Biomedical subjects

Debbie J Rhea

Publications and source records attributed to Debbie J Rhea.

10 recordsLinked to original sources

PubMed2006

Early weight gain does not decrease the incidence of low birth weight and small for gestational age triplets in mothers with normal pre-gestational body mass index.

OBJECTIVE: To examine if the recommended weight gain of >680 g/week during the first 24 weeks of pregnancy decreases the frequency of adverse birth weight outcomes in triplet mothers with a normal pregravid BMI. STUDY DESIGN: Retrospective observational study of a large sample of triplet mothers with a normal (19.8-26) pregravid BMI. Adequate, average, and inadequate weight gains were defined as >680, 500-680, and <500 g/week. Outcome measures were the incidence of >or=1 SGA infant and total triplet birth weight <4500 g. RESULTS: Of the 1166 triplet mothers, 208 (17.8%) gained >680 g/week during their pregnancy. This presumed adequate weight gain did not reduce the incidence of SGA triplets or that of total birth weight <4500 g, irrespective of parity. These adverse birth weight outcomes were 2 to 3.5 times lower among multiparous compared to nulliparous mothers. CONCLUSION: Early weight gain of >680 g/week in triplet mothers with a normal pre-pregnancy BMI is not associated with a decrease in the incidence of adverse outcomes. Weight gain recommendations in triplet pregnancies should be realistic and associated with a low risk-benefit ratio.

Body Mass Index↗

PubMed2005

Characteristics of mothers who delivered the heaviest, average-weight, and lightest triplet sets.

We analyzed a cohort of 2850 live-born triplet sets to compare age, parity, stature, pre-gravid body mass index (BMI), and weekly weight gain in mothers who delivered triplets with a total weight in the 10th, 5th, and 1st deciles corresponding to the heaviest, average-weight, and lightest triplet sets, respectively. Mothers who delivered the heaviest triplets were significantly older, multiparous, taller, heavily built, and gained more weight compared with mothers of average-weight triplets. In contrast, except for higher parity, mothers of average-weight sets were not significantly different compared with mothers who delivered the lightest triplet sets. We concluded that parity was the only significant factor for increased total triplet weight in the first five deciles. However, the presence of other factors in addition to parity is needed for a triplet pregnancy to be included in the 10th decile.

Adolescent↗

PubMed2005

Early adequate maternal weight gain is associated with fewer small for gestational age triplets.

OBJECTIVE: To examine whether the recommended weight gain during the first 24 weeks reduces the frequency of SGA triplets. STUDY DESIGN: We used data collected by the Women's Health Division of Matria Healthcare, Inc (Marietta, GA). We studied the frequency of SGA triplets (birth weight <10th percentile by triplet standards) by weight gain, parity, and pregravid BMI category. Adequate weight gain was defined as >16.2 kg at 24 weeks and BMI categories were defined as underweight (<19.8), normal (19.8-26), and obese (BMI>26). RESULTS: We studied 2890 triplet sets. Adequate weight gain reduces the frequency of SGA triplets, irrespective of pregravid BMI category and parity, except for obese nulliparous women. However, the reduced frequency of SGA infants was significant only in underweight nulli-paras (OR 0.3, 95% CI 0.1, 0.9). CONCLUSION: Higher pregravid BMI and parity seem to reduce the occurrence of SGA triplets. However, lean mothers, especially nulliparas, may be the most important target population for nutritional intervention in triplet pregnancies.

Adult↗

PubMed2004

The likelihood of adverse outcomes in triplet pregnancies estimated by pregravid maternal characteristics.

