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Understanding the Utility of Hemoglobin A1c in Diagnosing Gestational Diabetes in Early Pregnancy
In this retrospective cohort study of 243 pregnant women who had combined hemoglobin A1c (HbA1c) and a two-step oral glucose tolerance testing at less than 21 weeks of gestation, median values of HbA1c were higher in women with gestational diabetes compared to nondiabetics (5.8% compared to 5.3%; P < 0.001). The predictive probability of using HbA1c in diagnosing diabetes in early pregnancy was high compared to two-step testing (area under the curve, 0.8), with an optimal diagnostic threshold of 5.6%. Although a HbA1c level of > 6.5% is diagnostic of early gestational diabetes, a lower diagnostic threshold might be justified during pregnancy.
Outpatient Foley Catheter for Induction of Labor in Nulliparous Women
In this randomized controlled trial among nulliparous patients with low Bishop scores, outpatient placement of a Foley catheter the day prior to scheduled admission, when compared to inpatient placement, showed a decreased mean time from admission to delivery.
Maternal Sepsis: Risk Factors that Could Lead to Postpartum Readmission
In this analysis of California deliveries between 2008 and 2011, risk factors for maternal readmission for sepsis were found to include preterm birth, hemorrhage, obesity, and a primary cesarean delivery.
Prenatal Care Visits During COVID-19
In this nested case-control study in the Boston area, there was no association between testing positive for COVID-19 during pregnancy or on admission to labor and delivery and the number of in-person prenatal care visits.
Application of Acetic Acid to Identify Lesions During Colposcopy
In this prospective study, one minute of acetic acid application was found to be sufficient to identify the most severe colposcopic lesion in 96.7% of subjects.
Outcomes in Pregnant Women Treated with Anti-Tumor Necrosis Factor-Alpha Biologic Therapy
In this population-based cohort study of 1,027 infants born to women treated with anti-TNF-α biologic therapy, there was an increased prevalence of preterm birth (adjusted odds ratio [aOR], 1.61; 95% confidence interval [CI], 1.29-2.02), cesarean delivery (aOR, 1.57; 95% CI, 1.35-1.82), and small for gestational age neonates (aOR, 1.36; 95% CI, 0.96-1.92) when treatment with anti-TNF was compared to non-biologic systemic treatment. Since disease processes varied greatly in these pregnant women, it was difficult to rule out confounding by disease severity (confounding by indication).
Tamoxifen for the Management of Bleeding Irregularities in Contraceptive Implant Users
In this double-blind, randomized controlled trial, etonogestrel implant users with prolonged or frequent menses who took 10 mg of tamoxifen twice daily for seven days as needed for irregular bleeding had an average of 9.8 (95% confidence interval, 4.6-15.0) more consecutive days of amenorrhea over a 90-day period compared to those who took a placebo.
Race Correction in Clinical Calculations — Is It Time to Reconsider?
Many clinical calculators use race as a predictive variable to assess risk for outcomes. Although most of the tools assume a genetic disposition for these outcomes, other factors, such as health disparities and other potential confounders, are more likely to be the underlying reasons for any race-related differences in outcomes.
Etonogestrel Contraceptive Implant and VTE in Postpartum Women
In this national retrospective cohort study of postpartum women, use of the etonogestrel contraceptive implant immediately postpartum was not associated with an increased rate of readmission for venous thromboembolism within 30 days of delivery.
Maternal and Pregnancy Characteristics Associated with Periviable Interventions
In this case control study using U.S. live birth records between 22 and 23 weeks of gestation, maternal intervention was positively associated with increasing maternal age, Medicaid use, preeclampsia, birth defects, twin gestation, multiparity, and infertility treatments while being negatively associated with non-Hispanic Black race. Positive associations for neonatal intervention included non-Hispanic Black race, preeclampsia, Medicaid use, infertility treatments, less than a high school education, increasing maternal age, and twin gestation, and negative associations included birth defects and small for gestational age pregnancies.