Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 14 de 14
Filtrar
Mais filtros










Base de dados
Intervalo de ano de publicação
1.
Am J Perinatol ; 2019 Nov 18.
Artigo em Inglês | MEDLINE | ID: mdl-31739367

RESUMO

OBJECTIVE: To determine the association between low fetal fraction and birth weight among women with a negative cell-free DNA (cfDNA) result for common aneuploidies in the first trimester. STUDY DESIGN: This is a retrospective cohort of women who delivered a singleton between July 2016 and June 2018 at a single institution and had normal cfDNA testing in the first trimester. The primary variable of interest was "low fetal fraction," which was defined as fetal fractions less than 5th percentile among all fetal fractions in the cohort (fetal fraction < 5.34%). The primary outcomes were birth weight ≤ 5th and ≤ 10th percentiles. Multivariable logistic regressions assessed for the association between low fetal fraction and birth weight. RESULTS: A total of 7,478 women delivered a singleton at ≥24 weeks' gestation, of which 2,387 (32%) underwent genetic screening through cfDNA; the majority were in the first trimester (n = 2,052 [86%]). 2,035 met the inclusion criteria. Birth weight ≤ 5th percentile was significantly higher in the low fetal fraction group (6.9 vs. 3.2%; p = 0.04). A low fetal fraction was associated with higher odds of an infant with a low birth weight: adjusted odds ratio (aOR) of 2.32 (95% CI 1.15-4.67) for birth weight ≤ 10th percentile (p = 0.02) and aOR of 3.73 (95% CI 1.40-9.03) for birth weight ≤ 5th percentile (p = 0.004). CONCLUSION: Low fetal fractions of ≤ 5th percentile were associated with an increased risk of birth weights ≤ 5th and ≤ 10th percentiles in women with negative cfDNA screening in the first trimester. Future work is needed to further investigate this relationship and to determine the potential clinical implications, such as third-trimester screening for growth restriction in women with low fetal fractions and negative cfDNA screening results.

2.
Am J Perinatol ; 2019 Jul 31.
Artigo em Inglês | MEDLINE | ID: mdl-31365936

RESUMO

OBJECTIVE: To test the hypothesis that high fetal fraction (FF) on first trimester cell-free deoxyribonucleic acid (cfDNA) aneuploidy screening is associated with adverse perinatal outcomes. STUDY DESIGN: This is a single-institution retrospective cohort study of women who underwent cfDNA screening at <14 weeks' gestation and delivered a singleton infant between July 2016 and June 2018. Women with abnormal results were excluded. Women with high FF (≥95th percentile) were compared with women with normal FF (5th-95th percentiles). Outcomes investigated were preterm birth, small for gestational age, and hypertensive disorders of pregnancy. RESULTS: A total of 2,033 women met inclusion criteria. The mean FF was 10.0%, and FF >16.5% was considered high (n = 102). Women with high FF had a greater chance of delivering a small for gestational age infant

4.
Am J Med Qual ; : 1062860619857028, 2019 Jun 21.
Artigo em Inglês | MEDLINE | ID: mdl-31226883

RESUMO

A variety of hospital characteristics, including teaching status, ownership, location, and size, have been shown to be associated with quality measure performance. The association of hospital characteristics, including teaching intensity, with performance on the Centers for Medicare & Medicaid Services (CMS) SEP-1 sepsis measure has not been well studied. Utilizing a statewide, all-payer database and the CMS Hospital Compare database, this study investigated the association of various hospital characteristics with early SEP-1 performance in 48 acute hospitals in Massachusetts. Hospital teaching intensity and Magnet designation did not have a statistically significant association with SEP-1 performance in multivariable linear modeling. However, SEP-1 performance was higher in smaller, for-profit hospitals with higher case mix index. This finding suggests that emergency department activity, hospital ownership, and patient complexity should be studied further across a larger geographic spectrum and longitudinally as hospitals implement efforts to reduce morbidity associated with sepsis.

