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Biomedical subjects

M K Lindsay

Publications and source records attributed to M K Lindsay.

At least 19 recordsLinked to original sources
PubMed2003

Pregnancy outcomes in foreign-born and US-born women.

OBJECTIVES: To compare pregnancy outcomes between foreign-born women and women born in the United States (US-born). METHODS: A retrospective cohort study (1991-2001) of all deliveries at Grady Memorial Hospital in Atlanta, Georgia. RESULTS: Among 49,904 deliveries, 27% were to foreign-born mothers representing 164 countries grouped into eight geographic regions. Compared with US-born women, foreign-born women had a higher mean birthweight (3315 vs. 3083 g), and a lower risk of preterm delivery (RR 0.46, 95% CI 0.43-0.49), perinatal mortality (RR 0.40, 95% CI 0.36-0.45), hypertension (RR 0.31, 95% CI 0.23-0.41), and HIV infection (RR 0.13, 95% CI 0.10-0.18). However, foreign-born women had an increased risk of diabetes (RR 1.63, 95% CI 1.48-1.79), perineal laceration (RR 1.71; 95% CI 1.66-1.76), and postpartum hemorrhage (RR 1.10; 95% CI 1.05-1.15). CONCLUSIONS: Foreign-born women have better health behaviors, pregnancy outcomes, and a lower risk of infectious diseases than US-born women, but they have a higher risk of certain medical conditions and obstetric complications.

Adolescent↗
PubMed2001

The effect of epidural analgesia on rates of episiotomy use and episiotomy extension in an inner-city hospital.

OBJECTIVE: To determine the relationship between epidural analgesia and episiotomy usage and episiotomy extension in parturients delivering vaginally. METHODS: A database of 20 888 women experiencing spontaneous vaginal delivery at Grady Memorial Hospital from 1990 to 1995 was examined to identify those receiving epidural analgesia. Patients who underwent epidural catheter placement and had adequate perineal anesthesia at delivery comprised the epidural group, and all others comprised the control group. Demographic characteristics and obstetric outcomes were compared. Univariate and multivariate analyses were used to test the association between epidural analgesia, rates of episiotomy and episiotomy extension. RESULTS: Of the 20888 women experiencing spontaneous vaginal deliveries 6785 (32.5%) received epidural analgesia. Women receiving epidural analgesia were more likely than those not receiving epidural analgesia to be African-American and nulliparous, and to have an occiput posterior presentation. Women receiving epidural analgesia were also more likely to receive an episiotomy (27.8% vs. 13.1%, odds ratio (OR) 2.56, 95% confidence interval (CI) 2.38-2.75) and were less likely to experience a second-degree perineal laceration (11.6% vs. 14.4%, OR 0.75, 95% CI 0.69-0.82) or a third- or fourth-degree extension (8.9% vs. 12.4%, OR 0.81, 95% CI 0.68-0.97). When the results were adjusted for nulliparity, posterior presentation, macrosomia, shoulder dystocia and prolonged second stage, epidural analgesia remained independently associated with receipt of episiotomy (OR 1.97, 95% CI 1.88-2.06) and reduced episiotomy extension (OR 0.74, 95% CI 0.54-0.94). CONCLUSION: Epidural analgesia increases the rates of episiotomy use, and decreases the rate of episiotomy extension, independently of clinical factors associated with episiotomy.

Adult↗
PubMed2001

Cigarette smoking and pre-eclampsia: their association and effects on clinical outcomes.

OBJECTIVE: To determine the effects of smoking on pre-eclampsia in an inner-city, predominantly African-American prenatal population. METHODS: We performed a retrospective cohort study of all primigravidas who delivered singletons in our institution between 1980 and 1989. The study population consisted of 1862 smokers and 16,508 non-smokers. Univariate analysis and multiple logistic regression were used to identify relationships between smoking and adverse outcomes. RESULTS: The pre-eclampsia rate was significantly lower among smokers (11.3% vs. 13.0%, OR 0.85, 95% CI 0.73-0.99). Smokers with pre-eclampsia had higher rates of infants with low birth weight (OR 1.44, 95% CI 1.26-1.65) and very low birth weight (OR 1.85, 95% Cl 1.55-2.20) and higher rates of placental abruption (OR 3.49, 95% CI 1.65-7.28) compared to non-smoking pre-eclamptics. This relationship persisted after correction for age, race, chronic hypertension and pre-eclampsia as confounding variables. CONCLUSIONS: Cigarette smoking was associated with a lower rate of pre-eclampsia among primigravidas independently of other maternal factors. Perinatal outcomes were significantly worsened among pre-eclamptics who smoked.

Adolescent↗
PubMed2001

Experience with routine voluntary perinatal human immunodeficiency virus testing in an inner city hospital.

Women enrolled in prenatal care at Grady Health System, Atlanta, GA, have routinely been offered HIV counseling and voluntary testing since 1987. Consistently >90% have accepted testing. With implementation of US Public Health Service guidelines for perinatal zidovudine prophylaxis in 1994, the mother-to-child HIV transmission rate rapidly decreased from 18% to 8% during the subsequent 2 years.

Anti-HIV Agents↗
PubMed1999

Racial patterns in the effects of tobacco use on fetal growth.

OBJECTIVE: The aim of this study was to characterize the interaction between the effects on fetal growth of maternal smoking and race by means of race-specific growth normograms. STUDY DESIGN: A case-control study was performed on white and African American mothers who were delivered at 2 hospitals in metropolitan Atlanta between February 1993 and December 1994. The study population consisted of 621 small for gestational age infants and their mothers and 324 appropriate for gestational age infants and their mothers. Face-to-face interviews with mothers and detailed anthropometric measurements of neonates were performed. Relationships among tobacco use, race, and fetal growth were evaluated by means of multiple logistic regression. The chi(2) test of trend was performed to assess a dose-response relationship between smoking and fetal growth. RESULTS: Mothers of small for gestational age neonates were significantly more likely than control mothers to be single (52% versus 40%), to be primiparous (47% versus 37%), to have a low body mass index (26% versus 17%), to have hypertension (22% versus 15%), and to use alcohol (15% versus 9%). Mothers of small for gestational age infants were significantly more likely than control mothers to smoke (26% versus 12%) and to smoke more cigarettes (P <.05). After controlling for potential confounders cigarette smoking in the second trimester was significantly associated with small for gestational age infants in both races (whites <1 pack/d adjusted odds ratio 3.82, 1-2 packs/d adjusted odds ratio 4.86, >2 packs/d crude odds ratio; African Americans <1 pack/d adjusted odds ratio 2. 35, 1-2 packs/d adjusted odds ratio 2.52). The chi(2) test of trend results were consistent with a dose-response relationship between smoking and small for gestational age infants (whites chi(2) = 14.06, P <.0001, African Americans chi(2) = 7.99). Comparison between the 2 races of the adverse effects of smoking on fetal growth showed no significant difference. CONCLUSION: Self-reported maternal smoking during the second trimester is associated with fetal growth restriction in a dose-response manner. According to race-specific growth normograms no significant difference in the effects of tobacco use on fetal growth was found between white and African American women.

Adult↗
PubMed1999

Intrauterine resuscitation of the compromised fetus.

The gold standard for assessment of fetal well being in labor is the adequacy of fetal oxygenation using continuous electronic fetal monitoring. Additional biophysical properties of the fetus are increasingly being used to ascertain the health of the intrauterine environment. This article focuses on the detection and management of the compromised fetus. The article describes the history, physiologic basis, and current techniques for fetal monitoring. In addition, it presents the common diagnostic tools used to identify the compromised fetus and available options for the management of fetal intolerance of labor.

Cesarean Section↗
PubMed1997

Adverse perinatal outcome in parturients who use crack cocaine.

OBJECTIVE: To determine the risk of adverse pregnancy outcome among crack cocaine users in a large homogeneous prenatal population with objective documentation of drug use. METHODS: A retrospective cohort study was performed on a population of inner-city women who were offered routine voluntary urine drug screening and who delivered between January and December 1992 at a large county hospital. The study population consisted of 483 users (positive drug screens) and 3158 non-users (negative drug screens). Univariate analysis and multiple logistic regression were used to identify the relation between crack cocaine use and adverse perinatal outcome. RESULTS: Users were significantly more likely than nonusers to deliver low birth weight (LBW) infants (31.3% versus 14.9%; crude odds ratio [OR] 2.6; 95% confidence interval [CI] 2.1, 3.2), growth-restricted infants (29.0% versus 13.0%; crude OR 2.7; 95% CI 2.2, 3.4), and preterm infants (28.2% versus 17.1%; crude OR 1.9; 95% CI 1.5, 2.4). In addition, users were more likely to have abruptions (3.3% versus 1.1%; crude OR 3.0; 95% CI 1.6, 5.6) and infants with low 5-minute Apgar scores (7.9% versus 4.5%; crude OR 1.8; 95% CI 1.2, 2.7). After adjusting for confounders (including alcohol use and smoking), only the risks of LBW and fetal growth restriction (FGR) remained significant, with adjusted OR 1.6 (95% CI 1.03, 2.4) and adjusted OR 1.7 (95% CI 1.2, 2.3), respectively. Although there was no significant difference in the rate of low 5-minute Apgar scores between users and non-users after controlling for confounders, users with a positive urine drug screen within 1 week of delivery were significantly more likely than non-users to deliver infants with low 5-minute Apgar scores: crude OR 2.4; adjusted OR 2.0 (95% CI 1.1, 3.7). CONCLUSION: In this inner-city population, crack cocaine use is associated with adverse pregnancy outcomes, as noted by increased risks of LBW and FGR.

