Publications by authors named "Kimberly Vesco"
Background: Understanding the risks and effects of gestational weight gain (GWG) is a prominent area of perinatal research but approaches for quantifying GWG are evolving and remain underdeveloped, especially in clinical settings for underserved demographic subgroups. To fill this gap, we demonstrated and compared six GWG metrics across pre-pregnancy BMI classifications: total GWG, trimester-specific linear rate of GWG, adherence to total and trimester-specific recommendations, area under the curve, and GWG for gestational age z-scores.
Methods: We used clinical data on 44,801 pregnant people from community-based health care organizations with extensive longitudinal measures and substantial representation of understudied subgroups.
Background: Electronic health record (EHR) data are an underused source for lactation-related research. The validity of ICD-10-CM-coded lactational mastitis is unknown.
Methods: We assessed lactational mastitis diagnosis code validity by medical record review.
Maternal Postpartum Readmission for Hypertension-Quality Metric or Call for Action?
J Womens Health (Larchmt)
November 2024
Objective: The objective of this study was to estimate the effects of trimester-specific gestational weight gain (GWG) on small and large (compared with appropriate) for gestational age (i.e., SGA, LGA, and AGA) by prepregnancy BMI classifications.
View Article and Find Full Text PDFImportance: COVID-19 vaccination is recommended throughout pregnancy to prevent pregnancy complications and adverse birth outcomes associated with COVID-19 disease. To date, data on birth defects after first-trimester vaccination are limited.
Objective: To evaluate the associated risks for selected major structural birth defects among live-born infants after first-trimester receipt of a messenger RNA (mRNA) COVID-19 vaccine.
Article Synopsis
- The study investigated the potential link between COVID-19 vaccination during pregnancy and the risk of stillbirth, addressing concerns of vaccine hesitancy among pregnant individuals.
- A matched case-control approach was used, analyzing data from 276 confirmed stillbirths and 822 live births to assess any significant associations with vaccination status.
- Results indicated no significant association between COVID-19 vaccination and stillbirth risk, regardless of vaccine type, number of doses, or timing of vaccination, suggesting that vaccination does not increase the risk of stillbirth in pregnant individuals.
Background: Lifestyle choices, metformin, and dietary supplements may prevent GDM, but the effect of intervention characteristics has not been identified. This review evaluated intervention characteristics to inform the implementation of GDM prevention interventions.
Methods: Ovid, MEDLINE/PubMed, and EMBASE databases were searched.
Article Synopsis
- - This study aimed to assess whether getting vaccinated with mRNA COVID-19 vaccines during pregnancy affects the risk of adverse pregnancy outcomes like preterm birth and small-for-gestational age infants.
- - Researchers analyzed data from over 55,000 individuals with live singleton pregnancies and found that 42.3% received one or two doses of the vaccine, with the vaccination rate varying across maternal demographics.
- - The results indicated that vaccinated individuals had a lower risk of preterm birth compared to unvaccinated individuals, but the vaccination did not significantly impact the risks of small-for-gestational age infants, gestational diabetes, gestational hypertension, or preeclampsia.
Background: Gestational weight gain (GWG) is a routinely monitored aspect of pregnancy health, yet critical gaps remain about optimal GWG in pregnant people from socially marginalized groups, or with pre-pregnancy body mass index (BMI) in the lower or upper extremes. The PROMISE study aims to determine overall and trimester-specific GWG associated with the lowest risk of adverse birth outcomes and detrimental infant and child growth in these underrepresented subgroups. This paper presents methods used to construct the PROMISE cohort using electronic health record data from a network of community-based healthcare organizations and characterize the cohort with respect to baseline characteristics, longitudinal data availability, and GWG.
View Article and Find Full Text PDFBackground: Breastfeeding information stored within electronic health records (EHR) has recently been used for pharmacoepidemiological research, however the data are primarily collected for clinical care.
Objectives: To characterise breastfeeding information recorded in structured fields in EHR during infant and postpartum health care visits, and to assess the validity of lactation status based on EHR data versus maternal report at research study visits.
Methods: We assessed breastfeeding information recorded in structured fields in EHR from one health system for a subset of 211 patients who were also enrolled in a study on breast milk composition between 2014 and 2017 that required participants to exclusively breastfeed their infants until at least 1 month of age.
Article Synopsis
- The study investigates whether COVID-19 vaccination affects the diagnosis and evaluation of abnormal uterine bleeding in women aged 16 to 44, using data from a large health system.
- Researchers compared diagnosis rates of abnormal uterine bleeding before and after COVID-19 vaccine availability, using segmented regression to analyze changes in trends.
- Findings show no significant increase in abnormal uterine bleeding diagnoses post-vaccination, and cases among recently vaccinated patients were found to be similar or less severe compared to unvaccinated individuals.
