Dwight J Rouse

Alpert Medical School - Brown University, Providence, Rhode Island, United States

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Publications (273)1582.57 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: To examine the association between gestational age (GA) at the time of treatment initiation for gestational diabetes (GDM) and maternal and perinatal outcomes. A secondary analysis of a multicenter randomized treatment trial of mild GDM in which women with mild GDM were randomized to treatment versus usual care. The primary outcome of the original trial, as well as this analysis, was a composite perinatal adverse outcome that included neonatal hypoglycemia, hyperbilirubinemia, hyperinsulinemia, and perinatal mortality. Other outcomes examined included the frequency of large for gestational age (LGA), birth weight, neonatal intensive care unit admission (NICU), gestational hypertension / preeclampsia and cesarean delivery. The interaction between GA at treatment initiation (stratified as 24-26 weeks, 27 weeks, 28 weeks, 29 weeks, ≥30 weeks) and treatment group (treated vs. routine care), with the outcomes of interest, was used to determine whether GA at treatment initiation was associated with outcome differences. Of 958 women analyzed, those who initiated treatment at an earlier GA did not gain an additional treatment benefit compared to those who initiated treatment at a later GA (p-value for interaction with the primary outcome is 0.44). Similarly, there was no evidence that other outcomes were significantly improved by earlier initiation of GDM treatment (LGA p=0.76; NICU admission p=0.8; cesarean delivery p=0.82). The only outcome that had a significant interaction between GA and treatment was gestational hypertension/preeclampsia (p=0.04), although there was not a clear cut GA trend where this outcome improved with treatment. Earlier initiation of treatment of mild GDM was not associated with stronger effect of treatment on perinatal outcomes. Copyright © 2015 Elsevier Inc. All rights reserved.
    American journal of obstetrics and gynecology 06/2015; DOI:10.1016/j.ajog.2015.06.022 · 3.97 Impact Factor
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    ABSTRACT: Objective This study aims to evaluate whether magnesium sulfate (MgSO4) infusion at the time of delivery or magnesium cord blood concentration is associated with cerebral palsy (CP) or death diagnosed by the age of 2 years. Methods Secondary analysis of data from a randomized trial of MgSO4 versus placebo for prevention of CP or death among offspring of women with anticipated preterm delivery. This study cohort included singleton, nonanomalous fetuses, whose mothers received MgSO4 as neuroprophylaxis. The primary outcomes were CP or death diagnosed by the age of 2 years. Results A total of 936 neonates (93 with CP or death, 843 controls) were included in the analysis. Infants in the group with CP or death had MgSO4 infusing at delivery at a similar frequency to that of controls (49 [52.7%] vs. 463 [54.9%], p = 0.68). Mean concentrations of cord blood magnesium, available for 596 neonates, also were not different between the two groups (2.7 ± 0.9 vs. 2.6 ± 0.9 mEq/L, p = 0.66, respectively). Multivariable analyses did not alter these findings. Conclusion Among the offspring of women exposed to MgSO4, in utero, neither MgSO4 infusion at the time of delivery nor magnesium cord blood concentration is associated with CP or death. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.
    American Journal of Obstetrics and Gynecology 06/2015; 212(1):S302-S303. DOI:10.1016/j.ajog.2014.10.815 · 3.97 Impact Factor
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    ABSTRACT: To compare adipose tissue concentration among obese women receiving 2 g compared with 3 g of precesarean cefazolin prophylaxis. This was a double-blind randomized controlled trial of women with singleton gestations and body mass indexes (BMIs) of 30 or greater at their first prenatal visit undergoing cesarean delivery at term. Women were randomly allocated, stratified by BMI, to receive 2 g or 3 g of cefazolin. Subcutaneous adipose tissue was harvested twice: before (opening) fascial incision and after (closing) fascial closure. The primary outcome was opening adipose tissue cefazolin concentration, measured by high-pressure liquid chromatography. From April 2013 to July 2014, 58 women were enrolled, 57 included in the analysis: 28 in the 2-g group and 29 in the 3-g group. Baseline characteristics were similar between groups. Median opening adipose tissue concentration was similar between the 2-g and 3-g groups (9.4 [interquartile range 5.1-13.4] compared with 11.7 [interquartile range 7-18.3] micrograms/g, P=.12). The percentage of women with opening concentrations above 8 micrograms/g, the minimally inhibitory concentration of cefazolin for Staphylococcus species, was similar (61% compared with 72%, P=.35). All samples were above 2 micrograms/g, the minimally inhibitory concentration for Enterobacteriaceae. Closing adipose tissue concentrations and stratified analyses were consistent with the overall analysis. In obese women undergoing cesarean delivery, prophylaxis with 3 g of cefazolin did not significantly increase adipose tissue concentration. Thus, our data do not support recommendations for 3-g dosing. ClinicalTrials.gov, www.clinicaltrials.gov, NCT01810354. I.
