-
[show abstract]
[hide abstract]
ABSTRACT: To evaluate whether ethnicity is associated with involuntary childlessness and perceived reasons for difficulties in becoming pregnant.
Cross-sectional analysis of baseline data from a longitudinal cohort.
Multiethnic, community-based observational study of US women.
Women in midlife (3,149), aged 42-52 years.
None.
Involuntary childlessness and perceived etiology of infertility.
One hundred thirty-three subjects (4.2%) were involuntarily childless, defined by a reported history of infertility and nulliparity. Ethnicity was significantly associated with self-reported involuntary childlessness. After controlling for economic and other risk factors, African American (odds ratio [OR] 0.30; 95% confidence interval [CI] 0.15-0.59) and Chinese women (OR 0.36; 95% CI 0.14-0.90) were less likely to suffer from involuntary childlessness compared with non-Hispanic white women. In addition, 302 subjects reported a perceived etiology of infertility. An unexpectedly large proportion of these women (24.5%, 74 of 302) reported etiologies not known to cause infertility (i.e., tipped uterus, ligaments for tubes were stretched), with African American women having been most likely to report these etiologies (OR 2.81; 95% CI 1.26-6.28) as the reason for not becoming pregnant.
Ethnicity is significantly associated with involuntary childlessness and perceived etiology of infertility. Misattribution of causes of infertility is common and merits further consideration with respect to language or cultural barriers, as well as possible physician misattribution.
Fertility and sterility 09/2011; 96(5):1200-5.e1. · 3.97 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: The present study aimed to characterise grandmultiparous women receiving intra-partum epidural analgesia and investigate associations between this method of pain relief and labour outcomes in grandmultiparas.
A population-based study was conducted comparing obstetric and perinatal characteristics of grandmultiparous women with and without epidural analgesia. Deliveries occurred during the years 1988-2006. Multiple logistic regression models were constructed to find independent risk factors associated with epidural analgesia, cesarean section and 1st stage labour dystocia.
Out of 41,488 deliveries to grandmultiparous women included in the study, intra-partum epidural analgesia was utilised in 877 (2.1%). Multivariate analysis revealed that grandmultiparas who received epidural pain relief were significantly older and more likely to suffer from pre-mature rupture of the membranes, polyhydramnion, oligohydramnion, labour induction and a macrosomic fetus. After controlling for potential confounding, use of epidural analgesia remained an independent risk factor for 1st stage labour dystocia (odds ratio (OR) = 1.5; 95% confidence interval (CI) = 1.08-2.2) and cesarean delivery (OR = 2.9; 95% CI = 2.4-3.5) in grandmultiparas.
Grandmultiparous women who received intra-partum epidural analgesia have entirely different obstetric characteristics as compared with those who did not receive this method of pain relief. Although epidural use was demonstrated to be an independent risk factor for 1st stage labour dystocia and cesarean section in this population, residual confounding cannot be excluded.
The journal of maternal-fetal & neonatal medicine: the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians 01/2009; 22(4):348-52. · 1.36 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: We evaluated the accuracy of diagnosis of fibromyalgia (FM) by family physicians.
We performed a retrospective cohort analysis of 646 consecutive patients newly referred to the outpatient rheumatology clinic of Soroka University Medical Center from January 1, 2005, until December 31, 2007. The kappa statistic was used to measure agreement between family-physician and rheumatologist diagnoses for FM in the total patient cohort as well as in groups stratified by ethnicity. Sensitivity and specificity of family-physician diagnosis of FM were calculated using rheumatologist diagnosis as the gold standard. There were no exclusion criteria.
During the time period of the study, 646 new patients were seen in the rheumatology clinic. Of 196 patients referred with an initial diagnosis of FM, the consultant rheumatologist confirmed this diagnosis in 71% of cases. The overall kappa for FM diagnosis between family physicians and rheumatologists was 0.70 (p<0.001), indicating a good level of agreement. Agreement was substantially lower among Bedouin patients (kappa=0.35, p=0.003). All other patients in our study were Jewish Israelis. Using rheumatologist diagnosis as the gold standard, overall sensitivity and specificity of FM diagnosis by family physicians were 87.4% and 88.3%, respectively.