Objective: Surveys of residents in obstetrics and gynecology, internal medicine, and family medicine have demonstrated low levels of knowledge and comfort in treating patients with menopausal symptoms, suggesting a need for improved training during residency. To address this problem, we used a flipped classroom design to deliver a novel menopause curriculum for medical residents. The curriculum included six podcast episodes followed by an interactive case-based classroom session.
View Article and Find Full Text PDFObjective: To describe insurance patterns and discontinuity during pregnancy, which may affect the experiences of the pregnant person: their timely access to care, continuity of care, and health outcomes.
Data Sources And Study Setting: Data are from the PROMISE study, which utilizes data from community-based health care organizations (CHCOs) (e.g.
Article Synopsis
- Precision medicine is an evolving approach in healthcare that aims to enhance decision-making and health outcomes, particularly in managing diabetes, which poses serious health risks for millions globally.
- The second international consensus report on precision diabetes medicine reviews current findings on prevention, diagnosis, treatment, and prognosis across different forms of diabetes, highlighting the potential for translating research into clinical practice.
- The report also identifies knowledge gaps and sets out key milestones for better clinical implementation, emphasizing the need for standards addressing cost-effectiveness, health equity, and accessibility in treatment options.
Background: Precision prevention involves using the unique characteristics of a particular group to determine their responses to preventive interventions. This study aimed to systematically evaluate the participant characteristics associated with responses to interventions in gestational diabetes mellitus (GDM) prevention.
Methods: We searched MEDLINE, EMBASE, and Pubmed to identify lifestyle (diet, physical activity, or both), metformin, myoinositol/inositol and probiotics interventions of GDM prevention published up to May 24, 2022.
Article Synopsis
- - A study examined postmenopausal bleeding trends before and after COVID-19 vaccination among Kaiser Permanente Northwest female members aged 45 and older, focusing on changes in diagnoses over time.
- - Using electronic medical records, researchers conducted a segmented regression analysis to determine if the rate of incident postmenopausal bleeding diagnoses differed with COVID-19 vaccination status between 2018 and 2021.
- - Findings revealed no statistically significant difference in postmenopausal bleeding rates pre- and post-vaccination, with 104 individuals experiencing new bleeding incidents but no clear link established to the vaccine.
Importance: Hypertensive disorders of pregnancy are a leading cause of pregnancy-related morbidity and mortality in the US.
Objective: To conduct a targeted systematic review to update the evidence on the effectiveness of screening for hypertensive disorders of pregnancy to inform the US Preventive Services Task Force.
Data Sources: MEDLINE and the Cochrane Central Register of Controlled Trials for relevant studies published between January 1, 2014, and January 4, 2022; surveillance through February 21, 2023.
Article Synopsis
- The study investigates the potential link between COVID-19 booster vaccinations during pregnancy and the risk of spontaneous abortion, addressing concerns about vaccine safety among pregnant individuals.
- Conducted across eight health systems, the research analyzed data from 112,718 unique pregnancies to evaluate outcomes based on vaccination timing and other factors such as maternal age and race.
- Findings aim to clarify the safety of receiving mRNA COVID-19 booster shots during early pregnancy, which is crucial for increasing vaccination adherence within this population.
Article Synopsis
- A study involving over 80,000 pregnant individuals found that receiving a COVID-19 mRNA booster shot did not increase the risk of serious health issues like thrombocytopenia, myocarditis, or stroke shortly after vaccination.
- However, the booster was linked to a higher incidence of mild symptoms such as malaise or fatigue within the first week, and lymph node swelling or inflammation in the following weeks.
- Overall, the results align with previous studies and suggest that it's safe for pregnant people to receive the COVID-19 booster.
Background And Aims: Precision prevention involves using the unique characteristics of a particular group to determine their responses to preventive interventions. This study aimed to systematically evaluate the participant characteristics associated with interventions in gestational diabetes mellitus (GDM) prevention.
Methods: We searched MEDLINE, EMBASE, and Pubmed to identify lifestyle (diet, physical activity, or both), metformin, myoinositol/inositol and probiotics interventions of GDM prevention published up to May 24, 2022.
Article Synopsis
- * Initial results suggested a protective effect of vaccination against SAB within certain time periods, but this effect diminished when extending the observation to later dates.
- * The findings indicate that the timing and method of surveillance significantly influence the perceived relationship between vaccination and SAB, with no clear association observed when using a time-dependent model.
Background: Healthier lifestyles in early pregnancy are associated with lower rates of pregnancy complications, childhood adiposity, and maternal and child cardiovascular risks. However, it is not known whether lifestyle coaching initiated prior to pregnancy can affect behavior and attitudes during pregnancy.
Methods: Three hundred and twenty six women planning pregnancy within 2 years with BMI ≥27 kg/m were randomized to a behavioral weight loss intervention or to usual care.