OBJECTIVE: To estimate the likelihood of adverse outcomes in triplet pregnancies by a score comprising pregravid maternal characteristics. DESIGN: A cross-sectional study. SETTING: Triplets database collected by Matria Healthcare, Inc. PATIENT(S): A scoring system was constructed, assigning 1 point for the presence of a risk factor (nulliparity, stature <165 cm, and age <35 years) and 0 for the absence of a risk factor. Data related to 2,887 triplet sets were analyzed. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Total triplet birth weight <4,500 and delivery at 27-32 weeks. RESULT(S): We identified 18% of triplets' mothers (score 3) in whom the likelihood for adverse results is 50%-90% higher and the likelihood for optimal results is 40% to 70% lower than background rates. CONCLUSION(S): A pregravid maternal profile could estimate the likelihood of adverse outcomes and be used for consulting patients at risk of having or carrying a triplet pregnancy.

Birth Weight↗

PubMed2004

Clinical and economic outcomes of preterm labor management: inpatient vs outpatient.

OBJECTIVE: To compare pregnancy and economic outcomes in women receiving inpatient vs outpatient tocolysis with continuous subcutaneous terbutaline (SQT). STUDY DESIGN: Identified within a database were women prescribed SQT at 24.0 to 33.9 weeks' gestation following stabilization of an acute episode of preterm labor. Women with cervical dilatation >3 cm, and/or maternal or fetal instability were excluded. Those with prolonged inpatient care were matched 1:1 to those discharged with outpatient follow-up by cervical dilatation, gestational age, and fetal number yielding 90 matched pairs (180 women). RESULTS: Inpatients had an earlier gestational age at delivery (34.1+/-2.9 vs 35.8+/-1.9 weeks, p<0.001), higher preterm birth rate (86.7% vs 74.4%, p=0.043) and higher overall costs (56,089 dollars+/-47,944 dollars vs 25,540 dollars+/-25,847 dollars, p<0.001) than outpatients. CONCLUSION: Outpatient management resulted in improved pregnancy outcomes at a cost less than that of inpatient management in this analysis of women treated with SQT.

Adult↗

PubMed2004

The ponderal index in triplets: I. Relationship to small for gestational age neonates.

The aim of the study was to examine the ponderal index in small for gestational age (SGA) triplets. Prospectively collected data from a cohort of triplets born at 28 to 37 weeks were analyzed. A low neonatal ponderal index (birth weight/[length]3) was defined as less than 1 SD below the mean (2.0), and SGA was considered as birth weight below the 10th percentile by triplet standards. We studied 2181 sets of triplets. Triplets delivered at < or = 33 weeks have a lower mean ponderal index compared with those delivered at > 33 weeks. About 70% of SGA triplets do not have a low ponderal index, whereas 79.2% of infants with a low ponderal index are not SGA by triplet standards. Both the frequency of a low ponderal index and the frequency of infants with a low ponderal index who are not SGA decrease with increasing gestational age. We conclude that the majority of triplets with a low ponderal index might not be considered growth restricted, supporting the concept that reduced fetal weight of triplets is more likely a physiological rather than a pathological phenomenon.

Anthropometry↗

PubMed2004

The ponderal index in triplets: II. Gestational age-related patterns of neonatal weights and lengths.

In order to evaluate the determinants of high and low ponderal indices in triplets, we analyzed prospectively collected data from a cohort of 2181 triplet births. Low and high neonatal ponderal indices (birth weight/[length]3) were defined as below or above 1 SD from the mean. The mean ponderal index was of 2.4 +/- 0.4. At 30-31 weeks, there were significantly more infants with a low ponderal index; after 33 weeks, more infants were born with a high index. Birth weights of infants with a high index were significantly higher throughout the entire range of gestational ages, whereas their lengths were significantly smaller. Both birth weights and infant length had significant correlations with gestational ages for infants with a low (R2=0.97 and R2=0.94, respectively) as well as with high ponderal indices (R2=0.95 and R2=0.94, respectively). The regression analyses suggest, however, different patterns for infants with low or high ponderal indices.

Anthropometry↗

PubMed2004

The ponderal index in triplets: III. Association with birth weight discordance.