    Obstetrics and Gynecology 05/2015; 125(5):1205-1210. DOI:10.1097/AOG.0000000000000789 · 4.37 Impact Factor
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    ABSTRACT: To evaluate whether racial and ethnic disparities exist in obstetric care and adverse outcomes. We analyzed data from a cohort of women who delivered at 25 hospitals across the United States over a 3-year period. Race and ethnicity was categorized as non-Hispanic white, non-Hispanic black, Hispanic, or Asian. Associations between race and ethnicity and severe postpartum hemorrhage, peripartum infection, and severe perineal laceration at spontaneous vaginal delivery as well as between race and ethnicity and obstetric care (eg, episiotomy) relevant to the adverse outcomes were estimated by univariable analysis and multivariable logistic regression. Of 115,502 studied women, 95% were classified by one of the race and ethnicity categories. Non-Hispanic white women were significantly less likely to experience severe postpartum hemorrhage (1.6% non-Hispanic white compared with 3.0% non-Hispanic black compared with 3.1% Hispanic compared with 2.2% Asian) and peripartum infection (4.1% non-Hispanic white compared with 4.9% non-Hispanic black compared with 6.4% Hispanic compared with 6.2% Asian) than others (P<.001 for both). Severe perineal laceration at spontaneous vaginal delivery was significantly more likely in Asian women (2.5% non-Hispanic white compared with 1.2% non-Hispanic black compared with 1.5% Hispanic compared with 5.5% Asian; P<.001). These disparities persisted in multivariable analysis. Many types of obstetric care examined also were significantly different according to race and ethnicity in both univariable and multivariable analysis. There were no significant interactions between race and ethnicity and hospital of delivery. Racial and ethnic disparities exist for multiple adverse obstetric outcomes and types of obstetric care and do not appear to be explained by differences in patient characteristics or by delivery hospital. II.
    Obstetrics and Gynecology 05/2015; 125(6):1. DOI:10.1097/AOG.0000000000000735 · 4.37 Impact Factor
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    ABSTRACT: Objective The aim of the study was to evaluate associations between fetal growth and weight at 2 years in infants born preterm using a customized approach for birth weight. Study Design This is a secondary analysis of a multicenter trial that included a 2-year follow-up of children born prematurely. Customized birth weight percentiles were calculated using the Gardosi model for a U.S. population, and the relation between customized percentile and weight and height at 2 years (adjusted for gender using z-score) was determined using regression analysis and by comparing z-scores for children with birth weight <10th versus ≥10th percentile. Results Weight z-score at 2 years was significantly lower in the <10th than in the ≥10th percentile group (median [interquartile range, IQR]: -0.66 [-1.58, -0.01] vs. -0.23 [-1.05, 0.55]; p < 0.001), and remained after adjusting for maternal education (p < 0.001). A similar relationship was noted for height z-score between groups (median [IQR]: -0.56 [-1.29, 0.19] vs. -0.24 [-0.99, 0.37]; p < 0.001). Positive relationships between customized birth weight percentile and weight and height at 2 years were noted (p < 0.001 for both), but were not strong (R (2) = 0.04 and 0.02, respectively). Conclusion Customized birth weight percentile is a minor determinant of weight at 2 years among children born preterm. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.
