Publications by authors named "George R Saade"

Preeclampsia is a severe obstetrical syndrome which contributes to 10-15% of all maternal deaths. Although the mechanisms underlying systemic damage in preeclampsia-such as impaired placentation, endothelial dysfunction, and immune dysregulation-are well studied, the initial triggers of the condition remain largely unknown. Furthermore, although the pathogenesis of preeclampsia begins early in pregnancy, there are no early diagnostics for this life-threatening syndrome, which is typically diagnosed much later, after systemic damage has already manifested.

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Objectives: Dilapan-S is a cervical ripening agent approved by the FDA that has been found to be just as effective as other agents and can be utilized for outpatient ripening. No large-scale studies have been conducted to compare cesarean delivery rates between Dilapan-S and other ripening methods. Our objective was to combine these trials to compare cesarean delivery rates for Dilapan-S with other cervical ripening methods, overall and in sub-groups.

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  • A study examined how inflammatory diets impact cardiovascular health, particularly in relation to adverse pregnancy outcomes (APOs) like preterm birth and gestational diabetes.
  • Data from over 3,200 pregnant individuals showed that higher inflammatory diet scores correlated with increased body mass index, waist circumference, blood pressure, triglycerides, and insulin levels, along with lower good cholesterol levels.
  • The study found that the negative impact of inflammatory diets on cardiometabolic health was more pronounced in individuals who experienced APOs during pregnancy.
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Background: Implications of lifelong, perceived discrimination on nutrient intake during the preconception period are unclear.

Objective: The objective was to identify associations between perceived discrimination and consumption of specific nutrients associated with risk of adverse pregnancy outcomes.

Design: This is a secondary data analysis of the prospective Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-Be cohort.

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  • The study evaluated the link between not following prenatal care guidelines and the causes of stillbirths.
  • It analyzed data from the Stillbirth Collaborative Research Network, focusing on adherence to ACOG/AAP and MiPATH recommendations for prenatal visits.
  • Results indicated that a significant portion of stillbirth cases were from mothers who weren't following these guidelines, with a particular increase in stillbirths associated with hypertensive disorders.
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Objective:  This study aimed to evaluate the safety of peripheral administration of vasopressor agents among patients with circulatory shock.

Study Design:  We reviewed the published literature evaluating the use of peripheral norepinephrine in patients with shock and proposed a protocol for use in labor and delivery units.

Results:  Peripheral administration of norepinephrine is a safe and potentially lifesaving intervention for patients in labor and delivery with extremely low complication rates.

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Purpose: We examined the association between iron deficiency anemia (IDA) and severe maternal morbidity (SMM) during delivery and up to 1-year postpartum.

Methods: In a retrospective cohort study across 3 states, we computed adjusted relative risks (aRR) for SMM comparing individuals with IDA versus those without, using modified Poisson regression models.

Results: Among 2459,106 individuals, 10.

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  • A recent study analyzed the effect of oxytocin dosage on cesarean delivery rates and adverse outcomes in low-risk nulliparous patients undergoing labor induction at 39 weeks or more.
  • The research compared mid- to high-dose oxytocin regimens with low-dose regimens, finding that higher doses were associated with fewer cesarean deliveries, without increasing negative perinatal outcomes.
  • The study was a secondary analysis of a larger randomized trial and utilized various statistical methods to evaluate the impact of the different oxytocin dosages on the primary outcomes.
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Background: Perinatal depression has been suggested to adversely impact child neurodevelopment. However, the complexity of the early childhood environment challenges conclusive findings.

Objective: To evaluate whether there is an association between perinatal depressive symptoms and child intelligence quotient (IQ) at 5 years of age.

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Background: The Chronic Hypertension and Pregnancy Study demonstrated that a target blood pressure of <140/90 mm Hg during pregnancy is associated with improved perinatal outcomes. Outside of pregnancy, pharmacologic therapy for patients with diabetes and hypertension is adjusted to a target blood pressure of <130/80 mm Hg. During pregnancy, patients with both diabetes and chronic hypertension may also benefit from tighter control with a target blood pressure <130/80 mm Hg.

