George Saade

University of Texas Medical Branch at Galveston, Galveston, Texas, United States

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Publications (707)2796.17 Total impact

  • [Show abstract] [Hide abstract]
    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: The objective of the Sleep Disordered Breathing substudy of the Nulliparous Pregnancy Outcomes Study Monitoring Mothers-to-be (nuMoM2b) is to determine whether sleep disordered breathing during pregnancy is a risk factor for adverse pregnancy outcomes. NuMoM2b is a prospective cohort study of 10,037 nulliparous women with singleton gestations that was conducted across 8 sites with a central Data Coordinating and Analysis Center. The Sleep Disordered Breathing substudy recruited 3702 women from the cohort to undergo objective, overnight in-home assessments of sleep disordered breathing. A standardized level 3 home sleep test was performed between 6(0)-15(0) weeks' gestation (visit 1) and again between 22(0)-31(0) weeks' gestation (visit 3). Scoring of tests was conducted by a central Sleep Reading Center. Participants and their health care providers were notified if test results met "urgent referral" criteria that were based on threshold levels of apnea hypopnea indices, oxygen saturation levels, or electrocardiogram abnormalities but were not notified of test results otherwise. The primary pregnancy outcomes to be analyzed in relation to maternal sleep disordered breathing are preeclampsia, gestational hypertension, gestational diabetes mellitus, fetal growth restriction, and preterm birth. Objective data were obtained at visit 1 on 3261 women, which was 88.1% of the studies that were attempted and at visit 3 on 2511 women, which was 87.6% of the studies that were attempted. Basic characteristics of the substudy cohort are reported in this methods article. The substudy was designed to address important questions regarding the relationship of sleep-disordered breathing on the risk of preeclampsia and other outcomes of relevance to maternal and child health. Copyright © 2015 Elsevier Inc. All rights reserved.
    American Journal of Obstetrics and Gynecology 03/2015; 212(4). DOI:10.1016/j.ajog.2015.01.021 · 3.97 Impact Factor
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    ABSTRACT: Background Stillbirths (>20 weeks’ gestation), which account for about 1 in 200 US pregnancies, may grieve parents deeply. Unresolved grief may lead to persistent depression.Methods We compared depressive symptoms in 2009 (6–36 months after index delivery) among consenting women in the Stillbirth Collaborative Research Network's population-based case–control study conducted 2006–08 (n = 275 who delivered a stillbirth and n = 522 who delivered a healthy livebirth (excluding livebirths <37 weeks, infants who had been admitted to a neonatal intensive care unit or who died). Women scoring >12 on the Edinburgh Depression Scale were classified as currently depressed. Crude (cOR) and adjusted (aOR) odds ratios and 95% confidence intervals [CI] were computed from univariate and multivariable logistic models, with weighting for study design and differential consent. Marginal structural models examined potential selection bias due to low follow-up.ResultsCurrent depression was more likely in women with stillbirth (14.8%) vs. healthy livebirth (8.3%, cOR 1.90 [95% CI 1.20, 3.02]). However, after control for history of depression and factors associated with both depression and stillbirth, the stillbirth association was no longer significant (aOR 1.35 [95% CI 0.79, 2.30]). Conversely, for the 76% of women with no history of depression, a significant association remained after adjustment for confounders (aOR 1.98 [95% CI 1.02, 3.82]).Conclusions Improved screening for depression and referral may be needed for women's health care. Research should focus on defining optimal methods for support of women suffering stillbirth so as to lower the risk of subsequent depression.
