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Publisher: Elsevier   (Total: 3044 journals)

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Showing 1 - 200 of 3044 Journals sorted alphabetically
AASRI Procedia     Open Access   (Followers: 15)
Academic Pediatrics     Hybrid Journal   (Followers: 22, SJR: 1.402, h-index: 51)
Academic Radiology     Hybrid Journal   (Followers: 21, SJR: 1.008, h-index: 75)
Accident Analysis & Prevention     Partially Free   (Followers: 84, SJR: 1.109, h-index: 94)
Accounting Forum     Hybrid Journal   (Followers: 23, SJR: 0.612, h-index: 27)
Accounting, Organizations and Society     Hybrid Journal   (Followers: 28, SJR: 2.515, h-index: 90)
Achievements in the Life Sciences     Open Access   (Followers: 4)
Acta Anaesthesiologica Taiwanica     Open Access   (Followers: 5, SJR: 0.338, h-index: 19)
Acta Astronautica     Hybrid Journal   (Followers: 341, SJR: 0.726, h-index: 43)
Acta Automatica Sinica     Full-text available via subscription   (Followers: 3)
Acta Biomaterialia     Hybrid Journal   (Followers: 25, SJR: 2.02, h-index: 104)
Acta Colombiana de Cuidado Intensivo     Full-text available via subscription   (Followers: 1)
Acta de Investigación Psicológica     Open Access   (Followers: 2)
Acta Ecologica Sinica     Open Access   (Followers: 8, SJR: 0.172, h-index: 29)
Acta Haematologica Polonica     Free   (SJR: 0.123, h-index: 8)
Acta Histochemica     Hybrid Journal   (Followers: 3, SJR: 0.604, h-index: 38)
Acta Materialia     Hybrid Journal   (Followers: 215, SJR: 3.683, h-index: 202)
Acta Mathematica Scientia     Full-text available via subscription   (Followers: 5, SJR: 0.615, h-index: 21)
Acta Mechanica Solida Sinica     Full-text available via subscription   (Followers: 9, SJR: 0.442, h-index: 21)
Acta Oecologica     Hybrid Journal   (Followers: 10, SJR: 0.915, h-index: 53)
Acta Otorrinolaringologica (English Edition)     Full-text available via subscription   (Followers: 1)
Acta Otorrinolaringológica Española     Full-text available via subscription   (Followers: 3, SJR: 0.311, h-index: 16)
Acta Pharmaceutica Sinica B     Open Access   (Followers: 2)
Acta Poética     Open Access   (Followers: 4)
Acta Psychologica     Hybrid Journal   (Followers: 23, SJR: 1.365, h-index: 73)
Acta Sociológica     Open Access  
Acta Tropica     Hybrid Journal   (Followers: 6, SJR: 1.059, h-index: 77)
Acta Urológica Portuguesa     Open Access  
Actas Dermo-Sifiliograficas     Full-text available via subscription   (Followers: 4)
Actas Dermo-Sifiliográficas (English Edition)     Full-text available via subscription   (Followers: 3)
Actas Urológicas Españolas     Full-text available via subscription   (Followers: 4, SJR: 0.383, h-index: 19)
Actas Urológicas Españolas (English Edition)     Full-text available via subscription   (Followers: 2)
Actualites Pharmaceutiques     Full-text available via subscription   (Followers: 5, SJR: 0.141, h-index: 3)
Actualites Pharmaceutiques Hospitalieres     Full-text available via subscription   (Followers: 4, SJR: 0.112, h-index: 2)
Acupuncture and Related Therapies     Hybrid Journal   (Followers: 3)
Acute Pain     Full-text available via subscription   (Followers: 13)
Ad Hoc Networks     Hybrid Journal   (Followers: 11, SJR: 0.967, h-index: 57)
Addictive Behaviors     Hybrid Journal   (Followers: 15, SJR: 1.514, h-index: 92)
Addictive Behaviors Reports     Open Access   (Followers: 5)
Additive Manufacturing     Hybrid Journal   (Followers: 7, SJR: 1.039, h-index: 5)
Additives for Polymers     Full-text available via subscription   (Followers: 21)
Advanced Drug Delivery Reviews     Hybrid Journal   (Followers: 135, SJR: 5.2, h-index: 222)
Advanced Engineering Informatics     Hybrid Journal   (Followers: 11, SJR: 1.265, h-index: 53)
Advanced Powder Technology     Hybrid Journal   (Followers: 17, SJR: 0.739, h-index: 33)
Advances in Accounting     Hybrid Journal   (Followers: 9, SJR: 0.299, h-index: 15)
Advances in Agronomy     Full-text available via subscription   (Followers: 15, SJR: 2.071, h-index: 82)
Advances in Anesthesia     Full-text available via subscription   (Followers: 25, SJR: 0.169, h-index: 4)
Advances in Antiviral Drug Design     Full-text available via subscription   (Followers: 3)
Advances in Applied Mathematics     Full-text available via subscription   (Followers: 6, SJR: 1.054, h-index: 35)
Advances in Applied Mechanics     Full-text available via subscription   (Followers: 10, SJR: 0.801, h-index: 26)
Advances in Applied Microbiology     Full-text available via subscription   (Followers: 22, SJR: 1.286, h-index: 49)
Advances In Atomic, Molecular, and Optical Physics     Full-text available via subscription   (Followers: 16, SJR: 3.31, h-index: 42)
Advances in Biological Regulation     Hybrid Journal   (Followers: 4, SJR: 2.277, h-index: 43)
Advances in Botanical Research     Full-text available via subscription   (Followers: 3, SJR: 0.619, h-index: 48)
Advances in Cancer Research     Full-text available via subscription   (Followers: 25, SJR: 2.215, h-index: 78)
Advances in Carbohydrate Chemistry and Biochemistry     Full-text available via subscription   (Followers: 9, SJR: 0.9, h-index: 30)
Advances in Catalysis     Full-text available via subscription   (Followers: 5, SJR: 2.139, h-index: 42)
Advances in Cellular and Molecular Biology of Membranes and Organelles     Full-text available via subscription   (Followers: 12)
Advances in Chemical Engineering     Full-text available via subscription   (Followers: 25, SJR: 0.183, h-index: 23)
Advances in Child Development and Behavior     Full-text available via subscription   (Followers: 10, SJR: 0.665, h-index: 29)
Advances in Chronic Kidney Disease     Full-text available via subscription   (Followers: 10, SJR: 1.268, h-index: 45)
Advances in Clinical Chemistry     Full-text available via subscription   (Followers: 28, SJR: 0.938, h-index: 33)
Advances in Colloid and Interface Science     Full-text available via subscription   (Followers: 18, SJR: 2.314, h-index: 130)
Advances in Computers     Full-text available via subscription   (Followers: 16, SJR: 0.223, h-index: 22)
Advances in Dermatology     Full-text available via subscription   (Followers: 12)
Advances in Developmental Biology     Full-text available via subscription   (Followers: 11)
Advances in Digestive Medicine     Open Access   (Followers: 5)
Advances in DNA Sequence-Specific Agents     Full-text available via subscription   (Followers: 5)
Advances in Drug Research     Full-text available via subscription   (Followers: 22)
Advances in Ecological Research     Full-text available via subscription   (Followers: 41, SJR: 3.25, h-index: 43)
Advances in Engineering Software     Hybrid Journal   (Followers: 25, SJR: 0.486, h-index: 10)
Advances in Experimental Biology     Full-text available via subscription   (Followers: 7)
Advances in Experimental Social Psychology     Full-text available via subscription   (Followers: 40, SJR: 5.465, h-index: 64)
Advances in Exploration Geophysics     Full-text available via subscription   (Followers: 3)
Advances in Food and Nutrition Research     Full-text available via subscription   (Followers: 48, SJR: 0.674, h-index: 38)
Advances in Fuel Cells     Full-text available via subscription   (Followers: 15)
Advances in Genetics     Full-text available via subscription   (Followers: 15, SJR: 2.558, h-index: 54)
Advances in Genome Biology     Full-text available via subscription   (Followers: 11)
Advances in Geophysics     Full-text available via subscription   (Followers: 6, SJR: 2.325, h-index: 20)
Advances in Heat Transfer     Full-text available via subscription   (Followers: 21, SJR: 0.906, h-index: 24)
Advances in Heterocyclic Chemistry     Full-text available via subscription   (Followers: 8, SJR: 0.497, h-index: 31)
Advances in Imaging and Electron Physics     Full-text available via subscription   (Followers: 2, SJR: 0.396, h-index: 27)
Advances in Immunology     Full-text available via subscription   (Followers: 35, SJR: 4.152, h-index: 85)
Advances in Inorganic Chemistry     Full-text available via subscription   (Followers: 9, SJR: 1.132, h-index: 42)
Advances in Insect Physiology     Full-text available via subscription   (Followers: 3, SJR: 1.274, h-index: 27)
Advances in Integrative Medicine     Hybrid Journal   (Followers: 6)
Advances in Life Course Research     Hybrid Journal   (Followers: 8, SJR: 0.764, h-index: 15)
Advances in Lipobiology     Full-text available via subscription   (Followers: 2)
Advances in Magnetic and Optical Resonance     Full-text available via subscription   (Followers: 9)
Advances in Marine Biology     Full-text available via subscription   (Followers: 15, SJR: 1.645, h-index: 45)
Advances in Mathematics     Full-text available via subscription   (Followers: 10, SJR: 3.261, h-index: 65)
Advances in Medical Sciences     Hybrid Journal   (Followers: 6, SJR: 0.489, h-index: 25)
Advances in Medicinal Chemistry     Full-text available via subscription   (Followers: 5)
Advances in Microbial Physiology     Full-text available via subscription   (Followers: 4, SJR: 1.44, h-index: 51)
Advances in Molecular and Cell Biology     Full-text available via subscription   (Followers: 22)
Advances in Molecular and Cellular Endocrinology     Full-text available via subscription   (Followers: 10)
Advances in Molecular Toxicology     Full-text available via subscription   (Followers: 7, SJR: 0.324, h-index: 8)
Advances in Nanoporous Materials     Full-text available via subscription   (Followers: 4)
