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Short sleep duration has been widely linked to increased cardiovascular morbidity and mortality. We performed a post-hoc analysis of 24-hour ambulatory blood pressure monitoring (ABPM) in the Lifestyle Modification in Blood Pressure Lowering Study (LIMBS) and Penn Icelandic Sleep Apnea (PISA) Study. The 24-hour mean systolic blood pressure was 12.7 mmHg higher in LIMBS (p<0.001; n=66) and 4.7 mmHg higher in PISA (p=0.005; n=153) among participants with shorter sleep duration (less than seven hours) compared to those with longer sleep duration (at least seven hours). In multivariable adjusted models, shorter sleep duration was strongly associated with higher systolic blood pressure on 24-hour ABPM, independent of nocturnal blood pressure and in-office blood pressure. There was no effect modification by obstructive sleep apnea. Adults with shorter sleep duration may benefit from screening with 24-hour ABPM to promote earlier detection of hypertension and potentially mitigate their increased risk for future cardiovascular disease.

Objective This article evaluates gender differences in academic rank and National Institutes of Health (NIH) funding among academic maternal–fetal medicine (MFM) physicians. Study Design This was a cross-sectional study of board-certified academic MFM physicians. Physicians were identified in July 2017 from the MFM fellowship Web sites. Academic rank and receipt of any NIH funding were compared by gender. Data on potential confounders were collected, including years since board certification, region of practice, additional degrees, number of publications, and h-index. Results We identified 659 MFM physicians at 72 institutions, 312 (47.3%) male and 347 (52.7%) female. There were 246 (37.3%) full, 163 (24.7%) associate, and 250 (37.9%) assistant professors. Among the 154 (23.4%) MFM physicians with NIH funding, 89 (57.8%) were male and 65 (42.2%) were female (p = 0.003). Adjusting for potential confounders, male MFM physicians were twice as likely to hold a higher academic rank than female MFM physicians (adjusted odds ratio [aOR], 2.04 [95% confidence interval, 1.39–2.94], p < 0.001). There was no difference in NIH funding between male and female MFM physicians (aOR, 1.23 [0.79–1.92], p = 0.36). Conclusion Compared with female academic MFM physicians, male academic MFM physicians were twice as likely to hold a higher academic rank but were no more likely to receive NIH funding.

Objective Although preterm delivery (PTD) before 34 weeks for severe hypertensive disease is a diagnostic criterion for antiphospholipid syndrome (APS), there is no consensus regarding testing for antiphospholipid antibodies (aPL) in this setting. We aim to describe the frequency of and the characteristics associated with inpatient aPL testing in this population. Study Design In this retrospective study of PTD before 34 weeks for severe hypertensive disease, charts were reviewed for aPL testing, gestational age at delivery, fetal complications, and severity of maternal disease. Wilcoxon rank-sum test, Fisher's exact, and chi-squared tests were used for analyses of continuous and categorical variables, and multivariate logistic regression for adjusted odds ratios. Results Among 133 cases, 14.3% had APS screening via aPL testing. Screened patients delivered earlier than unscreened patients (28.9 vs. 31.7 weeks, p <0.001). Each additional week of gestation was associated with a 39% decrease in the odds of screening (95% confidence interval: 0.43–0.85). There were no other differences between the groups. Conclusion APS screening after PTD for severe hypertensive disease is uncommon but more likely with earlier PTD. Despite conflicting recommendations from professional organizations, prior studies demonstrate contraceptive, obstetrical, and long-term risks associated with APS, suggesting that we should increase our screening efforts.

Due to advances in neonatal care, prenatal diagnostics, and artificial reproductive techniques, women affected by skeletal disorders now survive into their reproductive years, desire fertility, and become pregnant. Osteogenesis imperfecta (OI) is a disease of brittle bones prone to fracture and is one of the most common of the skeletal dysplasias. Fibrodysplasia ossificans progressiva (FOP) is a rare debilitating genetic condition characterized by congenital malformations of the great toes and progressive, disabling heterotopic ossification (HO) in which bone forms outside of the skeleton. Here we report two cases of viable pregnancies with severe maternal skeletal disorders. This is only the fourth reported case of a viable pregnancy in a woman with FOP. These cases highlight the complexity of caring for women during pregnancy affected by severe skeletal disorders, the formidable risks when these women become pregnancy, and how these high-risk pregnancies can be successfully managed by a collaborative multidisciplinary care team.

We describe a novel measurement of mediastinal shift in cases of CPAM and its relationship with adverse perinatal outcomes and hydrops. These findings may shape the evaluation and management of CPAMs, improve our understanding of their prognosis, and influence patient counseling.

Inclusion criteria were EFWD ! 20% before 27 weeks and adequate ultrasound (US) information to assess for interval growth until delivery, defined as last US within 5 weeks of delivery. We excluded those with major structural anomalies, pregnancies that were terminated, those that developed twin-twin transfusion syndrome, and those that developed polyhydramnios. The primary outcome was development of sFGR in the smaller twin, defined as estimated fetal weight 10th percentile for gestational age (GA). Predictors included maternal demographics (age, nulliparity, and use of assisted reproductive technology), US findings (cord insertion of smaller twin and presence of arterio-arterial anastomosis), and details at time of EFWD diagnosis (GA at diagnosis and degree of EFWD). The Kruskal-Wallis test generated median values for non-parametric continuous variables, and Fisher's exact tests compared proportions between categorical variables. RESULTS: A total of 38 MCDA pairs met the inclusion criteria, with 26 (68%) developing sFGR at a median GA of 23.9 weeks (20.7-35.1). There were no statistically significant differences in maternal demographics, US findings, or GA at time of EFWD diagnosis comparing those who developed sFGR and those who did not. The sFGR group had a greater degree of EFWD at initial diagnosis, which approached but did not reach statistical significance (median EFWD 32.8% vs 29.2%, p ¼ 0.055). The relative risk of developing sFGR with initial EFWD ! 30% was 1.3 (95% CI 0.8-2.1). CONCLUSION: The majority of MCDA twins with EFWD ! 20% ultimately develop sFGR in the smaller twin. While a statistically significant difference was not reached, we did observe a trend toward a greater degree of EFWD being associated with subsequent development of sFGR. Larger studies are required to further evaluate this finding and to enable providers to risk-stratify MCDA pairs with EFWD.