    Paediatric and Perinatal Epidemiology 03/2015; 29(2). DOI:10.1111/ppe.12176 · 2.81 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: Autism Spectrum Disorder (ASD) is associated with preterm birth (PTB); though the reason underlying this relationship is still unclear. Our objective was to examine DNA methylation patterns of four ASD candidate genes in human fetal membranes from spontaneous PTB and uncomplicated term birth (TB). A literature search for genes implicated in ASD yielded 14 candidate genes (OXTR, SHANK3, BCL2, RORA, EN2, RELN, MECP2, AUTS2, NLGN3, NRXN1, SLC6A4, UBE3A, GABA, AFF2) that were epigenetically modified in relation to ASD. DNA methylation in fetal leukocyte DNA in four of these genes (OXTR, SHANK3, BCL2 and RORA) associated with PTB in a previous study. This study evaluated DNA methylation, transcription (qPCR) and translation patterns (immunostaining and western blot) in fetal membrane from term labor (TL; n=14), term not in labor (TNIL; n=29) and spontaneous preterm birth (PTB; n=27). Statistical analysis was performed using ANOVA and a p-value of < 0.05 was significant. Higher methylation of the OXTR promoter was seen in fetal membranes from PTB compared to TL or TNIL. No other gene showed any methylation differences between groups. Expression of OXTR was not different between groups but the 70 kDa OXTR protein was seen only in PTB, and immunostaining was more intense in PTB amniocytes than TL or TNIL. Among the four genes studied, fetal membranes from PTB demonstrate differences in OXTR methylation and regulation and expression, suggesting that epigenetic alteration of this gene in fetal membrane may likely be indicating an in utero programing of this gene and serve as a surrogate in a subset of PTB. The usefulness of OXTR hypermethylation as a surrogate for link to ASD should be further evaluated in longitudinal and in vitro studies. Copyright © 2015 Elsevier Inc. All rights reserved.
    American Journal of Obstetrics and Gynecology 02/2015; 212(1). DOI:10.1016/j.ajog.2015.02.011 · 3.97 Impact Factor
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    ABSTRACT: Spontaneous preterm birth (SPTB) is a complex condition that is likely a final common pathway with multiple possible etiologies. We hypothesized that a comprehensive classification system could appropriately group women with similar STPB etiologies, and provide an explanation, at least in part, for the disparities in SPTB associated with race and gestational age at delivery. Planned analysis of a multicenter, prospective study of singleton SPTB. Women with SPTB < 34 weeks were included. We defined 9 potential SPTB phenotypes based on clinical data, including infection/inflammation, maternal stress, decidual hemorrhage, uterine distention, cervical insufficiency, placental dysfunction, premature rupture of the membranes, maternal comorbidities, and familial factors. Each woman was evaluated for each phenotype. Delivery gestational age was compared between those with and without each phenotype. Phenotype profiles were also compared between women with very early (20.0-27.9 weeks) SPTB vs. those with early SPTB (28.0-34.0 weeks), and between African-American and Caucasian women. Statistical analysis was by t-test and chi-square as appropriate. The phenotyping tool was applied to 1025 women with SPTB who delivered at a mean 30.0 (+/- 3.2) weeks gestation. Of these, 800 (78%) had ≥2 phenotypes. Only 43 (4.2%) had no phenotypes. The 281 women with early SPTB were more likely to have infection/inflammation, decidual hemorrhage, and cervical insufficiency phenotypes (all p≤0.001). African-American women had more maternal stress and cervical insufficiency but less decidual hemorrhage and placental dysfunction compared to Caucasian women (all p<0.05). Gestational age at delivery decreased as the number of phenotypes present increased. Precise SPTB phenotyping classifies women with SPTB and identifies specific differences between very early and early SPTB and between African-Americans and Caucasians. Copyright © 2015 Elsevier Inc. All rights reserved.