5.
Cell ; 178(1): 202-215.e14, 2019 Jun 27.
Artigo em Inglês | MEDLINE | ID: mdl-31204102

RESUMO

Despite the worldwide success of vaccination, newborns remain vulnerable to infections. While neonatal vaccination has been hampered by maternal antibody-mediated dampening of immune responses, enhanced regulatory and tolerogenic mechanisms, and immune system immaturity, maternal pre-natal immunization aims to boost neonatal immunity via antibody transfer to the fetus. However, emerging data suggest that antibodies are not transferred equally across the placenta. To understand this, we used systems serology to define Fc features associated with antibody transfer. The Fc-profile of neonatal and maternal antibodies differed, skewed toward natural killer (NK) cell-activating antibodies. This selective transfer was linked to digalactosylated Fc-glycans that selectively bind FcRn and FCGR3A, resulting in transfer of antibodies able to efficiently leverage innate immune cells present at birth. Given emerging data that vaccination may direct antibody glycosylation, our study provides insights for the development of next-generation maternal vaccines designed to elicit antibodies that will most effectively aid neonates.

6.
Vaccine ; 36(45): 6711-6717, 2018 10 29.
Artigo em Inglês | MEDLINE | ID: mdl-30268731

RESUMO

INTRODUCTION: As Zika virus infection during pregnancy can cause a range of congenital anomalies, pregnant women may be a target population for vaccination in future outbreaks. Their inclusion in vaccine trials is critical to ensure safe and effective vaccines in pregnancy. Though many vaccine candidates are in development, pregnant women's willingness to participate in Zika virus vaccine research is unknown. This study aims to describe pregnant women's attitudes toward Zika virus vaccine research participation, as well as perceived barriers to and facilitators of enrollment. METHODS: Pregnant and recently postpartum women (n = 128) attending prenatal care at Massachusetts General Hospital completed surveys querying their willingness to participate in four hypothetical Zika virus vaccine trials and their motivations for participation. Demographics, information on prior Zika virus exposure, and vaccine acceptance were collected. RESULTS: Most women (77%) accepted participation in at least one hypothetical Zika virus vaccine trial, and women were significantly more likely to accept prospective enrollment in an inactivated vaccine trial compared to a live-attenuated vaccine trial (p-value <0.0001) or a nucleic acid-based vaccine trial (p-value <0.0444). Important motivators for participation included evidence from research with pregnant and non-pregnant people, a desire to protect the baby from Zika, perceptions of vaccine safety, and provider recommendation. CONCLUSIONS: A majority of women in this cohort were willing to participate in a Zika virus vaccine trial while pregnant, however, differences in acceptance exist between vaccine platforms. The high value placed on evidence by participants highlights the importance of gathering and communicating pregnancy-specific data to potential research participants and their providers. Women's motivations for accepting research participation during pregnancy are important to inform the Zika virus vaccine research agenda, candidate prioritization, and trial design.


Assuntos
Período Pós-Parto/psicologia , Infecção por Zika virus/prevenção & controle , Zika virus/imunologia , Zika virus/patogenicidade , Adulto , Feminino , Humanos , Aceitação pelo Paciente de Cuidados de Saúde , Gravidez , Gestantes , Cuidado Pré-Natal/métodos , Inquéritos e Questionários , Vacinação/psicologia , Infecção por Zika virus/imunologia
7.
Reprod Sci ; 25(5): 788-796, 2018 05.
Artigo em Inglês | MEDLINE | ID: mdl-28884630

RESUMO

INTRODUCTION: While there is evidence for a relationship between cell-free fetal DNA (cffDNA) and parturition, questions remain regarding whether cffDNA could trigger a pro-inflammatory response on the pathway to parturition. We hypothesized that placental and/or fetal DNA stimulates toll-like receptor 9 (TLR9) leading to secretion of pro-inflammatory cytokines by macrophage cells. METHODS: Four in vitro DNA stimulation studies were performed using RAW 264.7 mouse peritoneal macrophage cells incubated in media containing the following DNA particles: an oligodeoxynucleotide (ODN2395), intact genomic DNA (from mouse placentas, fetuses and adult liver), mouse DNA complexed with DOTAP (a cationic liposome forming compound), and telomere-depleted mouse DNA. Interleukin 6 (IL6) secretion was measured in the media by enzyme-linked immunosorbent assay; and the cell pellet was homogenized for protein content (picograms IL6/mg protein). RESULTS: Robust IL6 secretion was observed in response to ODN2395 (a CpG-rich TLR9 agonist), mouse DNA-DOTAP complexes, and telomere-depleted mouse DNA in concentrations of 5 to 15 µg/mL. In contrast, ODN A151 (containing telomere sequence motifs), intact genomic mouse DNA, and restriction enzyme-digested DNA had no effect on IL6 secretion. The IL6 response was significantly inhibited by chloroquine (10 µg/mL), thereby confirming the important role for TLR9 in the response by macrophage cells. CONCLUSIONS: DNA derived from mouse placentas and fetuses, and depleted of telomeric sequences, stimulates a robust pro-inflammatory response by macrophage cells, thereby supporting the hypothesis that cffDNA is able to stimulate an innate immune response that could trigger the onset of parturition. These findings are of clinical importance, as we search for effective treatment/prevention of preterm parturition.


