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Victoria M Allen

Publications and source records attributed to Victoria M Allen.

16 recordsLinked to original sources
PubMed2006

Study protocol: a double blind placebo controlled trial examining the effect of domperidone on the composition of breast milk [NCT00308334].

BACKGROUND: Domperidone, a drug that enhances upper gastric motility, is an anti-dopaminergic medication that also elevates prolactin levels. It has been shown to safely increase the milk supply of lactating women. To date, researchers have analyzed the effects of domperidone on lactating woman with respect to the quantity of their milk production, adverse effects, and drug levels in the breast milk. However, the effect of domperidone on the macronutrient composition of breast milk has not been studied and current guidelines for fortification of human milk for premature infants do not distinguish between those women using or those not using domperidone. The purpose of this study is to evaluate the effect of domperidone (given to lactating mothers of very preterm infants) on the macronutrient composition of breast milk. METHODS/DESIGN: Mothers of infants delivered at less than 31 weeks gestation, who are at least 3 weeks postpartum, and experiencing lactational failure despite non-pharmacological interventions, will be randomized to receive domperidone (10 mg three times daily) or placebo for a 14-day period. Breast milk samples will be obtained the day prior to beginning treatment and on days 4, 7 and 14. The macronutrient (protein, fat, carbohydrate and energy) and macromineral content (calcium, phosphorus and sodium) will be analyzed and compared between the two groups. Additional outcome measures will include milk volumes, serum prolactin levels (measured on days 0, 4, and 10), daily infant weights and breastfeeding rates at 2 weeks post study completion and at discharge. Forty-four participants will be recruited into the study. Analysis will be carried out using the intention to treat approach. DISCUSSION: If domperidone causes significant changes to the nutrient content of breast milk, an alteration in feeding practices for preterm infants may need to be made in order to optimize growth, nutrition and neurodevelopment outcomes.

Journal Article↗
PubMed2006

Risk factors for hyperemesis gravidarum requiring hospital admission during pregnancy.

OBJECTIVE: To identify risk factors for hyperemesis requiring hospital admission during pregnancy. METHODS: Data from a population-based cohort of all deliveries in Nova Scotia, Canada between 1988 and 2002 were obtained from the Nova Scotia Atlee Perinatal Database. Women with 1 or more antepartum admissions for hyperemesis were compared with women with no admissions for hyperemesis. Relative risks (RRs) and 95% confidence intervals (CIs) were estimated using logistic regression and used to determine a set of independent risk factors for hyperemesis. RESULTS: The overall rate of admission for hyperemesis was 0.8% (n = 1,301) among 157,922 deliveries. In the adjusted analysis, hyperthyroid disorders (RR 4.5, 95% CI 1.8-11.1), psychiatric illness (RR 4.1, 95% CI 3.0-5.7), previous molar pregnancy (RR 3.3, 95% CI 1.6-6.8), preexisting diabetes (RR 2.6, 95% CI 1.5-4.7), gastrointestinal disorders (RR 2.5, 95% CI 1.8-3.6), and asthma (RR 1.5, 95% CI 1.2-1.9) were all statistically significant risk factors for hyperemesis, whereas maternal smoking and maternal age older than 30 were associated with decreased risk. Compared with singleton male pregnancies, singleton female pregnancies, pregnancies with multiple male fetuses, and male and female combinations were associated with statistically significant increased risk of hyperemesis. CONCLUSION: Although hospitalization for hyperemesis occurs in less than 1% of pregnant women, this translates to a large number of hospital admissions. The factors associated with hyperemesis are primarily medical and fetal factors that are not easily modifiable, but identification of these factors may be useful in determining those women at high risk for developing hyperemesis. LEVEL OF EVIDENCE: II-2.

Adult↗
PubMed2006

Outcomes of pregnancies complicated by hyperemesis gravidarum.

