Browsing by Author "Esplin, M. Sean"

Now showing 1 - 2 of 2
  • Thumbnail Image
    Item
    Prescription and Other Medication Use in Pregnancy
    (Wolters Kluwer, 2018-05) Haas, David M.; Marsh, Derek J.; Dang, Danny T.; Parker, Corette B.; Wing, Deborah A.; Simhan, Hyagriv N.; Grobman, William A.; Mercer, Brian M.; Silver, Robert M.; Hoffman, Matthew K.; Parry, Samuel; Iams, Jay D.; Caritis, Steve N.; Wapner, Ronald J.; Esplin, M. Sean; Elovitz, Michal A.; Peaceman, Alan M.; Chung, Judith; Saade, George R.; Reddy, Uma M.; Obstetrics and Gynecology, School of Medicine
    OBJECTIVE: To characterize prescription and other medication use in a geographically and ethnically diverse cohort of women in their first pregnancy. METHODS: In a prospective, longitudinal cohort study of nulliparous women followed through pregnancy from the first trimester, medication use was chronicled longitudinally throughout pregnancy. Structured questions and aids were used to capture all medications taken as well as reasons they were taken. Total counts of all medications taken including number in each category and class were captured. Additionally, reasons the medications were taken were recorded. Trends in medications taken across pregnancy and in the first trimester were determined. RESULTS: Of the 9,546 study participants, 9,272 (97.1%) women took at least one medication during pregnancy with 9,139 (95.7%) taking a medication in the first trimester. Polypharmacy, defined as taking at least five medications, occurred in 2,915 (30.5%) women. Excluding vitamins, supplements, and vaccines, 73.4% of women took a medication during pregnancy with 55.1% taking one in the first trimester. The categories of drugs taken in pregnancy and in the first trimester include the following: gastrointestinal or antiemetic agents (34.3%, 19.5%), antibiotics (25.5%, 12.6%), and analgesics (23.7%, 15.6%, which includes 3.6%; 1.4% taking an opioid pain medication). CONCLUSION: In this geographically and ethnically diverse cohort of nulliparous pregnant women, medication use was nearly universal and polypharmacy was common.
  • Thumbnail Image
    Item
    Role of early second-trimester uterine artery Doppler screening to predict small-for-gestational-age babies in nulliparous women
    (Elsevier, 2017) Parry, Samuel; Sciscione, Anthony; Haas, David M.; Grobman, William A.; Iams, Jay D.; Mercer, Brian M.; Silver, Robert M.; Simhan, Hyagriv N.; Wapner, Ronald J.; Wing, Deborah A.; Elovitz, Michal A.; Schubert, Frank P.; Peaceman, Alan; Esplin, M. Sean; Caritis, Steve; Nageotte, Michael P.; Carper, Benjamin A.; Saade, George R.; Reddy, Uma M.; Parker, Corette B.; Department of Obstetrics and Gynecology, School of Medicine
    Background Trophoblastic invasion of the uterine spiral arteries substantially increases compliance to accommodate increased blood flow to the placenta. Failure of this process impedes uterine artery blood flow, and this may be detected by uterine artery Doppler flow studies. However, the clinical utility of uterine artery Doppler flow studies in the prediction of adverse pregnancy outcomes in a general population remains largely unknown. Objective We sought to determine the utility of early second-trimester uterine artery Doppler studies as a predictor of small-for-gestational-age neonates. Study Design Nulliparous women with a viable singleton pregnancy were recruited during their first trimester into an observational prospective cohort study at 8 institutions across the United States. Participants were seen at 3 study visits during pregnancy and again at delivery. Three indices of uterine artery Doppler flow (resistance index, pulsatility index, and diastolic notching) were measured in the right and left uterine arteries between 16 weeks 0 days’ and 22 weeks 6 days’ gestation. Test characteristics for varying thresholds in the prediction of small for gestational age (defined as birthweight <5th percentile for gestational age [Alexander growth curve]) were evaluated. Results Uterine artery Doppler indices, birthweight, and gestational age at birth were available for 8024 women. Birthweight <5th percentile for gestational age occurred in 358 (4.5%) births. Typical thresholds for the uterine artery Doppler indices were all associated with birthweight <5th percentile for gestational age (P < .0001 for each), but the positive predictive values for these cutoffs were all <15% and areas under receiver operating characteristic curves ranged from 0.50-0.60. Across the continuous scales for these measures, the areas under receiver operating characteristic curves ranged from 0.56-0.62. Incorporating maternal age, early pregnancy body mass index, race/ethnicity, smoking status prior to pregnancy, chronic hypertension, and pregestational diabetes in the prediction model resulted in only modest improvements in the areas under receiver operating characteristic curves ranging from 0.63-0.66. Conclusion In this large prospective cohort, early second-trimester uterine artery Doppler studies were not a clinically useful test for predicting small-for-gestational-age babies.