Advances in Oncobiology     Full-text available via subscription   (Followers: 3)
Advances in Organometallic Chemistry     Full-text available via subscription   (Followers: 15, SJR: 2.885, h-index: 45)
Advances in Parallel Computing     Full-text available via subscription   (Followers: 7, SJR: 0.148, h-index: 11)
Advances in Parasitology     Full-text available via subscription   (Followers: 7, SJR: 2.37, h-index: 73)
Advances in Pediatrics     Full-text available via subscription   (Followers: 24, SJR: 0.4, h-index: 28)
Advances in Pharmaceutical Sciences     Full-text available via subscription   (Followers: 13)
Advances in Pharmacology     Full-text available via subscription   (Followers: 15, SJR: 1.718, h-index: 58)
Advances in Physical Organic Chemistry     Full-text available via subscription   (Followers: 7, SJR: 0.384, h-index: 26)
Advances in Phytomedicine     Full-text available via subscription  
Advances in Planar Lipid Bilayers and Liposomes     Full-text available via subscription   (Followers: 3, SJR: 0.248, h-index: 11)
Advances in Plant Biochemistry and Molecular Biology     Full-text available via subscription   (Followers: 8)
Advances in Plant Pathology     Full-text available via subscription   (Followers: 5)
Advances in Porous Media     Full-text available via subscription   (Followers: 4)
Advances in Protein Chemistry     Full-text available via subscription   (Followers: 18)
Advances in Protein Chemistry and Structural Biology     Full-text available via subscription   (Followers: 19, SJR: 1.5, h-index: 62)
Advances in Psychology     Full-text available via subscription   (Followers: 61)
Advances in Quantum Chemistry     Full-text available via subscription   (Followers: 5, SJR: 0.478, h-index: 32)
Advances in Radiation Oncology     Open Access  
Advances in Small Animal Medicine and Surgery     Hybrid Journal   (Followers: 2, SJR: 0.1, h-index: 2)
Advances in Space Research     Full-text available via subscription   (Followers: 349, SJR: 0.606, h-index: 65)
Advances in Structural Biology     Full-text available via subscription   (Followers: 8)
Advances in Surgery     Full-text available via subscription   (Followers: 7, SJR: 0.823, h-index: 27)
Advances in the Study of Behavior     Full-text available via subscription   (Followers: 30, SJR: 1.321, h-index: 56)
Advances in Veterinary Medicine     Full-text available via subscription   (Followers: 16)
Advances in Veterinary Science and Comparative Medicine     Full-text available via subscription   (Followers: 13)
Advances in Virus Research     Full-text available via subscription   (Followers: 5, SJR: 1.878, h-index: 68)
Advances in Water Resources     Hybrid Journal   (Followers: 43, SJR: 2.408, h-index: 94)
Aeolian Research     Hybrid Journal   (Followers: 5, SJR: 0.973, h-index: 22)
Aerospace Science and Technology     Hybrid Journal   (Followers: 318, SJR: 0.816, h-index: 49)
AEU - Intl. J. of Electronics and Communications     Hybrid Journal   (Followers: 8, SJR: 0.318, h-index: 36)
African J. of Emergency Medicine     Open Access   (Followers: 5, SJR: 0.344, h-index: 6)
Ageing Research Reviews     Hybrid Journal   (Followers: 8, SJR: 3.289, h-index: 78)
Aggression and Violent Behavior     Hybrid Journal   (Followers: 407, SJR: 1.385, h-index: 72)
Agri Gene     Hybrid Journal  
Agricultural and Forest Meteorology     Hybrid Journal   (Followers: 15, SJR: 2.18, h-index: 116)
Agricultural Systems     Hybrid Journal   (Followers: 30, SJR: 1.275, h-index: 74)
Agricultural Water Management     Hybrid Journal   (Followers: 39, SJR: 1.546, h-index: 79)
Agriculture and Agricultural Science Procedia     Open Access  
Agriculture and Natural Resources     Open Access   (Followers: 1)
Agriculture, Ecosystems & Environment     Hybrid Journal   (Followers: 54, SJR: 1.879, h-index: 120)
Ain Shams Engineering J.     Open Access   (Followers: 5, SJR: 0.434, h-index: 14)
Air Medical J.     Hybrid Journal   (Followers: 5, SJR: 0.234, h-index: 18)
AKCE Intl. J. of Graphs and Combinatorics     Open Access   (SJR: 0.285, h-index: 3)
Alcohol     Hybrid Journal   (Followers: 9, SJR: 0.922, h-index: 66)
Alcoholism and Drug Addiction     Open Access   (Followers: 8)
Alergologia Polska : Polish J. of Allergology     Full-text available via subscription   (Followers: 1)
Alexandria Engineering J.     Open Access   (Followers: 1, SJR: 0.436, h-index: 12)
Alexandria J. of Medicine     Open Access  
Algal Research     Partially Free   (Followers: 8, SJR: 2.05, h-index: 20)
Alkaloids: Chemical and Biological Perspectives     Full-text available via subscription   (Followers: 3)
Allergologia et Immunopathologia     Full-text available via subscription   (Followers: 1, SJR: 0.46, h-index: 29)
Allergology Intl.     Open Access   (Followers: 4, SJR: 0.776, h-index: 35)
Alpha Omegan     Full-text available via subscription   (SJR: 0.121, h-index: 9)
ALTER - European J. of Disability Research / Revue Européenne de Recherche sur le Handicap     Full-text available via subscription   (Followers: 8, SJR: 0.158, h-index: 9)
Alzheimer's & Dementia     Hybrid Journal   (Followers: 47, SJR: 4.289, h-index: 64)
Alzheimer's & Dementia: Diagnosis, Assessment & Disease Monitoring     Open Access   (Followers: 5)
Alzheimer's & Dementia: Translational Research & Clinical Interventions     Open Access   (Followers: 3)
American Heart J.     Hybrid Journal   (Followers: 48, SJR: 3.157, h-index: 153)
American J. of Cardiology     Hybrid Journal   (Followers: 45, SJR: 2.063, h-index: 186)
American J. of Emergency Medicine     Hybrid Journal   (Followers: 39, SJR: 0.574, h-index: 65)
American J. of Geriatric Pharmacotherapy     Full-text available via subscription   (Followers: 6, SJR: 1.091, h-index: 45)
American J. of Geriatric Psychiatry     Hybrid Journal   (Followers: 16, SJR: 1.653, h-index: 93)
American J. of Human Genetics     Hybrid Journal   (Followers: 31, SJR: 8.769, h-index: 256)
American J. of Infection Control     Hybrid Journal   (Followers: 24, SJR: 1.259, h-index: 81)
American J. of Kidney Diseases     Hybrid Journal   (Followers: 33, SJR: 2.313, h-index: 172)
American J. of Medicine     Hybrid Journal   (Followers: 46, SJR: 2.023, h-index: 189)
American J. of Medicine Supplements     Full-text available via subscription   (Followers: 3)
American J. of Obstetrics and Gynecology     Hybrid Journal   (Followers: 192, SJR: 2.255, h-index: 171)
American J. of Ophthalmology     Hybrid Journal   (Followers: 56, SJR: 2.803, h-index: 148)
American J. of Ophthalmology Case Reports     Open Access   (Followers: 4)
American J. of Orthodontics and Dentofacial Orthopedics     Full-text available via subscription   (Followers: 6, SJR: 1.249, h-index: 88)
American J. of Otolaryngology     Hybrid Journal   (Followers: 24, SJR: 0.59, h-index: 45)
American J. of Pathology     Hybrid Journal   (Followers: 26, SJR: 2.653, h-index: 228)
American J. of Preventive Medicine     Hybrid Journal   (Followers: 21, SJR: 2.764, h-index: 154)
American J. of Surgery     Hybrid Journal   (Followers: 34, SJR: 1.286, h-index: 125)
American J. of the Medical Sciences     Hybrid Journal   (Followers: 12, SJR: 0.653, h-index: 70)
Ampersand : An Intl. J. of General and Applied Linguistics     Open Access   (Followers: 5)
Anaerobe     Hybrid Journal   (Followers: 4, SJR: 1.066, h-index: 51)
Anaesthesia & Intensive Care Medicine     Full-text available via subscription   (Followers: 55, SJR: 0.124, h-index: 9)
Anaesthesia Critical Care & Pain Medicine     Full-text available via subscription   (Followers: 9)
Anales de Cirugia Vascular     Full-text available via subscription  
Anales de Pediatría     Full-text available via subscription   (Followers: 2, SJR: 0.209, h-index: 27)
Anales de Pediatría (English Edition)     Full-text available via subscription  
Anales de Pediatría Continuada     Full-text available via subscription   (SJR: 0.104, h-index: 3)
Analytic Methods in Accident Research     Hybrid Journal   (Followers: 2, SJR: 2.577, h-index: 7)
Analytica Chimica Acta     Hybrid Journal   (Followers: 37, SJR: 1.548, h-index: 152)
Analytical Biochemistry     Hybrid Journal   (Followers: 167, SJR: 0.725, h-index: 154)
Analytical Chemistry Research     Open Access   (Followers: 8, SJR: 0.18, h-index: 2)
Analytical Spectroscopy Library     Full-text available via subscription   (Followers: 11)
Anesthésie & Réanimation     Full-text available via subscription   (Followers: 1)
Anesthesiology Clinics     Full-text available via subscription   (Followers: 22, SJR: 0.421, h-index: 40)
Angiología     Full-text available via subscription   (SJR: 0.124, h-index: 9)
Angiologia e Cirurgia Vascular     Open Access  
Animal Behaviour     Hybrid Journal   (Followers: 157, SJR: 1.907, h-index: 126)
Animal Feed Science and Technology     Hybrid Journal   (Followers: 5, SJR: 1.151, h-index: 83)
Animal Reproduction Science     Hybrid Journal   (Followers: 5, SJR: 0.711, h-index: 78)
Annales d'Endocrinologie     Full-text available via subscription   (Followers: 1, SJR: 0.394, h-index: 30)
Annales d'Urologie     Full-text available via subscription  
Annales de Cardiologie et d'Angéiologie     Full-text available via subscription   (SJR: 0.177, h-index: 13)
Annales de Chirurgie de la Main et du Membre Supérieur     Full-text available via subscription  
Annales de Chirurgie Plastique Esthétique     Full-text available via subscription   (Followers: 2, SJR: 0.354, h-index: 22)
Annales de Chirurgie Vasculaire     Full-text available via subscription   (Followers: 1)