    American Journal of Perinatology 03/2015; 32(06). DOI:10.1055/s-0035-1544947 · 1.60 Impact Factor
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    ABSTRACT: To compare the rates of neonatal morbidity and cerebral palsy among preterm neonates (less than 37 weeks of gestation) delivered by cesarean for a nonreassuring fetal heart rate (FHR) tracing compared with those who did not. This was a secondary analysis of a multicenter randomized trial of MgSO4 for the prevention of cerebral palsy. Newborns of women delivered by cesarean delivery for nonreassuring FHR were compared with a control group composed of the offspring of women who labored for 2 hours or longer but did not undergo cesarean delivery for nonreassuring FHR regardless of the mode of delivery. Using multivariable analysis to adjust for potential confounders, our objective was to compare two outcomes: 1) composite neonatal morbidity (Apgar score 3 or less at 5 minutes, seizure, sepsis, necrotizing enterocolitis grade II or III, intraventricular hemorrhage grade III or IV, or death before discharge) and 2) neurologic injury (cerebral palsy) at 2 years or more of corrected age between the groups. Of the 1,291 preterm neonates who met the inclusion criteria, 177 (14%) were delivered by cesarean for nonreassuring FHR compared with 1,114 (86%) in the control group. Composite neonatal morbidity was similar between the groups (30.5 compared with 22.2%, adjusted odds ratio [OR] 1.4, 95% confidence interval [CI] 0.9-2.1). The rate of cerebral palsy of any severity (8.3 compared with 4.0%, adjusted OR 2.3, 95% CI 1.2-4.5) and moderate-to-severe cerebral palsy at 2 years of corrected age (6.0 compared with 2.2%, adjusted OR 3.2, 95% CI 1.4-7.1) was significantly higher in children born through cesarean delivery for nonreassuring FHR. Nonreassuring fetal tracing deemed so serious as to require cesarean delivery is associated with an increased risk of cerebral palsy in preterm neonates. LEVEL OF EVIDENCE:: II.
    Obstetrics and Gynecology 03/2015; 125(3):1. DOI:10.1097/AOG.0000000000000673 · 4.37 Impact Factor
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    ABSTRACT: To describe recent maternal and neonatal delivery outcomes among women with a morbidly adherent placenta in major centers across the United States. This study reviewed a cohort of 115,502 women and their neonates born in 25 hospitals in the United States between March 2008 and February 2011 from the Assessment of Perinatal EXcellence data set. All cases of morbidly adherent placenta were identified. Maternal demographics, procedures undertaken, and maternal and neonatal outcomes were analyzed. There were 158 women with a morbidly adherent placenta (1/731 births, 95% confidence interval 1/632-866). Eighteen percent of women with a morbidly adherent placenta were nulliparous and 37% had no prior cesarean delivery. Only 53% (84/158) were suspected to have a morbidly adherent placenta before delivery. Women with a prenatally suspected morbidly adherent placenta experienced large blood loss (33%), hysterectomy (92%), and intensive care unit admission (39%) compared with 19%, 45%, and 22%, respectively, in those not suspected prenatally to have a morbidly adherent placenta (P<.05 for all). Eighteen percent of women with a morbidly adherent placenta were nulliparous. Half of the morbidly adherent placenta cases were suspected before delivery and outcomes were poorer in this group, probably because the more clinically significant morbidly adherent placentas are more likely to be suspected before delivery. LEVEL OF EVIDENCE:: II.
    Obstetrics and Gynecology 03/2015; 125(3):1. DOI:10.1097/AOG.0000000000000680 · 4.37 Impact Factor
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    ABSTRACT: To compare four national guidelines for the prevention and management of postpartum hemorrhage (PPH). We performed a descriptive analysis of guidelines from the American College of Obstetrician and Gynecologists (ACOG) practice bulletin, Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZOG), Royal College of Obstetrician and Gynaecologists (RCOG), and Society of Obstetricians and Gynaecologists of Canada (SOGC) on PPH to determine differences, if any, with regard to definitions, risk factors, prevention, treatment, and resuscitation. PPH was defined differently in all four guidelines. Risk factors emphasized in the guidelines which conferred a high risk of catastrophic bleeding (e.g. previous cesarean delivery and placenta previa). All organizations except ACOG recommended active management of the third stage of labor (AMTSL) for primary prevention of PPH in all vaginal deliveries. Oxytocin was universally recommended as the medication of choice for PPH prevention in vaginal deliveries. RANZOG and RCOG recommended development of a massive transfusion protocol to manage PPH resuscitation. Recommendations for non-surgical treatment strategies such as uterine packing, and balloon tamponade varied across all guidelines. All organizations recommended transfer to a tertiary care facility for suspicion of abnormal placentation. Specific indications for hysterectomy were not available in any guideline, with RCOG recommending hysterectomy 'sooner rather than later' with the assistance of a second consultant. Substantial variation exists in postpartum hemorrhage prevention and management guidelines among four national organizations, highlighting the need for better evidence and more consistent synthesis of the available evidence with regard to a leading cause of maternal mortality. Copyright © 2015 Elsevier Inc. All rights reserved.
