Browsing by Author "Campbell, Meredith"

Now showing 1 - 7 of 7
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    Adequacy of glycemic control in early pregnancy with Type 2 diabetes and perinatal outcomes
    (2023-02-09) Izewski, Joanna; Tang, Rachel; Crites, Kundai; Campbell, Meredith; Pelton, Sarah; Saiko-Blair, Morgan; Scifres, Christina
    Objective In non-pregnant individuals with type 2 DM (T2DM), an HbA1c target < 7% is recommended. We sought to assess if an HbA1c < 7% in early pregnancy is associated with a lower risk for adverse pregnancy outcomes. Study Design We conducted a retrospective cohort study of individuals with T2DM and a singleton gestation who delivered at 2 health systems between 2018-2020. Demographics, markers of health care utilization, and perinatal outcomes were abstracted from the medical record. Race and ethnicity were self-reported. The primary exposure was levels of glycemic control at less than 20 weeks’ gestation using recommended HbA1c targets in non-pregnant individuals (HbA1c < 7% vs. HbA1c ≥7%). Patients without documentation of HbA1c prior to 20 weeks were excluded. Perinatal outcomes were abstracted from the medical record, and logistic regression was used to adjust for covariates. Results Of the individuals who had a documented HbA1c < 20 weeks of gestation, 128/281 (46%) had a HbA1c < 7%, and 153/281 (54%) had a HbA1c ≥7%. Patients with HbA1c < 7% were more likely to be of White race and have private insurance. They also had the first HbA1c measured earlier in pregnancy, a lower mean HbA1c across gestation, less overall weight gain, and were less likely to require insulin at the time of delivery. There were no significant differences in other demographics or markers of healthcare utilization (Table 1). Outcomes are shown in Table 2. After adjusting for covariates, those with a HbA1c ≥7% were more likely to have a preterm birth < 37 weeks (aOR 2.3, 95% CI 1.3-4.0), cesarean delivery (aOR 1.9, 95% CI 1.1-3.3), and a neonate requiring NICU admission (aOR 2.9, 95% CI 1.7-4.9). Conclusion Adverse perinatal outcomes are common among individuals with T2DM even when early pregnancy HbA1c values are within recommended targets for non-pregnant individuals. Those who present with a HbA1c ≥7% are at even higher risk for several outcomes. We observed important disparities in HbA1c values in early pregnancy that likely represent barriers in accessing medical care prior to pregnancy.
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    Approach to Treatment of Cervical Pregnancy: A Case Report
    (2022) Campbell, Meredith; Chaudhary, Aysha; Pandhiri, Taruni; Tominack, Hope; Rouse, Caroline E.
    CASE: A 25yo G1 at 11wk4d dated by LMP and confirmed with a 10 week ultrasound presents with a possible cervical ectopic pregnancy. Past medical, surgical, and OBGYN histories are unremarkable. A cervical pregnancy was suspected on ultrasound due to low implantation of the gestational sac, and a significant posterior bulge with an hourglass shaped uterus. MRI suggested implantation of the placenta in the posterior uterine and cervical wall due to extreme thinning of these structures. Our institution had previously created a protocol for multidisciplinary management of cesarean scar and cervical pregnancies. She desires fertility preservation, and so consented to combined local and systemic treatment with Methotrexate (MTX). Preprocedural Beta-hCG was 81,514.8 mU/mL. Ultrasound-guided transvaginal intra-gestational sac injection of MTX was performed without complication, though cardiac activity was still present at the conclusion of the procedure. The patient also received an IM injection of MTX before discharge. Serial Beta-hCG are still being followed, and are trending towards zero. CONCLUSION: The optimal management for cervical pregnancies is not known, and decisions around type of management are informed by the patient’s desire for fertility preservation. In this case, a protocol created by a multidisciplinary team was used to guide treatment. This protocol using MTX successfully treated the cervical pregnancy at 11wk4d and avoided a surgery that could complicate future fertility. CLINICAL SIGNIFICANCE: Due to the rare occurrence of cervical pregnancy, there is not a universally accepted treatment protocol. This case shows that medical management can be successful for cervical pregnancies. Clear guidelines must be established for cervical pregnancies to optimize outcomes, and decrease maternal morbidity and mortality and to preserve future fertility.