OBJECTIVE: To evaluate maternal and neonatal outcomes among women with hyperemesis during pregnancy. METHODS: A population-based retrospective cohort study was conducted among women with singleton deliveries between 1988 and 2002. Hyperemetic pregnancies were defined as those requiring one or more antepartum admissions for hyperemesis before 24 weeks of gestation. Severity of hyperemesis was evaluated according to the number of antenatal hospital admissions (1 or 2 versus 3 or more) and according to weight gain during pregnancy (< 7 kg [15.4 lb] versus > or = 7 kg). Maternal outcomes evaluated included weight gain during pregnancy, gestational diabetes, gestational hypertension, labor induction, and cesarean delivery. Neonatal outcomes included 5-minute Apgar score of less than 7, low birth weight, small for gestational age, preterm delivery, and perinatal death. Logistic regression was used to generate adjusted odds ratios for all outcomes, and the odds ratios were converted to relative risks. RESULTS: Of the 156,091 singleton pregnancies, 1,270 had an admission for hyperemesis. Compared to women without hyperemesis, infants born to women with hyperemesis and with low pregnancy weight gain (< 7 kg [15.4 lb]) were more likely to be low birth weight, small for gestational age (SGA), born before 37 weeks of gestation, and have a 5-minute Apgar score of less than 7. Compared with infants born to women without hyperemesis, rates of low birth weight and preterm delivery were substantially higher among infants born to women with hyperemesis and low pregnancy weight gain (4.2% versus 12.5% and 4.9% versus 13.9%, respectively). The outcomes among infants born to women with hyperemesis with pregnancy weight gain of 7 kg (15.4 lb) or more were not different from the outcomes among women without hyperemesis. CONCLUSION: The results of this study suggest that the adverse infant outcomes associated with hyperemesis are a consequence of, and mostly limited to, women with poor maternal weight gain. LEVEL OF EVIDENCE: II-2.

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PubMed2006

Maternal morbidity associated with cesarean delivery without labor compared with induction of labor at term.

OBJECTIVE: To estimate the maternal morbidity associated with cesarean deliveries performed at term without labor compared with morbidity associated with induction of labor at term. METHODS: A 15-year population-based cohort study (1988-2002) using the Nova Scotia Atlee Perinatal Database compared maternal outcomes in nulliparous women delivering by cesarean delivery without labor and nulliparous women at term undergoing induction of labor for planned vaginal delivery with singleton, cephalic presentation. RESULTS: A total of 5,779 pregnancies satisfied inclusion and exclusion criteria, 879 of which were cesarean deliveries without labor. There were no maternal deaths. There was no difference in wound infection, puerperal febrile morbidity, blood transfusion or intraoperative trauma. After controlling for potential confounders, women undergoing cesarean delivery without labor were less likely to have complications of early postpartum hemorrhage (relative risk 0.61, 95% confidence interval 0.42-0.88, number needed to treat 32) and composite maternal morbidity (relative risk 0.71, 95% confidence interval 0.52-0.95, number needed to treat 34) compared with women undergoing induction of labor. Subgroup analyses of maternal outcomes after induction of labor in women by method of delivery were also performed and demonstrated additional risks of traumatic morbidity after induction of labor. The highest morbidity was found in the assisted vaginal delivery and cesarean delivery in labor groups. CONCLUSION: Early postpartum hemorrhage and composite maternal morbidity were decreased in cesarean delivery without labor compared with induction of labor. Hemorrhagic and traumatic morbidities with labor induction are increased after assisted vaginal delivery and cesarean delivery in labor compared with cesarean delivery without labor.

Adult↗
PubMed2006

Cumulative economic implications of initial method of delivery.

OBJECTIVE: To examine the cumulative costs of hospital care in the first and subsequent pregnancies associated with different methods in the initial delivery of nulliparous women. METHODS: An 18-year population-based cohort study (1985-2002) using the Nova Scotia Atlee Perinatal Database compared cumulative delivery costs in the first and subsequent pregnancies. Women were identified by initial method of delivery for nulliparous women with singleton cephalic presentation at term undergoing spontaneous or induced labor for planned vaginal delivery, and for nulliparous women undergoing cesarean delivery without labor. Costs that were assessed included nursing hours in antepartum, labor and delivery, postpartum and neonatal intensive care units, physician costs, labor induction agents, consumables, and costs for postpartum hysterectomy, tubal ligation, and dilatation and curettage. RESULTS: A total of 27,613 pregnancies satisfied inclusion and exclusion criteria. When cumulative costs by type of labor at first delivery were considered, induction of labor (7,220 dollars) was more costly than spontaneous onset of labor (6,919 dollars, P = .006). The cumulative costs of assisted vaginal delivery at first delivery (7,288 dollars) and cesarean delivery in labor at first delivery (9,524 dollars) were similar in magnitude and were higher than spontaneous vaginal delivery at first delivery (P < .001). Cesarean delivery in labor in the first delivery was the most costly type of delivery (9,524 dollars), and the differences in cost increased with increasing number of deliveries (P < .05). CONCLUSION: Cesarean delivery in labor in the first delivery is associated with increased cumulative costs compared with other methods of delivery, regardless of the number or type of subsequent deliveries.

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PubMed2005

Customized birth weight for gestational age standards: Perinatal mortality patterns are consistent with separate standards for males and females but not for blacks and whites.

BACKGROUND: Some currently available birth weight for gestational age standards are customized but others are not. We carried out a study to provide empirical justification for customizing such standards by sex and for whites and blacks in the United States. METHODS: We studied all male and female singleton live births and stillbirths (22 or more weeks of gestation; 500 g birth weight or over) in the United States in 1997 and 1998. White and black singleton live births and stillbirths were also examined. Qualitative congruence between gestational age-specific growth restriction and perinatal mortality rates was used as the criterion for identifying the preferred standard. RESULTS: The fetuses at risk approach showed that males had higher perinatal mortality rates at all gestational ages compared with females. Gestational age-specific growth restriction rates based on a sex-specific standard were qualitatively consistent with gestational age-specific perinatal mortality rates among males and females. However, growth restriction patterns among males and females based on a unisex standard could not be reconciled with perinatal mortality patterns. Use of a single standard for whites and blacks resulted in gestational age-specific growth restriction rates that were qualitatively congruent with patterns of perinatal mortality, while use of separate race-specific standards led to growth restriction patterns that were incompatible with patterns of perinatal mortality. CONCLUSION: Qualitative congruence between growth restriction and perinatal mortality patterns provides an outcome-based justification for sex-specific birth weight for gestational age standards but not for the available race-specific standards for blacks and whites in the United States.

Journal Article↗
PubMed2005

Economic implications of method of delivery.

OBJECTIVE: This study was undertaken to examine the costs of hospital care associated with different methods of delivery. STUDY DESIGN: An 18-year population-based cohort study (1985-2002) using the Nova Scotia Atlee Perinatal Database compared outcomes in nulliparous women at term undergoing spontaneous or induced labor for planned vaginal delivery, or undergoing cesarean delivery without labor. Costs that were assessed included physician fees, nursing hours in the labor and delivery, postpartum and neonatal intensive care units, epidural use, induction of labor agents, and consumables. RESULTS: A total of 27,614 pregnancies satisfied inclusion and exclusion criteria, 5233 of which had labor induced. A comparison of mean costs per mother/infant pair demonstrated that cesarean delivery in labor ($2137) was increased compared with spontaneous vaginal delivery ($1340, P=.01), assisted vaginal delivery ($1594, P=.01), and cesarean delivery without labor ($1532, P=.01). The cost of delivery after induction of labor ($1715) was increased compared with spontaneous onset of labor ($1474, P<.001). CONCLUSION: Cesarean delivery in labor occurs more frequently with labor induction and is associated with increased costs compared with other methods of delivery.

Adult↗
PubMed2005

Fetal response to maternal exercise in pregnancies with uteroplacental insufficiency.

OBJECTIVE: The purpose of this study was to determine the fetal response to submaximal maternal exercise at 22 to 26 weeks in pregnancies with abnormal uterine artery Doppler. STUDY DESIGN: This was a prospective comparison of singleton pregnancies with uteroplacental vascular insufficiency (UPVI) (mean uterine pulsatility index [PI] values >1.45 [n = 12]) and those with normal uterine artery Doppler (n = 23). Maternal and fetal cardiovascular responses to 5 minutes of steady state cycling at 10% and at 15% of predicted work rate maximum were studied. RESULTS: Umbilical artery Doppler deteriorated after exercise in patients with UPVI (pre PI 1.4 [0.35-2.14], post PI 1.64 [0.45-2.18]). Three (25%) had transient absent-end diastolic flow (AEDF) in umbilical artery, 2 of which developed early-onset intrauterine growth restriction (IUGR) with AEDF. Fetal cardiac output studies remained stable during the examinations. CONCLUSION: Submaximal steady state exercise had a transient deleterious effect in a subset of women with uteroplacental vascular insufficiency destined to develop early-onset IUGR.

Adult↗
PubMed2005

Maternal and perinatal morbidity of caesarean delivery at full cervical dilatation compared with caesarean delivery in the first stage of labour.