    American Journal of Obstetrics and Gynecology 02/2015; DOI:10.1016/j.ajog.2015.02.023 · 3.97 Impact Factor
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    ABSTRACT: To evaluate whether the presence of condition-specific obstetric protocols within a hospital was associated with better maternal and neonatal outcomes. Cohort study of a random sample of deliveries performed at 25 hospitals over three years. Condition-specific protocols were collected from all hospitals and categorized independently by two authors. Data on maternal and neonatal outcomes, as well as data necessary for risk adjustment were collected. Risk-adjusted outcomes were compared according to whether the patient delivered in a hospital with condition-specific obstetric protocols at the time of delivery. Hemorrhage-specific protocols were not associated with a lower rate of postpartum hemorrhage or with fewer cases of EBL >1000cc. Similarly, in the presence of a shoulder dystocia protocol, there were no differences in the frequency of shoulder dystocia or number of shoulder dystocia maneuvers used. Conversely, preeclampsia-specific protocols were associated with fewer ICU admissions (OR 0.28, 95% CI 0.18-0.44) and fewer cases of severe maternal hypertension (OR 0.86, 95% CI 0.77-0.96). The presence of condition-specific obstetric protocols was not consistently shown to be associated with improved risk-adjusted outcomes. Our study would suggest that the presence or absence of a protocol does not matter and regulations to require protocols are not fruitful. Copyright © 2015 Elsevier Inc. All rights reserved.
    American Journal of Obstetrics and Gynecology 02/2015; DOI:10.1016/j.ajog.2015.01.055 · 3.97 Impact Factor
  • Maureen S Hamel, Brenna L Hughes, Dwight J Rouse
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    ABSTRACT: Oxygen is frequently administered to women in labor in the hope of improving fetal status. However there is a paucity of outcome data to support this practice. Although maternal oxygen administration may make physiologic sense, unwarranted faith in maternal oxygen therapy may delay indicated intervention or result in continued labor stimulation when neither is in the best interests of the fetus. A properly designed clinical trial would help answer whether maternal oxygen supplementation in labor should be considered an indicated intervention for non-reassuring fetal status. Copyright © 2015 Elsevier Inc. All rights reserved.
    American Journal of Obstetrics and Gynecology 02/2015; 212(4). DOI:10.1016/j.ajog.2015.01.057 · 3.97 Impact Factor
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    ABSTRACT: Objective This study aims to determine whether there is a threshold 3-hour oral glucose tolerance test (OGTT) value associated with accelerated risk of adverse pregnancy outcomes. Study Design In a secondary analysis of a cohort of women with untreated mild gestational glucose intolerance, we used generalized additive models with smoothing splines to explore nonlinear associations between each of the 3-hour OGTT values (fasting, 1-hour, 2-hour, and 3-hour) and adverse pregnancy outcomes, including the study's composite outcome (perinatal mortality, hypoglycemia, hyperbilirubinemia, neonatal hyperinsulinemia, and/or birth trauma), large for gestational age birth weight, small for gestational age birth weight, shoulder dystocia, neonatal hypoglycemia, gestational hypertension (gHTN), and preeclampsia. Results Among the 1,360 eligible women, each timed OGTT value was linearly associated with increased odds of composite adverse outcome. We found evidence of a departure from linearity only for the association between fasting glucose and gHTN/preeclampsia, with a stronger association for values of 85 to 94 mg/dL (p = 0.03). We found no evidence of departure from linearity for any other OGTT values and measured outcomes (all chi-square test p-values ≥ 0.05). Conclusion In a population of untreated women with mild gestational glucose intolerance and fasting OGTT < 95 mg/dL, we found an increasing risk of gHTN with a fasting glucose between 85 and 94 mg/dL. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.
