Adverse pregnancy outcomes and risk of type 2 diabetes in postmenopausal women

Journal of the American Geriatrics Society

Background Elevated psychosocial stress has been linked with accelerated biological aging, including composite DNA methylation (DNAm) markers that predict aging‐related outcomes (“epigenetic age”). However, no study has examined whether stressful life events (SLEs) are associated with epigenetic age acceleration in postmenopausal women, an aging population characterized by increased stress burden and disease risk. Methods We leveraged the Women's Health Initiative, a large muti‐ancestry cohort of postmenopausal women with available psychosocial stress measures over the past year and epigenomic data. SLEs and social support were ascertained via self‐report questionnaires. Whole blood DNAm array (450 K) data were used to calculate five DNAm‐based predictors of chronological age, health span and life span, and telomere length (HorvathAge, HannumAge, PhenoAge, GrimAge …

Annals of Internal Medicine

Background Although calcium and vitamin D (CaD) supplementation may affect chronic disease in older women, evidence of long-term effects on health outcomes is limited. Objective To evaluate long-term health outcomes among postmenopausal women in the Women’s Health Initiative CaD trial. Design Post hoc analysis of long-term postintervention follow-up of the 7-year randomized intervention trial of CaD. (ClinicalTrials.gov: NCT00000611) Setting A multicenter (n = 40) trial across the United States. Participants 36 282 postmenopausal women with no history of breast or colorectal cancer. Intervention Random 1:1 assignment to 1000 mg of calcium carbonate (400 mg of elemental calcium) with 400 IU of vitamin D3 daily or placebo …

Arthritis Care & Research

Objective The objective was to determine whether baseline fatty acid intake and erythrocyte omega‐3 and omega‐6 polyunsaturated fatty acids (PUFAs) can predict risk of total hip arthroplasty (THA) and total knee arthroplasty (TKA) in older women. Methods This was a prospective analysis of 34,990 women in the Women's Health Initiative. Dietary fatty acids were estimated from food frequency questionnaires. Imputed erythrocyte PUFAs were available in a subcohort of 3,428 women. Arthroplasty (THA and TKA), used as a surrogate of severe osteoarthritis, was identified via linked Medicare data. Cox proportional hazards models were constructed to estimate risk of arthroplasty. Results Risk of THA was associated with higher intake of arachidonic acid, (multivariable hazard ratio [HR] quartile 4 [Q4] vs Q1: 1.16; 95% confidence interval [CI] 1.01–1.34; P = 0.03) and higher intake of eicosapentaenoic acid (EPA …

Food Chemistry

This study introduces a multidisciplinary approach to investigate bioactive food metabolites often overlooked due to their low concentrations. We integrated an in-house food metabolite library (n = 494), a human metabolite library (n = 891) from epidemiological studies, and metabolite pharmacological databases to screen for food metabolites with potential bioactivity. We identified six potential metabolites, including meglutol (3-hydroxy-3-methylglutarate), an understudied low-density lipoprotein (LDL)-lowering compound. We further focused on meglutol as a case study to showcase the range of characterizations achievable with this approach. Green pea tempe was identified to contain the highest meglutol concentration (21.8 ± 4.6 mg/100 g). Furthermore, we identified a significant cross-sectional association between plasma meglutol and lower LDL cholesterol in two Hispanic adult cohorts (n = 1,628) (β …

Journal of the American Geriatrics Society

Background Caregiving is commonly undertaken by older women. Research is mixed, however, about the impact of prolonged caregiving on their health, well‐being, and mortality risk. Using a prospective study design, we examined the association of caregiving with mortality in a cohort of older women. Methods Participants were 158,987 postmenopausal women aged 50–79 years at enrollment into the Women's Health Initiative (WHI) who provided information on current caregiving status and caregiving frequency at baseline (1993–1998) and follow‐up (2004–2005). Mortality was ascertained from baseline through March of 2019. Cox regression with caregiving status defined as a time‐varying exposure was used to estimate hazard ratios (HR) and 95% confidence intervals (CI) for mortality, adjusting for sociodemographic factors, smoking, and history of diabetes, hypertension, cardiovascular disease (CVD …

Digestive Diseases and Sciences

BackgroundIndividuals with inflammatory bowel disease (IBD) who lack traditional cardiovascular disease (CVD) risk factors, such as young females, are observed to experience adverse CVD outcomes. Whether women with IBD have increased CVD risk after the menopause transition is unclear.MethodsWe conducted a survival analysis of Women’s Health Initiative (WHI) participants and excluded those with missing IBD diagnosis, model covariate data, follow-up data, or a baseline history of the following CVD outcomes: coronary heart disease (CHD), ischemic stroke, venous thromboembolism (VTE), peripheral arterial disease (PAD). Risk of outcomes between IBD and non-IBD women was performed using Cox proportional hazard models, stratified by WHI trial and follow-up. Models were adjusted for age, socio-demographics, comorbidities (e.g., hypertension, diabetes, hypercholesterolemia, etc.), family history …

Science of The Total Environment

Although numerous evidences suggest that zinc may have a beneficial impact on preventing and treating diabetes, findings from the population studies are inconclusive. To address this gap, we conducted a nested case-control study, employing restricted cubic splines and a conditional logistic regression model to explore the association between serum zinc levels and the risk of diabetes. We also assessed potential effect modifications through stratified analyses and examined the mediating effects of metabolic indicators using a multiclass mediation effect model. We measured baseline serum zinc concentrations using Inductively Coupled Plasma Mass Spectrometry in a cohort of 2156 participants, including 1078 individuals with diabetes and 1078 matched controls. Our findings revealed a 51 % increased risk of diabetes when comparing the highest quartile (Q4) to the lowest quartile (Q1) of serum zinc levels …