    American Journal of Obstetrics and Gynecology 02/2015; 212(4). DOI:10.1016/j.ajog.2015.02.010 · 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
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    ABSTRACT: Objective Celox gauze (7.5 cm wide, 3 m long) is covered with chitosan, a hemostatic agent derived from chitin. The objective of our analysis was to compare a 26 mth period before and a 38 mth period after the introduction of Celox in the treatment of PPH and to evaluate the numbers of postpartum hysterectomies (ppHE). Study Design Women suffering from severe PPH at the Marienkrankenhaus Hamburg, Germany, were treated by uterine packing with Celox through the hysterotomy in cesarean delivery (CS), or transvaginally. In CS packing was generally combined with B-Lynch and/or Pereira stitches. 15036 consecutive births before and after the introduction of Celox (n=5498 vs. n=9538 deliveries) were analyzed. 1-tailed Fisher exact test was used for statistics. Results Celox was used in 65 cases of PPH including 21 severe cases where ppHE seemed inevitable. 35 women had delivered vaginally (1 vacuum), 27 by elective (n=13) or emergency (n=14) CS. In 6 out of 35 vaginal deliveries laparotomy was necessary to apply compression sutures. Celox was left in utero for up to 48 hrs (mean 20.63) before extraction. Compared with 26 mth before, in the 38 mth after introduction of Celox the rate of ppHEs was significantly reduced (10 vs. 5; OR 3.47, 95% CI 1.19-10.16; p=.023). Indications for HEs were uterine rupture (n=2), failure of compression sutures (n=2, in one case no Celox was used), recurrence of PPH after removal of Celox after 48 hrs due to preexisting thrombopenia (18 thr per nl, n=1). The longest period without ppHE after Celox was 23.5 months. One of the Celox treated patients is pregnant again (34 wks gestation). Maternal mortality after the introduction of Celox was 0. Conclusion Celox is a viable option in the treatment of PPH and reduces ppHE significantly. It can safely be used after both vaginal and CS, and we observed no specific treatment associated morbidity. It is inexpensive compared to other treatments, making it suitable for use also in low resource-countries, where the death toll due to PPH is high.
    The Pregnancy Meeting™ 2015, San Diego, California, United States; 02/2015
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    ABSTRACT: The primary aim of the "Nulliparous Pregnancy Outcomes Study: monitoring mothers-to-be" is to determine maternal characteristics, which include genetic, physiologic response to pregnancy, and environmental factors that predict adverse pregnancy outcomes. Nulliparous women in the first trimester of pregnancy were recruited into an observational cohort study. Participants were seen at 3 study visits during pregnancy and again at delivery. We collected data from in-clinic interviews, take-home surveys, clinical measurements, ultrasound studies, and chart abstractions. Maternal biospecimens (serum, plasma, urine, cervicovaginal fluid) at antepartum study visits and delivery specimens (placenta, umbilical cord, cord blood) were collected, processed, and stored. The primary outcome of the study was defined as pregnancy ending at <37+0 weeks' gestation. Key study hypotheses involve adverse pregnancy outcomes of spontaneous preterm birth, preeclampsia, and fetal growth restriction. We recruited 10,037 women to the study. Basic characteristics of the cohort at screening are reported. The "Nulliparous Pregnancy Outcomes Study: monitoring mothers-to-be" cohort study methods and procedures can help investigators when they plan future projects. Copyright © 2015 Elsevier Inc. All rights reserved.
    American Journal of Obstetrics and Gynecology 01/2015; 212(4). DOI:10.1016/j.ajog.2015.01.019 · 3.97 Impact Factor
  • American Journal of Obstetrics and Gynecology 01/2015; 212(1). DOI:10.1016/j.ajog.2014.10.055 · 3.97 Impact Factor
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    ABSTRACT: To determine whether β2 -adrenoceptor (β2 AR) genotype is associated with shortening of the cervix or with preterm birth (PTB) risk among women with a short cervix in the second trimester. A case-control ancillary study to a multicentre randomised controlled trial. Fourteen participating centres of the Maternal-Fetal Medicine Units Network of the Eunice Kennedy Shriver National Institute of Child Health and Human Development. Four hundred thirty-nine women, including 315 with short cervix and 124 with normal cervical length. Nulliparous women with cervical length <30 mm upon a 16-22-week transvaginal sonogram and controls frequency-matched for race/ethnicity with cervical lengths ≥40 mm were studied. β2 AR genotype was determined at positions encoding for amino acid residues 16 and 27. Genotype distributions were compared between case and control groups. Within the short cervix group, pregnancy outcomes were compared by genotype, with a primary outcome of PTB <37 weeks. Genotype data were available at position 16 for 433 women and at position 27 for 437. Using a recessive model testing for association between short cervix and genotype, and adjusted for ethnicity, there was no statistical difference between cases and controls for Arg16 homozygosity (OR 0.7, 95% CI 0.4-1.3) or Gln27 homozygosity (OR 0.9, 95% CI 0.3-2.7). Among cases, Arg16 homozygosity was not associated with protection from PTB or spontaneous PTB. Gln27 homozygosity was not associated with PTB risk, although sample size was limited. β2 AR genotype does not seem to be associated with short cervical length or with PTB following the second-trimester identification of a short cervix. Influences on PTB associated with β2 AR genotype do not appear to involve a short cervix pathway. © 2015 Royal College of Obstetricians and Gynaecologists.