Assuntos
DNA/metabolismo , Inflamação/metabolismo , Parto , Placenta/metabolismo , Receptor Toll-Like 9/metabolismo , Animais , Feminino , Feto , Interleucina-6/metabolismo , Macrófagos/metabolismo , Camundongos , Gravidez , Células RAW 264.7 , Telômero/metabolismo
9.
Hum Pathol ; 67: 187-197, 2017 09.
Artigo em Inglês | MEDLINE | ID: mdl-28823573

RESUMO

There is considerable interest in using pathology to confirm acute abruptions. It has been suggested that pathologic findings can help to determine the timing of abruptions. Because of the dearth of evidence in the literature supporting this claim and its medicolegal implications, we undertook this study to explore further the possibility of timing abruptions by histopathology. We sought to correlate bleeding interval (duration from maternal presentation with vaginal bleeding [revealed abruption] to placental delivery) with placental histopathologic findings. We performed a retrospective review of clinical data and placental pathology from all cases of clinically diagnosed, acute, revealed abruptions at a single, large institution in New England between 2000 and 2015. Cases were identified based on clinical diagnoses, bleeding intervals were calculated from clinical notes, and histologic evaluations were performed by 2 pathologists blinded to the bleeding intervals. A total of 177 cases were analyzed. Of these, 103 (58%) had histologic findings corroborating the clinical diagnosis of abruption. The most frequent finding was maternal surface indentation (51 cases) followed by intravillous hemorrhage (50 cases). The former was also the earliest finding, with a minimum bleeding interval of 4 minutes. In multivariate modeling, plasma cell deciduitis was significantly associated with a longer bleeding interval (median 63 hours). If there were 2 pathologic findings, there was a trend toward a longer bleeding interval. There was modest sensitivity for the pathologic diagnosis of acute revealed abruption. Although there was not a clear, stepwise progression of histologic lesions; the presence of 2 or more findings tended to be seen with longer bleeding intervals. Our results suggest that histologic findings cannot be used to time acute revealed abruptions reliably, and any interpretation of such should be made with caution.


Assuntos
Descolamento Prematuro da Placenta/patologia , Placenta/patologia , Doença Aguda , Adolescente , Adulto , Biópsia , Boston , Corioamnionite/patologia , Progressão da Doença , Feminino , Hematoma/patologia , Humanos , Modelos Lineares , Pessoa de Meia-Idade , Análise Multivariada , Valor Preditivo dos Testes , Gravidez , Resultado da Gravidez , Reprodutibilidade dos Testes , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Hemorragia Uterina/patologia , Adulto Jovem
10.
Telemed J E Health ; 22(7): 564-71, 2016 07.
Artigo em Inglês | MEDLINE | ID: mdl-27172448

RESUMO

OBJECTIVE: To test the functionality and acceptability of a wireless vital sign monitor in an inpatient obstetric unit. MATERIALS AND METHODS: Pregnant women at a U.S. tertiary-care hospital wore a wireless vital sign sensor that captures heart rate, respiratory rate, and temperature. Measurements were compared with vital signs obtained by standard devices. We defined continuous capture of vital signs for 30 min with wireless data transfer to a central monitor as functional success. Acceptability was assessed per the pregnant women and nurses observing the device. Bland-Altman plots were constructed to assess agreement between the wireless sensor and standard measurements. RESULTS: Thirty of 32 enrolled pregnant women had successful monitoring; 2 cases were stopped early for non-study-related reasons. Comparing wireless sensor and standard measurements, the mean difference (limits of agreement) values at the 25th and 75th percentiles were 1.6 (±13.2) and 4.2 (±18.6) heartbeats/min, 4.2 (±6.1) and 0.7 (±5.4) respirations/min, and 0.02°C (±1.5) and 0.5°C (±1.8), respectively. Most pregnant women found the device comfortable, likeable, and useful (78%, 81%, and 97%, respectively); 80% of nurses found the monitor easy to use, and 84% would recommend it to a patient. CONCLUSIONS: We successfully obtained maternal vital signs using a simple wireless monitor with high acceptability. Well-validated monitors of this nature could significantly alleviate the human resource burden of monitoring during labor and confer greatly desired mobility to laboring pregnant women, although incorporation of blood pressure monitoring will be critical.