Adolescent↗
PubMed1997

Correlation between self-reported cocaine use and urine toxicology in an inner-city prenatal population.

To determine the prevalence of recent cocaine use and the accuracy of self-reported use, the results of a urine assay for the major cocaine metabolite benzoylecgonine were compared with self-reported cocaine use in an inner-city prenatal population offered routine voluntary urine toxicology screening at the time of registration for prenatal care. During a 1-year period, 6866 women registered for prenatal care and 5200 (76%) consented to urine assays for cocaine metabolites. Of the women consenting to urine assays, 253 (5%) had positive assays for benzoylecgonine. Women with positive assays were significantly more likely than those with negative assays to be older (mean [SD] 27 [5] versus 23 [6] years), black, single, and unemployed. In addition, women with positive assays were significantly more likely to be multiparous, report > two sexual partners in the previous year, and acknowledge a history of a sexually transmitted disease (STD). Forty-seven percent of women with positive assays acknowledged cocaine use in the 6 months prior to sampling. Women with positive assays who denied cocaine use were significantly more likely than those who admitted use to be younger (mean [SD] 26 [5] versus 28 [4] years), to report > or = two sexual partners in the past year, and acknowledge a history of an STD. This analysis revealed a poor correlation between self-reported cocaine use and the results of urine assays for cocaine metabolites among women seeking prenatal care in an inner-city institution.

Cocaine↗
PubMed1997

Human immunodeficiency virus infection in pregnant women and their newborns.

Along with increasing knowledge of factors that put infants at risk for mother-to-infant HIV transmission (e.g., maternal-viral load, HIV-disease state, prematurity, and prolonged membrane rupture), there are new approaches to reducing the likelihood of such transmission (e.g., zidovudine treatment). Additional means of reducing transmission may become available in years to come. In this context, prenatal voluntary identification of HIV-infected women is vital. Finally, appropriate use of early diagnostic tests in HIV-exposed infants will allow effective use of prophylactic and therapeutic means.

AIDS Serodiagnosis↗
PubMed1996

Routine voluntary antepartum HIV antibody counseling and testing: a sound public health prevention strategy.

Routine voluntary antepartum HIV antibody counseling and testing are important HIV prevention strategies based on sound public health principles. The ultimate goal of this testing strategy is two-fold: identification of high-risk seronegative women for risk reduction counseling; and identification of HIV-infected parturients for counseling, prenatal care, and long-term medical management. To achieve these objectives, there must be nationwide implementation of the CDC HIV prenatal testing guidelines. Our challenge as healthcare providers is to ensure that all of our prenatal patients are afforded the opportunity to have HIV counseling and testing performed.

Anonymous Testing↗
PubMed1995

The impact of knowledge of human immunodeficiency virus serostatus on contraceptive choice and repeat pregnancy.

OBJECTIVE: To examine relationships among human immunodeficiency virus (HIV) serostatus, postpartum contraceptive choice, and the rate of repeat pregnancy within a short interval. METHODS: This retrospective cohort study was performed in 83 seropositive and 218 seronegative women identified from an inner-city prenatal population undergoing routine voluntary HIV antibody screening from July 1987 through June 1989. Postpartum contraceptive choices and rate of repeat pregnancies were compared based on HIV serostatus. RESULTS: Seropositive women were significantly more likely than seronegative women to undergo tubal sterilization (27 versus 15%; odds ratio [OR] 2.9, 95% confidence interval [CI] 1.5-5.9). This relationship persisted after controlling for age, race, marital status, and parity by logistic regression modeling (adjusted OR 2.9, 95% CI 1.4-5.9). Seropositive women were significantly less likely than seronegative women to select oral contraceptives (34 versus 68%; OR 0.2, 95% CI 0.1-0.4), a relationship that persisted after controlling for age, race, marital status, parity, and foam and condom use (adjusted OR 0.2, 95% CI 0.1-0.5). Seropositive women were significantly more likely than seronegative women to select foam and condoms as their primary method of contraception (30 versus 15%; OR 2.4, 95% CI 1.2-4.5), a relationship that did not persist after controlling for age, race, marital status, and parity (adjusted OR 0.7, 95% CI 0.4-1.3). The risk of repeat pregnancy was slightly lower in seropositive versus seronegative women (34 versus 44%; OR 0.7, 95% CI 0.4-1.3). Most repeat pregnancies among seropositive and seronegative women were unplanned (90 and 82%, respectively). CONCLUSION: There was a relationship between the method of postpartum contraception and HIV serostatus, but no significant difference in repeat pregnancy rates associated with choice of method.

Adolescent↗
PubMed1993

The risk of sexually transmitted diseases in human immunodeficiency virus-infected parturients.