    BJOG An International Journal of Obstetrics & Gynaecology 01/2015; DOI:10.1111/1471-0528.13243 · 3.86 Impact Factor
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    ABSTRACT: Preterm birth is the leading cause of infant morbidity and mortality. Despite extensive research, the genetic contributions to spontaneous preterm birth (SPTB) are not well understood. Term controls were matched with cases by race/ethnicity, maternal age, and parity prior to recruitment. Genotyping was performed using Affymetrix SNP Array 6.0 assays. Statistical analyses utilized PLINK to compare allele occurrence rates between case and control groups, and incorporated quality control and multiple-testing adjustments. We analyzed DNA samples from mother–infant pairs from early SPTB cases (200/7–336/7 weeks, 959 women and 979 neonates) and term delivery controls (390/7–416/7 weeks, 960 women and 985 neonates). For validation purposes, we included an independent validation cohort consisting of early SPTB cases (293 mothers and 243 infants) and term controls (200 mothers and 149 infants). Clustering analysis revealed no population stratification. Multiple maternal SNPs were identified with association P-values between 10 × 10–5 and 10 × 10–6. The most significant maternal SNP was rs17053026 on chromosome 3 with an odds ratio (OR) 0.44 with a P-value of 1.0 × 10–6. Two neonatal SNPs reached the genome-wide significance threshold, including rs17527054 on chromosome 6p22 with a P-value of 2.7 × 10–12 and rs3777722 on chromosome 6q27 with a P-value of 1.4 × 10–10. However, we could not replicate these findings after adjusting for multiple comparisons in a validation cohort. This is the first report of a genome-wide case-control study to identify single nucleotide polymorphisms (SNPs) that correlate with SPTB.
    Genetic Epidemiology 01/2015; 39(3). DOI:10.1002/gepi.21887 · 2.95 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
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    ABSTRACT: In the 1970s, studies demonstrated that timely access to risk-appropriate neonatal and obstetric care could reduce perinatal mortality. Since the publication of the Toward Improving the Outcome of Pregnancy report, more than 3 decades ago, the conceptual framework of regionalization of care of the woman and the newborn has been gradually separated with recent focus almost entirely on the newborn. In this current document, maternal care refers to all aspects of antepartum, intrapartum, and postpartum care of the pregnant woman. The proposed classification system for levels of maternal care pertains to birth centers, basic care (level I), specialty care (level II), subspecialty care (level III), and regional perinatal health care centers (level IV). The goal of regionalized maternal care is for pregnant women at high risk to receive care in facilities that are prepared to provide the required level of specialized care, thereby reducing maternal morbidity and mortality in the United States. Copyright © 2015 Elsevier Inc. All rights reserved.
    American Journal of Obstetrics and Gynecology 01/2015; DOI:10.1016/j.ajog.2014.12.030 · 3.97 Impact Factor
  • American Journal of Obstetrics and Gynecology 01/2015; 212(1):S286. DOI:10.1016/j.ajog.2014.10.779 · 3.97 Impact Factor
  • American Journal of Obstetrics and Gynecology 01/2015; 212(1):S279-S280. DOI:10.1016/j.ajog.2014.10.607 · 3.97 Impact Factor
  • American Journal of Obstetrics and Gynecology 01/2015; 212(1):S99-S100. DOI:10.1016/j.ajog.2014.10.216 · 3.97 Impact Factor
  • American Journal of Obstetrics and Gynecology 01/2015; 212(1):S221-S222. DOI:10.1016/j.ajog.2014.10.474 · 3.97 Impact Factor
  • American Journal of Obstetrics and Gynecology 01/2015; 212(1):S51. DOI:10.1016/j.ajog.2014.10.119 · 3.97 Impact Factor
  • American Journal of Obstetrics and Gynecology 01/2015; 212(1):S51. DOI:10.1016/j.ajog.2014.10.120 · 3.97 Impact Factor

Publication Stats

7k Citations
2,796.17 Total Impact Points

Institutions

  • 1997–2015
    • University of Texas Medical Branch at Galveston
      • • Department of Obstetrics and Gynecology
      • • Department of Radiology
      • • Maternal Fetal Medicine Division
      Galveston, Texas, United States
  • 2001–2014
    • Columbia University
      New York, New York, United States
    • University of Nottingham
      Nottigham, England, United Kingdom
    • University of Freiburg
      Freiburg, Baden-Württemberg, Germany
    • West Georgia Obstetrics and Gynecology
      Georgetown, Georgia, United States
  • 1992–2014
    • Baylor College of Medicine
      • Department of Obstetrics and Gynecology
      Houston, Texas, United States
  • 2013
    • George Washington University
      Washington, Washington, D.C., United States
    • Eastern Virginia Medical School
      • Division of Obstetrics and Gynecology
      Norfolk, Virginia, United States
  • 1999–2013
    • Society for Maternal-Fetal Medicine
      Galveston, Texas, United States
  • 2010–2012
    • Drexel University
      Filadelfia, Pennsylvania, United States
  • 2011
    • University of North Carolina at Chapel Hill
      North Carolina, United States
    • University of Texas Health Science Center at Houston
      • Department of Obstetrics, Gynecology and Reproductive Sciences
      Houston, Texas, United States
    • The Ohio State University
      • Department of Obstetrics and Gynecology
      Columbus, OH, United States
  • 1998–2010
    • Texas A&M University - Galveston
      Galveston, Texas, United States
  • 2009
    • University of California, San Francisco
      San Francisco, California, United States
    • Eunice Kennedy Shriver National Institute of Child Health and Human Development
      Maryland, United States
  • 1999–2009
    • University of Utah
      • • Department of Obstetrics and Gynecology
      • • Division of Maternal-Fetal Medicine
      Salt Lake City, UT, United States
  • 2008
    • Alpert Medical School - Brown University
      Providence, Rhode Island, United States
    • University of Alabama at Birmingham
      • Department of Obstetrics and Gynecology
      Birmingham, Alabama, United States
  • 2006
    • Boston University
      • Department of Biostatistics
      Boston, Massachusetts, United States
    • Icahn School of Medicine at Mount Sinai
      • Department of Obstetrics, Gynecology, and Reproductive Science
      Borough of Manhattan, New York, United States
  • 2005–2006
    • Yale University
      • Department of Obstetrics, Gynecology and Reproductive Sciences
      New Haven, CT, United States
    • University of Maryland, Baltimore
      • Department of Medicine
      Baltimore, Maryland, United States
    • Johns Hopkins University
      Baltimore, Maryland, United States
    • Imperial College London
      Londinium, England, United Kingdom
    • Galveston College
      Galveston, Texas, United States
    • CUNY Graduate Center
      New York City, New York, United States
  • 2004
    • CARDIO MD
      Newark, New Jersey, United States
  • 2003
    • University of Chicago
      • Department of Obstetrics & Gynecology
      Chicago, Illinois, United States
    • Fukushima Medical University
      • Department of Obstetrics
      Hukusima, Fukushima, Japan