Brian E. Brocato’s research while affiliated with University of Alabama at Birmingham and other places

OBJECTIVE Continuous glucose monitoring (CGM) improves maternal glycemic control and neonatal outcomes in type 1 diabetes pregnancies compared with self-monitoring of blood glucose. However, CGM targets for pregnancy are based on expert opinion. We aimed to evaluate the association between CGM metrics and perinatal outcomes and identify evidence-based targets to reduce morbidity. RESEARCH DESIGN AND METHODS This was a retrospective cohort study of pregnant patients with type 1 or 2 diabetes who used real-time CGM and delivered at a U.S. tertiary center (2018–2021). Multiple gestations, fetal anomalies, and early pregnancy loss were excluded. Exposures included time in range (TIR; 65–140 mg/dL), time above range (TAR), time below range (TBR), glucose variability, average glucose, and glucose management indicator. The primary outcome was a composite of fetal or neonatal mortality, large or small for gestational age at birth, neonatal intensive care unit admission, hypoglycemia, shoulder dystocia or birth trauma, and hyperbilirubinemia. Logistic regression estimated the association between CGM metrics and outcomes, and optimal TIR was calculated. RESULTS Of 117 patients, 16 (13.7%) used CGM before pregnancy and 68 (58.1%) had type 1 diabetes. Overall, 98 patients (83.8%) developed the composite neonatal outcome. All CGM metrics, except TBR, were associated with neonatal morbidity. For each 5 percentage-point increase in TIR, there was 28% reduced odds of neonatal morbidity (odds ratio 0.72, 95% CI 0.58–0.89). The statistically optimal TIR was 66–71%. CONCLUSIONS Nearly all CGM metrics were associated with adverse neonatal morbidity and mortality and may aid management of preexisting diabetes in pregnancy. Our findings support the American Diabetes Association recommendation of 70% TIR.

Background : The prevalence of opioid use disorder and medication assisted treatment in pregnancy is increasing. Compared to term infants, preterm infants have a lower incidence of neonatal opioid withdrawal syndrome (NOWS). It is unknown whether early term delivery, compared to full or late term, decreases the risk of NOWS. Objective : To compare neonatal outcomes among opioid-exposed infants born in the early, full and late-term periods. Study design : Retrospective cohort of opioid-exposed pregnancies delivering at a single center from 2010–2017 at ≥37weeks gestation. Participants with multiple gestations or fetal anomalies were excluded. Maternal opioid exposure was defined as prescription (including medication assisted treatment) or non-prescription opioids or a positive urine drug screen in pregnancy for opiates. The primary outcome was a neonatal composite of respiratory distress syndrome, neonatal sepsis, neonatal seizures, hypoxic ischemic encephalopathy, jaundice requiring treatment, five-minute Apgar<5, neonatal intensive care unit admission, NOWS or neonatal death. Secondary outcomes included individual components of the primary outcome, birthweight, need for and length of NOWS treatment, length of hospital admission and maximum Finnegan scores. Early (37⁰ – <39), full (39⁰ – <41) and late (41⁰ – <42weeks) term groups were defined by the American College of Obstetrics and Gynecology. Results : Of 399 infants, 136 (34.1%), 229 (57.4%) and 34 (8.5%) were born in the early, full and late term periods. Two hundred and seventy patients (67.7%) received medication assisted treatment for opioid use disorder and baseline characteristics were similar in all groups except for history of intranasal heroin use, positive urine toxicology screen for heroin or any opiates and delivery indication (p<0.05). The primary composite outcome occurred in 313 (78.4%) neonates and 296 (74.2%) neonates had NOWS. More than half (219 [54.9%]) of opioid exposed neonates were admitted to the neonatal intensive care unit and 160 (40.1%) required pharmacologic NOWS treatment for a mean duration of almost three weeks (19.0 ± 16.1 days). There were no significant differences in the primary composite outcome, incidence of NOWS, or other secondary outcomes (except birthweight) between neonates born in the early, full or late term periods. Conclusion : Although neonatal morbidity was frequent among opioid-exposed neonates, the incidence and severity of NOWS or other neonatal outcomes were not different between neonates delivered in the early, full and late term periods, suggesting that opioid-exposed infants may not benefit from early term delivery.

Introduction: This study aimed to determine the effect of a prenatal education program for opioid-dependent women on breastfeeding frequency, newborn hospital length of stay, and cost of care for neonates at risk of developing neonatal abstinence syndrome. Methods: From January 1, 2015 to January 1, 2020, opioid-dependent obstetric patients were educated on non-pharmacological preventative measures for neonatal abstinence syndrome (NAS), with focused counseling on breastfeeding. Data were collected and compared to a control group of opioid-dependent pregnant women who received standard care before initiation of the education program. Results: Sample size calculation revealed that to detect doubling of the breastfeeding rate from 25% to 50% with 80% power and α error of 0.05, 66 participants were required in each group. Conclusion: There were 75 women with opioid use disorder who had prenatal NAS education (study group) and 108 women with opioid use disorder who underwent standard care before NAS education (control group). Prenatal NAS education participants significantly increased breastfeeding initiation rates compared to the control group. Newborn length of stay significantly decreased after initiation of prenatal NAS education compared to the 36 months before NAS education program.