Association of Obesity, BMI, and Hispanic Ethnicity on Ambulatory Status in Children with Spinal Dysraphism followed near the California-Mexico Border.

PURPOSE: Evaluate the relationship between body mass index (BMI), overweight status (OW), or obesity (OB) and ambulatory status in a predominantly Hispanic population of children with spinal dysraphism (SD). METHODS: Retrospective data were extracted from records of 272 children and youth aged 0-24 years with a diagnosis of SD. Body mass index (BMI) and OW / OB rates were calculated for children 0-3 years, 4-11 years, and adolescents older than 11. RESULTS: Ethnicity was predominantly Hispanic (65.4%). No difference in mean BMI or OW / OB rate was found between ambulation groups (p = .20; p = .72). Mean BMI and OW / OB rate increased with increasing age in all groups (p < .001; p = .02). Forty-four percent of patients were OW / OB, which was greater among Hispanics (48.2%) compared with non-Hispanics [(35.2%), p = .03]. Female gender was a risk factor for increased BMI among Hispanics (p = .00). CONCLUSION: Despite no difference in ambulatory status, increasing BMI and OW / OB are associated with Hispanic ethnicity and increasing age.

Transition to adult care for patients with spina bifida.

More individuals with spina bifida are living into adulthood, and unique challenges arise as they age. These patients have multiple organ system involvement in addition to physical impairments, disabilities, cognitive involvement, and psychosocial challenges. There is a growing need for transitional care for adults with spina bifida. This article explores the 5 key elements for a transition program to adult care: preparation, flexible timing, care coordination, transitional clinic visits, and health care providers who are interested in taking care of adults with disabilities.

Pediatric limb differences and amputations.

Congenital limb differences are uncommon birth defects that may go undetected even with prenatal screening ultrasound scans and often go undetected until birth. For children with congenital limb differences, a diagnostic evaluation should be done to rule out syndromes involving other organ systems or known associations. The most common etiology of acquired amputation is trauma. Postamputation complications include pain and terminal bony overgrowth. A multidisciplinary approach to management with the child and family can lead to a successful, functional, and fulfilling life.

Pregnancy outcomes of women with physical disabilities: a matched cohort study.

OBJECTIVE: To document pregnancy outcomes of women with moderate-to-severe physical disabilities and to evaluate maternal and fetal outcomes compared with those of nondisabled 1:1 matched controls within the same hospital system. DESIGN: A retrospective matched cohort. SETTING: A multidisciplinary outpatient reproductive health care clinic for women with physical disabilities, situated in an urban rehabilitation hospital and affiliated with a large tertiary medical care center. POPULATION: Women with physical disabilities. METHODS: A chart review of 755 women with physical disabilities who were seen at a multidisciplinary specialty reproductive health care clinic, in which 48 total pregnancies of 34 women with physical disabilities were found. Thirty-four of these pregnancies were carried to delivery in 25 of these women with physical disabilities. MAIN OUTCOME MEASURES: Obstetric and disability-related pregnancy and delivery complications. RESULTS: Twenty-nine of the 34 pregnancies (85%) occurred in women with moderate-to-severe neurologic disabilities who were wheelchair users, with 33 resultant infants (1 twin pregnancy), and 2 instances of intrauterine fetal demise. Forty percent of the women delivered prematurely, although only 3 of 34 delivered before 32 weeks (9%). Thirty-four percent of the infants (12) were of low birthweight, all of whom were preterm. Although there was a higher rate of pregnancy-related complications (P = .003) in the disabled cohort, there were no maternal deaths, and few of the complications were severe or life threatening. Rates of urinary tract infections and other maternal infections were significantly higher in the disabled cohort and were correlated with both increased preterm delivery and lower birthweight infants (P = .009 and 0.023, respectively). Thirty-eight percent of the infants were delivered by cesarean section. The disabled cohort had lower rates of augmentation of labor (P = .03) and breastfeeding (P = .02) compared with nondisabled controls. Although bladder and functional status changes were noted during the pregnancies of women with physical disabilities, these women reverted to their prepregnancy functional status by 6 weeks postpartum. CONCLUSION: Our study describes a cohort of women who had moderate-to-severe physical disabilities who historically have been discouraged from pregnancy. Women with physical disabilities experienced higher rates of preterm deliveries, low birthweight infants, and pregnancy complications. The pregnancy complications in most cases were not severe and were readily managed. Although it was common to experience functional changes during pregnancy, these changes had largely resolved by 6 weeks postpartum. Larger observational studies are needed to better understand the etiology and prevention of preterm labor and low-birthweight infants in this population, and, in particular, the role of maternal infections.