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Journal Cover American Journal of Obstetrics and Gynecology
  [SJR: 2.255]   [H-I: 171]   [192 followers]  Follow
    
   Hybrid Journal Hybrid journal (It can contain Open Access articles)
   ISSN (Print) 0002-9378
   Published by Elsevier Homepage  [3044 journals]
  • Health and economic burden of preeclampsia: no time for complacency
    • Authors: Rui Li; Eleni Z. Tsigas; William M. Callaghan
      Pages: 235 - 236
      Abstract: Publication date: September 2017
      Source:American Journal of Obstetrics and Gynecology, Volume 217, Issue 3
      Author(s): Rui Li, Eleni Z. Tsigas, William M. Callaghan


      PubDate: 2017-09-05T22:25:12Z
      DOI: 10.1016/j.ajog.2017.06.011
       
  • Short-term costs of preeclampsia to the United States health care system
    • Authors: Warren Stevens; Tiffany Shih; Devin Incerti; Thanh G.N. Ton; Henry C. Lee; Desi Peneva; George A. Macones; Baha M. Sibai; Anupam B. Jena
      Pages: 237 - 248.e16
      Abstract: Publication date: September 2017
      Source:American Journal of Obstetrics and Gynecology, Volume 217, Issue 3
      Author(s): Warren Stevens, Tiffany Shih, Devin Incerti, Thanh G.N. Ton, Henry C. Lee, Desi Peneva, George A. Macones, Baha M. Sibai, Anupam B. Jena
      Background Preeclampsia is a leading cause of maternal morbidity and mortality and adverse neonatal outcomes. Little is known about the extent of the health and cost burden of preeclampsia in the United States. Objective This study sought to quantify the annual epidemiological and health care cost burden of preeclampsia to both mothers and infants in the United States in 2012. Study Design We used epidemiological and econometric methods to assess the annual cost of preeclampsia in the United States using a combination of population-based and administrative data sets: the National Center for Health Statistics Vital Statistics on Births, the California Perinatal Quality Care Collaborative Databases, the US Health Care Cost and Utilization Project database, and a commercial claims data set. Results Preeclampsia increased the probability of an adverse event from 4.6% to 10.1% for mothers and from 7.8% to 15.4% for infants while lowering gestational age by 1.7 weeks (P < .001). Overall, the total cost burden of preeclampsia during the first 12 months after birth was $1.03 billion for mothers and $1.15 billion for infants. The cost burden per infant is dependent on gestational age, ranging from $150,000 at 26 weeks gestational age to $1311 at 36 weeks gestational age. Conclusion In 2012, the cost of preeclampsia within the first 12 months of delivery was $2.18 billion in the United States ($1.03 billion for mothers and $1.15 billion for infants), and was disproportionately borne by births of low gestational age.

      PubDate: 2017-09-05T22:25:12Z
      DOI: 10.1016/j.ajog.2017.04.032
       
  • Metformin, the aspirin of the 21st century: its role in gestational
           diabetes mellitus, prevention of preeclampsia and cancer, and the
           promotion of longevity
    • Authors: Roberto Romero; Offer Erez; Maik Hüttemann; Eli Maymon; Bogdan Panaitescu; Agustin Conde-Agudelo; Percy Pacora; Bo Hyun Yoon; Lawrence I. Grossman
      Pages: 282 - 302
      Abstract: Publication date: September 2017
      Source:American Journal of Obstetrics and Gynecology, Volume 217, Issue 3
      Author(s): Roberto Romero, Offer Erez, Maik Hüttemann, Eli Maymon, Bogdan Panaitescu, Agustin Conde-Agudelo, Percy Pacora, Bo Hyun Yoon, Lawrence I. Grossman
      Metformin is everywhere. Originally introduced in clinical practice as an antidiabetic agent, its role as a therapeutic agent is expanding to include treatment of prediabetes mellitus, gestational diabetes mellitus, and polycystic ovarian disease; more recently, experimental studies and observations in randomized clinical trials suggest that metformin could have a place in the treatment or prevention of preeclampsia. This article provides a brief overview of the history of metformin in the treatment of diabetes mellitus and reviews the results of metaanalyses of metformin in gestational diabetes mellitus as well as the treatment of obese, non-diabetic, pregnant women to prevent macrosomia. We highlight the results of a randomized clinical trial in which metformin administration in early pregnancy did not reduce the frequency of large-for-gestational-age infants (the primary endpoint) but did decrease the frequency of preeclampsia (a secondary endpoint). The mechanisms by which metformin may prevent preeclampsia include a reduction in the production of antiangiogenic factors (soluble vascular endothelial growth factor receptor-1 and soluble endoglin) and the improvement of endothelial dysfunction, probably through an effect on the mitochondria. Another potential mechanism whereby metformin may play a role in the prevention of preeclampsia is its ability to modify cellular homeostasis and energy disposition, mediated by rapamycin, a mechanistic target. Metformin has a molecular weight of 129 Daltons and therefore readily crosses the placenta. There is considerable evidence to suggest that this agent is safe during pregnancy. New literature on the role of metformin as a chemotherapeutic adjuvant in the prevention of cancer and in prolonging life and protecting against aging is reviewed briefly. Herein, we discuss the mechanisms of action and potential benefits of metformin.

      PubDate: 2017-09-05T22:25:12Z
      DOI: 10.1016/j.ajog.2017.06.003
       
  • Optimizing postpartum care for the patient with gestational diabetes
           mellitus
    • Authors: Noelle G. Martinez; Charlotte M. Niznik; Lynn M. Yee
      Pages: 314 - 321
      Abstract: Publication date: September 2017
      Source:American Journal of Obstetrics and Gynecology, Volume 217, Issue 3
      Author(s): Noelle G. Martinez, Charlotte M. Niznik, Lynn M. Yee
      Gestational diabetes mellitus poses well-established risks to both the mother and infant. As >50% of women with gestational diabetes mellitus will develop type 2 diabetes mellitus in their lifetime, performing postpartum oral glucose tolerance testing is paramount to initiation of appropriate lifestyle interventions and pharmacologic therapy. Nonetheless, test completion among women with gestational diabetes mellitus is estimated to be <50%, with particularly low rates in Latina patients, as well as patients with public insurance, low education levels, and low health literacy. Data suggest our current health services infrastructure loses patients in the postpartum gap between pregnancy-focused care and primary care. Previous studies have suggested strategies to promote oral glucose tolerance testing completion to identify type 2 diabetes mellitus. Based on existing evidence, we propose best practices for the postpartum care of women with gestational diabetes mellitus: (1) enhanced patient support for identifying long-term health care providers, (2) patient-centered medical home utilization when possible, (3) patient and provider test reminders, and (4) formalized obstetrician-primary care provider hand offs using the Situation Background Assessment Recommendation (SBAR) mnemonic. These strategies deserve future investigation to solidify a multilevel approach for identifying and preventing the continuum of diabetes.

      PubDate: 2017-09-05T22:25:12Z
      DOI: 10.1016/j.ajog.2017.04.033
       
  • Reproductive rights advocacy: not just for the family-planning community
    • Authors: Cara C. Heuser; Karen J. Gibbins; Marcela C. Smid; D. Ware Branch
      Pages: 322.e1 - 322.e4
      Abstract: Publication date: September 2017
      Source:American Journal of Obstetrics and Gynecology, Volume 217, Issue 3
      Author(s): Cara C. Heuser, Karen J. Gibbins, Marcela C. Smid, D. Ware Branch
      Women and families benefit from access to the full spectrum of reproductive care, including family-planning services. We commend our family-planning colleagues on their tireless dedication to preserve the rights of women through advocacy. While several of our perinatology peers have also set an example by dedication to these issues, advocacy for patient access to reproductive care options has not been a focus of the larger perinatology community. The time has come for individual perinatologists, as well as the overall perinatology community, to join them and do the work needed to preserve access to safe care, including contraception and abortion services. In this call to action, we detail several ways that individuals and the community can become more involved in working for reproductive rights.

      PubDate: 2017-09-05T22:25:12Z
      DOI: 10.1016/j.ajog.2017.06.006
       
  • Decreasing postoperative narcotics in reconstructive pelvic surgery:
           a randomized controlled trial
    • Authors: Krista M.L. Reagan; David M. O’Sullivan; Richard Gannon; Adam C. Steinberg
      Pages: 325.e1 - 325.e10
      Abstract: Publication date: September 2017
      Source:American Journal of Obstetrics and Gynecology, Volume 217, Issue 3
      Author(s): Krista M.L. Reagan, David M. O’Sullivan, Richard Gannon, Adam C. Steinberg
      Background Postoperative pain control is crucial to any successful recovery plan. Many currently used medication regimens are narcotic-focused. Objective The objective of our study was to evaluate the efficacy of a multimodal pain regimen after pelvic reconstructive surgery. Study Design The primary outcome measure was narcotic use. Secondary outcomes included pain, nausea, and constipation. Patients were randomized to either usual care postoperative treatment or multimodal pain regimen. Usual care included no specific preoperative or intraoperative medications, and postoperative narcotics with ibuprofen. Multimodal pain regimen included preoperative and postoperative celecoxib, gabapentin, intraoperative and postoperative intravenous and oral acetaminophen and ibuprofen, and narcotics as needed. All narcotics were converted to milligram equivalents of oral morphine for standardization according to Centers for Disease Control and Prevention guidelines where conversion factors for oral hydrocodone = 1, oral oxycodone = 1.5, and oral hydromorphone = 4. Patients were given the validated Brief Pain Inventory survey preoperatively (baseline), at postoperative day 1, and 1 week postoperatively. At 1 week, bowel function and narcotics usage was assessed. Results Seventy patients were randomized to the usual care arm and 68 to the multimodal pain regimen arm. Patients in the multimodal pain regimen arm used significantly fewer intravenous narcotics in the operating room (90.7 ± 39.1 mg vs 104.6 ± 33.5 mg; P = .026) and while in the hospital (10.8 ± 15.1 mg vs 31.2 ± 29.6 mg; P < .001) and were more likely to use 0 oral narcotics after discharge to home (34.8% of patients vs 10.6%; P = .001). Of the patients who did use oral narcotics after discharge to home, there was no difference in amount used between groups (121.3 ± 103.7 mg in the multimodal pain regimen arm vs 153.0 ± 113.8 mg in the usual care arm; P = .139). Total narcotic usage (operating room + hospital + home) was significantly less in the multimodal pain regimen arm of the study (195.5 ± 147.2 mg vs 304.0 ± 162.1 mg; P < .001). There were no significant differences in pain scores between the 2 arms of the study on either postoperative time point. There were no significant differences in antiemetic use while in hospital, consistency of first bowel movement, length of stay, or number of telephone calls to nurses in first 3 weeks postoperatively. Conclusion A multimodal pain regimen in pelvic reconstructive surgery was found to decrease postoperative opioid requirements, while providing equivalent pain control.

