INTRODUCTION: Illicit drug use during pregnancy causes changes in neonatal growth parameters that are associated with neurodevelopmental outcomes and childhood chronic diseases. This study aims to describe racial differences in substance use and birth measurement outcomes. METHODS: A retrospective study of singleton births from August 2013 through December 2014 was conducted using urine drugs screen collected universally at the initiation of prenatal care. Excluded were multiple gestations and preterm deliveries. Reported are substance use patterns and race (Caucasian, African American, and Asian) as well as mean neonatal birth measurements (head circumference, birth length, and birthweight). RESULTS: 2,270 patients met study criteria. There was a significant difference in birthweight between Caucasians, Asians and African Americans at baseline without substance use (3,386 g, 3,338 g and 3,181 g respectively, P<.001). However those with substance use had no significant difference in birth measurements seen between races. Infants of Caucasian mothers with substance use were noted to have significantly smaller birthweights compared with Caucasian nonusers (3,386 g vs 3,191 g, P<.001). Whereas infant birthweights of African American mothers with substance use were not different from African American nonusers (3,181 g vs 3,170 g, P=.738). Of the 117 Asians screened in the study, there were no substance users. CONCLUSION: Our study addresses the racial differences of drug use during pregnancy and its effect on neonatal growth measurements at birth. Substance use impacts overall birthweight in Caucasian substance users but not African Americans. Efforts should be taken to describe substance use patterns by race and its effect on neonatal growth outcomes long term.
INTRODUCTION: Prior studies have suggested that marijuana exposure may affect the growth of the fetus and the ultimate birth weight of an infant but have been inconsistent in their methodologies and have shown conflicting results. This study aims to clarify any association between marijuana use and pregnancy outcomes. METHODS: A retrospective chart review of electronic medical records for singleton births from September 2013 through January 2015 with available urine drug screens (UDS) at initiation of prenatal care and delivery was conducted. Patients who used drugs other than marijuana were excluded. Patients were grouped into no positive UDS, positive UDS for only tetrahydrocannabinol (THC) at presentation, positive UDS for only THC at delivery, and positive UDS for only THC at both initial presentation and delivery. RESULTS: The incidence of marijuana use in pregnancy exclusive of other drugs as evidenced by only tetrahydrocannabinol in the urine of 2173 patients was 22.5%. Infants born to mothers who tested positive at both times during pregnancy were of lower birth weight compared to non-users [2925 gm (IQR 2522-3265) versus 3235 gm (IQR: 2900-3591), P = < 0.001]. This effect cannot be explained by earlier gestational age alone as persistent marijuana users only delivered two gestational days earlier than non-users (39 vs 39.3 weeks). Concomitant tobacco use during pregnancy was not noted to impact infant birth weight using the ANCOVA. CONCLUSION: Marijuana use is negatively correlated with fetal birth weight and length at birth. Additional patient education and cessation interventions should be explored.
INTRODUCTION: To determine if maternal hypoglycemia on the GCT is associated with small for gestational age (SGA) infants. The hypothesis is there will be an increased incidence of SGA in pregnancies with hypoglycemia (<88 mg/dL) as compared to euglycemia (88–129 mg/dL). METHODS: IRB approved, retrospective cohort study of singleton pregnancies from January 2015 to December 2017 with a GCT result between 24–28 weeks and delivery information were included. Patients with GCT >129 mg/dL and those with fetal anomalies were excluded. Neonatal and maternal outcomes were collected from the medical record. Growth classification was based on infant gender and gestational age at birth. Parametric and non-parametric tests, Fisher's exact and chi-squared tests were used for statistical analysis. RESULTS: 2386 patients were euglycemic (88–129 mg/dL) and 966 patients were hypoglycemic (<88 mg/dL) on the GCT results. The cohort gestational age at delivery was 39.1 weeks. Hypoglycemia was associated with increased risk for SGA infants (9.3% vs 7.0%, P=.027) and intrauterine growth restriction (IUGR) (7.9% vs 5.1%, P=.003) and less likely to have large for gestational age infant (5.1% vs 7.3%). Patients with hypoglycemia had a decreased incidence of gestational hypertension (4.8% vs. 6.7%, P=.039) and pre-eclampsia (0.8% vs. 2.2%, P=.006). CONCLUSION: Hypoglycemia (GCT level <88 mg/dL) is associated with increased risk of SGA infants and IUGR along with decreased incidence of gestational hypertension and pre-eclampsia. This information can be used to increase fetal growth surveillance by sonography in the third trimester to improve identification of SGA and IUGR.
INTRODUCTION: Nearly one third of gynecology visits are related to abnormal uterine bleeding and many are treated with endometrial ablation. Little research describing the impact of ablation on the structure and appearance of the endometrium and uterus post operatively has been done. The primary objective of this retrospective study is to describe and define changes within the endometrium and uterus seen on ultrasound of the post ablated endometrium. METHODS: We conducted a retrospective chart review of hospital electronic medical records from 2012 to 2016 to collect data on patients with ultrasound performed after endometrial ablation. Ultrasound reports were manually reviewed to collect quantitative and qualitative data on the post-ablative uterus. RESULTS: The mean endometrial thickness of the study sample (n=74) postoperatively was 7.0 mm (SD 3.3), significantly lower than pre operatively (p < 0.001) and the uterine height was 4.7 mm (SD 0.9), significantly lower than pre operatively (p=0.001). The mean endometrial thickness over time trended down from 9.3 (SD 3.4) to 5.5 (SD 2.2). Appearance of heterogeneity, vascularity, and cystic spaces also increased over time. CONCLUSION: Endometrial thickness decreases post operatively while presence of heterogeneity vascular or cystic spaces increase but more data is needed to meaningfully compare the trend over time. A prospective study is ongoing to describe the changes of the uterus overtime after ablation to help providers interpret postoperative ultrasound studies.
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