Effect of a Low-Glycemic Load Diet Intervention on Maternal and Pregnancy Outcomes in Obese Pregnant Women.

The increased prevalence of obese, pregnant women who have a higher risk of glucose intolerance warrants the need for nutritional interventions to improve maternal glucose homeostasis. In this study, the effect of a low-glycemic load (GL) ( = 28) was compared to a high-GL ( = 34) dietary intervention during the second half of pregnancy in obese women (body mass index (BMI) > 30 or a body fat >35%). Anthropometric and metabolic parameters were assessed at baseline (20 week) and at 28 and 34 weeks gestation.

Reproductive Rights and Women's Mental Health: Essential Information for the Obstetrician-Gynecologist.

Reproductive health care is crucial to women's well-being and that of their families. State and federal laws restricting access to contraception and abortion in the United States are proliferating. Often the given rationales for these laws state or imply that access to contraception and abortion promote promiscuity, and/or that abortion is medically dangerous and causes a variety of adverse obstetric, medical, and psychological sequelae.

Applying the COM-B model to creation of an IT-enabled health coaching and resource linkage program for low-income Latina moms with recent gestational diabetes: the STAR MAMA program.

Background: One of the fastest growing risk groups for early onset of diabetes is women with a recent pregnancy complicated by gestational diabetes, and for this group, Latinas are the largest at-risk group in the USA. Although evidence-based interventions, such as the Diabetes Prevention Program (DPP), which focuses on low-cost changes in eating, physical activity and weight management can lower diabetes risk and delay onset, these programs have yet to be tailored to postpartum Latina women. This study aims to tailor a IT-enabled health communication program to promote DPP-concordant behavior change among postpartum Latina women with recent gestational diabetes.

Incorporating Nurse-Midwifery Students into Graduate Medical Education: Lessons Learned in Interprofessional Education.

There is a current emphasis on interprofessional education in health care with the aim to improve teamwork and ultimately the quality and safety of care. As part of a Health Resources and Services Administration Advanced Nursing Education project, an interprofessional faculty and student team planned and implemented the first didactic coursework for nurse-midwifery and medical students at the University of California, San Francisco and responded to formative feedback in order to create a more meaningful educational experience for future combined cohorts. This article describes the process of including advanced nurse-midwifery students into 2 classes previously offered solely to medical students: 1) an elective in which students are matched with a pregnant woman to observe care that she receives before, during, and after giving birth; and 2) a required course on basic clinical care across the human lifespan.

Labor and Delivery Experiences of Mothers with Suspected Large Babies.

Objective: To characterize the prevalence of and factors associated with clinicians' prenatal suspicion of a large baby; and to determine whether communicating fetal size concerns to patients was associated with labor and delivery interventions and outcomes.

Methods: We examined data from women without a prior cesarean who responded to Listening to Mothers III, a nationally representative survey of women who had given birth between July 2011 and June 2012 (n = 1960). We estimated the effect of having a suspected large baby (SLB) on the odds of six labor and delivery outcomes.

Counseling patients on preventing prenatal environmental exposures--a mixed-methods study of obstetricians.

Objective: Describe the attitudes, beliefs, and practices of U.S. obstetricians on the topic of prenatal environmental exposures.

Elevated mercury levels in pregnant woman linked to skin cream from Mexico.

Mercury exposure during pregnancy can have serious health effects for a developing fetus including impacting the child's neurologic and cognitive development. Through biomonitoring in a low-income Latina population in California, we identified a patient with high levels of mercury and traced the source to face creams purchased in a pharmacy in Mexico.

Improving diet and exercise in pregnancy with Video Doctor counseling: a randomized trial.

Objective: To determine if an interactive, computerized Video Doctor counseling tool improves self-reported diet and exercise in pregnant women.

Methods: A randomized trial comparing a Video Doctor intervention to usual care in ethnically diverse, low-income, English-speaking pregnant women was conducted. Brief messages about diet, exercise, and weight gain were delivered by an actor-portrayed Video Doctor twice during pregnancy.

The association between body mass index and gestational diabetes mellitus varies by race/ethnicity.

We examined body mass index (BMI) as a screening tool for gestational diabetes (GDM) and its sensitivity among different racial/ethnic groups. In a retrospective cohort study of 24,324 pregnant women at University of California, San Francisco, BMI was explored as a screening tool for GDM and was stratified by race/ethnicity. Sensitivity and specificity were examined using chi-square test and receiver-operator characteristic curves.

When should women with placenta previa be delivered? A decision analysis.

Objective: To determine the optimal gestational age of delivery for women with placenta previa by accounting for both neonatal and maternal outcomes.

Study Design: A decision-analytic model was designed comparing total maternal and neonatal quality-adjusted life years for delivery of women with previa at gestational ages from 34 to 38 weeks. At each week, we allowed for four different delivery strategies: (1) immediate delivery, without amniocentesis or steroids; (2) delivery 48 hours after steroid administration (without amniocentesis); (3) amniocentesis with delivery if fetal lung maturity (FLM) positive or retesting in one week if FLM negative; (4) amniocentesis with delivery if FLM testing is positive or administration of steroids if FLM negative.

