Integrating Community-Based Doulas into the Maternity Health Care System in an Urban Hospital.

Background: Maternal morbidity and mortality in the United States are higher than peer countries. These adverse events disproportionally affect Black women.

Local Problem: Rates of maternal morbidity and mortality among Black childbearing women in West Louisville, Kentucky are higher than rates in Kentucky and the United States.

The use of digital peripheral artery tonometry to detect endothelial dysfunction in pregnant women who smoke.

Objective: We hypothesized that, as has been shown outside of pregnancy, endothelial dysfunction would be seen in a dose-dependent fashion among women who smoke in the midtrimester of pregnancy.

Study Design: Endothelial function in women with singleton pregnancies between 16 and 23 weeks was analyzed utilizing the Endo-PAT2000 device (Itamar Medical Ltd., Caesarea, Israel) and expressed as a reactive hyperemia ratio (RHI).

Extreme morbid obesity and labor outcome in nulliparous women at term.

We examined the prevalence of cesarean delivery (CD) among women with morbid obesity and extreme morbid obesity. Using Kentucky birth certificate data, a cross-sectional analysis of nulliparous singleton gestations at term was performed. We examined the prevalence of CD by body mass index (BMI; in kg/m2) using the National Institutes of Health/World Health Organization schema and a modified schema that separates extreme morbid obesity (BMI ≥ 50) from morbid obesity (BMI ≥ 40 to < 50).

Violence against women and postpartum depression.

Background: Violence against women (VAW), including intimate partner violence (IPV) in its various forms (sexual, physical, or stalking), and childhood violence (sexual or physical) are common and are associated with depressive symptoms. We examined the association between these violence exposures and self-reported history of postpartum depression (PPD).

Methods: Women from the Kentucky Women's Health Registry (KWHR) who reported at least one live birth were included in this study.

Implications of type 2 diabetes on adolescent reproductive health risk: an expert model.

Purpose: The purpose of this article was to summarize scientific knowledge from an expert panel on reproductive health among adolescents with type 2 diabetes (T2D).

Methods: Using a mental model approach, a panel of experts--representing perspectives on diabetes, adolescents, preconception counseling, and reproductive health--was convened to discuss reproductive health issues for female adolescents with T2D.

Results: Several critical issues emerged.

A multicenter, randomized trial of treatment for mild gestational diabetes.

Background: It is uncertain whether treatment of mild gestational diabetes mellitus improves pregnancy outcomes.

Methods: Women who were in the 24th to 31st week of gestation and who met the criteria for mild gestational diabetes mellitus (i.e.

Neonatal adiposity following maternal treatment of gestational diabetes with glyburide compared with insulin.

Objective: We hypothesized that body composition would be similar among neonates of women with gestational diabetes (GDM) treated with glyburide or insulin.

Study Design: Women with GDM requiring medical therapy were randomized to insulin or glyburide. The primary outcome was percent neonatal fat mass measured by total body electrical conductivity.

Factors that affect maternal insulin resistance and modify fetal growth and body composition.

Fetal growth is multifactorial and can be altered by a variety of extrinsic and intrinsic factors. The maternal, placental, and fetal contribution to growth must all be considered. Of particular interest are maternal metabolic regulation and the availability of nutrients to the developing fetus.

First trimester adipocytokine concentrations and risk of developing gestational diabetes later in pregnancy.

Objective: Adipocytokines are important regulators of insulin resistance. The aim of this study was to compare maternal adipocytokines in early pregnancy among women diagnosed with and without gestational diabetes (GDM) months later.

Design: A nested case-control study.

Evidence of endothelial dysfunction in preeclampsia and risk of adverse pregnancy outcome.

The purpose of this study is to investigate whether endothelial dysfunction, as assessed by elevated cellular fibronectin (cFN), in women with preeclampsia is associated with an increased risk of preterm and/or small-for-gestational-age (SGA) births. Maternal plasma cFN was measured by enzyme-linked immunosorbent assay in samples collected at admission to delivery in 605 normotensive women, 171 women with transient hypertension, and 187 women with preeclampsia. Logistic regression was used to estimate the risk for preterm delivery, SGA, or both.