      PubDate: 2017-09-05T22:25:12Z
      DOI: 10.1016/j.ajog.2017.05.041
       
  • Pregnancy, birth, and infant outcomes by maternal fertility status: the
           Massachusetts Outcomes Study of Assisted Reproductive Technology
    • Authors: Barbara Luke; Daksha Gopal; Howard Cabral; Judy E. Stern; Hafsatou Diop
      Pages: 330.e1 - 330.e15
      Abstract: Publication date: September 2017
      Source:American Journal of Obstetrics and Gynecology, Volume 217, Issue 3
      Author(s): Barbara Luke, Daksha Gopal, Howard Cabral, Judy E. Stern, Hafsatou Diop
      Background Births to subfertile women, with and without infertility treatment, have been reported to have lower birthweights and shorter gestations, even when limited to singletons. It is unknown whether these decrements are due to parental characteristics or aspects of infertility treatment. Objective The objective of the study was to evaluate the effect of maternal fertility status on the risk of pregnancy, birth, and infant complications. Study Design All singleton live births of ≥22 weeks’ gestation and ≥350 g birthweight to Massachusetts resident women in 2004–2010 were linked to hospital discharge and vital records. Women were categorized by their fertility status as in vitro fertilization, subfertile, or fertile. Women whose births linked to in vitro fertilization cycles from the Society for Assisted Reproductive Technology Clinic Outcomes Reporting System were classified as in vitro fertilization. Women with indicators of subfertility but not treated with in vitro fertilization were classified as subfertile. Women without indicators of subfertility or in vitro fertilization treatment were classified as fertile. Risks of 15 adverse outcomes (gestational diabetes, pregnancy hypertension, antenatal bleeding, placental complications [placenta abruptio and placenta previa], prenatal hospitalizations, primary cesarean delivery, very low birthweight [<1500 g], low birthweight [<2500 g], small-for-gestation birthweight [z-score ≤–1.28], large-for-gestation birthweight [z-score ≥1.28], very preterm [<32 weeks], preterm [<37 weeks], birth defects, neonatal death [0–27 days], and infant death [0–364 days of life]) were modeled by fertility status with the fertile group as reference and the subfertile group as reference, using multivariate log binomial regression and reported as adjusted risk ratios and 95% confidence intervals. Results The study population included 459,623 women (441,420 fertile, 8054 subfertile, and 10,149 in vitro fertilization). Women in the subfertile and in vitro fertilization groups were older than their fertile counterparts. Risks for 6 of 6 pregnancy outcomes and 6 of 9 infant outcomes were increased for the subfertile group, and 5 of 6 pregnancy outcomes and 7 of 9 infant outcomes were increased for the in vitro fertilization group. For 4 of the 6 pregnancy outcomes (uterine bleeding, placental complications, prenatal hospitalizations, and primary cesarean) and 2 of the infant outcomes (low birthweight and preterm) the risk was greater in the in vitro fertilization group, with nonoverlapping confidence intervals to the subfertile group, indicating a substantially higher risk among in vitro fertilization–treated women. The highest risks for the in vitro fertilization women were uterine bleeding (adjusted risk ratio, 3.80; 95% confidence interval, 3.31–4.36) and placental complications (adjusted risk ratio, 2.81; 95% confidence interval, 2.57–3.08), and for in vitro fertilization infants, very preterm birth (adjusted risk ratio, 2.13; 95% confidence interval, 1.80–2.52), and very low birthweight (adjusted risk ratio, 2.15; 95% confidence interval, 1.80–2.56). With subfertile women as reference, risks for the in vitro fertilization group were significantly increased for uterine bleeding, placental complications, prenatal hospitalizations, primary cesarean delivery, low and very low birthweight, and preterm and very preterm birth. Conclusion These analyses indicate that, compared with fertile women, subfertile and in vitro fertilization–treated women tend to be older, have more preexisting chronic conditions, and are at higher risk for adverse pregnancy outcomes, particularly uterine bleeding and placental complications. The greater risk in in vitro fertilization–treated women may reflect more severe infertility, more extensive underlying pathology, or other unfavorable factors not measured in this study.

      PubDate: 2017-09-05T22:25:12Z
      DOI: 10.1016/j.ajog.2017.04.025
       
  • Adverse pregnancy, birth, and infant outcomes in twins: effects
           of maternal fertility status and infant gender combinations; the
           Massachusetts Outcomes Study of Assisted Reproductive Technology
    • Authors: Barbara Luke; Daksha Gopal; Howard Cabral; Judy E. Stern; Hafsatou Diop
      Pages: 330.e1 - 330.e15
      Abstract: Publication date: September 2017
      Source:American Journal of Obstetrics and Gynecology, Volume 217, Issue 3
      Author(s): Barbara Luke, Daksha Gopal, Howard Cabral, Judy E. Stern, Hafsatou Diop
      Background It is unknown whether the risk of adverse outcomes in twin pregnancies among subfertile women, conceived with and without in vitro fertilization, differs from those conceived spontaneously. Objective We sought to evaluate the effects of fertility status on adverse perinatal outcomes in twin pregnancies on a population basis. Study Design All twin live births of ≥22 weeks’ gestation and ≥350 g birthweight to Massachusetts resident women in 2004 through 2010 were linked to hospital discharge records, vital records, and in vitro fertilization cycles. Women were categorized by their fertility status as in vitro fertilization, subfertile, or fertile, and by twin pair genders (all, like, unlike). Women whose births linked to in vitro fertilization cycles were classified as in vitro fertilization; those with indicators of subfertility but without in vitro fertilization treatment were classified as subfertile; all others were classified as fertile. Risks of 6 adverse pregnancy outcomes (gestational diabetes, pregnancy hypertension, uterine bleeding, placental complications [placenta abruptio, placenta previa, and vasa previa], prenatal hospitalizations, and primary cesarean) and 9 adverse infant outcomes (very low birthweight, low birthweight, small-for-gestation birthweight, large-for-gestation birthweight, very preterm [<32 weeks], preterm, birth defects, neonatal death, and infant death) were modeled by fertility status with the fertile group as reference, using multivariate log binomial regression and reported as adjusted relative risk ratios and 95% confidence intervals. Results The study population included 10,352 women with twin pregnancies (6090 fertile, 724 subfertile, and 3538 in vitro fertilization). Among all twins, the risks for all 6 adverse pregnancy outcomes were significantly increased for the subfertile and in vitro fertilization groups, with highest risks for uterine bleeding (adjusted relative risk ratios, 1.92 and 2.58, respectively) and placental complications (adjusted relative risk ratios, 2.07 and 1.83, respectively). Among all twins, the risks for those born to subfertile women were significantly increased for very preterm birth and neonatal and infant death (adjusted relative risk ratios, 1.36, 1.89, and 1.87, respectively). Risks were significantly increased among in vitro fertilization twins for very preterm birth, preterm birth, and birth defects (adjusted relative risk ratios, 1.28, 1.07, and 1.26, respectively). Conclusion Risks of all maternal and most infant adverse outcomes were increased for subfertile and in vitro fertilization twins. Among all twins, the highest risks were for uterine bleeding and placental complications for the subfertile and in vitro fertilization groups, and neonatal and infant death in the subfertile group. These findings provide further evidence supporting single embryo transfer and more cautious use of ovulation induction.

