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Biomedical subjects

Naomi E Stotland

Publications and source records attributed to Naomi E Stotland.

10 recordsLinked to original sources
PubMed2006

Are there ethnic differences in the length of labor?

OBJECTIVE: The purpose of this study was to examine the lengths of the first and second stages of labor among different racial/ethnic groups to determine whether different norms should be established. STUDY DESIGN: This was a retrospective cohort study of all laboring, term, singleton, vertex deliveries in a single academic institution. Median lengths of first and second stages of labor were compared among 4 racial/ethnic groups: black, Asian, white, and Latina. Kruskal-Wallis, Wilcoxon rank sum tests, and multivariate linear and logistic regression models were performed. RESULTS: In 27,521 births, the lengths of first stage of labor did not differ significantly among groups in the multivariate analysis. In the second stage of labor, black women had shorter labors, both overall and stratified by epidural use. In the multivariate analysis, when controlled for demographics, parity, epidural, chorioamnionitis, birthweight, delivery year, and labor management, black women had a shorter second stage than did white women (nulliparous women, 22 minutes; multiparous women, 7.5 minutes; P < .001) and lower rates of prolonged second stage (odds ratio, 0.6; P < .001). Nulliparous Asian women had a significantly longer second stage and higher rates of prolonged second stage, and nulliparous Latina women had a shorter second stage, compared with nulliparous white women. CONCLUSION: When data are controlled for confounding factors, black women had a shorter length of second stage of labor than did women in other ethnic groups. These differences appear to be clinically significant. This contributes to the support of a multifactorial redefinition of labor curves, which are used widely in the management of labor.

Black or African American↗
PubMed2006

Gestational weight gain and adverse neonatal outcome among term infants.

OBJECTIVE: To examine the relationship between gestational weight gain and adverse neonatal outcomes among infants born at term (37 weeks or more). METHODS: This was a retrospective cohort study of 20,465 nondiabetic, term, singleton births. We performed univariable and multivariable analyses of the associations between gestational weight gain and neonatal outcomes. We categorized gestational weight gain by the Institute of Medicine guidelines as well as extremes of gestational weight gain (less than 7 kg and more than 18 kg). RESULTS: Gestational weight gain above the Institute of Medicine guidelines was more common than gestational weight gain below (43.3% compared with 20.1%). In multivariable analyses, gestational weight gain above guidelines was associated with a low 5-minute Apgar score (adjusted odds ratio [AOR] 1.33, 95% confidence interval [CI] 1.01-1.76), seizure (AOR 6.50, 95% CI 1.43-29.65), hypoglycemia (AOR 1.52, 95% CI 1.06-2.16), polycythemia (AOR 1.44, 95% CI 1.06-1.94), meconium aspiration syndrome (AOR 1.79, 95% CI 1.12-2.86), and large for gestational age (AOR 1.98, 95% CI 1.74-2.25) compared with women within weight gain guidelines. Gestational weight gain below guidelines was associated with decreased odds of neonatal intensive care unit admission (AOR 0.66, 95% CI 0.46-0.96) and increased odds of small for gestational age (SGA; AOR 1.66, 95% CI 1.44-1.92). Gestational weight gain less than 7 kg was associated with increased risk of seizure, hospital stay more than 5 days, and SGA. Gestational weight gain more than 18 kg was associated with assisted ventilation, seizure, hypoglycemia, polycythemia, meconium aspiration syndrome, and large for gestational age. CONCLUSION: Gestational weight gain above guidelines was common and associated with multiple adverse neonatal outcomes, whereas gestational weight gain below guidelines was only associated with SGA status. Public health efforts among similar populations should emphasize prevention of excessive gestational weight gain.

Analysis of Variance↗
PubMed2006

Weight gain and spontaneous preterm birth: the role of race or ethnicity and previous preterm birth.

OBJECTIVE: To study how the relationship between gestational weight gain and spontaneous preterm birth interacts with maternal race or ethnicity and previous preterm birth status. METHODS: This was a retrospective cohort study of singleton births to women of normal or low prepregnancy body mass index. Gestational weight gain was measured as total weight gain divided by weeks of gestation at delivery, and weight gain was categorized as low (less than 0.27 kg/wk,), normal (0.27-0.52 kg/wk), or high (more than 0.52 kg/wk). Univariable and multivariable analyses were performed on the relationship between weight gain categories and spontaneous preterm birth, stratified by maternal race or ethnicity and history of previous preterm birth. RESULTS: Overall, low weight gain was associated with spontaneous preterm birth (adjusted odds ratio [AOR] 2.5, 95% confidence interval [CI] 2.0-3.1). Although low gain was consistently associated with increased spontaneous preterm birth, some differences were found in subgroup analysis. Among African Americans with a previous preterm birth, both low and high weight gain were associated with increased odds of spontaneous preterm birth (AOR for low weight gain 4.3, 95% CI 1.2-15.5; AOR for high weight gain 6.1, 95% CI 1.8-20.2). For all other groups, high weight gain was not associated with spontaneous preterm birth. Among Asians with a previous preterm birth, low weight gain was not statistically significantly associated with spontaneous preterm birth (AOR 1.9, 95% CI 0.5-7.7). Among Asians there was also a non-statistically significant inverse relationship between high weight gain and spontaneous preterm birth (AOR 0.5, 95% CI 0.3-1.1). CONCLUSION: These results confirm an association between low maternal weight gain and spontaneous preterm birth. The effect modification of maternal race or ethnicity and history of previous preterm birth on this association deserves further study. LEVEL OF EVIDENCE: II-2.

