Sara I. Jones’s research while affiliated with University of Texas Southwestern Medical Center and other places

Objective: To evaluate the frequency of adverse maternal and neonatal outcomes associated with maternal obesity in a Hispanic population. We hypothesized that obesity confers a dose-dependent risk associated with these outcomes. Study Design: This was a retrospective cohort study of singleton pregnancies delivered between 24 and 42 weeks gestation at an urban county hospital between 2013 and 2021. Body mass index (BMI) at first prenatal visit was used as a proxy for pre-pregnancy weight. Patients were excluded if their first trimester BMI was not available. Trends in adverse outcomes across increasing obesity classes were assessed. Results: During the study period, 58,497 patients delivered a singleton infant, of which 12,365 (21.1%), 5429 (9.3%), and 3482 (6.0%) were in class I, II, and III obesity, respectively. Compared with non-obese patients, more obese patients were more likely to be younger and nulliparous with a higher incidence of hypertension and pregestational diabetes. Higher BMI was associated with a significant dose-dependent increase in cesarean delivery (27% for non-obese, 34% for class I, 39% for class II, and 46% for class III obesity); severe preeclampsia (8% in non-obese and 19% for class III obesity); and gestational diabetes (5% in non-obese and 15% in class III obesity). There were significant trends in increasing morbidity for infants born to patients with correspondingly higher obesity classes. Some of these adverse outcomes included respiratory distress syndrome, neonatal intensive care unit admission, fetal anomalies, and sepsis (all p < 0.001). Conclusion: Increasing body mass index is associated with a significant dose-dependent increase in multiple adverse perinatal outcomes in a Hispanic population. Associated adverse maternal outcomes include severe preeclampsia, gestational diabetes, and cesarean delivery. Infants born to patients with correspondingly higher BMI class have significantly increased associated morbidity. Often, only higher BMI classes are significantly associated with these adverse outcomes.

Objective This study aimed to examine the relationship of fetal station in the first stage of labor to labor curves and cesarean delivery rates among women presenting in spontaneous labor. Study Design Labor curves for patients with nonanomalous singletons who presented in spontaneous labor to our hospital's Obstetric Triage Unit with intact membranes from January 1, 2012, to August 31, 2016 were reviewed. Cervical exams and time of exam were obtained for each patient from presentation to triage until delivery. Station for each presentation and cervical dilation was estimated using a random effects model and the slope of cervical station change was calculated to estimate the change in dilation by hour. Perinatal outcomes, including cesarean delivery rates, were examined according to fetal station at initial presentation. Factors known to affect labor curves—epidural analgesia, infant birthweight, maternal habitus, and parity—were also examined. Results There were 8,123 patients presented in spontaneous labor with intact membranes. For patients presenting at 6-cm dilation, the rate of change of labor was significantly different when identified to have a station greater than 0 (+1 and more caudad) when compared with those with −1 and more cephalad station (both p < 0.001). This relationship persisted when analyzed according to epidural analgesia, birthweight, maternal habitus, and parity. The frequency of cesarean delivery was significantly higher for women presenting in spontaneous labor with negative fetal station (p < 0.05). When stratified across all dilation (3–9 cm), this trend remained significant (p < 0.001). Conclusion In the first stage of labor, advanced fetal station was significantly associated with differing rates of labor progression, and positive fetal station was significantly less likely to result in cesarean delivery. Physical examination, including station, remains a critical element in labor management. Key Points

Objective: While there is growing awareness of the relationship between air pollution and preterm birth, limited data exists regarding the relationship with spontaneous preterm birth and severe neonatal outcomes. Our aim was to examine the association between traffic-associated air pollution exposure in pregnancy and adverse perinatal outcomes including extremes of preterm birth, NICU admissions, low birthweight, neonatal respiratory diagnosis, neonatal respiratory support, and neonatal sepsis evaluation. Study design: This was a retrospective cohort study of singleton pregnancies residing in a metropolitan area in the southern United States. Using monitors strategically located across the region, average nitrogen dioxide (NO2) concentrations were obtained from the Environmental Protection Agency Air Quality System database. For patients living within 10 miles of a monitoring station, average exposure to NO2 was estimated for individual patients' pregnancy by trimester. Logistic regression models were used to assess the effect of pollutant exposure on gestational age at birth, indicated versus spontaneous delivery, and neonatal outcomes while adjusting for maternal age, self-reported race, parity, season of conception, diabetes, body mass index, registered Health Equity Index, and NO2 monitor region. Adjusted odds ratios and 95% confidence intervals were calculated for an interquartile increase in average NO2 exposure. Results: Between 1 Jan 2013 and 31 Dec 2021, 93,164 patients delivered a singleton infant. Of these, 62,189 had measured NO2 exposure during the pregnancy from a nearby monitoring station. Higher average NO2 exposure throughout pregnancy was significantly associated with preterm birth (aOR 1.94, 95%CI: 1.77, 2.12) and an increase in NICU admissions, low birthweight infants, neonatal respiratory diagnosis, neonatal respiratory support, and neonatal sepsis evaluation. This relationship persisted for nulliparous patients, spontaneous PTB, and had a greater association with earlier PTB. Conclusion: In a metropolitan area, increased exposure to the air pollutant NO2 in pregnancy was significantly associated with spontaneous preterm birth and had a greater association with extremely preterm birth. A greater association with NICU admissions, low birthweight infants, neonatal respiratory diagnosis, neonatal respiratory support, and neonatal sepsis evaluation was found even in term infants.