Faculty Bibliography

Ultrasound machines are nowadays part of the armamentarium of all modern Labor and Delivery Suites. Due to their portability, these machines are ideal for use in emergencies which can occur at any of the labor and delivery rooms. Many of the emergencies in Labor and Delivery can be life threatening; thus, maternal and fetal safety requires efficient and timely ultrasound evaluation. The purpose of this article is to provide guidelines for quick and efficient use of ultrasound based on both the authors' experience and the published literature.

OBJECTIVE: The objective of the study was to characterize trends in gestational diabetes (GDM) by maternal age, race, and geographic region in the United States. STUDY DESIGN: The National Hospital Discharge Survey, comprised of births in the United States between 1989 and 2004 (weighted n = 58,922,266), was used to examine trends in GDM, based on an International Classification of Diseases, Ninth Revision, Clinical Modification code of 648.8. We examined temporal trends by comparing GDM rates in the earliest (1989-1990) vs most recent (2003-2004) biennial periods. Relative risks, quantifying racial disparity (black vs white) in GDM, were derived through logistic regression models after adjusting for confounders. These analyses were further stratified by maternal age and geographic region. RESULTS: Prevalence rates of GDM increased from 1.9% in 1989-1990 to 4.2% in 2003-2004, a relative increase of 122% (95% confidence interval [CI] 120%, 124%). Among whites, GDM increased from 2.2% in 1989-1990 to 4.2% in 2003-2004 (relative increase of 94% [95% CI 91%, 96%]), and this was largely driven by an increase in the 25-34 year age group. In contrast, the largest relative increase in GDM (260% [95% CI 243%, 279%]) among blacks between 1989-1990 (0.6%) and 2003-2004 (2.1%) occurred to women aged younger than 25 years. The black-white disparity in GDM rates widened markedly among women aged younger than 35 years in the 1997-2004 periods. The largest relative increases were seen in the West (182% [95% CI 177%, 187%]) followed by the South and Northeast. The observed increase in GDM rates in the Northeast, Midwest, and South regions most likely is due to increase in GDM prevalence rates among blacks. CONCLUSION: This study shows that the prevalence rate of GDM in the United States has increased dramatically between 1989 and 2004. The temporal increase and the widening black-white disparity in the rate of GDM deserves further investigation.

OBJECTIVE: To examine the association between changes in prepregnancy body mass index (BMI) between a woman's first two pregnancies and incidence of preeclampsia in the second pregnancy. METHODS: We performed a population-based retrospective cohort analysis using data on women's first two singleton pregnancies (n=136,884) in Missouri (1989-1997). The study was restricted to women without preeclampsia in the first pregnancy. Prepregnancy BMI (kg/m(2)) was categorized as underweight (less than 18.5), normal (18.5-24.9), overweight (25-29.9), and obese (30 or greater). Analyses were adjusted for confounders through multivariable logistic regression. RESULTS: The incidence rate of preeclampsia in the second pregnancy was 2.0%. In comparison with women who were of normal BMI in both pregnancies, the risk for preeclampsia increased when BMI changed between the first two pregnancies from underweight to obese (odds ratio [OR] 5.6, 95% confidence interval [CI] 1.7-18.2), normal to overweight (OR 2.0, 95% CI 1.7-2.3), normal to obese (OR 3.2, 95% CI 2.5-4.2), and overweight to obese (OR 3.7, 95% CI 3.1-4.3). Being obese or overweight in both pregnancies was associated with increased risk of preeclampsia in the second pregnancy. Women who increased their BMI from underweight to normal or overweight between pregnancies had risks of preeclampsia comparable with those with normal BMI in both pregnancies. African-American, but not white, women who had a reduction in BMI from obese or overweight to normal between pregnancies remained at increased risk for preeclampsia. CONCLUSION: Increases in prepregnancy BMI from normal weight to overweight or obese between pregnancies are associated with increased risk of preeclampsia in the subsequent pregnancy. LEVEL OF EVIDENCE: II.