The relationship between discordant birth weight in twin pairs and the development of retinopathy of prematurity.

The association of low birth weight and development of retinopathy of prematurity (ROP) is well established for singletons; however, the association of birth weight and ROP in twins of discordant weight is understudied. Using an ROP registry, we investigated whether smaller twins were at greater risk for developing any stage ROP (stage 1 or greater in either eye) compared with their larger siblings, after adjusting for birth weight and gestational age. Discordance was defined as a birth weight difference of >25%.

Racial and sex differences in the polymorphisms of the endocannabinoid receptor genes in obesity.

Background: Obesity is a global epidemic and prevalence of obesity is higher in African Americans (AAs) compared to Caucasians. The endocannabinoid system (EC) and polymorphism in the endocannabinoid receptor type 1 (CNR1) gene 3813A/G and 4895A/G and in the fatty acid amide hydrolase (FAAH) are associated with obesity. The objective was to explore racial and sex differences in these polymorphisms and the biochemical abnormalities seen in obesity.

Factors associated with failure to achieve a glycated haemoglobin target of <8.0% in the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial.

The aim of this study was to identify the clinical features of participants in the standard therapy arm of the Action to Control Cardiovascular Risk in Diabetes (ACCORD) glycaemia trial who failed to reach the glycated haemoglobin (HbA1c) target. We analysed 4685 participants in the standard therapy arm, comparing participants who reached the HbA1c target of <8.0% with those whose HbA1c level was ≥8.

Evaluation of a Remote Monitoring System for Diabetes Control.

Purpose: The use of technology to implement cost-effective health care management on a large scale may be an alternative for diabetes management but needs to be evaluated in controlled trials. This study assessed the utility and cost-effectiveness of an automated Diabetes Remote Monitoring and Management System (DRMS) in glycemic control versus usual care.

Methods: In this randomized, controlled study, patients with uncontrolled diabetes on insulin were randomized to use of the DRMS or usual care.

Maternal obesity, gestational weight gain, and offspring adiposity: the exploring perinatal outcomes among children study.

Objective: To determine whether adequate vs excessive gestational weight gain (GWG) attenuated the association between maternal obesity and offspring outcomes.

Study Design: Data from 313 mother-child pairs participating in the Exploring Perinatal Outcomes among Children study were used to test this hypothesis. Maternal prepregnancy body mass index (BMI) and weight measures throughout pregnancy were abstracted from electronic medical records.

The long-term impact of intrauterine growth restriction in a diverse U.S. cohort of children: the EPOCH study.

Objective: To explore the long-term impact of intrauterine growth restriction (IUGR) among a diverse, contemporary cohort of U.S. children.

Determinants of weight gain in the action to control cardiovascular risk in diabetes trial.

Objective: Identify determinants of weight gain in people with type 2 diabetes mellitus (T2DM) allocated to intensive versus standard glycemic control in the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial.

Research Design And Methods: We studied determinants of weight gain over 2 years in 8,929 participants (4,425 intensive arm and 4,504 standard arm) with T2DM in the ACCORD trial. We used general linear models to examine the association between each baseline characteristic and weight change at the 2-year visit.

The impact of neonatal breast-feeding on growth trajectories of youth exposed and unexposed to diabetes in utero: the EPOCH Study.

Objective: To evaluate the influence of breast-feeding on the body mass index (BMI) growth trajectory from birth through 13 years of age among offspring of diabetic pregnancies (ODP) and offspring of non-diabetic pregnancies (ONDP) participating in the Exploring Perinatal Outcomes Among Children Study.

Subjects: There were 94 ODP and 399 ONDP who had multiple BMI measures obtained from birth throughout childhood. A measure of breast milk-months was derived from maternal self-report to categorize breast-feeding status as adequate (≥6 breast milk-months) or low (<6 breast milk-months).

Long-term impact of neonatal breastfeeding on childhood adiposity and fat distribution among children exposed to diabetes in utero.

Objective: To evaluate whether breastfeeding attenuates increased childhood adiposity associated with exposure to diabetes in utero.

