Chronic hypertension in pregnancy is traditionally classified according to degree of blood pressure (BP) elevation. Alternatively, stratifying women as high or low risk based on the etiology of hypertension, baseline work-up, and comorbid medical conditions will better inform clinicians about thresholds to initiate antihypertensive therapy, target BPs, frequency of antepartum visits, and timing of delivery. Women classified as high-risk chronic hypertension as described here require stricter BP management and more frequent follow-up visits as their associated rates of adverse maternal and/or fetal/neonatal outcomes appear higher than women classified as low-risk chronic hypertension. The latter group can in most cases be managed similarly to the general obstetric population.
The introduction of clickers into the learning environment evolved significantly reflecting major developments in student academic performance. From simple in-class, multiple-choice questions to global international competitions, this innovative tool has managed to combine both education and entertainment into an intuitive and positively reinforcing learning experience. In 2011, the PI was appointed by the International Union of Pure and Applied Chemistry (IUPAC) to represent and coordinate the activities in Lebanon in celebration of the International Year of Chemistry (IYC2011). The first seed of organic chemistry competition (OC) was thus planted, sparking a series of more successful events promoting a fun and proactive educational environment that recognized the participants' mastery of essential concepts of organic chemistry. As such, the OC has since became a platform for higher education and student-based academic involvement joining students from all around the world and different walks of life to experience and share a common interest: organic chemistry.
OBJECTIVE: Treatment of gestational diabetes (GDM) is associated with improved pregnancy outcomes. Obstacles to taking prescribed medications can lead to non-compliance. The objective was to determine the challenges that lead to low medication adherence and whether this increases the rate of adverse pregnancy outcomes in women with GDM. STUDY DESIGN: A prospective, observational study was performed of women with GDM treated with metformin, glyburide or insulin at a tertiary care center. Women greater than 16 weeks gestation and treated for a minimum of 2 weeks were included. Women with pre-DM were excluded. Women completed a validated survey, MMAS-8 (low: score <6 and high: score 7-8), to identify women with low and high medication adherence. Information resulting in medication compliance was collected. The primary outcome was neonatal birth weight >4,000g. Secondary outcomes included factors with medication adherence, adherence rates for each medication and neonatal outcomes. RESULTS: Of 79 women who met study criteria, 42 reported high and 37 reported low adherence. Birth weight >4,000g were similar in each group, (low: 16.2% vs. high: 7.1%, p ¼ 0.292). Women prescribed metformin had the highest rate of high adherence (38.1%) and women on glyburide had the highest rate of low adherence (46%). The rate of neonatal hypoglycemia was significantly higher in women with low adherence compared to high adherence, (low: 70.3% vs high 42.9%, p ¼ 0.023). There were similar rates of induction of labor, cesarean section, NICU admissions, and neonatal respiratory complications. There were no cases of shoulder dystocia, Erb's palsy, or major neonatal morbidities. Obstacles to medication adherence were documented in 14% of women including prescription error, insurance difficulties and delay in dispensing the medications. Adverse effects to medication were reported in 10-20% of women. CONCLUSION: Although there were no differences in neonatal birthweight between groups, low medication adherence was associated with neonatal hypoglycemia. Challenges to compliance with prescribed medications occurred in 14% of GDM women and up to 1 in 5 women reported a medication side effects. Further studies are needed to investigate patient-specific and system-level strategies to improve medication adherence in women with GDM.
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