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    Being Born into a Pandemic: COVID-19 and Pregnancy
    (2021) Swiezy, Sarah; Campbell, Meredith; Eckert, Nicole
    Case #1: 34yo Asian female G2P1001 presents COVID19+ in 1st trimester. PMH insignificant. Meds: prenatal vitamins. Surg Hx: c/s healthy boy (2017). No h/o GHTN, GDM, or eclampsia. D/t COVID19+ infection, frequent fetal u/s monitoring done at 32w5d, 34w5d, 38w0d. Fetal growth over time: 63.4%, 48.8%, 14.3%. Fluid over time: AFI 8.58cm, MVP 4.52cm; AFI 10.86, MVP 3.52; AFI 2.73, MVP <2. Oligohydramnios diagnosed at 38w0d; emergent repeat c/s performed. Mother and baby healthy s/p delivery, d/c home on PPD#2. Pathology of placental tissue shows increases in villous fibrin accumulation and maternal vascular malperfusion. Case #2: 29yo Caucasian female G1P0 presents to ED at 18w4d with c/o runny nose, cough, and headache; temp. 100.3*F; tests COVID+. PMH insignificant. Meds: prenatal vitamins. No h/o GHTN, GDM, or eclampsia. 21w0d u/s: growth 71.4%, normal anatomy. 30w0d u/s: growth at 82.3%, AFI 15.10cm, MVP 5.38cm. At 39w1d, healthy infant boy (7lb12oz) via VAVD. Mother and baby healthy s/p delivery, d/c home on PPD#2. Placenta not sent for surgical pathology. Conclusion Due to the short time course of the COVID19 pandemic, adequate evidence to link maternal-fetal outcomes to infection during pregnancy is just now becoming available. Other coronaviruses, SARS and MERS, are preferentially fatal in pregnant mothers; and, adverse perinatal outcomes in COVID19+ women are appearing. Case reports have associated COVID19 with preterm birth; one study reported 47% preterm deliveries in COVID19+ mothers. Molecular studies have confirmed ACE2 (receptor allowing viral cellular entry) mRNA overexpression in placentas. Placental histopathology has shown maternal-placental interfacing blood vessel anomalies. Clinical Significance COVID19 represents a monumental threat to public health. Pregnant women and fetuses may be at increased risk for complications compared to the general public. As yet, the relationship between COVID19 and pregnancy remains to be clarified and will require further investigations to understand associations and promote evidence-based treatment practices.
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    A Case Series of COVID-19 and Pregnancy Outcomes
    (2021) Swiezy, Sarah; Eckert, Nicole; Campbell, Meredith
    Introduction: COVID-19 has been the largest public health crisis of our lifetime. Much of the morbidity and mortality caused by COVID-19 has been due to lack of adequate research and understanding of the virus. In the absence of data for COVID-19, scientists have used evidence collected during other coronavirus outbreaks, including SARS and MERS, to forecast outcomes in different populations. Both of these coronavirus outbreaks were preferentially fatal in pregnant women, suggesting that COVID-19 may also have grave consequences for gravid women and their fetuses. Given that molecular studies have confirmed that COVID-19 enters cells through the ACE-2 receptor, which is also present on human placental cells, there is potential for COVID-19-induced abnormalities in the interface between mom and baby, leading to maternal-fetal morbidity or mortality. To date, several case series have demonstrated adverse perinatal outcomes in COVID-19-positive pregnant women, including placental abnormalities and pre-term birth; however, these studies have been limited in scale and scope. More data is needed to fully understand the implications of COVID-19 infection in pregnancy so that evidence- based treatment recommendations can be made to OB/GYNs caring for COVID+ patients. Methods: We reviewed the charts of all of the pregnant women presenting for routine obstetric care to the UAP OB/GYN offices in Terre Haute, IN between Nov 2020 and Feb 2021. We identified 33 women who were pregnant at the time of COVID-19 infection. Data were input into a Qualtrics survey for ease of viewing the results. Results/Conclusions: We are currently waiting for 6 (18%) of the patients in our sample to deliver in the next 4-6 weeks To date we have a sample of mostly Caucasian women infected in their 2nd and 3rd trimester. Here we evaluate their pre-, peri-, and immediate post-partum maternal and infant outcomes.
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    Connecting Faith and Health: Improving Health Outcomes Through Congregant Networks
    (2020-12-15) Campbell, Meredith; Christenson, Jacob; Craig, David M.
    BACKGROUND AND HYPOTHESIS: People living in areas of high social vulnerability face health disparities in part due to disconnection. Health institutions recognize the importance of treating whole persons but are disconnected from local knowledge of community health assets and social and cultural barriers. People in health-challenged neighborhoods may experience disconnection and distrust in seeking the many resources and services needed for good health. Congregations are longstanding anchor institutions in marginalized communities. They build trusted relationships among members through shared values and care for wellness. Sometimes they extend these connections through on-the-ground service to neighboring communities. We hypothesize that a network of congregations can build trusted connections and share local knowledge and cultural competence to improve health outcomes and holistic wellness in vulnerable neighborhoods. METHODS: Community-engaged participatory research requires reciprocity in mapping assets, identifying priorities, narrating shared values, designing projects and messaging results. We developed mixed-methods tools to ensure community expertise drives an iterative research process. Methods include: an initial health and wellness survey, follow-up wellness interviews to collect stories and assets, an online learning community for 14 congregations with monthly focus groups, and visual maps of health data and wellness assets. RESULTS: While the study is ongoing, preliminary survey data demonstrates that congregations have local knowledge of issues affecting health and wellness among their congregants and the surrounding neighborhood. Their preexisting support for health and wellness through community outreach programs indicates building on their current network could expand their reach and improve health and wellness in vulnerable neighborhoods. CONCLUSION AND POTENTIAL IMPACT: Successful community engaged research prioritizes iterative methods that allow community participants to use their voice and tell their stories. Congregations' practice of shared values and knowledge of lived experience can forge connections for greater resilience and health supports in socially vulnerable communities.
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    The Heart of Maternal Mortality: Postpartum Cardiomyopathy and Its Upstream Determinants of Health
    (2020) Campbell, Meredith; Lee, Deborah; Marks, Claire; Palma, Samantha; Yang, Caroline
    CASE: A 25-year-old obese African American female presented with dyspnea 6 weeks after a full-term vaginal delivery complicated by pre-eclampsia. Further work up showed LV enlargement without hypertrophy and globally decreased contractility consistent with postpartum cardiomyopathy as well as endocarditis with vegetations on the aortic and tricuspid valves. In the setting of poor patient compliance, patient progressed to worsening systolic heart failure as LVEF dropped from 45% to 25% within a year. Despite further management including valve replacement, ICD placement and a continuous milrinone treatment, LVEF continued to decline, with the lowest value at 12%. During one of her recurrent acute respiratory failures, the patient and team made the difficult decision to transition to palliative care, where she expired. BACKGROUND: Postpartum cardiomyopathy (PPCM) is a life-threatening disease that arises between the last month of pregnancy and four months after delivery, where patients present with dyspnea, dizziness, or lower extremity edema. Although it is rare with an incidence of 1 case per 2187 live births, it has a high mortality rate in the US ranging from 6% to 10%, mostly in the first 30 days. DISCUSSION: Multiple recent studies have demonstrated the significance of early diagnosis of PPCM and its strong association with more favorable outcomes, including greater LVEF recovery and lower rates of morbidity and mortality. This evidence suggests the need for pre-discharge screening, in order to diagnose patients earlier and give them the greatest opportunity for a full recovery. Additionally, patient noncompliance, largely influenced by socioeconomic status and medical literacy of the patient, is another crucial factor that affects the prognosis of PPCM. Effective strategies to increase compliance include educating the patient, using an inter-professional healthcare team, and working with the psychological and socioeconomic barriers to compliance.
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    Maternal weight gain among individuals with Type 2 diabetes and associated perinatal outcomes
    (2023-02-10) Izewski, Joanna; Crites, Kundai; Tang, Rachel; Saiko-Blair, Morgan; Campbell, Meredith; Pelton, Sarah; Scifres, Christina
    Objective The prevalence of type 2 Diabetes Mellitus (T2DM) in pregnancy is increasing, and adverse perinatal outcomes are common. We sought to assess whether higher or lower weight gain is associated with adverse perinatal outcomes in T2DM. Study Design This was a retrospective cohort study of patients with T2DM and a singleton gestation who delivered at 2 health systems between 2018-2020. Demographics, markers of health care utilization, and various perinatal outcomes were abstracted from the medical record. Race and ethnicity were self-reported. Our primary exposure was weight gain < 5 kilograms(kg) across gestation compared to those who gained ≥5kg. We excluded patients for whom weight gain could not be calculated. We assessed multiple perinatal outcomes, and we used multinomial logistic regression to adjust for covariates. Results We included 341 individuals with T2DM. There were 216/341 (63%) in the ≥5kg group, and 125/341 (37%) in the < 5kg group. The < 5kg group was more likely to be of Black race. The ≥5kg group initiated prenatal care earlier in gestation, were more likely to have ≥12 total prenatal visits, and be on insulin at the time of delivery. There were no significant differences in other demographics or markers of healthcare utilization (Table 1). Perinatal outcomes are shown in Table 2. Those with < 5kg of weight gain were less likely to develop a hypertensive disorder of pregnancy (aOR 0.3, 95% CI 0.2-0.5), or undergo a cesarean delivery (aOR 0.6, 95% CI 0.4-0.9). Stillbirth was more common among those who gained < 5kg (7 vs. 2%, p=0.02). There was a statistical difference in neonatal birthweight category (AGA vs. SGA vs. LGA) (p=0.04) between the 2 groups that did not persist after adjusting for covariates. Conclusion Weight gain is associated with adverse perinatal outcomes among individuals with T2DM. While weight gain < 5kg is associated with a reduced risk for certain outcomes, the increased risk for stillbirth deserves further study.