    American Journal of Perinatology 01/2015; DOI:10.1055/s-0034-1543949 · 1.60 Impact Factor
  • Dwight J Rouse
  • American Journal of Obstetrics and Gynecology 01/2015; 212(1):S398-S399. DOI:10.1016/j.ajog.2014.10.1037 · 3.97 Impact Factor
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    ABSTRACT: OBJECTIVE: To evaluate whether exposure to 17[alpha]-hydroxyprogesterone caproate is associated with the rate of peripartum infection in women who deliver preterm and their neonates. METHODS: This is a retrospective cohort study of patients who delivered before 37 weeks of gestation at a tertiary care hospital between July 1, 2005, and December 31, 2012. Women in the case group (women exposed to 17[alpha]-hydroxyprogesterone caproate) were matched to women in a control group (unexposed patients) by gestational age and delivery date. The primary outcome was a composite infection rate comprising histologic or clinical chorioamnionitis, endometritis, or early-onset neonatal sepsis. To detect a 15% difference in composite infection rate between women exposed to 17[alpha]-hydroxyprogesterone caproate and those unexposed (two-tailed [alpha]=0.05 and power=80%), 183 patients per group were required. Logistic regression was performed to control for a history of prior spontaneous preterm birth and exposure to betamethasone. RESULTS: The primary outcome frequency for women exposed to 17[alpha]-hydroxyprogesterone caproate was 34.6% (64 patients) compared with 33% (61 patients) in those unexposed (P=.74). There was no significant difference between women exposed to 17[alpha]-hydroxyprogesterone caproate and those unexposed in frequency of clinical chorioamnionitis (1.9% compared with 1.1%, P=.66), histologic chorioamnionitis (39.4% compared with 40%, P=.92), or early-onset neonatal sepsis (2.7% compared with 1.1%, P=.28). A total of 7.1% of women exposed to 17[alpha]-hydroxyprogesterone caproate developed endometritis compared with 2.7% of those unexposed (P=.05). The adjusted odds ratio for the primary outcome in women exposed to 17[alpha]-hydroxyprogesterone caproate was 0.65 (95% confidence interval 0.31-1.38). CONCLUSION: Exposure to 17[alpha]-hydroxyprogesterone caproate does not increase the risk of peripartum infection among women who deliver preterm or their neonates. LEVEL OF EVIDENCE: II
    Obstetrics and Gynecology 01/2015; DOI:10.1097/AOG.0000000000000881 · 4.37 Impact Factor
  • American Journal of Obstetrics and Gynecology 01/2015; 212(1):S28. DOI:10.1016/j.ajog.2014.10.087 · 3.97 Impact Factor
  • American Journal of Perinatology 12/2014; 32(01):093-100. DOI:10.1055/s-0034-1374815 · 1.60 Impact Factor
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    ABSTRACT: Objective This study aims to assess the risk of morbidity associated with maternal lactic acid concentration in women with possible sepsis in pregnancy. Study Design Retrospective cohort of pregnant and postpartum patients with signs of sepsis. Morbidity outcomes were compared by lactic acid concentration. Linear regression was used to evaluate the association between lactic acid and adverse outcomes. Results Out of the 850 women included, 159 had lactic acid measured. Patients with lactic acid measured had higher morbidity: positive blood cultures (16.8 vs. 5.5%, p = 0.04), admission to the intensive care unit (5 vs. 0.1%, p < 0.01) or acute monitoring unit (17.2 vs. 0.9%, p < 0.01), longer hospital stay (median 3 vs. 2 days, p < 0.01), and preterm delivery (18.3 vs. 10.9%, p = 0.05). The mean lactic concentration was higher in patients admitted to the intensive care (2.6 vs. 1.6 mmol/L, p = 0.04) and telemetry unit (2.0 vs. 1.6, p = 0.03), and in those with positive blood cultures (2.2 vs. 1.6, p < 0.01). Lactic acid was positively associated with intensive care or telemetry unit admission, adjusted odds ratio per 1 mmol/L increase in lactic acid 2.34 (95% confidence interval, 1.33-4.12). Conclusion Elevated lactic acid in pregnancy is associated with adverse maternal outcomes from presumed sepsis. In this cohort, lactic acid measurement was a marker of more severe infection. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.
    American Journal of Perinatology 12/2014; 210(1). DOI:10.1055/s-0034-1395477 · 1.60 Impact Factor
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    ABSTRACT: To evaluate the accuracy of sonographic classification of chorionicity in a large cohort of twins and investigate which factors may be associated with sonographic accuracy. We conducted a secondary analysis of a randomized trial of preterm birth prevention in twins. Sonographic classification of chorionicity was compared with pathologic examination of the placenta. Maternal (age, body mass index, diabetes, and hypertension), obstetric (prior cesarean delivery, gestational age at the first sonographic examination, and antepartum bleeding), and sonographic (oligohydramnios, polyhydramnios, and twin-twin transfusion syndrome) factors were assessed for their possible association with accuracy. A total of 545 twin sets in which chorionicity was classified by sonography before 20 weeks' gestation were included; 455 were dichorionic and 90 were monochorionic based on pathologic examination. Sonography misclassified 35 of 545 twin pregnancies (6.4%): 18 of 455 dichorionic twins (4.0%) and 17 of 90 monochorionic twins (19.0%). The sensitivity and specificity of sonographic diagnosis of monochorionicity were 81.1% and 96.0%, respectively. In a multivariable analysis, pregnancies with initial sonographic examinations before 14 weeks' gestation were less likely to have misclassified chorionicity than those with sonographic examinations at 15 to 20 weeks (odds ratio [OR], 0.47; 95% confidence interval [CI], 0.23-0.96). For each week increase in gestational age, the odds of misclassification rose by 10% (OR, 1.10; 95% CI, 1.01-1.2). In the multivariable analysis, maternal age, body mass index, parity, and prior cesarean delivery were not associated with sonographic accuracy. Sonography before 20 weeks incorrectly classified chorionicity in 6.4% of twin gestations. Those with first sonographic examinations performed at earlier gestational ages had improved chorionicity diagnosis. © 2013 by the American Institute of Ultrasound in Medicine.
    Journal of ultrasound in medicine: official journal of the American Institute of Ultrasound in Medicine 12/2014; 33(12):2187-92. DOI:10.7863/ultra.33.12.2187 · 1.53 Impact Factor
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    ABSTRACT: To evaluate whether treatment of mild gestational diabetes mellitus (GDM) confers sustained offspring health benefits, including a lower frequency of obesity. Follow-up study of children (ages 5-10) of women enrolled in a multicenter trial of treatment versus no treatment of mild GDM. Height, weight, blood pressure, waist circumference, fasting glucose, fasting insulin, triglycerides, and HDL cholesterol were measured. Five hundred of 905 eligible offspring (55%) were enrolled. Maternal baseline characteristics were similar between the follow-up treated and untreated groups. The frequencies of BMI ≥95th (20.8% and 22.9%) and 85th (32.6% and 38.6%) percentiles were not significantly different in treated versus untreated offspring (P = 0.69 and P = 0.26). No associations were observed for BMI z score, log waist circumference, log triglycerides, HDL cholesterol, blood pressure, or log HOMA estimated insulin resistance (HOMA-IR). The effect of treatment was different by sex for fasting glucose and log HOMA-IR (P for interaction = 0.002 and 0.02, respectively) but not by age-group (5-6 and 7-10 years) for any outcomes. Female offspring of treated women had significantly lower fasting glucose levels. Although treatment for mild GDM has been associated with neonatal benefits, no reduction in childhood obesity or metabolic dysfunction in the offspring of treated women was found. However only female offspring of women treated for mild GDM had lower fasting glucose. © 2014 by the American Diabetes Association. Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered.
    Diabetes Care 11/2014; 38(3). DOI:10.2337/dc14-2159 · 8.57 Impact Factor
  • Maureen S Hamel, Brenna L Hughes, Dwight J Rouse

Publication Stats

5k Citations
1,582.57 Total Impact Points

Institutions

  • 2011–2015
    • Alpert Medical School - Brown University
      • Department of Obstetrics and Gynecology
      Providence, Rhode Island, United States
    • Brown University
      • Department of Obstetrics and Gynecology
      Providence, Rhode Island, United States
    • The Ohio State University
      • Department of Obstetrics and Gynecology
      Columbus, OH, United States
  • 1993–2015
    • University of Alabama at Birmingham
      • • Department of Obstetrics and Gynecology
      • • Division of Maternal-Fetal Medicine
      Birmingham, Alabama, United States
  • 2010–2014
    • University of Texas Health Science Center at Houston
      Houston, Texas, United States
    • Eunice Kennedy Shriver National Institute of Child Health and Human Development
      Maryland, United States
    • Wake Forest University
      Winston-Salem, North Carolina, United States
    • Aga Khan University Hospital, Karachi
      Kurrachee, Sindh, Pakistan
  • 2006–2014
    • Columbia University
      • Department of Obstetrics and Gynecology
      New York, New York, United States
  • 2013
    • Women & Infants Hospital
      Providence, Rhode Island, United States
  • 2005–2013
    • George Washington University
      • Biostatistics Center
      Washington, Washington, D.C., United States
  • 2012
    • University of Texas Medical Branch at Galveston
      • Department of Obstetrics and Gynecology
      Galveston, TX, United States
  • 2007–2011
    • Drexel University
      • Department of Obstetrics and Gynecology
      Filadelfia, Pennsylvania, United States
  • 2009–2010
    • University of Pittsburgh
      • Division of General Obstetrics and Gynecology
      Pittsburgh, Pennsylvania, United States
    • Northwestern University
      • Department of Obstetrics and Gynecology
      Evanston, IL, United States
  • 2005–2006
    • University of Texas Southwestern Medical Center
      • Department of Obstetrics and Gynecology
      Dallas, Texas, United States
  • 2003
    • West Georgia Obstetrics and Gynecology
      Georgetown, Georgia, United States