Assuntos
Satisfação do Paciente , Tecnologia de Sensoriamento Remoto/instrumentação , Sinais Vitais , Tecnologia sem Fio/instrumentação , Adolescente , Adulto , Estudos Transversais , Feminino , Humanos , Gravidez , Tecnologia de Sensoriamento Remoto/normas , Centros de Atenção Terciária , Estados Unidos , Tecnologia sem Fio/normas , Adulto Jovem
11.
Prenat Diagn ; 36(7): 656-61, 2016 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-27130707

RESUMO

OBJECTIVE: To study the offer and uptake of chromosomal microarray analysis (CMA) among women undergoing invasive prenatal testing. METHODS: This is a retrospective cohort study of women who underwent chorionic villus sampling (CVS) or amniocentesis. Charts were reviewed for CMA offer and uptake, in additional to clinical and demographic variables. RESULTS: One hundred forty-one women underwent CVS (n = 53) or amniocentesis (n = 91) over the study period. Overall, 41% of women underwent CMA. Women who underwent invasive testing for a fetal structural abnormality were more likely to undergo CMA than women who underwent invasive testing for all other indications (aOR 43.18, 95% CI 4.64 - 401.58). Chromosomal microarray was offered more often to women who primarily spoke English (p < 0.001), self-identified as white (p = 0.046) and did not receive prenatal care in a community health center (p = 0.044). Statistically significant differences in CMA uptake by race/ethnicity, language, insurance or provider type were not noted. Multiparous women were less likely to accept this test than nulliparas (aOR 0.39, 95% CI 0.17 - 0.86). CONCLUSION: Women who undergo invasive fetal testing are more likely to undergo CMA if the indication is for a fetal structural anomaly. There may be important demographic disparities in the offering of CMA which bear further exploration. © 2016 John Wiley & Sons, Ltd.


Assuntos
Amniocentese , Amostra da Vilosidade Coriônica , Transtornos Cromossômicos/diagnóstico , Análise em Microsséries/estatística & dados numéricos , Adulto , Estudos de Coortes , Centros Comunitários de Saúde , Grupos Étnicos , Grupo com Ancestrais do Continente Europeu , Feminino , Humanos , Linguagem , Modelos Logísticos , Idade Materna , Análise Multivariada , Padrões de Prática Médica , Gravidez , Diagnóstico Pré-Natal , Estudos Retrospectivos
12.
PLoS One ; 10(1): e0117043, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-25622043

RESUMO

We tested functionality and acceptability of a wireless fetal monitoring prototype technology in pregnant women in an inpatient labor unit in the United States. Women with full-term singleton pregnancies and no evidence of active labor were asked to wear the prototype technology for 30 minutes. We assessed functionality by evaluating the ability to successfully monitor the fetal heartbeat for 30 minutes, transmit this data to Cloud storage and view the data on a web portal. Three obstetricians also rated fetal cardiotocographs on ease of readability. We assessed acceptability by administering closed and open-ended questions on perceived utility and likeability to pregnant women and clinicians interacting with the prototype technology. Thirty-two women were enrolled, 28 of whom (87.5%) successfully completed 30 minutes of fetal monitoring including transmission of cardiotocographs to the web portal. Four sessions though completed, were not successfully uploaded to the Cloud storage. Six non-study clinicians interacted with the prototype technology. The primary technical problem observed was a delay in data transmission between the prototype and the web portal, which ranged from 2 to 209 minutes. Delays were ascribed to Wi-Fi connectivity problems. Recorded cardiotocographs received a mean score of 4.2/5 (± 1.0) on ease of readability with an interclass correlation of 0.81(95%CI 0.45, 0.96). Both pregnant women and clinicians found the prototype technology likable (81.3% and 66.7% respectively), useful (96.9% and 66.7% respectively), and would either use it again or recommend its use to another pregnant woman (77.4% and 66.7% respectively). In this pilot study we found that this wireless fetal monitoring prototype technology has potential for use in a United States inpatient setting but would benefit from some technology changes. We found it to be acceptable to both pregnant women and clinicians. Further research is needed to assess feasibility of using this technology in busy inpatient settings.