Adult↗
PubMed2005

Body mass index, provider advice, and target gestational weight gain.

OBJECTIVE: To study the relationships among prepregnancy body mass index (BMI), women's target gestational weight gain, and provider weight gain advice. METHODS: Project WISH, the acronym for Women and Infants Starting Healthy, is a longitudinal cohort study of pregnant women in the San Francisco Bay area. We excluded subjects with preterm birth, multiple gestation, or maternal diabetes. RESULTS: Among overweight women (prepregnancy BMI 26.1-29.0), 24.1% reported a target weight gain above the Institute of Medicine (IOM) guidelines, compared with 4.3% of normal weight women (P < .001). Among women with a low prepregnancy BMI (< 19.8), 51.2% reported a target weight gain below the guidelines, compared with 10.4% of normal weight women (P < .001). These patterns persisted in a multivariate analysis. Latina ethnicity, lower maternal education, low prepregnancy BMI (< 19.8), lack of provider advice about weight gain, and provider advice to gain below guidelines were all independently associated with a target weight gain below IOM guidelines. Prepregnancy BMI more than 26, multiparity, lower age, and provider advice to gain above guidelines were all associated with a target gain above IOM guidelines. CONCLUSION: Women's beliefs about the proper amount of weight gain and provider recommendations for weight gain vary significantly by maternal prepregnancy BMI. Many women report incorrect advice about gestational weight gain, and women with high or low prepregnancy BMI are more likely to have an incorrect target weight gain. New approaches to provider education are needed to implement the IOM guidelines for gestational weight gain.

Body Mass Index↗
PubMed2005

Maternal ethnicity, paternal ethnicity, and parental ethnic discordance: predictors of preeclampsia.

OBJECTIVE: To examine the association of maternal and paternal ethnicity as well as parental ethnic discordance with preeclampsia. METHODS: Retrospective cohort study of all low-risk women delivered from 1995 to 1999 within a mature managed care organization. Rates of preeclampsia were calculated for maternal, paternal, and combined ethnicity using both univariate and multivariate analyses. RESULTS: Among the 127,544 low-risk women, when examining maternal ethnicity in a multivariate model controlling for maternal age, parity, education, and gestational age, we found that the rates of preeclampsia were higher among African American (5.2%; odds ratio [OR] 1.41, 95% confidence interval [CI] 1.25-1.62) women and lower among Latina (4.0%; OR 0.90, 95% CI 0.84-0.97) and Asian women (3.5%; OR 0.79, 95% CI 0.72-0.88), with all results being statistically significant as compared with white women. When paternal ethnicity was controlled for separately, however, the difference in the rate of preeclampsia among Asian women disappeared, the effect of African-American maternal ethnicity increased slightly (OR 1.49, 95% CI 1.33-1.72), and Asian paternity was found to be associated with the lowest rate of preeclampsia (3.2%; OR 0.76, 95% CI 0.68-0.85). Further, parental ethnic discordance was associated with an increase in the rate of preeclampsia (OR 1.13, 95% CI 1.02 - 1.26). CONCLUSION: We found that rates of preeclampsia were lower with Asian paternal ethnicity. We also found that having a differing paternal and maternal ethnicity was associated with increased rates of preeclampsia. For every 1,000 pregnancies, there would be approximately 10 fewer cases of preeclampsia in the setting of Asian paternity and 5 more cases of preeclampsia in the setting of parental ethnic discordance. These differences may be useful in further investigation of the cause of preeclampsia. LEVEL OF EVIDENCE: II-2.

Adult↗
PubMed2004

Gestational weight gain, macrosomia, and risk of cesarean birth in nondiabetic nulliparas.