      PubDate: 2017-09-05T22:25:12Z
      DOI: 10.1016/j.ajog.2017.04.025
       
  • Survival of women with microinvasive adenocarcinoma of the cervix is not
           improved by radical surgery
    • Authors: Lisa M. Bean; Kristy K. Ward; Steven C. Plaxe; Michael T. McHale
      Pages: 332.e1 - 332.e6
      Abstract: Publication date: September 2017
      Source:American Journal of Obstetrics and Gynecology, Volume 217, Issue 3
      Author(s): Lisa M. Bean, Kristy K. Ward, Steven C. Plaxe, Michael T. McHale
      Background Treatment for early-invasive adenocarcinoma of the cervix remains controversial. Although data have shown similar survival rates to those seen with squamous cell carcinoma, conservative options for patients with microinvasive adenocarcinoma have not been as widely accepted. Despite comparable survival outcomes, patients with early-invasive adenocarcinoma are still routinely subjected to more radical surgical techniques than their equivalently staged squamous cell counterparts. Objective The objective of the study was to evaluate how less radical surgery has an impact on 5 year survival in patients with microinvasive adenocarcinoma of the cervix. Study Design The Surveillance, Epidemiology, and End Results database was queried from 1988 through 2010 to perform a retrospective analysis of women with International Federation of Gynecology and Obstetrics stage IA1 or IA2 cervical carcinoma. Five year survival by procedure type (local excision, simple hysterectomy, or radical hysterectomy) was determined for each cell type (squamous or adenocarcinoma), as was lymph node status. Results Among 1567 patients with cervical adenocarcinoma, 5 year survival was 97.3% (confidence interval, 95.8–98.2%) for stage IA1 disease and 98.3% (confidence interval, 96.5%, 99.2%) for stage IA2. For comparison, the 5-year survival rates for 5,749 patients with stage IAI or lA2 squamous cell carcinoma were 96.7% (confidence interval, 96.0–97.3%) and 95.6% (confidence interval, 94.4–96.5%), respectively. For stage IA1 ACA, survival was 96.6%, 98.4% and 96.5% following excision, hysterectomy and radical hysterectomy, respectively. For stage IA2 ACA, survival rates were 100%, 96.9% and 99.4%, respectively. There was no statistical difference in survival between patients having either cell type undergoing local excision (P = .26), simple hysterectomy (P = .08), or radical hysterectomy (P = .87). We also found no statistically significant difference in survival among patients with adenocarcinoma compared by treatment type (local excision compared with simple hysterectomy [P = .64]; local excision compared with radical hysterectomy [P = .82]; or simple hysterectomy compared with radical hysterectomy [P = .70]). Among patients with adenocarcinoma, 0.97% had positive pelvic lymph nodes, none had positive aortic lymph nodes, and 91.85% had confirmed negative lymph nodes. For squamous cell carcinoma, 0.72% of patients had positive pelvic lymph nodes and 0.10% had positive aortic lymph nodes. Conclusion There was no significant difference in survival when patients were compared by cell type or procedure, suggesting that survival of patients with microinvasive adenocarcinoma is not improved by utilizing more invasive surgical methods. Regardless of histology, the frequency of nodal involvement was very low among both groups, supporting an overall excellent prognosis for all patients with microinvasive disease. We submit these data as evidence that preoperative planning of more conservative techniques is appropriate, not just for those with squamous histology or who desire future fertility, but for all patients with microinvasive cervical disease.

      PubDate: 2017-09-05T22:25:12Z
      DOI: 10.1016/j.ajog.2017.05.021
       
  • BRCA mutational status, initial disease presentation, and clinical outcome
           in high-grade serous advanced ovarian cancer: a multicenter study
    • Authors: Marco Petrillo; Claudia Marchetti; Rossella De Leo; Angela Musella; Ettore Capoluongo; Ida Paris; Pierluigi Benedetti Panici; Giovanni Scambia; Anna Fagotti
      Pages: 334.e1 - 334.e9
      Abstract: Publication date: September 2017
      Source:American Journal of Obstetrics and Gynecology, Volume 217, Issue 3
      Author(s): Marco Petrillo, Claudia Marchetti, Rossella De Leo, Angela Musella, Ettore Capoluongo, Ida Paris, Pierluigi Benedetti Panici, Giovanni Scambia, Anna Fagotti
      Background In the last decades, there have been several efforts to clarify the role of BRCA mutational status in women with advanced ovarian cancer, demonstrating its role in cancer development, as well as the prognostic significance of BRCA genotype. Objective Our aim is to evaluate the correlation between BRCA mutational status and disease presentation in a large series of advanced high-grade serous ovarian cancer patients. Study Design This is a retrospective multicenter study including a consecutive series of newly diagnosed high-grade serous ovarian cancer patients with International Federation of Gynecology and Obstetrics stage IIIC-IV disease, at least 18 months of follow-up time, and tested for BRCA 1/2 germline mutation status. Disease presentation was analyzed using the following variables: laparoscopic predictive index value, incidence of bulky lymph nodes, and ovarian masses. Progression-free survival was defined as the months elapsed from initial diagnosis (staging laparoscopy) and recurrent disease or last follow-up. Results In all, 324 high-grade serous ovarian cancer patients received BRCA testing, and 273 fulfilled inclusion criteria. BRCA1/2 germline mutations were observed in 107 women (39.2%). No differences were documented according to BRCA mutation status in terms of International Federation of Gynecology and Obstetrics stage, CA125 levels, or presence of ascites. In patients with BRCA1/2 mutations we observed a higher incidence of peritoneal spread without ovarian mass (25.2% vs 13.9%; P value = .018) and of bulky lymph nodes (30.8% vs 17.5%; P value = .010) compared with women showing BRCA1/2 wild type genotype. Furthermore, women with BRCA1/2 mutations showed high peritoneal tumor load (laparoscopic predictive index value ≥8; 42.1% vs 27.1%; P value = .016) more frequently. Focusing on survival, no differences in term of median progression-free survival were observed among women treated with primary debulking surgery and neoadjuvant chemotherapy in the group of patients with BRCA1/2 mutations (P value = .268). On the other hand, in women showing BRCA wild type genotype, median progression-free survival after primary debulking surgery was 8 months longer compared with patients treated with neoadjuvant chemotherapy approach (26 vs 18 months; P value = .003). Conclusion Women with BRCA1/2 mutations show at diagnosis higher peritoneal tumor load and increased frequency of bulky lymph nodes compared to patients without germline BRCA mutations. Primary debulking surgery seems to ensure a longer progression-free survival in women with BRCA wild type genotype compared to neoadjuvant chemotherapy. BRCA testing might be a reliable tool to personalize treatment in patients with high-grade serous ovarian cancer, thus giving novel points of discussion to the ongoing debate regarding the best initial treatment approach.

      PubDate: 2017-09-05T22:25:12Z
      DOI: 10.1016/j.ajog.2017.05.036
       
  • Effect of professional society recommendations on women’s desire for a
           routine pelvic examination
    • Authors: George F. Sawaya; Karen K. Smith-McCune; Steven E. Gregorich; Michelle Moghadassi; Miriam Kuppermann
      Pages: 338.e1 - 338.e7
      Abstract: Publication date: September 2017
      Source:American Journal of Obstetrics and Gynecology, Volume 217, Issue 3
      Author(s): George F. Sawaya, Karen K. Smith-McCune, Steven E. Gregorich, Michelle Moghadassi, Miriam Kuppermann
      Background The American College of Physicians strongly recommends against performing pelvic examinations in asymptomatic, nonpregnant women, citing evidence of harm (false-positive testing, unnecessary surgery) and no evidence of benefit. In contrast, the American Congress of Obstetricians and Gynecologists recommends pelvic examinations in asymptomatic women beginning at age 21 years, citing expert opinion. Objective We sought to evaluate if providing women with professional societies’ conflicting statements about pelvic examinations (recommendations and rationales) would influence their desire for a routine examination. Study Design We recruited 452 women ages 21-65 years from 2 women’s clinics to participate in a 50-minute face-to-face interview about cervical cancer screening that included a 2-phase study related to pelvic examinations. In the first phase, 262 women were asked about their desire for the examination without being provided information about professional societies’ recommendations. In the second phase, 190 women were randomized to review summaries of the American College of Physicians or American Congress of Obstetricians and Gynecologists statement followed by an interview. Results First-phase participants served as the referent: 79% (208/262) indicated they would want a routine examination if given a choice. In the second phase, a similar percentage of women randomized to the American Congress of Obstetricians and Gynecologists summary had this desire (82%: 80/97; adjusted odds ratio, 1.37; 95% confidence interval, 0.69–2.70). Women randomized to the American College of Physicians summary, however, were less likely to indicate they would opt for an examination (39%: 36/93; adjusted odds ratio, 0.12; 95% confidence interval, 0.06–0.21). Overall, 94% (179/190) believed the potential benefits and harms should be discussed prior to the examination. Conclusion Providing women with a professional society’s recommendation advising against routine pelvic examinations substantially reduced their desire to have one. Educational materials are needed to ensure women’s informed preferences and values are reflected in decisions about pelvic examinations.

      PubDate: 2017-09-05T22:25:12Z
      DOI: 10.1016/j.ajog.2017.05.003
       
  • The maternal childbirth experience more than a decade after delivery
    • Authors: Carla M. Bossano; Kelly M. Townsend; Alexandra C. Walton; Joan L. Blomquist; Victoria L. Handa
      Pages: 342.e1 - 342.e8
      Abstract: Publication date: September 2017
      Source:American Journal of Obstetrics and Gynecology, Volume 217, Issue 3
      Author(s): Carla M. Bossano, Kelly M. Townsend, Alexandra C. Walton, Joan L. Blomquist, Victoria L. Handa
      Background Maternal satisfaction with the birth experience is multidimensional and influenced by many factors, including mode of delivery. To date, few studies have investigated maternal satisfaction outside of the immediate postpartum period. Objective This study investigated whether differences in satisfaction based on mode of delivery are observed more than a decade after delivery. Study Design This was a planned, supplementary analysis of data collected for the Mothers’ Outcomes after Delivery study, a longitudinal cohort study of pelvic floor disorders in parous women and their association with mode of delivery. Obstetric and demographic data were obtained through patient surveys and obstetrical chart review. Maternal satisfaction with childbirth experience was assessed via the Salmon questionnaire, administered to Mothers’ Outcomes after Delivery study participants >10 years from their first delivery. This validated questionnaire yields 3 scores: fulfillment, distress, and difficulty. These 3 scores were compared by mode of delivery (cesarean prior to labor, cesarean during labor, spontaneous vaginal delivery, and operative vaginal delivery). In addition, the impact of race, age, education level, parity, episiotomy, labor induction, and duration of second stage of labor on maternal satisfaction were examined. Results Among 576 women, 10.1-17.5 years from delivery, significant differences in satisfaction scores were noted by delivery mode. Salmon scale scores differed between women delivering by cesarean and those delivering vaginally: women delivering vaginally reported greater fulfillment (0.40 [–0.37 to 0.92] vs 0.15 [–0.88 to 0.66], P < .001) and less distress (–0.34 [–0.88 to 0.38] vs 0.20 [–0.70 to 0.93], P < .001) than those who delivered by cesarean. Women who delivered by cesarean prior to labor reported the greatest median fulfillment scores and the lowest median difficulty scores. Median distress scores were lowest among those who delivered by spontaneous vaginal birth. Among women who underwent cesarean delivery, labor induction and prolonged second stage were associated with higher difficulty scores. These factors did not affect satisfaction scores among women who delivered vaginally. Among women who delivered vaginally, operative vaginal delivery was associated with less favorable scores across all 3 scores. Conclusion Maternal satisfaction with childbirth is influenced by mode of delivery. The birth experience leaves an impression on women more than a decade after delivery.

