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  • 1
    Online Resource
    Online Resource
    810: Puerperal infection and antibiotic utilization rates before and after implementation of a policy to deliver women with class III obesity at 39 weeks gestation
    Elsevier BV ; 2018
    In:  American Journal of Obstetrics and Gynecology Vol. 218, No. 1 ( 2018-01), p. S482-S483
    Details
    In: American Journal of Obstetrics and Gynecology, Elsevier BV, Vol. 218, No. 1 ( 2018-01), p. S482-S483
    Type of Medium: Online Resource
    ISSN: 0002-9378
    URL: Article
    DOI: 10.1016/j.ajog.2017.11.343
    RVK:
    XA 19400
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2018
    detail.hit.zdb_id: 2003357-6
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  • 2
    Online Resource
    Online Resource
    Insulin Dosing, Glycemic Control, and Perinatal Outcomes in Pregnancies Complicated by Type-2 Diabetes
    Georg Thieme Verlag KG ; 2021
    In:  American Journal of Perinatology Vol. 38, No. 06 ( 2021-05), p. 535-543
    Details
    In: American Journal of Perinatology, Georg Thieme Verlag KG, Vol. 38, No. 06 ( 2021-05), p. 535-543
    Abstract: Objective This study aimed to evaluate the prevalence of severe insulin resistance (insulin requirements ≥2 units/kg) at delivery and the relationship between severe insulin resistance, glycemic control, and adverse perinatal outcomes in pregnant women with type-2 diabetes mellitus. Study Design This is a retrospective cohort study of women with type-2 diabetes mellitus who delivered between January 2015 and December 2017 at a tertiary academic medical center. Maternal demographic information, self-monitored blood sugars, and insulin doses were abstracted from the medical record. Multivariable logistic regression was used to identify maternal baseline characteristics associated with severe insulin resistance at delivery. Results Overall 72/160 (45%) of women had severe insulin resistance. Women in the severe insulin resistance group demonstrated evidence of suboptimal glycemic control as evidenced by higher mean hemoglobin A1c (HbA1c) values (7.2 [ ±  1.1] vs. 6.6 [ ±  1.3%] , p = 0.003), higher mean fasting (104.0 [ ±  17.4] vs. 95.2 [ ±  11.7 mg/dL] , p  〈  0.001) and postprandial glucose values (132.4 [ ±  17.2] vs. 121.9 [ ± 16.9 mg/dL] ), p  〈  0.001), and a higher percentage of total glucose values that were elevated above targets (37.7 [95% confidence interval (CI): 26.8–50] vs. 25.6 [95% CI: 13.3–41.3%] , p  〈  0.001). Maternal HbA1c ≥6.5% and insulin use prior to pregnancy were associated with a higher prevalence of severe insulin resistance, while Hispanic ethnicity and non-White race were associated with a lower prevalence of severe insulin resistance. The rates of adverse perinatal outcomes including large for gestational age (LGA) birth weight, cesarean delivery, and hypertensive disorders of pregnancy did not differ between groups. Conclusion Severe insulin resistance is common among pregnant women with type-2 diabetes, and it is associated with suboptimal glycemic control. Future studies are necessary to develop strategies to identify women with severe insulin resistance early in pregnancy and facilitate adequate insulin dosing. Key Points
    Type of Medium: Online Resource
    ISSN: 0735-1631 , 1098-8785
    URL: Article
    DOI: 10.1055/s-0040-1718579
    Language: English
    Publisher: Georg Thieme Verlag KG
    Publication Date: 2021
    detail.hit.zdb_id: 2042426-7
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  • 3
    Online Resource
    Online Resource
    Impact of a Policy to Deliver at 39 Weeks for the Indication of Class III Obesity
    Wiley ; 2020
    In:  Obesity Vol. 28, No. 3 ( 2020-03), p. 563-569
    Details
    In: Obesity, Wiley, Vol. 28, No. 3 ( 2020-03), p. 563-569
    Abstract: The aim of this study was to evaluate the effect of a policy to deliver at 39 weeks for class III obesity. Methods This was a retrospective cohort study of women with class III obesity delivering at ≥ 37 weeks before (May 2012 to April 2014) and after the policy (September 2014 to August 2016). The primary outcome was the cesarean rate. Secondary outcomes included maternal morbidities and a neonatal morbidity composite. Modified Poisson regression was used to adjust for demographic differences between groups. Results The study included a total of 1,210 patients, 580 before the policy and 630 after the policy. Before and after the policy, cesarean rates were similar (41.6% vs. 47.1%; risk ratio [RR]: 1.13 [95% CI: 1.00‐1.29] ; adjusted RR [aRR]: 1.03 [95% CI: 0.92‐1.14] ). In adjusted comparisons of women undergoing labor induction, parous women had lower cesarean rates (aRR: 0.62; 95% CI: 0.41‐0.94) but nulliparous women had higher cesarean rates (aRR: 1.32; 95% CI: 1.04‐1.68) after the policy ( P for interaction = 0.01). Rates of chorioamnionitis, endometritis, and cesarean wound infection were not different between groups. Composite neonatal morbidity was not different between pre‐ and postpolicy groups. Conclusions A policy of delivery at 39 weeks for class III obesity did not affect overall cesarean rate or rates of maternal or neonatal morbidity. Further investigation should evaluate subsets of women who may have a higher cesarean rate with this policy.
