American journal of obstetrics and gynecology
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Am. J. Obstet. Gynecol. · Oct 2016
Trends in hospitalizations of pregnant HIV-infected women in the United States: 2004 through 2011.
With the development and widespread use of combination antiretroviral therapy, HIV-infected women live longer, healthier lives. Previous research has shown that, since the adoption of combination antiretroviral therapy in the United States, rates of morbidity and adverse obstetric outcomes remained higher for HIV-infected pregnant women compared with HIV-uninfected pregnant women. Monitoring trends in the outcomes these women experience is essential, as recommendations for this special population continue to evolve with the progress of HIV treatment and prevention options. ⋯ The numbers of hospitalizations during pregnancy and delivery have not increased for HIV-infected women since 2004, a departure from previously estimated trends. Pregnancy hospitalizations of HIV-infected women remain more medically complex than those of HIV-uninfected women. An increasing trend in infections among the delivery hospitalizations of HIV-infected pregnant women warrant further attention.
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Am. J. Obstet. Gynecol. · Oct 2016
A prediction model of vaginal birth after cesarean in the preterm period.
A validated model exists that predicts the probability of vaginal birth after cesarean delivery in patients at term who are undergoing a trial of labor after cesarean delivery. However, a model that predicts the success of a vaginal birth after cesarean delivery in the preterm period has not been developed. ⋯ A cross-validated predictive model was created for patients undergoing a trial of labor after cesarean delivery in the preterm period using 8 variables known on admission. These factors were notably different from factors used in the model for term patients. This new model can be used to counsel patients in the preterm period who want to undergo a trial of labor after cesarean delivery on their predicted vaginal birth after cesarean delivery success.
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Am. J. Obstet. Gynecol. · Oct 2016
Pregnancy as a window to future health: maternal placental syndromes and short-term cardiovascular outcomes.
Cardiovascular disease is the leading cause of death among women. Identifying risk factors for future cardiovascular disease may lead to earlier lifestyle modifications and disease prevention. Additionally, interpregnancy development of cardiovascular disease can lead to increased perinatal morbidity in subsequent pregnancies. Identification and implementation of interventions in the short term (within 5 years of first pregnancy) may decrease morbidity in subsequent pregnancies. ⋯ Women and girls experiencing placental syndromes and preterm birth or small-for-gestational-age infant are at increased risk of subsequent cardiovascular disease in short-term follow-up. Strategies to identify and improve cardiovascular disease risk in the postpartum period may improve future heart disease outcomes.
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Am. J. Obstet. Gynecol. · Oct 2016
The association of early unexplained elevated alanine aminotransferase with large-for-gestational-age birthweight.
Nonalcoholic fatty liver disease causes hepatic insulin resistance and is associated with metabolic syndrome. Elevated levels of alanine aminotransferase are associated with nonalcoholic fatty liver disease. The effect of hepatic insulin resistance is not only increased glycogen breakdown but also liberation of free fatty acids due to increased lipolysis. Both of these fuel sources are associated with macrosomia. There is little known about the impact of maternal nonalcoholic fatty liver disease on excessive fetal growth. ⋯ Unexplained elevated alanine aminotransferase in the first trimester was associated with a 4-fold increase in the odds of large-for-gestational-age birthweight even in the absence of clinical glucose intolerance. This may represent the impact of maternal nonalcoholic fatty liver on the fetal developmental milieu.