Biomedical subjects

Barbara Luke

Publications and source records attributed to Barbara Luke.

22 records · Page 2Linked to original sources

PubMed2003

Specialized prenatal care and maternal and infant outcomes in twin pregnancy.

OBJECTIVE: This study was undertaken to evaluate the effect of a prenatal nutrition and education program on twin pregnancy, neonatal, and early childhood outcomes. STUDY DESIGN: This prospective intervention study of women who participated in a specialized program (Program Pregnancies) versus nonparticipants included twice-monthly visits, dietary prescription of 3000 to 4000 kcal per day, multimineral supplementation, and patient education. RESULTS: Program Pregnancies were associated with improved pregnancy outcomes (preeclampsia, adjusted odds ratio [AOR] 0.41, 95% CI, 0.23-0.75; preterm premature rupture of membranes, AOR 0.35, 95% CI, 0.20-0.60; delivery <36 weeks, AOR 0.62, 95% CI, 0.43-0.89; low birth weight, AOR 0.42, 95% CI, 0.29-0.61), significantly longer gestations (+7.6 days), higher birth weights (+220 g), lower neonatal morbidity (retinopathy of prematurity, necrotizing enterocolitis, intraventricular hemorrhage, or ventilator support, AOR 0.44, 95% CI, 0.31-0.62), length of stay (-5.3 days), and cost per twin (-14,023 dollars). Through 3 years of age, program children were significantly less likely to be rehospitalized (AOR 0.31, 95% CI, 0.11-0.91) or to be developmentally delayed (AOR 0.65, 95% CI, 0.44-0.96). CONCLUSION: Program participation was associated with improved outcomes at birth and through age 3 years.

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PubMed2003

Body mass index--specific weight gains associated with optimal birth weights in twin pregnancies.

OBJECTIVE: To formulate maternal weight gain guidelines, by maternal pregravid body mass index (BMI) status, associated with optimal fetal growth and birth weight in twins. STUDY DESIGN: This historical cohort study was based on 2,324 pregnancies with nonanomalous, liveborn twins (4,684 infants) from Ann Arbor, Charleston, Baltimore and Miami. Rates of maternal weight gain and fetal growth were modeled using multiple regression for 0-20 weeks, 20-28 weeks and 28-38 weeks (projected as necessary), controlling for potentially confounding factors. Optimal rates of fetal growth were defined as growth between the singleton and twin 50th percentiles, and optimal birth weights were defined as between the singleton 50th percentile and twin 90th percentile at > or = 36 weeks (2,850-2,950 g). RESULTS: Optimal rates of fetal growth and birth weights were associated with rates of maternal weight gain for underweight women of 1.25-1.75 lb/wk (0.57-0.79 kg/wk) to 20 weeks, 1.50-1.75 lb/wk (0.68-0.79 kg/wk) between 20 and 28 weeks and 1.25 lb/wk (0.57 kg/wk) from 28 weeks to delivery; for normal-weight women, 1-1.5 lb/wk (0.45-0.68 kg/wk) to 20 weeks, 1.25-1.75 lb/wk (0.57-0.79 kg/wk) between 20 and 28 weeks and 1.0 lb/wk (0.45 kg/wk) from 28 weeks to delivery; for overweight women, 1-1.25 lb/wk (0.45-0.57 kg/wk) to 20 weeks, 1-1.5 lb/wk (0.45-0.68 kg/wk) between 20 and 28 weeks and 1 lb/wk (0.45 kg/wk) from 28 weeks to delivery; for obese women, 0.75-1 lb/wk (0.34-0.45 kg/wk) to 20 weeks, 0.75-1.25 lb/wk (0.34-0.57 kg/wk) between 20 and 28 weeks and 0.75 lb/wk (0.34 kg/wk) from 28 weeks to delivery. CONCLUSION: Optimal rates of fetal growth and birth weights in twins are achieved at rates of maternal weight gain that vary by period of gestation and maternal pregravid BMI status.

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PubMed2002

A survey of a novel epilepsy clinic.

The management of a group of epilepsy patients from primary care, in a geographical area with clear epilepsy management guidelines and secondary care clinics is surveyed. Suggestions are made to improve liaison between primary and secondary care as well as epilepsy management in primary care. All 42 local primary care practices were invited to take part in this project. A study day providing a broad overview of epilepsy management was held. Those attending were expected to identify all patients in their practice with epilepsy using diagnostic codes and prescribing data. Nine of the invited 42 practices took part in the project, and identified 506 patients prescribed anti-epilepsy drugs (AEDs). Three hundred and three patients were invited for review by their practice nurse, following exclusion of those prescribed AEDs for other conditions, children and those already under specialist review. One hundred and sixteen patients attended for review. Seventy-one patients were identified as requiring specialist review and a consultant neurologist, epilepsy nurse specialist and clinical assistant completed them. Of the 71 patients 31 had experienced no seizures for 5 years, 40 had experienced seizures in the past 5 years, of whom 32 had experienced seizures in the last year. Sixteen were suffering at least one seizure per month, and a few had poorly controlled epilepsy. Patients were taking mainly Phenytoin, Carbamazepine and Sodium valproate. Twenty were taking polytherapy and one no treatment.Fifty-two patients reported side effects and 15 poor compliance. Many patients reviewed were considered to be taking unnecessary medication and suffering unnecessary side effects. There is a need for improved epilepsy management in primary care and better liaison between primary and secondary care.

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PubMed2002

The association between maternal factors and perinatal outcomes in triplet pregnancies.

OBJECTIVE: The purpose of this study was to evaluate the associations between maternal factors and outcomes in triplet pregnancies. STUDY DESIGN: This was a historic cohort study of 194 triplet pregnancies of >or=24 weeks of gestation that were delivered from 1983 through 2001 from five medical centers. RESULTS: In analyses that were limited to pregnancies with all live-born triplets (178 pregnancies), women with a previous good outcome (>2500 g + >37 weeks of gestation) had longer gestations (+7.9 days, P =.03), better rates of fetal growth (+4.9 g/wk, P <.0001), and higher birth weights (+153 g, P <.0001). Maternal weight gains of <36 pounds by 24 weeks of gestation were associated with lower birth weights (-197 g, P <.0001), and fetal growth rates at <or=25th percentile were associated with a shorter length of gestation (-36.7 days, P <.0001). CONCLUSION: Previous obstetric outcome and weight gain by 24 weeks of gestation were associated significantly with fetal growth rate and birth weight; fetal growth rate, in turn, was associated significantly with length of gestation.

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