    Type of Medium: Online Resource
    ISSN: 1930-7381 , 1930-739X
    URL: Issue
    URL: Article
    DOI: 10.1002/oby.v28.3
    DOI: 10.1002/oby.22729
    Language: English
    Publisher: Wiley
    Publication Date: 2020
    detail.hit.zdb_id: 2027211-X
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  • 4
    Online Resource
    Online Resource
    1417-P: Glycemic Control and Insulin Dosing in Pregnancies Complicated by Type 2 Diabetes Mellitus
    American Diabetes Association ; 2019
    In:  Diabetes Vol. 68, No. Supplement_1 ( 2019-06-01)
    Details
    In: Diabetes, American Diabetes Association, Vol. 68, No. Supplement_1 ( 2019-06-01)
    Abstract: Type 2 diabetes mellitus (DM) is associated with adverse perinatal outcomes, but insulin requirements and the prevalence of inadequate glycemic control across gestation are not well characterized. We therefore conducted a retrospective cohort study of women with type 2 DM who delivered from 2015 to 2017. Self-monitored blood glucose and insulin doses across gestation were abstracted, and inadequate glycemic control was defined as a mean blood glucose & gt;95 mg/dL fasting or & gt;140 mg/dL 1 hour post-prandial. We compared insulin dosing in early gestation and at delivery by maternal glycemic control. Multivariable logistic regression was used to identify predictors of high insulin requirements at delivery. Inadequate glycemic control occurred in 96/155 (62%) of women. Maternal BMI, gestational age at first prenatal visit, and duration of diabetes were similar between women with inadequate and adequate control. Baseline HbA1c (8.1 ±2.0 vs. 7.5 ±1.9%, p=0.10) and percent of women receiving medical therapy before initiation of prenatal care (71.3% vs. 69.5%, p=0.81) were also similar between groups. Women with inadequate and adequate control had similar insulin doses in early pregnancy (0.7 ±0.5 vs. 0.7 ±0.5 units/kg, p=0.86), but by delivery women with inadequate control required significantly higher doses (2.3 ±1.2 vs. 1.8 ±1.0 units/kg, p=0.004). The highest quartile of insulin dose at delivery was & gt;2.7 units/kg. Multivariable logistic regression modeling demonstrated that maternal BMI at the first prenatal visit (aOR 1.0, 95% CI 0.99-1.01), non-white race (aOR 0.35, 95% CI 0.16-0.78), and baseline HbA1c (aOR 1.22, 95% CI 1.02-1.46) had poor ability to predict high insulin requirements at delivery (AUC 0.67). Although high insulin requirements may be related to suboptimal glycemic control in women with type 2 DM, it is difficult to identify these women using baseline characteristics. Further studies are urgently needed to optimize insulin dosing in women with Type 2 DM. Disclosure H.C. Nadeau: None. M.E. Maxted: None. D. Madhavan: None. S. Pierce: None. M.N. Feghali: None. C.M. Scifres: None.
    Type of Medium: Online Resource
    ISSN: 0012-1797 , 1939-327X
    URL: Article
    DOI: 10.2337/db19-1417-P
    Language: English
    Publisher: American Diabetes Association
    Publication Date: 2019
    detail.hit.zdb_id: 1501252-9
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