OBJECTIVE: To examine how the association between excessive weight gain and cesarean birth is modified by infant birth weight in nondiabetic women. METHODS: We designed a retrospective cohort study of singleton, term, nulliparous women with cephalic presentations delivering at a single university hospital. Subjects with diabetes were excluded. Bivariate and multivariate analyses were performed. Regression models controlled for maternal age, maternal prepregnancy body mass index, gestational age, ethnicity, smoking, birth weight, and date of delivery. RESULTS: Women gaining above Institute of Medicine guidelines were more likely to have a cesarean birth, even if birth weight was less than 4,000 g. In the multivariate analysis, women with excessive weight gain had an odds ratio of 1.40 (95% confidence interval 1.22-1.59) for cesarean birth. When absolute weight gain (total pregnancy weight gain minus birth weight and placental weight) was used in the multivariate analysis, excessive weight gain was still an independent predictor of cesarean delivery. Although macrosomia was a stronger predictor of cesarean than weight gain alone, excessive weight gain was much more common than macrosomia in our cohort. CONCLUSION: Excessive weight gain during pregnancy is an independent risk factor for cesarean birth, even when birth weight is not excessive. Other mechanisms besides macrosomia may be involved in the association between high weight gain and cesarean birth. We estimate that of the approximately 288,000 primary cesarean deliveries performed in nulliparas annually in the United States, 64,000 would be prevented if no women gained above Institute of Medicine recommendations. LEVEL OF EVIDENCE: II-2

Adult↗
PubMed2004

Out-of-pocket expenditures for oral contraceptives and number of packs per purchase.

OBJECTIVE: Two potential barriers to use of oral contraceptives (OCPs) are out-of-pocket expenditures and the inconvenience of monthly pharmacy visits. This study used nationally representative data to examine the out-of-pocket costs of OCPs and whether women obtain more than 1 pack per purchase. METHODS: We used data from the 1996 Medical Expenditure Panel Survey. Dependent variables were out-of-pocket expenditures per pack and the number of packs obtained per purchase. Chi2 tests were used to examine the bivariate relationships between the dependent variables and covariates. Regression analyses were used to examine the predictors of OCP expenditures and the number of packs obtained per purchase. RESULTS: Women paid an average of 14 dollars per pack of OCPs, and 73% obtained only 1 pack per purchase. On average, privately insured women paid 60% of the total expenditures for OCPs. Women who had no prescription drug coverage, who were uninsured, or who were privately insured but not in managed care plans had higher out-of-pocket expenditures. Women who were without prescription drug coverage or who were in managed care plans were more likely to obtain only 1 pack per purchase. CONCLUSION: Out-of-pocket costs and dispensing restrictions may be barriers to consistent use of OCPs. Women's health care providers should consider options to overcome these barriers, such as the use of mail order prescription services.

Adolescent↗
PubMed2003

What is the best measure of maternal complications of term pregnancy: ongoing pregnancies or pregnancies delivered?

OBJECTIVE: The purpose of this study was to determine whether rates of hypertensive disorders of pregnancy increase beyond 37 weeks of gestation and to address how best to analyze these rates. STUDY DESIGN: This was a retrospective cohort study of all women delivered beyond 37 weeks' gestational age from 1995 to 1999 at all Kaiser Permanente Medical Care Program delivery hospitals in Northern California. Rates of gestational hypertension, preeclampsia, and eclampsia were calculated by use of both pregnancy delivered (PD) and ongoing pregnancy (OP) as the denominator. Bivariate and multivariate analyses were conducted with use of P<.05 to indicate statistical significance. RESULTS: Among the 135,560 women in this cohort, the rates of gestational hypertension, preeclampsia, and eclampsia were the same or decreased from 37 to 43 weeks' gestation using PD, but all three increased when calculated according to OP (P<.01). CONCLUSION: We found that among complications of pregnancy that are diagnosed ante partum, use of a different denominator led to contradictory conclusions. When hypertensive disorders of pregnancy are analyzed, ongoing pregnancies should be used as the denominator.

Adult↗
PubMed2002

Delivery strategies for women with a previous classic cesarean delivery: a decision analysis.

OBJECTIVE: The purpose of this study was to compare four strategies for treating patients with a previous classic cesarean delivery by medical outcomes and quality-adjusted life years. STUDY DESIGN: A decision tree was designed that compared four strategies for a hypothetical cohort of 10,000 women with a previous classic cesarean delivery: (1) delivery at 39 weeks of gestation, (2) delivery at 36 weeks of gestation without amniocentesis, (3) amniocentesis at 36 weeks of gestation with delivery if the fetus was mature and antenatal corticosteroids if the fetus was immature, and (4) weekly amniocentesis starting at 36 weeks of gestation with delivery when mature. RESULTS: Strategy 2 provided the greatest maternal quality-adjusted life years. Comparing strategy 1 with strategy 2, it was determined that 27 cesarean deliveries must be performed at 36 weeks of gestation with one associated case of respiratory distress syndrome to prevent one case of uterine rupture. Sensitivity analysis revealed that the uterine rupture rate must be below 0.36% for any strategy to surpass strategy 2 (elective cesarean delivery at 36 weeks of gestation without amniocentesis). CONCLUSION: A 36-week delivery may be preferable because it provides a lower risk of severe adverse outcomes and higher maternal quality of life.

Adrenal Cortex Hormones↗