To estimate maternal and perinatal morbidity associated with caesarean delivery at full cervical dilatation, a population-based cohort study from 1997 to 2002 was used, which included 1623 nullipara with singleton pregnancies at 37-42 weeks of gestation requiring caesarean delivery in labour. Compared to caesarean delivery at less than full dilatation, women undergoing caesarean delivery at full dilatation were more likely to have complications of intraoperative trauma (RR 2.6, P < 0.001) and infants with perinatal asphyxia (RR 1.5, P < 0.05). There was no difference in maternal or perinatal morbidity when duration of the second stage of labour or when failed assisted vaginal delivery was considered.

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PubMed2004

The effect of hypertensive disorders in pregnancy on small for gestational age and stillbirth: a population based study.

BACKGROUND: Hypertensive disorders in pregnancy are leading causes of maternal, fetal and neonatal morbidity and mortality worldwide. However, studies attempting to quantify the effect of hypertension on adverse perinatal outcomes have been mostly conducted in tertiary centres. This population-based study explored the frequency of hypertensive disorders in pregnancy and the associated increase in small for gestational age (SGA) and stillbirth. METHODS: We used information on all pregnant women and births, in the Canadian province of Nova Scotia, between 1988 and 2000. Pregnancies were excluded if delivery occurred < 20 weeks, if birthweight was < 500 grams, if there was a high-order multiple pregnancy (greater than twin gestation), or a major fetal anomaly. RESULTS: The study population included 135,466 pregnancies. Of these, 7.7% had mild pregnancy-induced hypertension (PIH), 1.3% had severe PIH, 0.2% had HELLP (hemolysis, elevated liver enzymes, low platelets), 0.02% had eclampsia, 0.6% had chronic hypertension, and 0.4% had chronic hypertension with superimposed PIH. Women with any hypertension in pregnancy were 1.6 (95% CI 1.5-1.6) times more likely to have a live birth with SGA and 1.4 (95% CI 1.1-1.8) times more likely to have a stillbirth as compared with normotensive women. Adjusted analyses showed that women with gestational hypertension without proteinuria (mild PIH) and with proteinuria (severe PIH, HELLP, or eclampsia) were more likely to have infants with SGA (RR 1.5, 95% CI 1.4-1.6 and RR 3.2, 95% CI 2.8-3.6, respectively). Women with pre-existing hypertension were also more likely to give birth to an infant with SGA (RR 2.5, 95% CI 2.2-3.0) or to have a stillbirth (RR 3.2, 95% CI 1.9-5.4). CONCLUSIONS: This large, population-based study confirms and quantifies the magnitude of the excess risk of small for gestational age and stillbirth among births to women with hypertensive disease in pregnancy.

Journal Article↗
PubMed2004

Influenza vaccine programs and pregnancy: a need for more evidence.

Influenza viruses are the most common cause of seasonal respiratory morbidity in the world. Annual influenza vaccination is recommended for persons at high risk for serious disease. In the United States, in 2004, the Advisory Committee on Immunization Practices added all pregnant women to its high-risk list. In Canada, the National Advisory Committee on Immunization only includes pregnant women who have other underlying risk factors in the high-priority category for influenza immunization. This commentary provides an overview of maternal morbidity in pandemic and nonpandemic influenza seasons as well as a list of research questions whose answers are needed for evidence-based public health policy in this area.

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PubMed2004

The influence of hospital closures in Nova Scotia on perinatal outcomes.