      PubDate: 2017-09-05T22:25:12Z
      DOI: 10.1016/j.ajog.2017.04.027
       
  • The placental imprinted DLK1-DIO3 domain: a new link to prenatal and
           postnatal growth in humans
    • Authors: Anna Prats-Puig; Gemma Carreras-Badosa; Judit Bassols; Patricia Cavelier; Agnés Magret; Cristina Sabench; Francis de Zegher; Lourdes Ibáñez; Robert Feil; Abel López-Bermejo
      Pages: 350.e1 - 350.e13
      Abstract: Publication date: September 2017
      Source:American Journal of Obstetrics and Gynecology, Volume 217, Issue 3
      Author(s): Anna Prats-Puig, Gemma Carreras-Badosa, Judit Bassols, Patricia Cavelier, Agnés Magret, Cristina Sabench, Francis de Zegher, Lourdes Ibáñez, Robert Feil, Abel López-Bermejo
      Background The developmentally important DLK1-DIO3 imprinted domain on human chromosome 14 is regulated by 2 differentially methylated regions, the intergenic differentially methylated region and the MEG3 differentially methylated region. Objective The aim was to determine the natural variation in DNA methylation at these differentially methylated regions in human placentas, and to determine its link to gene expression levels at the domain. The second goal was to explore whether the domain’s methylation and gene expression correlate with prenatal and early postnatal growth of the conceptus. Study Design Using pyrosequencing, we determined methylation levels at CpG dinucleotides across the 2 regulatory differentially methylated regions in placentas from 91 healthy mothers. At birth, placentas and infants were weighed (gestational age 39 ± 1 weeks; birthweight SD score 0.1 ± 0.8) and placental biopsies were collected. RNA expression was quantitated by real-time polymerase chain reaction. Infants’ weights and lengths were followed up monthly during the first year. Results Methylation levels at the 2 regulatory differentially methylated regions were linked and varied considerably between placentas. MEG3 promoter differentially methylated region methylation correlated negatively with weight increase (β = –0.406, P = .001, R2 = 0.206) and length increase (β = –0.363, P = .002, R2 = 0.230) during the first postnatal year. The methylation level of the intergenic differentially methylated region correlated with DIO3 expression (β = 0.313, P = .032, R2 = 0.152). Furthermore, the expression of both DIO3 and RTL1 (both imprinted genes within the DLK1-DIO3 domain) was negatively associated with birthweight (β = –0.331, P = .002, R2 = 0.165; and β = –0.307, P = .005, R2 = 0.159, respectively). RTL1 expression, in addition, was negatively linked to birth length (β = –0.306, P = .007, R2 = 0.162). Conclusion Our combined findings strongly suggest that placental DNA methylation at the DLK1-DIO3 domain’s intergenic differentially methylated region and MEG3 promoter differentially methylated region relates to measures of early human growth, and may thus contribute to its control.

      PubDate: 2017-09-05T22:25:12Z
      DOI: 10.1016/j.ajog.2017.05.002
       
  • Contribution of maternal age and pregnancy checkbox on maternal mortality
           ratios in the United States, 1978–2012
    • Authors: Nicole L. Davis; Donna L. Hoyert; David A. Goodman; Ashley H. Hirai; William M. Callaghan
      Pages: 352.e1 - 352.e7
      Abstract: Publication date: September 2017
      Source:American Journal of Obstetrics and Gynecology, Volume 217, Issue 3
      Author(s): Nicole L. Davis, Donna L. Hoyert, David A. Goodman, Ashley H. Hirai, William M. Callaghan
      Background Maternal mortality ratios (MMR) appear to have increased in the United States over the last decade. Three potential contributing factors are (1) a shifting maternal age distribution, (2) changes in age-specific MMR, and (3) the addition of a checkbox indicating recent pregnancy on the death certificate. Objective To determine the contribution of increasing maternal age on changes in MMR from 1978 to 2012 and estimate the contribution of the pregnancy checkbox on increases in MMR over the last decade. Study Design Kitagawa decomposition analyses were conducted to partition the maternal age contribution to the MMR increase into 2 components: changes due to a shifting maternal age distribution and changes due to greater age-specific mortality ratios. We used National Vital Statistics System natality and mortality data. The following 5-year groupings were used: 1978–1982, 1988–1992, 1998–2002, and 2008–2012. Changes in age-specific MMRs among states that adopted the standard pregnancy checkbox onto their death certificate before 2008 (n = 23) were compared with states that had not adopted the standard pregnancy checkbox on their death certificate by the end of 2012 (n = 11) to estimate the percentage increase in the MMR due to the pregnancy checkbox. Results Overall US MMRs for 1978–1982, 1988–1992, and 1998–2002 were 9.0, 8.1, and 9.1 deaths per 100,000 live births, respectively. There was a modest increase in the MMR between 1998–2002 and 2008–2012 in the 11 states that had not adopted the standard pregnancy checkbox on their death certificate by the end of 2012 (8.6 and 9.9 deaths per 100,000, respectively). However, the MMR more than doubled between 1998–2002 and 2008–2012 in the 23 states that adopted the standard pregnancy checkbox (9.0–22.4); this dramatic increase was almost entirely attributable to increases in age-specific MMRs (94.9%) as opposed to increases in maternal age (5.1%), with an estimated 90% of the observed change reflecting the change in maternal death identification rather than a real change in age-specific rates alone. Of all age categories, women ages 40 and older in states that adopted the standard pregnancy checkbox had the largest increase in MMR—from 31.9 to 200.5—a relative increase of 528%, which accounted for nearly one third of the overall increase. An estimated 28.8% of the observed change was potentially due to maternal death misclassification among women ≥40 years. Conclusion Increasing age-specific maternal mortality seems to be contributing more heavily than a changing maternal age distribution to recent increases in MMR. In states with the standard pregnancy checkbox, the vast majority of the observed change in MMR over the last decade was estimated to be due to the pregnancy checkbox, with the greatest change in MMR occurring in women ages ≥40 years. The addition of a pregnancy checkbox on state death certificates appears to be increasing case identification but also may be leading to maternal death misclassification, particularly for women ages ≥40 years.

      PubDate: 2017-09-05T22:25:12Z
      DOI: 10.1016/j.ajog.2017.04.042
       
  • Early pregnancy vaginal microbiome trends and preterm birth
    • Authors: Molly J. Stout; Yanjiao Zhou; Kristine M. Wylie; Phillip I. Tarr; George A. Macones; Methodius G. Tuuli
      Pages: 356.e1 - 356.e18
      Abstract: Publication date: September 2017
      Source:American Journal of Obstetrics and Gynecology, Volume 217, Issue 3
      Author(s): Molly J. Stout, Yanjiao Zhou, Kristine M. Wylie, Phillip I. Tarr, George A. Macones, Methodius G. Tuuli
      Background Despite decades of attempts to link infectious agents to preterm birth, an exact causative microbe or community of microbes remains elusive. Nonculture 16S ribosomal RNA gene sequencing suggests important racial differences and pregnancy specific changes in the vaginal microbial communities. A recent study examining the association of the vaginal microbiome and preterm birth documented important findings but was performed in a predominantly white cohort. Given the important racial differences in bacterial communities within the vagina as well as persistent racial disparities in preterm birth, it is important to examine cohorts with varied demographic compositions. Objective To characterize vaginal microbial community characteristics in a large, predominantly African-American, longitudinal cohort of pregnant women and test whether particular vaginal microbial community characteristics are associated with the risk for subsequent preterm birth. Study Design This is a nested case-control study within a prospective cohort study of women with singleton pregnancies, not on supplemental progesterone, and without cervical cerclage in situ. Serial mid-vaginal swabs were obtained by speculum exam at their routine prenatal visits. Sequencing of the V1V3 region of the 16S rRNA gene was performed on the Roche 454 platform. Alpha diversity community characteristics including richness, Shannon diversity, and evenness as well as beta diversity metrics including Bray Curtis Dissimilarity and specific taxon abundance were compared longitudinally in women who delivered preterm to those who delivered at term. Results A total of 77 subjects contributed 149 vaginal swabs longitudinally across pregnancy. Participants were predominantly African-American (69%) and had a preterm birth rate of 31%. In subjects with subsequent term delivery, the vaginal microbiome demonstrated stable community richness and Shannon diversity, whereas subjects with subsequent preterm delivery had significantly decreased vaginal richness, diversity, and evenness during pregnancy (P < .01). This change occurred between the first and second trimesters. Within-subject comparisons across pregnancy showed that preterm birth is associated with increased vaginal microbiome instability compared to term birth. No distinct taxa were associated with preterm birth. Conclusion In a predominantly African-American population, a significant decrease of vaginal microbial community richness and diversity is associated with preterm birth. The timing of this suppression appears early in pregnancy, between the first and second trimesters, suggesting that early gestation may be an ecologically important time for events that ordain subsequent term and preterm birth outcomes.