Our objective was to determine the association of the ponderal index with birth weight discordance in triplets. We analyzed data from triplets delivered at 28-37 weeks for birth weight discordance (>25% difference between the heaviest and lightest triplet). Three categories of discordance (low skew, symmetrical, and high skew) were classified according to the relative position of the middle triplet. Birth weights and the ponderal index (birth weight/[length]3) of all concordant and discordant triplet groups were compared. Of 752 triplet sets included, 184 (24.5%) were discordant. Total triplet birth weight was higher in the concordant compared to all discordant categories. As opposed to birth weight, where only the middle triplet differed according to discordance pattern, the ponderal index for the largest triplet was significantly higher in the low skew discordant group compared to the concordant and other discordant triplet groups. In contrast, the ponderal index for the smallest and middle triplets were similar among the discordant groups. We concluded that discordance in triplet pregnancies exhibits different patterns of mass (birth weight) versus size (ponderal index). Our findings suggest that it may be the size of largest triplet that determines the presence or absence or discordance in triplet gestations.

Adult↗

PubMed2004

The ponderal index in triplets: IV. Relationship with maternal height.

The purpose of the study was to further evaluate the relationship between maternal height and neonatal ponderal index and length. A total of 774 triplet sets with matched maternal stature was available for analyses. We found a significant correlation between maternal height and infant length for both nulliparas (R2=0.70, p=0.04) and multiparas (R2=0.99, p=0.00005). The slopes of the regressions were different than zero, but the difference between the respective regressions was not significant (p=0.83). The analysis revealed a significant correlation between infant ponderal index and maternal stature for nulliparas (R2=0.68, p=0.04) but not for the multiparas (R2=0.08, p=0.6). The slope of the regression for nulliparas was different than zero, but that for the nulliparas was not. The difference between the respective regressions was significant (p=0.03). We conclude that taller mothers deliver longer infants, irrespective of parity, whereas the effect of maternal height on the ponderal index is parity-dependent.

Anthropometry↗

PubMed2004

Measuring outpatient outcomes of emesis and nausea management in pregnant women.

PURPOSE: Nausea and vomiting during pregnancy (NVP) can create a significant clinical, psychological, and economic burden for patients, health care providers, and payers. The purpose of this analysis is to describe the clinical and economic outcomes of patients diagnosed with NVP utilizing an outpatient program of nursing support and pharmacologic treatment with subcutaneous metoclopramide (SMT). DESIGN: Women with singleton gestations who were experiencing NVP and whose physicians prescribed an outpatient program with SMT between January 2000 and February 2002 were identified from a database. METHODOLOGY: Descriptive and statistical methods were used to analyze and report incidence of treatment failure, hospitalization/emergency room (ER) visits, degree of ketonuria, and Pregnancy-Unique Quantification of Emesis and Nausea (PUQE) score at program start/stop. PRINCIPAL FINDINGS: For a treatment duration of 26.9 +/- 20.8 days, 428 women were enrolled for outpatient SMT at 10.9 +/- 3.2 weeks' gestation. Improvement in NVP symptoms was achieved in 382 women with SMT (89.3 percent), while 46 (10.7 percent) required alteration of antiemetic therapy to subcutaneous ondansetron. The PUQE score at the start of SMT was 7.8 +/- 2.9, decreasing to 3.9 +/- 1.7 by therapy completion (P < .001). At treatment initiation, a PUQE score greater than or equal to 7 was reported by 63.1 percent of women versus 9.1 percent at the program's end (P < .001). Patients with ketonuria that was more than or equal to 1+ decreased from 36.2 percent to 1.4 percent (P < .001). The portion of patients with hospital/ER visits decreased from 65.4 percent to 3.3 percent during treatment (P < .001). Oral dietary improvement was noted in 78.7 percent of patients during treatment. CONCLUSION: Outpatient management was effective in controlling NVP and was associated with a reduced need for hospital or emergency room treatment.

Adult↗