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Objective: To compare differences in postpartum blood pressure (BP) control (BP below 140/90 mm Hg) for participants with hypertension randomized to receive antihypertensive treatment compared with no treatment during pregnancy.

Methods: This study was a planned secondary analysis of a multicenter, open-label, randomized controlled trial (The CHAP [Chronic Hypertension and Pregnancy] trial). Pregnant participants with mild chronic hypertension (BP below 160/105 mm Hg) were randomized into two groups: active (antihypertensive treatment) or control (no treatment unless severe hypertension, BP 160/105 mm Hg or higher).

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Objective: To evaluate the risks of adverse maternal and neonatal outcomes associated with pregnancies complicated by hepatitis C virus (HCV) infection.

Methods: This is a secondary analysis of a multicenter prospective cohort study of HCV infection in pregnancy. Participants were screened for HCV infection with serum antibody tests, and each participant with a positive HCV result (case group) was matched with up to two individuals with negative HCV results (control group) prospectively by gestational age (±2 weeks) at enrollment.

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To examine the incidence of overt hypothyroidism 1 and 5 years after pregnancies where screening before 21 weeks identified subclinical hypothyroidism (SH) or hypothyroxinemia (HT). Secondary analysis of two multicenter treatment trials for either SH or HT diagnosed between 8 and 20 weeks gestation. Current analyses focus only on individuals randomized to the placebo groups in the two parallel studies.

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Objective: To investigate the optimal gestational age to deliver pregnant people with chronic hypertension to improve perinatal outcomes.

Methods: We conducted a planned secondary analysis of a randomized controlled trial of chronic hypertension treatment to different blood pressure goals. Participants with term, singleton gestations were included.

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  • - The study aims to determine how common post-acute sequelae of SARS-CoV-2 (PASC) are among pregnant individuals and to identify factors that increase risk after their first infection with the virus. - Conducted from December 2021 to September 2023, the research involved 1,502 pregnant participants and found that 9.3% experienced PASC, with common symptoms including fatigue, malaise, and gastrointestinal issues. - Key findings suggested that obesity and pre-existing mental health conditions, such as depression or anxiety, were associated with a higher likelihood of developing PASC after COVID-19 infection.
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Objective: To evaluate maternal and neonatal outcomes by type of antihypertensive used in participants of the CHAP (Chronic Hypertension in Pregnancy) trial.

Methods: We conducted a planned secondary analysis of CHAP, an open-label, multicenter, randomized trial of antihypertensive treatment compared with standard care (no treatment unless severe hypertension developed) in pregnant patients with mild chronic hypertension (blood pressure 140-159/90-104 mm Hg before 20 weeks of gestation) and singleton pregnancies. We performed three comparisons based on medications prescribed at enrollment: labetalol compared with standard care, nifedipine compared with standard care, and labetalol compared with nifedipine.

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  • A study was conducted to explore racial and ethnic disparities in severe maternal morbidity (SMM) not just during childbirth, but also before and after, including up to a year postpartum.
  • Researchers analyzed data from over 2.5 million individuals across three states, focusing on non-transfusion SMM and total SMM per 10,000 cases, categorized by race, ethnicity, maternal education, and insurance type.
  • The results highlighted that 1.4% experienced non-transfusion SMM and 2.5% had any SMM, indicating significant disparities beyond just the intrapartum period, particularly affecting Black individuals.
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Objective: It is currently unknown whether adjunctive azithromycin prophylaxis at the time of non-elective cesarean has differential effects on neonatal outcomes in the context of prematurity. The objective of this study was to compare whether neonatal outcomes differ in term and preterm infants exposed to adjunctive azithromycin prophylaxis before non-elective cesarean delivery.

Study Design: A planned secondary analysis of a multi-center randomized controlled trial that enrolled women with singleton pregnancies ≥24 weeks gestation undergoing non-elective cesarean delivery (during labor or ≥4 h after membrane rupture).

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