      PubDate: 2017-09-05T22:25:12Z
      DOI: 10.1016/j.ajog.2017.05.030
       
  • Giants in Obstetrics and Gynecology Series: A profile of
           Leon Speroff, MD
    • Authors: Roberto Romero
      Pages: 112 - 120.e3
      Abstract: Publication date: September 2017
      Source:American Journal of Obstetrics and Gynecology, Volume 217, Issue 3
      Author(s): Roberto Romero


      PubDate: 2017-09-05T22:25:12Z
      DOI: 10.1016/j.ajog.2017.05.044
       
  • Thyroid stimulating hormone, anti-thyroid antibodies and pregnancy
           outcomes
    • Authors: Torie C. Plowden; Enrique F. Schisterman; Lindsey A. Sjaarda; Neil J. Perkins; Robert Silver; Rose Radin; Keewan Kim; Noya Galai; Alan H. DeCherney; Sunni L. Mumford
      Abstract: Publication date: Available online 14 September 2017
      Source:American Journal of Obstetrics and Gynecology
      Author(s): Torie C. Plowden, Enrique F. Schisterman, Lindsey A. Sjaarda, Neil J. Perkins, Robert Silver, Rose Radin, Keewan Kim, Noya Galai, Alan H. DeCherney, Sunni L. Mumford
      Background Overt thyroid dysfunction has been associated with adverse obstetrical outcomes. However, less is known regarding subclinical hypothyroidism or thyroid autoimmunity and their relationship to pregnancy complications. Objective To examine the association between pre-pregnancy anti-thyroid antibodies and subclinical hypothyroidism and preterm delivery (PTD), gestational diabetes (GDM), and preeclampsia. Study Design Secondary analysis of a prospective cohort of 18-40 year old women with 1-2 prior pregnancy losses (n=1193) participating in a multi-center randomized, placebo-controlled trial of low-dose aspirin. Pre-pregnancy levels of thyroid stimulating hormone (TSH), free thyroxine, thyroglobulin antibody (anti-TG) and thyroid peroxidase antibody (anti-TPO) were measured. Relative risks (RR) and 95% confidence intervals (CIs) were estimated using generalized linear models adjusting for age and body mass index (BMI). Results Among women with an ongoing pregnancy of >20 weeks estimated gestational age, there was no association between pre-pregnancy TSH level (>2.5 versus ≤2.5 mIU/L) and PTD (aRR 0.77; 95% CI 0.40, 1.47), GDM (aRR 1.28; 95% CI 0.54, 3.04) or preeclampsia (aRR 1.20; 95% CI 0.71, 2.04). Similarly, among women with thyroid antibodies, there was no increase in the likelihood of PTD (RR 1.26; 95% CI 0.65, 2.45), GDM (RR 1.33; 95% CI 0.51, 3.49) or preeclampsia (RR 1.02; 95% CI 0.54, 1.92), compared to women without these antibodies. Conclusions Among women with 1-2 prior pregnancy losses, subclinical hypothyroidism and thyroid autoimmunity were not associated with an increased risk of PTD, GDM, or preeclampsia. These data support current recommendations that low-risk asymptomatic women should not be routinely screened for thyroid dysfunction or autoimmunity.

      PubDate: 2017-09-18T00:30:17Z
      DOI: 10.1016/j.ajog.2017.09.001
       
  • Reply to Letter # L17-089AR1
    • Authors: LEE Yoon
      Abstract: Publication date: Available online 14 September 2017
      Source:American Journal of Obstetrics and Gynecology
      Author(s): Sa Ra LEE, Ha Na Yoon


      PubDate: 2017-09-18T00:30:17Z
       
  • Condom Use and Incident Sexually Transmitted Infection after Initiation of
           Long-Acting Reversible Contraception
    • Authors: Colleen P. Mcnicholas; Jessica B. Klugman; Qiuhong Zhao; Jeffrey F. Peipert
      Abstract: Publication date: Available online 14 September 2017
      Source:American Journal of Obstetrics and Gynecology
      Author(s): Colleen P. Mcnicholas, Jessica B. Klugman, Qiuhong Zhao, Jeffrey F. Peipert
      Background Use of more effective contraception may lead to less condom use and increased incidence of sexually transmitted infection. Objective The objective of this study was to compare changes in condom use and incidence of sexually transmitted infection acquisition among new initiators of long-acting reversible contraceptives to those initiating non-long acting reversible contraceptive methods. Study Design This is a secondary analysis of the Contraceptive CHOICE Project. We included two sample populations of 12-month continuous contraceptive users. The first included users with complete condom data (baseline, 3, 6, and 12 months) (long-acting reversible contraceptive users: n=2371; other methods: n=575). The second included users with 12-month sexually transmitted infection data (long-acting reversible contraceptive users: n=2102; other methods: n=592). Self-reported condom use was assessed at baseline and at 3, 6, and 12 months following enrollment. Changes in condom use and incident sexually transmitted infection rates were compared using chi-square tests. Risk factors for sexually transmitted infection acquisition were identified using multivariable logistic regression. Results Few participants in either group reported consistent condom use across all survey time points and with all partners (long-acting reversible contraceptive users: 5.2%; other methods: 11.3%, P<0.001). There was no difference in change of condom use at 3, 6 and 12 months compared to baseline condom use regardless of method type (p=0.65). A total of 94 incident sexually transmitted infections were documented, with long-acting reversible contraceptive users accounting for a higher proportion (3.9% vs. 2.0%; P=0.03). Initiation of a long-acting reversible contraceptive method was associated with increased sexually transmitted infection incidence (OR 2.0, 95% CI: 1.07, 3.72). Conclusions Long-acting reversible contraceptive initiators reported lower rates of consistent condom use, but did not demonstrate a change in condom use when compared to pre-initiation behaviors. Long-acting reversible contraceptive users were more likely to acquire a sexually transmitted infection in the 12 months following initiation.

      PubDate: 2017-09-18T00:30:17Z
      DOI: 10.1016/j.ajog.2017.09.009
       
  • Comment on: Predicting the difficulty of operative vaginal delivery by
           ultrasound measurements of the fetal head station.
    • Authors: Shunji Suzuki
      Abstract: Publication date: Available online 14 September 2017
      Source:American Journal of Obstetrics and Gynecology
      Author(s): Shunji Suzuki


      PubDate: 2017-09-18T00:30:17Z
      DOI: 10.1016/j.ajog.2017.09.006
       
  • Emergency in the clinic: A simulation curriculum to improve outpatient
           safety
    • Authors: Eve Espey; Gillian Baty; John Rask; Michelle Chungtuyco; Brenda Pereda; Lawrence Leeman
      Abstract: Publication date: Available online 14 September 2017
      Source:American Journal of Obstetrics and Gynecology
      Author(s): Eve Espey, Gillian Baty, John Rask, Michelle Chungtuyco, Brenda Pereda, Lawrence Leeman
      Background Emergency response skills are essential when events such as seizure, anaphylaxis or hemorrhage occur in the outpatient setting. As services and procedures increasingly move outside the hospital, training to manage complications may improve outcomes. Objective The objective of this study was to evaluate a simulation-based curriculum in outpatient emergency management skills with the outcome measures of graded objective performance and learner self-efficacy. Study Design This pre-post curriculum study enrolled residents and fellows in Obstetrics and Gynecology and Family Medicine in a simulation-based, outpatient emergency management curriculum. Learners completed self-efficacy questionnaires and were videotaped managing three medical emergency scenarios (seizure, over-sedation/cardiopulmonary arrest and hemorrhage) in the simulation lab both before and after completing the curriculum. Evaluators, blinded to training level, scored the simulation performance videotapes using a graded rubric with critical action checklists. Scenario scores were assigned in five domains and globally. Paired t-tests were used to determine differences pre- and post- curriculum. Results Thirty residents completed the curriculum and pre- and post-curriculum testing. Subjects’ objective performance scores improved in all five domains (p < .05) in all scenarios. When stratified by level of training, all participants demonstrated global improvement. When stratified by prior outpatient simulation experience, subjects with prior experience improved in all but management of excess sedation. Pre- and post-curriculum self-efficacy evaluations demonstrated improvement in seven of eight measured areas: confidence, use of appropriate resources, communication skills, complex airway management, bag mask ventilation, resuscitation, and hemorrhage management. Self-efficacy assessment showed improvement in confidence managing outpatient emergencies (p=0.001) and ability to communicate well in emergency situations (p<0.001). Conclusion A simulation-based curriculum improved both self-efficacy and objectively rated performance scores in management of outpatient medical emergencies. Simulation based curricula should be incorporated into residency education.

      PubDate: 2017-09-18T00:30:17Z
      DOI: 10.1016/j.ajog.2017.09.008
       
  • 3D Transvaginal Sonography in Obstetrics and Gynecology
    • Authors: Carlos M. Fernandez; Elliot M. Levine
      Abstract: Publication date: Available online 14 September 2017
      Source:American Journal of Obstetrics and Gynecology
      Author(s): Carlos M. Fernandez, Elliot M. Levine


      PubDate: 2017-09-18T00:30:17Z
      DOI: 10.1016/j.ajog.2017.09.004
       
  • Predicting the Difficulty of Operative Vaginal Delivery by Ultrasound
           Measurement of Fetal Head Station
    • Authors: Sidi Kasbaoui; François Severac; N. Sananes
      Abstract: Publication date: Available online 14 September 2017
      Source:American Journal of Obstetrics and Gynecology
      Author(s): Sidi Kasbaoui, François Severac, N. Sananes


      PubDate: 2017-09-18T00:30:17Z
      DOI: 10.1016/j.ajog.2017.09.007
       
  • Management of premature rupture of membranes at term: the need to correct
           a recurring mistake in articles, chapters, and recommendations of
           professional organizations
    • Authors: Eyal Krispin
      Abstract: Publication date: Available online 8 September 2017
      Source:American Journal of Obstetrics and Gynecology
      Author(s): Eyal Krispin
      Recommendations about the management of premature rupture of membranes at term are based, in part, on a large, randomized controlled trial published in 1996: the “TERMPROM” trial. The original article contained an error in Table 1, in which “Interval from membrane rupture to delivery” was listed instead of “Interval from membrane rupture to study entry”. While the authors and journal corrected this error, the mistake published in the original paper has made its way into subsequent publications and even in guidelines or practice bulletins issued by professional organizations, textbooks, and other publications around the world. The mistake, that half of women with PROM at term who were managed expectantly delivered within 5 hours and 95% delivered within 28 hours of membrane rupture, should be replaced with the actual fact that half of women with PROM at term who were managed expectantly delivered within 33 hours, and 95% delivered within 94 to 107 hours of membrane rupture. Correcting this error in contemporary health care information and publications is important to counsel patients accurately and to optimize the clinical care of women with premature rupture of membranes at term.