OBJECTIVE: To evaluate the effect of hospital closures on critical obstetrical interventions and perinatal outcomes in rural communities in Nova Scotia, Canada. METHODS: A population-based cohort study was carried out for the years 1988 to 2002, using data extracted from the Nova Scotia Atlee Perinatal Database. Regions of maternal residence were defined geographically and administratively as Eastern, Northern,Western, and Central. The time periods of 1988 to 1993 and 1996 to 2002 were chosen based on the timing of hospital closures. Changes in rates of several perinatal outcomes were examined by region in relation to the extent of hospital closures experienced by that region. RESULTS: The majority of hospital closures occurred in 1994 to 1995 with the establishment of new health regions, and affected the Western region most profoundly. In comparison with the Central region (relative risk [RR], 0.56; 95% confidence interval [CI], 0.53-0.59), the temporal reduction in the rate of forceps-assisted vaginal delivery was smaller in the Western region (RR, 0.83; 95% CI, 0.76-0.91; P < .001), but greater in the Northern (RR, 0.36; 95% CI, 0.32-0.41; P < .001) and Eastern (RR, 0.26; 95% CI, 0.23-0.30; P < .001) regions. The temporal increase in the rate of breastfeeding at discharge from hospital was smaller in the Northern region (RR, 1.36; 95% CI, 1.29-1.45; P < .001) compared to that in the Central region (RR, 1.55; 95% CI, 1.49-1.61). The decrease in the rate of fetal growth restriction was smaller in the Western (RR, 0.95; 95% CI, 0.87-1.02; P = .002) and Eastern (RR, 0.90; 95% CI, 0.82-0.98; P = .002) regions of residence compared to the Central region (RR, 0.75; 95% CI, 0.71-0.79). There were no significant regional differences in temporal patterns of preterm induction and/or preterm Caesarean delivery, or perinatal mortality. CONCLUSION: Although trends over time demonstrated some regional differences in obstetrical interventions and perinatal outcomes, our retrospective evaluation did not reveal a consistent relationship between reductions in maternity services associated with hospital closures and systematic, population-level adverse perinatal consequences in Nova Scotia.

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PubMed2004

Twin-twin transfusion syndrome: a population-based study.

OBJECTIVE: To study the incidence and mortality and morbidity rates of twin-twin transfusion syndrome in a complete population-based cohort in Nova Scotia. METHODS: A population-based cohort study of all monochorionic diamniotic twin pregnancies of 20 weeks of gestation or longer born to Nova Scotia (Canada) residents between 1988 and 2000 was examined. The effect of gestational age adjustment and birth weight discordancy of more than 20% on mortality and 1-year survival was studied. Other outcomes studied included birth depression, respiratory distress syndrome, chronic lung disease, interventricular hemorrhage, periventricular leukomalacia, acute renal failure, and congestive heart failure. RESULTS: Of 404 monochorionic-diamniotic twin pregnancies examined, 48 were identified with twin-twin transfusion syndrome. Total mortality rates per pregnancy were significantly greater in the twin-twin transfusion syndrome group than in the remainder of our monochorionic diamniotic population (P < .01). However, when adjusted for gestational age, mortality failed to achieve statistical significance. Similarly, no differences were noted for 1-year survival and other outcomes of liveborn infants after gestational age adjustment. Discordance in birth weight predicted a higher incidence of morbid outcomes per pregnancy, but this effect was lost after gestational age adjustment. CONCLUSION: Increased morbidity and mortality of twins with twin-twin transfusion syndrome is likely to be due to a higher incidence of preterm birth. Birth weight discordancy was not found to be an independent predictor of mortality after controlling for gestational age and twin-twin transfusion syndrome.

Birth Weight↗
PubMed2003

Changes in maternal characteristics and obstetric practice and recent increases in primary cesarean delivery.

OBJECTIVE: To estimate the contribution of changes in maternal characteristics (namely, age, parity, prepregnancy weight, weight gain in pregnancy, smoking status) and obstetric practice (namely, labor induction, epidural anesthesia, delivery by an obstetrician, midpelvic forceps delivery) to recent increases in primary cesarean delivery rates. METHODS: We studied all deliveries in Nova Scotia, Canada, between 1988 and 2000 after excluding women who had a previous cesarean delivery (n = 127,564). Logistic regression was used to study the effect of changes in maternal characteristics and obstetric practice on primary cesarean delivery rates. The effect of changes in midpelvic forceps delivery was examined through ecologic Poisson regression. RESULTS: Primary cesarean delivery rates increased from 13.4% of deliveries in 1988 to 17.5% in 2000. This was due to increases in cesarean deliveries for dystocia (14% increase), breech (24% increase), suspected fetal distress (21% increase), hypertension (47% increase), and miscellaneous indications (73% increase). Adjustment for maternal characteristics reduced the temporal increase in primary cesarean delivery rates between 1988-1991 and 1998-2000 from 21% (95% confidence interval [CI] 16%, 25%) to 2% (95% CI -2%, 7%). Additional adjustment for obstetric practice factors further reduced period effects. Midpelvic forceps delivery was significantly and negatively associated with primary cesarean delivery (P =.001). CONCLUSION: Recent increases in primary cesarean delivery rates are a consequence of changes in maternal characteristics. Obstetric practice, which has altered due to changes in maternal characteristics and concerns related to fetal and maternal safety, has also contributed to increases in primary cesarean delivery.

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