Publications by authors named "Towner D"

Background: Maternal obesity is a health concern that may predispose newborns to a high risk of medical problems later in life. To understand the intergenerational effect of maternal obesity, we hypothesized that the maternal obesity effect is mediated by epigenetic changes in the CD34+/CD38-/Lin- hematopoietic stem cells (uHSCs) in the offspring. Towards this, we conducted a DNA methylation centric multi-omics study.

View Article and Find Full Text PDF

Objective: This study aimed to compare cesarean delivery (CD) rates and maternal/neonatal outcomes before and after the 2014 ACOG/SMFM Obstetric Care Consensus for Safe Prevention of Primary CD.

Study Design: This retrospective study compared unscheduled CD rates and outcomes of singleton, cephalic, term pregnancies at a tertiary-care teaching maternity hospital. Births 5 years before (March 2009-February 2014) and after (June 2014-May 2019) release of the consensus were included.

View Article and Find Full Text PDF
Article Synopsis
  • Alpha thalassemia major (ATM) poses a high risk of perinatal loss without in utero transfusions (IUTs), prompting an international registry to assess the impact of IUTs on survival and neurodevelopmental outcomes.
  • Among 49 prenatally diagnosed patients, those who received IUTs had significantly better health outcomes, such as resolution of hydrops and shorter hospital stays, compared to those diagnosed postnatally.
  • Data suggested that the earlier the IUT started, the better the neurodevelopmental scores, highlighting the importance of IUTs in improving survival and normal development in ATM patients, and suggesting that prenatal counseling should include this option for expectant parents.
View Article and Find Full Text PDF

Objectives: Early diagnosis of gestational diabetes can lead to greater optimization of glucose control. We evaluated associations between maternal serum analytes (alpha-fetoprotein [AFP], free beta-human chorionic gonadotropin [beta-hCG], inhibin, and estriol) and the development of gestational diabetes mellitus (GDM).

Methods: This retrospective cohort study identified single-ton pregnancies with available second trimester serum analytes between 2009 and 2017.

View Article and Find Full Text PDF

COVID-19 pandemic is changing profoundly the obstetrics and gynecology (OB/GYN) academic clinical learning environment in many different ways. Rapid developments affecting our learners, patients, faculty and staff require unprecedented collaboration and quick, deeply consequential readjustments, almost on a daily basis. We summarized here our experiences, opportunities, challenges and lessons learned and outline how to move forward.

View Article and Find Full Text PDF

Introduction: Preeclampsia is a medical condition complicated with hypertension and proteinuria during pregnancy. While preeclampsia affects approximately 5% of pregnancies, it remains without a cure. In addition, women who had preeclampsia during pregnancy have been reported to have an increased risk for cardiovascular disease later in life.

View Article and Find Full Text PDF

Background: Fetal intracranial injury is a potentially devastating sequelae of maternal trauma, but there is little guidance regarding fetal evaluation in this setting.

Case: A 23-year-old woman at 27-week gestation was admitted after a high-speed motor vehicle accident. The initial obstetrical ultrasound was unremarkable, but persistently minimal fetal heart rate variability was observed.

View Article and Find Full Text PDF

Objective: Pregnant patients receiving hemodialysis (HD) have long hospital stays for the purpose of electronic fetal monitoring (EFM) during HD, which allows for monitoring of fetal well-being. However, more frequent dialysis allows for smaller fluid shifts, preventing maternal hypotension. Our aim was to determine differences in rates of EFM abnormalities during HD versus non-stress testing (NST) off dialysis for gravid women with renal failure.

View Article and Find Full Text PDF

Introduction: α-klotho is an anti-aging protein, potentially important in preeclampsia (PE). Produced by kidney, brain and placenta, and by mRNA splicing is both a full-length membrane-bound and a truncated soluble protein in the circulation. The membrane-bound protein is an obligate co-receptor for fibroblast growth factor 23 (FGF23) and its action on receptor (FGFR), but ADAM proteinases also cause its shedding.

View Article and Find Full Text PDF

Objective: To describe adverse outcomes and fetal abnormalities in women with a positive prenatal screening result for more than one disorder.

Study Design: Study participants were drawn from a population of 452 901 women pregnant with singletons entering the California Prenatal Screening Program in their first-trimester. Risk assessment was provided for trisomy 21 and trisomy 18 in the first-trimester and trisomy 21, trisomy 18, neural tube defects, and Smith-Lemli-Opitz syndrome in the second-trimester.

View Article and Find Full Text PDF

Amniocentesis is an invasive procedure performed during pregnancy to determine, among other things, whether the fetus has Down syndrome. It is often preceded by screening, which gives a probabilistic risk assessment. Thus, ample information is conveyed to women with the goal to inform their decisions.