OBJECTIVE: We assessed the prevalence of and defined the relationship between other sexually transmitted diseases and human immunodeficiency virus infection. STUDY DESIGN: We performed a case-control study among 121 human immunodeficiency virus-infected and 222 randomly selected seronegative parturient women. These women were identified from a prenatal population undergoing routine voluntary antibody screening in a large urban hospital in the southeastern United States. RESULTS: During the 24-month study period, 16,868 women consented to human immunodeficiency virus antibody screening; 121 (7.2/1000) were infected with human immunodeficiency virus. Cases were significantly more likely than controls to be infected with at least one sexually transmitted disease during pregnancy (48% vs 21%; odds ratio 3.4, 95% confidence interval 2.1 to 5.7). The prevalence of Chlamydia trachomatis and hepatitis B infection did not differ significantly among the groups. Cases were significantly more likely than controls to be infected with Treponema pallidum (29% vs 4%; odds ratio 9.6, 95% confidence interval 4.2 to 22.4). This relationship persisted after we controlled for confounding risk factors (odds ratio 9.2, 95% confidence interval 2.1 to 13.3). In addition, cases were significantly more likely than controls to be infected with Neisseria gonorrhoeae (17.2% vs 4%; odds ratio 5.2, 95% confidence interval 2.1 to 13.3). This relationship also persisted after we controlled for confounders (odds ratio 3.7, 95% confidence interval 1.4 to 10.0). CONCLUSION: Human immunodeficiency virus-infected parturient women in our center are at substantial risk of having other sexually transmitted diseases.

Adult↗
PubMed1993

A protocol for routine voluntary antepartum human immunodeficiency virus antibody screening.

Human immunodeficiency virus infection among both women of reproductive age and their infants is rapidly increasing. One strategy to address this increase involves the offering of routine voluntary antepartum human immunodeficiency virus antibody counseling and testing. The rationale for this policy is that all prenatal patients are educated about the major modes of viral transmission and encouraged to practice risk reduction behavior. Human immunodeficiency virus-infected women receive comprehensive prenatal care; they are referred for medical follow-up, and their infants are identified and targeted for pediatric infectious disease follow-up. During the past 4 years we have developed a protocol for antepartum human immunodeficiency virus screening in our institution. The protocol includes a self-reported human immunodeficiency virus risk behavior profile, pretest counseling conducted by trained human immunodeficiency virus counselors in small groups, written informed consent for human immunodeficiency virus antibody testing, posttest counseling, and education. By following this protocol we have identified and referred for follow-up > 350 human immunodeficiency virus-infected women.

Counseling↗
PubMed1993

Human immunodeficiency virus infection among patients in a gynecology emergency department.

OBJECTIVE: To determine the extent of human immunodeficiency virus (HIV) infection risk factors and the relationship to the clinical diagnosis in women seen in a busy inner-city gynecology emergency department. METHODS: We performed a cross-sectional survey by offering routine voluntary HIV-1 antibody screening and obtaining HIV risk behavior profiles in 1033 (35%) of 2952 women seeking care in our gynecology emergency department during a 5-week period. RESULTS: The HIV seroprevalence was 2%. Six (35%) of the infected women reported a history of intravenous drug use, five (29%) reported a history of crack cocaine use, and five (29%) reported no risk factors for infection. Seropositive women were more likely than were seronegative women to have clinical symptoms consistent with pelvic inflammatory disease (18 versus 3%; P < .01). CONCLUSION: These data suggest that women attending the gynecology emergency room in our hospital are at substantial risk for HIV infection.

Acquired Immunodeficiency Syndrome↗
PubMed1992

Human immunodeficiency virus infection among inner-city adolescent parturients undergoing routine voluntary screening, July 1987 to March 1991.

OBJECTIVE: The objective of our study was to describe the human immunodeficiency virus epidemic among pregnant adolescents undergoing follow-up in a large inner-city hospital. STUDY DESIGN: We conducted a case-control study comparing demographic and risk behaviors of seropositive and seronegative adolescents (aged 13 to 20) identified from a population undergoing routine voluntary antibody screening at Grady Memorial Hospital in Atlanta, Georgia, between July 1987 and March 1991. RESULTS: Of 10,794 pregnant adolescents screened, 51 (4.7/1000) were infected with human immunodeficiency virus. More than one fourth of case patients were < or = 17 years old. Significantly more case patients than controls reported a history of crack cocaine use (10 [19.6%] vs 23 [8.2%] p < 0.05). A majority (58.8%) of case patients reported no risk factors for infection, and the remainder (41.2%) were presumably infected by heterosexual contact. Thirty-nine controls (13.8%) had self-identified risk factors for infection. CONCLUSIONS: Pregnant adolescents in our center are at risk for human immunodeficiency virus infection and should be targeted for human immunodeficiency virus education and risk reduction counseling.

Adolescent↗