      PubDate: 2017-09-11T22:32:29Z
      DOI: 10.1016/j.ajog.2017.08.111
       
  • Ultrasound Estimated Fetal Weight
    • Authors: Michael G. Ross
      Abstract: Publication date: Available online 8 September 2017
      Source:American Journal of Obstetrics and Gynecology
      Author(s): Michael G. Ross


      PubDate: 2017-09-11T22:32:29Z
      DOI: 10.1016/j.ajog.2017.08.104
       
  • Variation in Waiting Period for Medicaid Postpartum Sterilizations –
           Results of a National Survey of Obstetricians-Gynecologists
    • Authors: Kavita Shah Arora; Neko Castleberry; Jay Schulkin
      Abstract: Publication date: Available online 6 September 2017
      Source:American Journal of Obstetrics and Gynecology
      Author(s): Kavita Shah Arora, Neko Castleberry, Jay Schulkin


      PubDate: 2017-09-11T22:32:29Z
      DOI: 10.1016/j.ajog.2017.08.112
       
  • Effective evidence based medicine: considering factors not included in
           research studies
    • Authors: Abdulrahim A. Rouzi; Rigmor C. Berg
      Abstract: Publication date: Available online 6 September 2017
      Source:American Journal of Obstetrics and Gynecology
      Author(s): Abdulrahim A. Rouzi, Rigmor C. Berg


      PubDate: 2017-09-11T22:32:29Z
      DOI: 10.1016/j.ajog.2017.08.116
       
  • Beyond the traditional models of group prenatal care: the case for Moms2B
    • Authors: Patricia T. Gabbe; Steven G. Gabbe; Courtney D. Lynch
      Abstract: Publication date: Available online 6 September 2017
      Source:American Journal of Obstetrics and Gynecology
      Author(s): Patricia T. Gabbe, Steven G. Gabbe, Courtney D. Lynch


      PubDate: 2017-09-11T22:32:29Z
      DOI: 10.1016/j.ajog.2017.08.117
       
  • Reply letter: evidence-based therapy for APS
    • Authors: Gabriele Saccone; Vincenzo Berghella; Giuseppe Maria Maruotti; Pasquale Martinelli
      Abstract: Publication date: Available online 6 September 2017
      Source:American Journal of Obstetrics and Gynecology
      Author(s): Gabriele Saccone, Vincenzo Berghella, Giuseppe Maria Maruotti, Pasquale Martinelli


      PubDate: 2017-09-11T22:32:29Z
      DOI: 10.1016/j.ajog.2017.08.114
       
  • Effective evidence based medicine: considering factors not included in
           research studies
    • Authors: Angelia L. Sakyi-Agyekum
      Abstract: Publication date: Available online 6 September 2017
      Source:American Journal of Obstetrics and Gynecology
      Author(s): Angelia L. Sakyi-Agyekum


      PubDate: 2017-09-11T22:32:29Z
      DOI: 10.1016/j.ajog.2017.08.115
       
  • Hydroxychloroquine as additional treatment in pregnant patients with
           refractory APS
    • Authors: S. De Carolis; F. Rizzo; S. Tabacco
      Abstract: Publication date: Available online 6 September 2017
      Source:American Journal of Obstetrics and Gynecology
      Author(s): S. De Carolis, F. Rizzo, S. Tabacco


      PubDate: 2017-09-11T22:32:29Z
      DOI: 10.1016/j.ajog.2017.08.113
       
  • Lessons learned from domestic and international human papillomavirus
           vaccination programs: a review
    • Authors: Kathryn Miller; Sarah E. Dilley; Warner K. Huh
      Abstract: Publication date: Available online 6 September 2017
      Source:American Journal of Obstetrics and Gynecology
      Author(s): Kathryn Miller, Sarah E. Dilley, Warner K. Huh
      Since the development of the human papillomavirus vaccine, many countries have created implementation programs to bolster vaccination rates and protect their populations. Despite demonstrated efficacy with decreased HPV-related disease abroad, the vaccine's potential to prevent morbidity and mortality in the US is not being met. The purpose of this review is to discuss strategies of both international and domestic vaccination programs, their impact on HPV-related diseases, the unique obstacles faced by the US, and future directions for success.

      PubDate: 2017-09-11T22:32:29Z
      DOI: 10.1016/j.ajog.2017.08.109
       
  • NSAID resistance in dysmenorrhea: epidemiology, causes, and treatment
    • Authors: Folabomi A. Oladosu; Frank F. Tu; Kevin M. Hellman
      Abstract: Publication date: Available online 6 September 2017
      Source:American Journal of Obstetrics and Gynecology
      Author(s): Folabomi A. Oladosu, Frank F. Tu, Kevin M. Hellman
      Although non-steroidal anti-inflammatory drugs can alleviate menstrual pain, about 18% of women with dysmenorrhea are unresponsive, leaving them and their physicians to pursue less well-studied strategies. The goal of this review is to provide a background for treating menstrual pain when first-line options fail. Research on menstrual pain and failure of similar drugs in the antiplatelet category has suggested potential mechanisms underlying non-steroidal anti-inflammatory drug resistance. Based on these mechanisms, alternative options may be helpful for refractory cases. This review also identifies key pathways in need of further study to optimize menstrual pain treatment.

      PubDate: 2017-09-11T22:32:29Z
      DOI: 10.1016/j.ajog.2017.08.108
       
  • ASPRE trial: influence of compliance on beneficial effect of aspirin in
           prevention of preterm preeclampsia
    • Authors: David Wright; Liona C. Poon; Daniel L. Rolnik; Argyro Syngelaki; Juan Luis Delgado; Denisa Vojtassakova; Mercedes de Alvarado; Evgenia Kapeti; Anoop Rehal; Andrea Pazos; Ilma Floriana Carbone; Vivien Dutemeyer; Walter Plasencia; Nikos Papantoniou; Kypros H. Nicolaides
      Abstract: Publication date: Available online 6 September 2017
      Source:American Journal of Obstetrics and Gynecology
      Author(s): David Wright, Liona C. Poon, Daniel L. Rolnik, Argyro Syngelaki, Juan Luis Delgado, Denisa Vojtassakova, Mercedes de Alvarado, Evgenia Kapeti, Anoop Rehal, Andrea Pazos, Ilma Floriana Carbone, Vivien Dutemeyer, Walter Plasencia, Nikos Papantoniou, Kypros H. Nicolaides
      Objective To examine the influence of compliance on the beneficial effect of aspirin in prevention of preterm preeclampsia in the Combined Multimarker Screening and Randomized Patient Treatment with Aspirin for Evidence-Based Preeclampsia Prevention (ASPRE) trial. Study design This was a secondary analysis of data from the ASPRE trial. In this multicenter-study women with singleton pregnancies had screening by means of an algorithm that combines maternal factors and biomarkers (mean arterial pressure, uterine-artery pulsatility index, and maternal serum pregnancy-associated plasma protein A and placental growth factor) at 11-13 weeks’ gestation. Those with an estimated risk for preterm preeclampsia of >1 in 100 were invited to participate in a double-blind trial of aspirin (150 mg per day) vs. placebo from 11 to 14 until 36 weeks’ gestation. Preterm preeclampsia with delivery at <37 weeks’ gestation, which was the primary outcome, occurred in 1.6% (13/798) participants in the aspirin group, as compared with 4.3% (35/822) in the placebo group (odds ratio in the aspirin group, 0.38; 95% confidence interval, 0.20 to 0.74). The proportion of prescribed tablets taken was used as an overall measure of compliance. Logistic-regression analysis was used to estimate the effect of aspirin on the incidence of preterm preeclampsia according to compliance of <90% and >90%, after adjustment for the estimated risk of preterm preeclampsia at screening and the participating center. The choice of cut-off of 90% was based on an exploratory analysis of the treatment effect. Logistic regression analysis was used to investigate predictors of compliance >90% among maternal characteristics and medical history. Results Preterm preeclampsia occurred in 5/555 (0.9%) participants in the aspirin group with compliance ≥90%, in 8/243 (3.3%) of participants in the aspirin group with compliance <90%, in 22/588 (3.7%) of participants in the placebo group with compliance ≥90%, and in 13/234 (5.6%) of participants in the placebo group with compliance <90%. The odds ratio in the aspirin group for preterm preeclampsia was 0.24 (95% confidence interval, 0.09 to 0.65) for compliance >90% and 0.59 (95% confidence interval, 0.23 to 1.53) for compliance <90%. Compliance was positively associated with family history of preeclampsia and negatively associated with smoking, maternal age <25 years, Afro-Caribbean and South Asian racial origin, and history of preeclampsia in a previous pregnancy. Conclusions The beneficial effect of aspirin in the prevention of preterm preeclampsia appears to depend on compliance.

      PubDate: 2017-09-11T22:32:29Z
      DOI: 10.1016/j.ajog.2017.08.110
       
  • Reply
    • Authors: Sara Mazzoni; Ebony Boyce Carter
      Abstract: Publication date: Available online 6 September 2017
      Source:American Journal of Obstetrics and Gynecology
      Author(s): Sara Mazzoni, Ebony Boyce Carter


      PubDate: 2017-09-11T22:32:29Z
       
  • Assessing Standards Used to Review Online Health Information
    • Authors: Anna S. Miller; Phaedra Thomas; Jill R. Kavanaugh
      Abstract: Publication date: Available online 5 September 2017
      Source:American Journal of Obstetrics and Gynecology
      Author(s): Anna S. Miller, Phaedra Thomas, Jill R. Kavanaugh


      PubDate: 2017-09-05T22:25:12Z
      DOI: 10.1016/j.ajog.2017.08.105
       
  • Reply
    • Authors: Martin Hirsch; Claire Barker James M.N. Duffy
      Abstract: Publication date: Available online 5 September 2017
      Source:American Journal of Obstetrics and Gynecology
      Author(s): Martin Hirsch, Claire Barker, James M.N. Duffy


      PubDate: 2017-09-05T22:25:12Z
       
  • Information for Readers
    • Abstract: Publication date: September 2017
      Source:American Journal of Obstetrics and Gynecology, Volume 217, Issue 3


      PubDate: 2017-09-05T22:25:12Z
       
 
 
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