Browsing by Author "Ibrahim, Sherrine"

Now showing 1 - 3 of 3
  • Thumbnail Image
    Item
    Analysis of Factors Contributing to Antenatal Corticosteroid Administration in Threatened Preterm Labor
    (Wolters Kluwer Health, Inc., 2023-05) Bode, Leah; McKinzie, Alexandra; Gidia, Nadia; Ibrahim, Sherrine; Haas, David
    INTRODUCTION: Antenatal corticosteroids (ACS) are recommended for pregnant persons at risk for imminent preterm delivery within 7 days. Many diagnosed with threatened preterm labor (tPTL) are given ACS but do not deliver until term. The objective of this study was to analyze characteristics of those seen for tPTL who receive ACS to better understand clinical decision-making. METHODS: This retrospective cohort study consisted of patients seen in triage at an urban hospital caring for underserved patients in 2021 for tPTL during pregnancy. Demographic variables (maternal age, race and ethnicity, prior preterm delivery) and obstetric variables (cervical dilation, effacement, membrane rupture, tocolytic administration) were evaluated against the primary outcome of ACS administration. RESULTS: Two hundred ninety pregnant people with 372 unique encounters for tPTL were identified. The mean gestational age at presentation was 33.5 weeks. 107 patients in 111 encounters received ACS, which was associated with lower body mass index (BMI), greater cervical dilation and effacement, membrane rupture, and more frequent contractions (all P<.01). Logistic regression, limited to first encounter in triage, found that BMI (odds ratio 0.91, 95% CI 0.87–0.95), cervical dilation 2 cm or greater (2.49, 1.12–5.35), and cervical effacement 50% or higher (4.80, 2.25–10.24) were significantly associated with patients receiving ACS. Forty-four percent of those receiving ACS delivered within 7 days, compared to 11% of those who did not receive ACS (P<.001). CONCLUSION: Greater cervical dilation and effacement and a lower BMI were associated with ACS administration, although most patients receiving ACS did not deliver within 7 days. These findings will contribute to developing a clinical decision model for administering ACS.
  • Thumbnail Image
    Item
    Analysis of Factors Contributing to Antenatal Corticosteroid Administration in Threatened Preterm Labor
    (2022-07) Bode, Leah; McKinzie, Alexandra; Gidia, Nadia; Ibrahim, Sherrine; Haas, David
    Introduction: Antenatal corticosteroids (ACS) are recommended for pregnant persons who are between 24 and 36+6/7 weeks’ gestational age (GA) and at risk for imminent delivery within 7 days. Many individuals diagnosed as having threatened preterm labor (tPTL) are given ACS but do not deliver until they reach term. This study aimed to describe characteristics of those seen for tPTL who receive ACS to better understand clinical decision-making. Methods: This retrospective cohort study consisted of mothers seen in triage at Eskenazi Hospital in 2021 for tPTL during pregnancy. Multiple demographic variables were evaluated against the primary outcome of ACS administration including maternal age, race/ethnicity, and prior preterm delivery, as well as obstetrical variables such as cervical dilation, effacement, membrane rupture, and tocolytic administration. Results: After exclusions, a cohort of 290 pregnant people with 372 unique encounters remained. The average maternal age was 26.7, and 15.6% of patients had a history of prior preterm birth. 107 patients in 111 encounters received ACS, which were associated with lower BMI, greater cervical dilation, greater effacement, membrane rupture, and more frequent contractions (all p<0.01). The mean GA at triage was 33.5 weeks. Logistic regression, adjusting for significant factors in the univariable analysis, found that BMI (OR 0.93, 0.89-0.97), cervical dilation (OR 1.34, 1.07-1.71), and cervical effacement (OR 1.02, 1.01-1.03) were significantly associated with giving ACS. 44% of those receiving ACS delivered within 7 days, compared to 11% of those who did not receive ACS (p<0.001). Conclusion: Greater cervical dilation and effacement and a lower BMI were associated with ACS administration, though most patients receiving ACS still did not deliver within 7 days. These findings will be further categorized and used to develop a clinical decisional model for administering ACS in those likely to imminently deliver preterm. Presentation recording available online: https://media.dlib.indiana.edu/media_objects/3b5922009
  • Thumbnail Image
    Item
    Urinary Iodine, Perchlorate, and Thiocyanate Concentrations in U.S. Lactating Women
    (Mary Ann Liebert, 2017-12) Lee, Sun Y.; McCarthy, Alicia M.; Stohl, Hindi; Ibrahim, Sherrine; Jeong, Christina; Braverman, Lewis E.; Ma, Wendy; He, Xuemei; Mestman, Jorge H.; Schuller, Kristin E.; Jahreis, Katherine A.; Pearce, Elizabeth N.; Leung, Angela M.; Obstetrics and Gynecology, School of Medicine
    Background: Iodine is an essential micronutrient for thyroid hormone production. Adequate iodine intake and normal thyroid function are important during early development, and breastfed infants rely on maternal iodine excreted in breast milk for their iodine nutrition. The proportion of women in the United States of childbearing age with urinary iodine concentration (UIC) <50 μg/L has been increasing, and a subset of lactating women may have inadequate iodine intake. UIC may also be influenced by environmental exposure to perchlorate and thiocyanate, competitive inhibitors of iodine transport into thyroid, and lactating mammary glands. Data regarding UIC in U.S. lactating women are limited. To adequately assess the iodine sufficiency of lactating women and potential associations with environmental perchlorate and thiocyanate exposure, we conducted a multicenter, cross-sectional study of urinary iodine, perchlorate, and thiocyanate concentrations in healthy U.S. lactating women. Methods: Lactating women ≥18 years of age were recruited from three U.S. geographic regions: California, Massachusetts, and Ohio/Illinois from November 2008 to June 2016. Demographic information and multivitamin supplements use were obtained. Iodine, perchlorate, and thiocyanate levels were measured from spot urine samples. Correlations between urinary iodine, perchlorate, and thiocyanate levels were determined using Spearman's rank correlation. Multivariable regression models were used to assess predictors of urinary iodine, perchlorate, and thiocyanate levels, and UIC <100 μg/L. Results: A total of 376 subjects (≥125 from each geographic region) were included in the final analyses [mean (SD) age 31.1 (5.6) years, 37% white, 31% black, and 11% Hispanic]. Seventy-seven percent used multivitamin supplements, 5% reported active cigarette smoking, and 45% were exclusively breastfeeding. Median urinary iodine, perchlorate, and thiocyanate concentrations were 143 μg/L, 3.1 μg/L, and 514 μg/L, respectively. One-third of women had UIC <100 μg/L. Spot urinary iodine, perchlorate, and thiocyanate levels all significantly positively correlated to each other. No significant predictors of UIC, UIC <100 μg/L, or urinary perchlorate levels were identified. Smoking, race/ethnicity, and marital status were significant predictors of urinary thiocyanate levels. Conclusion: Lactating women in three U.S. geographic regions are iodine sufficient with an overall median UIC of 143 μg/L. Given ubiquitous exposure to perchlorate and thiocyanate, adequate iodine nutrition should be emphasized, along with consideration to decrease these exposures in lactating women to protect developing infants.