Intrapartum Management in Maternal Brugada Syndrome.

Brugada syndrome is a genetic cardiac disease associated with increased risk of ventricular tachyarrhythmia and sudden cardiac arrest. Labor and delivery in this population poses management challenges of labor induction, analgesia, postpartum hemorrhage, and arrhythmic events. This case report describes a multidisciplinary approach to intrapartum management in maternal Brugada syndrome.

Does a video module improve patient adherence to recommended gestational weight gain guidelines?

OBJECTIVES: We aim to assess if implementation of an educational video module can improve patient adherence to recommended weight gain guidelines. Secondarily, we investigated if patients' knowledge about gestational weight gain was improved with use of the video, as well as if there was a difference in maternal and neonatal outcomes, and patient satisfaction. METHODS: This was an IRB-approved, prospective cohort study conducted from February 2019 to October 2019. Patients were recruited from a large academic practice during their first trimester of pregnancy. Patients in the control cohort received routine care. Patients in the video cohort watched a 5-min educational video module about gestational weight gain. Pre-pregnancy weight and baseline demographics were recorded. All patients took a baseline questionnaire assessing gestational weight gain knowledge upon enrollment, and again 4 weeks later. Pre and post score differences were calculated. On admission to the hospital for delivery, all patients' gestational weight gain was calculated, and the overall gestational weight gain differences between the two groups were calculated. Maternal and neonatal delivery outcomes were also collected. T-tests, Mann-Whitney U tests, and Chi-square analyses were used to compare groups, and a p-value of <.05 was deemed statistically significant. RESULTS: During the study period, 155 patients were recruited, with 79 in control cohort and 76 in video cohort, respectively. There was no significant difference in the percentage of patients who gained the appropriate amount of weight between the two groups; 25% (18/74) of patients in the control vs. 25% (17/68) of patients in video cohort (p = .926). There was no difference in the improvement of the pre and post assessment scores when compared between the two cohorts; the average score improvement was 1.72 ± 15.09% for the control, vs. 6.20 ± 12.51% for video cohort (p = .129). There was no difference in maternal or neonatal outcomes between the two groups. Patients were overall satisfied with the video module, with 67.6% (n = 45) reporting the video to be very educational. CONCLUSIONS: Use of a video module did not improve GWG outcomes or knowledge in our study. Future work can focus on use of a recurring intervention throughout pregnancy, either with app-based technology or multiple videos.

Periconceptional diet quality is associated with gestational diabetes risk and glucose concentrations among nulliparous gravidas.

Background: Gestational diabetes mellitus (GDM) and elevated glucose concentrations below the threshold for GDM diagnosis have been associated with adverse pregnancy and offspring outcomes. Dietary interventions initiated during pregnancy have demonstrated inconsistent beneficial effects. Limited data exist regarding the effects of periconceptional diet on gestational glycemia. Objective: To evaluate independent associations between periconceptional diet quality with GDM frequency and glucose concentrations from GDM screening and diagnostic tests among nulliparous gravidas. Design: This is a secondary analysis of N=7997 participants from the NuMoM2b multicenter, prospective, observational cohort study of first pregnancies. The Alternative Healthy Eating Index (AHEI)-2010 was computed from food frequency questionnaires completed in early pregnancy (6-13 weeks), reporting usual dietary intake over the preceding 3 months. GDM screening was performed either by non-fasting 1-hour 50g glucose load (N=6845), followed by 3-hour 100g glucose tolerance test (GTT) for those with raised glucose concentrations (N=1116; at risk for GDM), or by a single 2-hour 75g GTT (N=569; all GDM risk levels). Logistic and linear regression were used to estimate the associations between the AHEI-2010 score with odds of GDM, having raised blood glucose on the 1-hour screening test, and continuous glucose concentrations on screening and diagnostic tests. All models were adjusted for a priori covariates: maternal age, race/ethnicity, early-pregnancy body mass index, smoking habits, rate of gestational weight gain, energy intake, nausea and vomiting in early pregnancy, study site. Results: Poorer periconceptional diet quality was observed among participants who were younger, with higher BMI, lower income levels, and of non-Hispanic Black or Hispanic ethnicity. The GDM rate was 4%. Each 1-point increase in AHEI-2010 score was associated with a 1% decrease in the odds of being diagnosed with GDM (beta=-0.015, p=0.022, OR=0.986, 95% CI 0.973 to 0.998). Diet quality was inversely associated with each post glucose load concentration on the non-fasting screening test and the 2-hour and 3-hour GTT. Conclusion: Poor periconceptional diet quality is independently associated with an increased risk of GDM and with minor elevations in serum glucose concentrations on GDM screening and diagnostic tests, in a diverse cohort of nulliparas. Periconception intervention studies targeting diet quality are warranted.

Psychological measures of patient's decision-making for prenatal genetic testing.

OBJECTIVE: To use a questionnaire to determine the levels of maternal decision-related distress, clarity of the pros and cons, and certainty when considering prenatal genetic diagnostic testing; and to assess the relationship between these constructs and patient characteristics. METHOD: Cross-sectional study. Voluntary, anonymous questionnaires distributed 2017-2019 to women referred for invasive prenatal genetic testing. Excluded: English or Spanish illiterate. Maternal characteristics were collected. Questions evaluated distress, decisional certainty, and decisional clarity on a 5-point Likert scale (range: 0 = low/uncertain/unclear to 4 = high/certain/clear). Analysis: non-parametric Kruskal-Wallis, correlation statistics, and ANOVA. RESULTS: Forty-four female patients completed it. Most were married, white, Catholic, and multiparous. 58% had already made a testing decision. Patients expressed low distress levels (mean 1.18 ± 0.80) and expressed high decisional certainty (mean 3.28 ± 0.76) and clarity (mean 3.30 ± 0.99). Decisional certainty and clarity were positively correlated (r = 0.47, p < .01), whereas distress was negatively correlated with decisional certainty (r = -0.8136, p < .0005) and decisional clarity (r = -0.49, p = .007). No significant differences by religion or parity. Greater distress (p < .05) and less decisional clarity (p = .07) occurred between those still debating testing vs those who had decided. CONCLUSIONS: Higher maternal distress scores were associated with lower decisional certainty and decisional clarity in women considering prenatal genetic testing.