Research Design And Methods: Retrospective cohort study of 89 children exposed to diabetes in utero and 379 unexposed youth with measured BMI, waist circumference, skinfolds, visceral (VAT) and subcutaneous (SAT) abdominal fat. A measure of breast milk-months was derived from maternal self-report and used to categorize breastfeeding status as low (<6) and adequate (≥ 6 breast milk-months).

Association of exposure to diabetes in utero with adiposity and fat distribution in a multiethnic population of youth: the Exploring Perinatal Outcomes among Children (EPOCH) Study.

Aims/hypothesis: To evaluate whether exposure to maternal gestational diabetes (GDM) is associated with adiposity and fat distribution in a multiethnic population of children.

Methods: Retrospective cohort study of 82 children exposed to maternal GDM and 379 unexposed youths 6-13 years of age with measured BMI, waist circumference, skinfold thickness, and visceral and subcutaneous abdominal fat.

Results: Exposure to maternal GDM was associated with higher BMI (p = 0.

Impact of a natural disaster on diabetes: exacerbation of disparities and long-term consequences.

Objective: To examine the impact of Hurricane Katrina on the health of individuals with diabetes.

Research Design And Methods: This was an observational study in 1,795 adults with an A1C measurement 6 months before and 6-16 months after Hurricane Katrina in three health care systems: private (Tulane University Hospital and Clinic [TUHC]), state (Medical Center of Louisiana at New Orleans [MCLNO]), and Veterans Affairs (VA). Glycemic control (A1C), blood pressure, and lipids before the hurricane were compared with the patients' first measurement thereafter.

The Action to Control Cardiovascular Risk in Diabetes (ACCORD) Trial and Hurricane Katrina: lessons for managing clinical trials during and after a natural disaster.

Hurricane Katrina was one of the most catastrophic natural disasters to hit the United States. It had a major impact on health care in New Orleans, LA and the surrounding region, not only in relation to acute illness but also chronic disease. When Hurricane Katrina struck New Orleans on August 29, 2005, there were 193 participants being followed in the Action to Control Cardiovascular Risk in Diabetes (ACCORD) Trial at Tulane University Health Sciences Center.

A descriptive evaluation of unfractionated heparin use during pregnancy.

Background: The mainstay of oral anticoagulant therapy, warfarin sodium, crosses the placenta during pregnancy and may cause fetal complications. Unfractionated heparin (UFH) and low-molecular-weight heparin (LMWH) do not cross the placenta and have demonstrated utility in the prevention and treatment of thrombosis during pregnancy.

Objectives: The purpose of this study was to review treatment strategy, indication, and maternal and fetal outcomes in anticoagulated pregnancies at Kaiser Permanente Colorado.

Intrauterine balloon tamponade in the management of postpartum hemorrhage.

This article reviews our experience with the use of intrauterine tamponade with balloon catheters in the management of severe postpartum hemorrhage. This is a case series report of 23 patients with postpartum hemorrhage unresponsive to medical therapy managed with intrauterine balloon tamponade. We identified these patients by International Classification of Diseases (ICD-9) codes and by reviewing labor and delivery logs.

Perinatal loss among twins.

Objective: We evaluated prenatal factors related to perinatal loss in twins, using medical records and death certificates, to determine the main perinatal event that contributed to babies' deaths.

Design: This was a retrospective cohort study of 550 monochorionic diamniotic or diamniotic dichorionic twins who were delivered at Kaiser Permanente Colorado between 1994 and 2001.

Main Outcome: The main outcome of the study was perinatal loss (stillbirth or neonatal death).

Increasing prevalence of gestational diabetes mellitus (GDM) over time and by birth cohort: Kaiser Permanente of Colorado GDM Screening Program.

Objective: The prevalence of gestational diabetes mellitus (GDM) varies in direct proportion with the prevalence of type 2 diabetes in a given population or ethnic group. Given that the number of people with diabetes worldwide is expected to increase at record levels through 2030, we examined temporal trends in GDM among diverse ethnic groups.