View Article and Find Full Text PDF

Objectives: This study seeks to determine whether there is a higher rate of false positive serum screening for Down syndrome in women with sickle cell anemia and, if so, which markers contribute to the false positive screen.

Methods: This is a retrospective cohort study of women who had serum screening between 1998 and 2011. Subjects were women with sickle cell anemia (n = 13), and controls were African American women who did not have that disease (n = 91).

View Article and Find Full Text PDF

Background: Preeclampsia is one of the leading causes of fetal and maternal morbidity and mortality worldwide. Preterm babies of mothers with early onset preeclampsia (EOPE) are at higher risks for various diseases later on in life, including cardiovascular diseases. We hypothesized that genome-wide epigenetic alterations occur in cord blood DNAs in association with EOPE and conducted a case control study to compare the genome-scale methylome differences in cord blood DNAs between 12 EOPE-associated and 8 normal births.

View Article and Find Full Text PDF

By applying the strengths of corporate models for effective teamwork, academic scientists can drive transdisciplinary research and accelerate biomedical translation.

View Article and Find Full Text PDF

Pre-eclampsia is the leading cause of fetal and maternal morbidity and mortality. Early onset pre-eclampsia (EOPE) is a disorder that has severe maternal and fetal outcomes, whilst its etiology is poorly understood. We hypothesize that epigenetics plays an important role to mediate the development of EOPE and conducted a case-control study to compare the genome-wide methylome difference between chorioamniotic membranes from 30 EOPE and 17 full-term pregnancies using the Infinium Human Methylation 450 BeadChip arrays.

View Article and Find Full Text PDF

Objective: The purpose of this study was to examine the relationship between second-trimester maternal serum biomarkers and the development of early- and late-onset severe preeclampsia in euploid pregnancies.

Study Design: Included were 136,139 pregnancies that obtained second-trimester prenatal screening through the California Prenatal Screening Program with live births in 2006-2008. We identified severe preeclampsia diagnoses from hospital discharge records.

View Article and Find Full Text PDF

Objective: To assess the risk of adverse obstetric, perinatal, and fetal outcomes for pregnant women participating in prenatal sequential integrated screening through the California Prenatal Screening Program who had a false-positive screening result.

Methods: Women who underwent first- and second-trimester prenatal integrated screening plus nuchal translucency measurement with outcome information available were included. Fetuses and neonates with chromosomal or neural tube defects were excluded.

View Article and Find Full Text PDF

Background: Anti-N-methyl-D-aspartate (NMDA) receptor encephalitis is an autoimmune disorder resulting in neurologic and psychiatric symptoms. Treatment is challenging in pregnancy, because little data exist to guide management.

Case: A 24-year-old woman with a known diagnosis of anti-NMDA receptor encephalitis using intravenous immunoglobulin therapy became pregnant.

View Article and Find Full Text PDF

Academic medical centers (AMCs) are pillars of the community; they provide health care, create jobs, educate biomedical professionals, and engage in research and innovation. To sustain their impact on human health, AMCs must improve the professional satisfaction of their faculty. Here, we describe ways to enhance recruitment, retention, creativity, and productivity of health science faculty.

View Article and Find Full Text PDF

Objective: The objective of the study was to determine the relationship between nighttime delivery and neonatal encephalopathy (NE).

Study Design: The design of the study was a retrospective population-based cohort of 1,864,766 newborns at a gestation of 36 weeks or longer in California, 1999-2002. We determined the risk of NE associated with nighttime delivery (7:00 (PM) to 6:59 (AM)).

View Article and Find Full Text PDF

Objective: The purpose of this study was to investigate whether multiple echogenic cardiac foci (ECF) are associated with an increased risk of fetal trisomy 21 in our patient population.

Methods: During a span of 38 months, all women found to have an ECF on obstetric sonography were identified as study patients and grouped into single- and multiple-ECF groups. Age- and race-matched patients were identified as a control group.

View Article and Find Full Text PDF

Background: Standard of care for patients with acute coronary syndrome/ST-segment elevation myocardial infarction (ACS/STEMI) is rapid revascularization of ischemic myocardium. Current optimal treatment is primary percutaneous coronary intervention (PCI) within 90 minutes after the patient accesses the health care system, and strategies to lower this time may improve outcomes.

Objective: To compare interhospital transport times (TTs) before and after instituting a no-medication-infusion policy during transport of ACS patients.

View Article and Find Full Text PDF

Objective: To assess antenatal and intrapartum risk factors for seizures occurring during the birth admission.

Study Design: Using multivariable logistic regression analysis, we evaluated the association between maternal characteristics and birth admission seizures in a cohort of 2.3 million California children born at >or=36 weeks' gestation between 1998 and 2002 using the California Office of Statewide Planning and Development database containing birth certificates linked to infant and maternal hospital discharge abstracts.

View Article and Find Full Text PDF