Metabolic changes in pregnancy.

Maternal metabolism changes substantially during pregnancy. Early gestation can be viewed as an anabolic state in the mother with an increase in maternal fat stores and small increases in insulin sensitivity. Hence, nutrients are stored in early pregnancy to meet the feto-placental and maternal demands of late gestation and lactation.

The effects of cigarette smoking on circulating maternal leukocytes during pregnancy.

During pregnancy, cigarette smoke exposure, a common environmental insult, is damaging to both mother and fetus and is associated with pregnancy loss. The mechanism underlying the pathophysiology of injury is not understood. We hypothesized that smoking during pregnancy interferes with the normal physiological adaptation of the maternal immune system.

Anatomic and functional changes of the upper urinary tract during pregnancy.

An appreciation of the maternal physiologic adaptations that occur in the renal system during pregnancy is fundamental to the understanding and proper clinical management of normal pregnancy, renal disorders in the gravid patient, and pregnancy-specific conditions such as pre-eclampsia. In this article, the authors first address the anatomic changes that occur in the upper urinary tract in normal pregnancy, followed by the dramatic alterations in maternal renal hemodynamics and glomerular filtration. They also briefly discuss renal handling of various substrates in pregnancy, including protein, uric acid, and glucose.

Preeclampsia activates circulating immune cells with engagement of the NF-kappaB pathway.

Problem: Compelling evidence implicates peripheral immune activation in the pathophysiology of preeclampsia. Polymorphonuclear neutrophils appear to be the cells most strongly affected, with changes in expression of surface markers and release of granule enzymes. Here, we investigated activation in additional leukocyte populations among women with preeclampsia.

Intracellular adhesion molecule concentrations in women who smoke during pregnancy.

Objective: Smoking and endothelial dysfunction are associated with adverse pregnancy outcomes. The effect of smoking on vascular endothelium during pregnancy has not been well studied. Our objectives were to determine if smoking has an impact on endothelial function in pregnancy by comparing markers of endothelial function and to evaluate the contribution from different cellular sources.

Uric acid is as important as proteinuria in identifying fetal risk in women with gestational hypertension.

Gestational hypertension is differentiated into higher and lower risk by the presence or absence of proteinuria. We asked if hyperuricemia, a common finding in pregnancy hypertension, might also be an indicator of increased risk. We examined fetal outcome data from 972 pregnancies collected from 1997 to 2002 in a nested case-control study.

Effect of smoking on uric acid and other metabolic markers throughout normal pregnancy.

Objectives: Smoking, pregnancy, and preeclampsia are all associated with changes in markers of the metabolic syndrome. Several markers are increased in all three conditions. However, smoking is negatively associated with preeclampsia, and therefore some markers would be expected to behave differently in smokers during pregnancy.

Second pregnancy outcomes following preeclampsia in a first pregnancy.

Objectives: We compared second pregnancy outcomes among women with and without preeclampsia in their first pregnancies who all had second pregnancies without preeclampsia.

Methods: One hundred thirty women with and 6148 without preeclampsia in their first pregnancies, who all had nonpreeclamptic second pregnancies, were included. Outcomes, including delivery gestational age, birthweight, small-for-gestational-age (SGA), and preterm delivery were compared.

Smoking during pregnancy is associated with alterations in markers of endothelial function.

Objective: Alterations in endothelial function may explain the reduced risk of preeclampsia that is associated with smoking. We hypothesized that markers of endothelial function increase over pregnancy but decrease with smoking.

Study Design: Plasma samples were obtained throughout pregnancy from 63 primiparous women with normal pregnancies.

Plasma homocysteine and malondialdehyde are correlated in an age- and gender-specific manner.

Homocysteine is an independent risk factor for peripheral vascular and coronary artery disease. The exact mechanism by which homocysteine promotes vascular dysfunction is unclear, but it is speculated to involve oxidative stress. Several studies have investigated the role of homocysteine in promoting oxidative stress and have obtained conflicting results.