Assuntos
Cardiotocografia/instrumentação , Adolescente , Adulto , Estudos Transversais , Feminino , Frequência Cardíaca Fetal , Humanos , Satisfação do Paciente , Projetos Piloto , Gravidez , Tecnologia sem Fio , Adulto Jovem
13.
Am J Obstet Gynecol ; 211(3): 299.e1-5, 2014 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-24858200

RESUMO

OBJECTIVE: A recent increase in pertussis cases prompted the Advisory Committee on Immunization Practices to recommend administering the perinatal tetanus, diphtheria, and pertussis (Tdap) vaccine during each pregnancy. We sought to describe uptake of Tdap and identify predictors of vaccination in pregnancy. STUDY DESIGN: We conducted a retrospective study of all women delivering at a university hospital between February and June 2013. Demographic, pregnancy, and vaccination data were abstracted from the medical record. The relationship between maternal age, parity, gestational age, race/ethnicity, marital status, prenatal provider/site, insurance, influenza vaccination status, and Tdap vaccine was described by univariate analysis. Independent predictors were identified by multivariable logistic regression. RESULTS: In our cohort of 1467 women, 1194 (81.6%) received a Tdap vaccine. After adjusting for potential confounders, 3 factors were found to be independent predictors of receiving the vaccine. Patients were more likely to receive Tdap if they had been vaccinated against influenza during this pregnancy (adjusted odds ratio [aOR], 1.7; 95% confidence interval [CI], 1.4-2.3). Black women were less likely to receive Tdap when compared with other women (aOR, 0.42; 95% CI, 0.27-0.67). Also, women who delivered preterm were less likely to receive the Tdap vaccine (aOR, 0.33; 95% CI, 0.22-0.48). CONCLUSION: A high overall Tdap vaccination rate was observed following implementation of the Advisory Committee on Immunization Practices guidelines. Black women, however, had significantly lower vaccine uptake than other women. Further research is needed to understand and minimize this disparity. Women who delivered prematurely also had a decreased rate of Tdap vaccination; vaccinating earlier should be considered to better capture this population.


Assuntos
Vacinas contra Difteria, Tétano e Coqueluche Acelular/imunologia , Gravidez/imunologia , Vacinação/estatística & dados numéricos , Adulto , Grupo com Ancestrais do Continente Africano , Estudos de Coortes , Feminino , Humanos , Modelos Logísticos , Estudos Retrospectivos
14.
Am J Obstet Gynecol ; 204(6 Suppl 1): S112-5, 2011 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-21345408

RESUMO

The goals of this study were to define the uptake of H1N1 and seasonal influenza vaccination during pregnancy among women delivering during the 2009 H1N1 pandemic and explore barriers to vaccination. All postpartum women at the Massachusetts General Hospital from January 2010 through March 2010 were invited to complete an anonymous questionnaire about demographics, vaccination status, and attitudes about vaccination during pregnancy. Among 370 participants (53% response rate), 81% accepted both the H1N1 and seasonal influenza vaccines during pregnancy. Patients who declined one or both vaccines cited concerns over safety as a major deterrent. Of the 36% of participants who reported having flu-like symptoms during this pregnancy only 8.6% took oseltamivir. While a high vaccination rate was identified in this study, further education is needed to reassure patients regarding vaccine safety. Education for providers and patients emphasizing the benefits of early treatment of pregnant women with flu-like symptoms should be a priority.


Assuntos
Vírus da Influenza A Subtipo H1N1/imunologia , Vacinas contra Influenza/administração & dosagem , Influenza Humana/prevenção & controle , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Complicações Infecciosas na Gravidez/prevenção & controle , Gestantes/psicologia , Vacinação/estatística & dados numéricos , Antivirais/uso terapêutico , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Vacinas contra Influenza/efeitos adversos , Influenza Humana/tratamento farmacológico , Influenza Humana/epidemiologia , Massachusetts/epidemiologia , Oseltamivir/uso terapêutico , Pandemias , Gravidez , Complicações Infecciosas na Gravidez/tratamento farmacológico , Segurança , Estações do Ano , Recusa do Paciente ao Tratamento/estatística & dados numéricos
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA