Browsing by Author "Peaceman, Alan"

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    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.
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    The moderating role of the built environment in prenatal lifestyle interventions
    (Springer Nature, 2021) Phelan, Suzanne; Marquez, Fred; Redman, Leanne M.; Arteaga, Sonia; Clifton, Rebecca; Grice, Brian A.; Haire-Joshu, Debra; Martin, Corby K.; Myers, Candice A.; Pomeroy, Jeremy; Vincent, Eileen; Van Horn, Linda; Peaceman, Alan; Ashby-Thompson, Maxine; Gallagher, Dympna; Pi-Sunyer, Xavier; Boekhoudt, Trisha; Drews, Kimberly; Brown, Greg; LIFE-Moms consortium; Emergency Medicine, School of Medicine
    This study examined whether the neighborhood built environment moderated gestational weight gain (GWG) in LIFE-Moms clinical trials. Participants were 790 pregnant women (13.9 weeks’ gestation) with overweight or obesity randomized within four clinical centers to standard care or lifestyle intervention to reduce GWG. Geographic information system (GIS) was used to map the neighborhood built environment. The intervention relative to standard care significantly reduced GWG (coefficient = 0.05; p = 0.005) and this effect remained significant (p < 0.03) after adjusting for built environment variables. An interaction was observed for presence of fast food restaurants (coefficient=−0.007; p = 0.003). Post hoc tests based on a median split showed that the intervention relative to standard care reduced GWG in participants living in neighborhoods with lower fast food density 0.08 [95% CI, 0.03,0.12] kg/week (p = 0.001) but not in those living in areas with higher fast food density (0.02 [−0.04, 0.08] kg/week; p = 0.55). Interaction effects suggested less intervention efficacy among women living in neighborhoods with more grocery/convenience stores (coefficient = −0.005; p = 0.0001), more walkability (coefficient −0.012; p = 0.007) and less crime (coefficient = 0.001; p = 0.007), but post-hoc tests were not significant. No intervention x environment interaction effects were observed for total number of eating establishments or tree canopy. Lifestyle interventions during pregnancy were effective across diverse physical environments. Living in environments with easy access to fast food restaurants may limit efficacy of prenatal lifestyle interventions, but future research is needed to replicate these findings.