Research Design And Methods: Kaiser Permanente of Colorado (KPCO) has used a standard protocol to universally screen for GDM since 1994.

Perinatal factors and development of islet autoimmunity in early childhood: the diabetes autoimmunity study in the young.

The objective of this study was to test whether maternal age at delivery, child's birth order, cesarean section, complicated delivery, maternal smoking during pregnancy, or neonatal jaundice predict islet autoimmunity in children at genetically increased risk of type 1 diabetes in a birth cohort with blood draws at ages 9, 15, and 24 months and yearly thereafter. Newborns with diabetes-associated human leukocyte antigen genotypes (n = 938) and offspring or siblings of persons with type 1 diabetes (n = 428) from the Denver, Colorado, metropolitan area were examined from January 1994 to February 2003. Information on perinatal factors was collected by using questionnaires soon after the birth.

Experimental intrauterine infection with Prevotella bivia in New Zealand White rabbits.

Objective: The purpose of this study was to develop a model of chronic intrauterine and fetal infection with Prevotella bivia, an anaerobe of the lower genital tract that is associated often with bacterial vaginosis.

Study Design: Thirty timed pregnant New Zealand White rabbits on gestational day 21 were inoculated with P bivia or saline solution in a planned ratio of 4:1 (24 P bivia: 6 saline solution). Rabbits were inoculated 6 cm transcervically with 10(5) to 10(8) colony-forming units/uterine horn of P bivia or with saline solution.

The contribution of assisted conception, chorionicity and other risk factors to very low birthweight in a twin cohort.

Objectives: To investigate the contribution of assisted conception (assisted reproductive technology and ovulation induction), chorionicity and selected maternal risk factors for very low birthweight.

Design: Retrospective twin cohort study.

Setting: Staff model Colorado Health Maintenance Organization.

Chronic intrauterine and fetal infection with Gardnerella vaginalis.

Objective: We sought to develop a model of chronic intrauterine and fetal infection with Gardnerella vaginalis.

Study Design: The uterine horns of pregnant New Zealand White rabbits were inoculated on day 21 of gestation with either 10(7) colony-forming units (cfu) of G vaginalis or saline solution. At necropsy, cultures were taken from blood, uterus, amniotic fluid, and fetal tissues.

A randomized controlled trial of interleukin-1 receptor antagonist in a rabbit model of ascending infection in pregnancy.

Objective: To determine whether treatment with interleukin-1 receptor antagonist (IL1-ra) would affect amniotic fluid concentrations of tumor necrosis factor alpha (TNF-alpha) and prostaglandins or clinical or microbiological outcomes in a model of ascending bacterial infection in pregnancy.

Methods: Timed pregnant New Zealand white rabbits at 70% of gestation underwent endoscopic inoculation of the cervices with 10(6) - 10(7) cfu Escherichia coli. Animals were randomly assigned in a blinded manner to a 5-h intravenous infusion of human IL1-ra (10 mg/kg) or placebo beginning 1-2 h after inoculation.

Preeclampsia in multiple gestation: the role of assisted reproductive technologies.

Objective: To estimate the relationship of assisted reproductive technologies and ovulation-inducing drugs with preeclampsia in multiple gestations.

Methods: This historical cohort study was conducted on 528 multiple gestations from a Colorado health maintenance organization. Using univariate and logistic regression analysis, we determined if women who conceived a multiple gestation as a result of assisted conception were at a greater risk of preeclampsia than those who conceived spontaneously.

Chronic intrauterine infection and inflammation in the preterm rabbit, despite antibiotic therapy.

Objective: In a pregnant rabbit model using intracervical inoculation of Escherichia coli with delayed antibiotic therapy, we investigated the rate of positive cultures and histologic inflammation of maternal and fetal compartments and the concentration of tumor necrosis factor-alpha in the amniotic fluid for up to 5 days.

Study Design: New Zealand White rabbits at 70% gestation were inoculated intracervically with 10(3) - 10(4) colony-forming units of E coli per uterine horn. At varying intervals after inoculation (0.