Family physicians in our region are able to accurately diagnose FM. Future studies might focus on evaluating the factors and biases accounting for differences in level of diagnostic accuracy for FM among various ethnic groups.
The Journal of Rheumatology 01/2009; 36(1):170-3. · 3.69 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: To examine pregnancy outcomes associated with diet-controlled gestational diabetes mellitus (GDM A1).
A retrospective cohort study compared pregnancy characteristics of women with and without GDM A1 at a center where GDM A1 patients are routinely induced at 40 weeks.
Higher rates of complications such as shoulder dystocia, congenital malformation, and macrosomia were observed in GDM A1 patients. A lower incidence of perinatal mortality was present in GDM A1 women compared with women without GDM A1. This association lost its significance when controlled for maternal age, ethnicity, induction, cesarean delivery, and birth weight in a multivariate model. Although the stillbirth rate before 40 weeks of gestation was identical among all participants, after 40 weeks it was significantly higher in women without GDM A1.
Induction of women with GDM A1 at 40 weeks may play a role in lowering perinatal mortality to below that of the general population.
International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics 12/2008; 104(3):199-202. · 1.41 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Bariatric surgery is both a popular and highly effective treatment for obesity. Pregnancy after these procedures has proved safe, with certain gestational complication rates lower than those associated with pregnancy in the obese. Current recommendations suggest delaying pregnancy until after the first postoperative year to avoid gestation during the rapid weight-loss phase. However, few controlled studies have examined the effects of postoperative pregnancy timing on gestational complications and outcomes. We discuss the current recommendations regarding timing of pregnancy after bariatric surgery. No conclusive evidence exists suggesting that pregnancy during the first postoperative year is unsafe, although more research is needed. Future studies should examine the safety of early postoperative pregnancy and determine whether or not its gestational complication rates are lower than those associated with obesity. Until the influence of pregnancy timing on post-bariatric surgery perinatal outcomes is better understood, clinicians should take into account all relevant data, consult with their postoperative patients, and create reproductive timelines best suited to individual needs.
American Journal of Perinatology 07/2008; 25(6):331-3. · 1.32 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Obesity continues to be a global epidemic, and strong evidence exists linking it with gestational complications such as macrosomia, hypertensive disorders of pregnancy, gestational diabetes, and cesarean section. Bariatric surgery, a highly effective treatment for obesity, may prevent such complications in subsequent pregnancies.
This review seeks to describe the risks and benefits of post-bariatric procedure pregnancies, in comparison to both community and obese cohorts.
A thorough review of the literature suggests that post-surgery women are not at increased risk for poor perinatal outcomes, and moreover their risks for many obesity-related gestational complications are reduced after bariatric surgery. Data regarding fertility after bariatric surgery are quite ambiguous, however, and studies exist demonstrating both positive and negative associations between weight loss procedures and fertility.
Clinicians should be aware that data collected on this subject were often gathered from post-op pregnant women provided with good prenatal care and screening for nutritional deficiencies. Although pregnancy after bariatric surgery appears to be safe, providers should take extra care to properly monitor their post-op pregnant patients for appropriate weight gain and nourishment.
Archives of Gynecology and Obstetrics 06/2008; 277(5):381-8. · 1.28 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Preeclampsia is a major cause of maternal morbidity, although its precise etiology remains elusive. A number of studies suggest that urinary tract infection (UTI) during the course of gestation is associated with elevated risk for preeclampsia, while others have failed to prove such an association. In our medical center, pregnant women who were exposed to at least one UTI episode during pregnancy were 1.3 times more likely to have mild preeclampsia and 1.8 times more likely to have severe preeclampsia as compared to unexposed women. Our results are based on univariate analyses and are not adjusted for potential confounders.
This editorial aims to discuss the relationship between urinary tract infection and preeclampsia, as well as examine the current problems regarding the interpretation of this association.
Although the relationship between UTI and preeclampsia has been demonstrated in studies with various designs, carried-out in a variety of settings, the nature of this association is unclear. By taking into account timeline, dose-response effects, treatment influences, and potential confounders, as well as by neutralizing potential biases, future studies may be able to clarify the relationship between UTI and preeclampsia by determining if it is causal, confounded, or spurious.
Archives of Gynecology and Obstetrics 05/2008; 277(6):479-81. · 1.28 Impact Factor