Maternal and paternal race/ethnicity are both associated with gestational diabetes.

Objective: The objective of the study was to examine the rates of gestational diabetes mellitus (GDM) associated with both maternal and paternal race/ethnicity.

Study Design: This was a retrospective cohort study of all women delivered within a managed care network. Rates of GDM were calculated for maternal, paternal, and combined race/ethnicity.

Preventing excessive weight gain in pregnancy: how do prenatal care providers approach counseling?

Background: Excessive weight gain during pregnancy is becoming more common and is associated with many adverse maternal and infant outcomes. There is a paucity of data on how weight gain counseling is actually provided in prenatal care settings. Our objective was to study prenatal care providers and their knowledge, attitudes, and practices regarding prevention of excessive weight gain during pregnancy and, secondarily, their approach to nutrition and physical activity counseling during pregnancy.

Who is at risk for prolonged and postterm pregnancy?

Objective: The objective of the study was to examine risk factors for postterm (gestational age >or= 42 weeks) or prolonged (gestational age >or= 41 weeks) pregnancy.

Study Design: We conducted a retrospective cohort study of all term, singleton pregnancies delivered at a mature, managed care organization. The primary outcome measures were the rates of pregnancies greater than 41 or 42 weeks' gestation.

Prepregnancy body mass index and the length of gestation at term.

Objective: The purpose of this study was to examine the relationship between prepregnancy body mass index (BMI) and length of gestation at term.

Study Design: This was a retrospective study of 9336 births at the University of California, San Francisco, at > or = 37 weeks' gestation. We performed univariate and multivariable analyses of the associations between prepregnancy BMI and length of gestation (> or = 40, > or = 41, and > or = 42 weeks' gestation).

Maternal and obstetric complications of pregnancy are associated with increasing gestational age at term.

Objective: We sought to estimate when rates of maternal pregnancy complications increase beyond 37 weeks of gestation.

Study Design: We designed a retrospective cohort study of all low-risk women delivered beyond 37 weeks' gestational age from 1995 to 1999 within a mature managed care organization. Rates of mode of delivery and maternal complications of labor and delivery were examined by gestational age with both bivariate and multivariable analyses.

Weight gain and spontaneous preterm birth: the role of race or ethnicity and previous preterm birth.

Objective: To study how the relationship between gestational weight gain and spontaneous preterm birth interacts with maternal race or ethnicity and previous preterm birth status.

Methods: This was a retrospective cohort study of singleton births to women of normal or low prepregnancy body mass index. Gestational weight gain was measured as total weight gain divided by weeks of gestation at delivery, and weight gain was categorized as low (less than 0.

Are there ethnic differences in the length of labor?

Objective: The purpose of this study was to examine the lengths of the first and second stages of labor among different racial/ethnic groups to determine whether different norms should be established.

Study Design: This was a retrospective cohort study of all laboring, term, singleton, vertex deliveries in a single academic institution. Median lengths of first and second stages of labor were compared among 4 racial/ethnic groups: black, Asian, white, and Latina.

Gestational weight gain and adverse neonatal outcome among term infants.

Objective: To examine the relationship between gestational weight gain and adverse neonatal outcomes among infants born at term (37 weeks or more).

Methods: This was a retrospective cohort study of 20,465 nondiabetic, term, singleton births. We performed univariable and multivariable analyses of the associations between gestational weight gain and neonatal outcomes.

Maternal ethnicity, paternal ethnicity, and parental ethnic discordance: predictors of preeclampsia.

Objective: To examine the association of maternal and paternal ethnicity as well as parental ethnic discordance with preeclampsia.

Methods: Retrospective cohort study of all low-risk women delivered from 1995 to 1999 within a mature managed care organization. Rates of preeclampsia were calculated for maternal, paternal, and combined ethnicity using both univariate and multivariate analyses.

Body mass index, provider advice, and target gestational weight gain.

Objective: To study the relationships among prepregnancy body mass index (BMI), women's target gestational weight gain, and provider weight gain advice.

Methods: Project WISH, the acronym for Women and Infants Starting Healthy, is a longitudinal cohort study of pregnant women in the San Francisco Bay area. We excluded subjects with preterm birth, multiple gestation, or maternal diabetes.

Gestational weight gain, macrosomia, and risk of cesarean birth in nondiabetic nulliparas.

Objective: To examine how the association between excessive weight gain and cesarean birth is modified by infant birth weight in nondiabetic women.

Methods: We designed a retrospective cohort study of singleton, term, nulliparous women with cephalic presentations delivering at a single university hospital. Subjects with diabetes were excluded.

Out-of-pocket expenditures for oral contraceptives and number of packs per purchase.

Objective: Two potential barriers to use of oral contraceptives (OCPs) are out-of-pocket expenditures and the inconvenience of monthly pharmacy visits. This study used nationally representative data to examine the out-of-pocket costs of OCPs and whether women obtain more than 1 pack per purchase.

Methods: We used data from the 1996 Medical Expenditure Panel Survey.