OBJECTIVETo examine the utility of commonly used insulin sensitivity indices in nondiabetic European Americans (EAs) and African Americans (AAs).RESEARCH DESIGN AND METHODSTwo-hundred forty nondiabetic participants were studied. Euglycemic-hyperinsulinemic clamp was the gold standard approach to assess glucose disposal rates (GDR) normalized by lean body mass. The homeostatic model assessment for insulin resistance (HOMA-IR) and the quantitative insulin sensitivity check index (QUICKI) were calculated from fasting plasma glucose and insulin (FIL). Oral glucose tolerance test (OGTT) was performed to determine Matsuda index, the simple index assessing insulin sensitivity (SIisOGTT), Avignon index, and Stomvoll index. Relationships among these indices with GDR were analyzed by multiple regression.RESULTSGDR values were similar in EA and AA subgroups; even so, AA exhibited higher FIL and were insulin-resistant compared with EA, as assessed by HOMA-IR, QUICKI, Matsuda index, SIisOGTT, Avignon index, and Stumvoll index. In the overall study population, GDR was significantly correlated with all studied insulin sensitivity indices (/r/ = 0.381–0.513); however, these indices were not superior to FIL in predicting GDR. Race and gender affected the strength of this relationship. In AA males, FIL and HOMA-IR were not correlated with GDR. In contrast, Matsuda index and SIisOGTT were significantly correlated with GDR in AA males, and Matsuda index was superior to HOMA-IR and QUICKI in AAs overall.CONCLUSIONSInsulin sensitivity indices based on glucose and insulin levels should be used cautiously as measures of peripheral insulin sensitivity when comparing mixed gender and mixed race populations. Matsuda index and SIisOGTT are reliable in studies that include AA males.

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A total of 1858 women (56% Jewish) had complete data for present analyses. Overall 83 women (4.5%) screened positive for mild PPD risk (EPDS 8) and 37 women (2.0%) screened positive for moderate PPD risk (EPDS 10). Logistic regression results showed that Cesarean delivery was significantly associated with mild PPD risk (OR¼3.04, 95% CI 2.00e4.60), which remained significant after adjusting for age and religion (OR 1.75, 95% CI 1.207e2.87, p¼0.03). CONCLUSION: Delivering by Cesarean section may be an independent risk factor for mild PPD symptoms in the immediate postpartum period. This cohort had low rates of PPD risk compared to epidemiological rates (10%), particularly in the Jewish women. Ethnic, racial and religious minorities encounter more stigma and may not readily report symptoms, therefore, cut-points are often lowered from the standard EPDS 10. Indeed, in our sample CS was significantly associated with EPDS 10 in the univariate model. Mild PPD risk in the immediate post partum period is also predictive of subsequent development of PPD. Obstetric providers may consider immediate PPD screening, education, and referral to treatment for patients, particularly for those who deliver via Cesarean section.

Objective The aim of this study was to evaluate the effect of a policy to deliver at 39 weeks for class III obesity. Methods This was a retrospective cohort study of women with class III obesity delivering at ≥ 37 weeks before (May 2012 to April 2014) and after the policy (September 2014 to August 2016). The primary outcome was the cesarean rate. Secondary outcomes included maternal morbidities and a neonatal morbidity composite. Modified Poisson regression was used to adjust for demographic differences between groups. Results The study included a total of 1,210 patients, 580 before the policy and 630 after the policy. Before and after the policy, cesarean rates were similar (41.6% vs. 47.1%; risk ratio [RR]: 1.13 [95% CI: 1.00‐1.29]; adjusted RR [aRR]: 1.03 [95% CI: 0.92‐1.14]). In adjusted comparisons of women undergoing labor induction, parous women had lower cesarean rates (aRR: 0.62; 95% CI: 0.41‐0.94) but nulliparous women had higher cesarean rates (aRR: 1.32; 95% CI: 1.04‐1.68) after the policy (P for interaction = 0.01). Rates of chorioamnionitis, endometritis, and cesarean wound infection were not different between groups. Composite neonatal morbidity was not different between pre‐ and postpolicy groups. Conclusions A policy of delivery at 39 weeks for class III obesity did not affect overall cesarean rate or rates of maternal or neonatal morbidity. Further investigation should evaluate subsets of women who may have a higher cesarean rate with this policy.

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