishop score ≤6 were included. Our primary outcome was the rate of vaginal delivery within 24 hours. Secondary outcomes included time to vaginal delivery, cesarean delivery rate, and maternal and neonatal morbidity. Based on a power of 80%, an alpha of .05, and the assumption that 50% of women in the multiple‐misoprostol group would deliver vaginally in 24 hours, a sample size of 220 patients was needed to detect a 20% increase in vaginal delivery rate within 24 hours in the 1‐misoprostol group. Continuous variables were compared with the use of the Mann‐Whitney test. Categoric variables were compared with the use of the Fisher’s exact test. Probability values <.05 were considered statistically significant. Results Two hundred fifty women were assigned randomly. Demographics and clinical characteristics were similar between groups. In the univariate analysis, there was no difference in the rate of vaginal delivery within 24 hours between the 1‐misoprostol group and the multiple‐dose group (41.7% vs 44.7%, respectively; P=.698) or time to vaginal delivery (1187 min vs 1321 min, respectively; P=.202). The 1‐misoprostol group had a greater cesarean delivery rate (35.8% vs 22.8%; P=.034). In a Poisson regression that controlled for Bishop score before the initiation of oxytocin, parity, gestational age, body mass index, estimated fetal weight, artificial rupture of membrane at <6 cm, and Foley balloon placement, the treatment group was no longer associated with cesarean delivery rate. Instead, a Bishop score of <4 before the initiation of oxytocin and nulliparity were associated significantly with cesarean delivery rate. Conclusion In this first randomized controlled trial in the literature to compare a single with a multiple dosing of misoprostol, we found that the 1‐dose regimen is an acceptable alternative for the induction for labor, especially for multiparous women and for patients with a Bishop score >4 after the first dose.

Qt Interval in Pregnant Women on Methadone-maintenance Therapy [27n]

The upper limit of normal for the QT interval is 450 msec. A prolonged QT is associated with an increase in sudden cardiac death. Female gender, pregnancy and methadone use are risk factors for QT prolongation. This study sought to assess the QT interval in pregnant women undergoing methadone-maintenance therapy (MMT) in the third trimester and the factors that are associated with QT prolongation. We performed a retrospective review of pregnant women on methadone at Boston University Medical Center between June 2012 and May 2014. Corrected QT (QTc) from a third trimester electrocardiogram (ECG) was calculated using Bazetts formula. The urine toxicity screen (utox) done on the day of the ECG was reviewed. Paired t-test was used to compare QTc of those with cocaine-positive utox to the QTc of those with a negative utox. The relationship between QTc and methadone dose was assessed using Pearson correlation. Of the 32 eligible pregnant women on methadone, 21 (65%) had an ECG performed. Their mean QTc was 428.7±33.9 msec. Pregnant women with a cocaine-positive utox had a longer QTc compared to those with a negative utox (476.0±31.7 msec vs. 420.8±28.6 msec, P = .04). There was no correlation between the dose of methadone (range 55 mg to 145 mg) and the QTc interval (p > .05). The QT interval in pregnant women on methadone was below the upper limit of normal, except for those with a cocaine-positive utox. The concomitant used cocaine place pregnant women on methadone at risk of cardiac arrhythmia.

Vitamin A Status in Breast Milk and Serum After Bariatric Surgery in an Urban Population [5K]

INTRODUCTION: Bariatric surgery increases the risk of nutritional deficiencies especially fat soluble vitamins including vitamin A. Levels in the mother influence fetal stores in the liver leading newborns to rely on maternal breast milk for their supply. We sought to determine the risk for maternal serum, cord blood, and breast milk vitamin A deficiency of post-bariatric surgery breastfeeding women compared to non-surgical controls. METHODS: A prospective cohort study was conducted. Antepartum women with bariatric surgery, singleton pregnancies planning to breastfeed were recruited. Controls with singleton pregnancies, no history of malabsorption, planning to breastfeed were recruited randomly. Background information and pregnancy outcomes were collected. Third trimester serum and cord blood samples were obtained. Postpartum, participants completed a nutritional survey. Postpartum maternal serum was collected on day 1. Three milk samples were collected: colostrum (PPD1-5), transitional (PPD7-14), and mature milk (PP 6 weeks). Each sample was analyzed for retinol, retinyl esters, and total retinol by HPLC. Power analysis estimated a total of 66 patients. RESULTS: 53 bariatric women and 61 controls were recruited. Breastfeeding rates were significantly different between groups (51% bariatric women vs 23% in controls). Colostrum and transitional milk retinol was significantly higher in bariatric women vs controls (P=.01 and P=.02, respectively). Postpartum serum retinol was significantly higher in women with bariatric surgery compared to controls (P<.0001). CONCLUSION: Vitamin A deficiency exists in the United States in the general urban population more than bariatric women. Consideration for monitoring levels in all breastfeeding women and supplementing is needed for maternal and newborn health.

Is the Cesarean Delivery Rate Higher After Abdominoplasty? Obstetrical Outcomes in the Setting of Abdominoplasty [7C]

INTRODUCTION: Abdominoplasty is frequently performed in women of child-bearing age. Pregnancy after abdominoplasty is discouraged due to aesthetic concerns, but there is no literature on the characteristics or risks of women who conceive after this surgery. This study aims to assess properties and outcomes of pregnant women who have previously undergone abdominoplasty. METHODS: Women with prior abdominoplasty presenting for prenatal care at an urban tertiary care center were identified through the electronic medical record. Baseline characteristics and maternal and fetal outcomes were compared to rates from our hospital and from the medical literature. The primary outcome was CD rate. RESULTS: Of the 99 women identified to have undergone abdominoplasty, mean age at delivery was 33.7 years, significantly older than in the literature (P<.001). Most identified as Hispanic (79%), more commonly than in our hospital population rate of 46% (P<.001). The mean parity was greater than national average (2.7 vs 1.9, P<.001). The rate of CD was 49.5%, higher than both the hospital (31.7%; P=.005) and national rates (32.7%; P<.001). For those with a prior vaginal delivery, the primary CD rate was higher than rates in the literature (22.6% vs 11.5%, P=.009). The rate of preterm delivery, estimated blood loss and fetal weight were similar to those reported in the general population. CONCLUSION: Pregnant patients with prior abdominoplasty appear to be older, more parous, and more likely to identify as Hispanic. They may have a higher rate of CD, even in the setting of a prior vaginal delivery.