Journal of the American College of Cardiology

BackgroundRacial disparities exist in all-cause mortality after breast cancer (BC). While Black BC survivors experience an elevated risk of BC mortality, the contribution of cardiovascular (CV) events and CV mortality relative to BC mortality is ill-defined.MethodsIn the Women's Health Initiative, we included women who were diagnosed with invasive BC during follow-up without a CV event prior to BC. CV events included adjudicated coronary heart disease, heart failure, or stroke. Cause of death was determined by medical chart review or ICD codes. Cumulative incidence rates were calculated for CV events, CV mortality, and BC mortality, accounting for competing risks, by race. Fine and Gray models were adjusted for age at BC diagnosis, stage, triple negative BC, BMI, and history of diabetes and hypertension.ResultsIn 7,647 BC survivors (mean age at BC= 71 years, median followup= 16.2 years), 8.1% self …

medRxiv

BACKGROUNDType 2 diabetes mellitus (T2D) confers a two-to three-fold increased risk of cardiovascular disease (CVD). However, the mechanisms underlying increased CVD risk among people with T2D are only partially understood. We hypothesized that a genetic association study among people with T2D at risk for developing incident cardiovascular complications could provide insights into molecular genetic aspects underlying CVD.METHODSFrom 16 studies of the Cohorts for Heart & Aging Research in Genomic Epidemiology (CHARGE) Consortium, we conducted a multi-ancestry time-to-event genome-wide association study (GWAS) for incident CVD among people with T2D using Cox proportional hazards models. Incident CVD was defined based on a composite of coronary artery disease (CAD), stroke, and cardiovascular death that occurred at least one year after the diagnosis of T2D. Cohort-level …

Journal of Alzheimer's Disease

Background: Multimorbidity is associated with increased rate of cognitive decline with age. It is unknown whether social engagement, which is associated with reduced risk of dementia, modifies associations between multimorbidity and cognitive decline.Objective: To examine the associations of multimorbidity with longitudinal cognitive test performance among communitydwelling older adults, and to determine whether associations differed by levels of social engagement. Methods: We used data from the Rancho Bernardo Study of Healthy Aging, a community-based prospective cohort study. Starting in 1992–1996, participants completed a battery of cognitive function tests at up to 6 study visits over 23.7 (mean= 7.2) years. Multimorbidity was defined as≥ 2 of 14 chronic diseases. Social engagement was assessed using items based on the Berkman-Syme Social Network Index. Multivariable linear mixed-effects …

JDDG: Journal der Deutschen Dermatologischen Gesellschaft

Background Few prospective studies exist with an evaluation of a dose‐response relationship between use of some photosensitizing antihypertensive medications and skin cancer. Patient and Methods We used prospective data from the Women's Health Initiative Observational Study to investigate the association between antihypertensive use and risk of non‐melanoma skin cancer (NMSC) and melanoma in postmenopausal women aged 50–79 years at baseline (n  =  64,918). Multivariable Cox proportional hazards regression models were used and hazard ratios (HRs) and 95 confidence intervals (CIs) were calculated. Results 8,777 NMSC and 1,227 melanoma cases were observed. Use of antihypertensives (HR [95% CI]: 1.12 [1.07–1.18]), ACE inhibitors (1.09 [1.01–1.18]), calcium channel blockers (1.13 [1.05–1.22]), diuretics (1.20 [1.12–1.27]), loop diuretics (1.17 [1.07–1.28]), and thiazides (1.17 [1.03–1 …

Osteoporosis International

Long-term physical functioning trajectories following distal forearm fracture are unknown. We found that women with versus those without distal forearm fracture were more likely to experience a 5-year decline in physical functioning, independent of initial physical functioning level. This association was most evident among women 80 years and older.IntroductionPhysical functioning trajectory following lower arm or wrist fracture is not well understood.PurposeThis study is to evaluate physical functioning trajectory before vs. after lower arm or wrist fracture, stratified by age.MethodsWe performed a nested case–control study of prospective data from the Women’s Health Initiative Study (n = 2097 cases with lower arm or wrist fracture, 20,970 controls). Self-reported fractures and the physical functioning subscale of the RAND 36-item Short-Form Health Survey were assessed annually. We examined three physical …

Med

BackgroundA healthy lifestyle is associated with a lower premature mortality risk and with longer life expectancy. However, the metabolic pathways of a healthy lifestyle and how they relate to mortality and longevity are unclear. We aimed to identify and replicate a healthy lifestyle metabolomic signature and examine how it is related to total and cause-specific mortality risk and longevity.MethodsIn four large cohorts with 13,056 individuals and 28-year follow-up, we assessed five healthy lifestyle factors, used liquid chromatography mass spectrometry to profile plasma metabolites, and ascertained deaths with death certificates. The unique healthy lifestyle metabolomic signature was identified using an elastic regression. Multivariable Cox regressions were used to assess associations of the signature with mortality and longevity.FindingsThe identified healthy lifestyle metabolomic signature was reflective of lipid …

International Journal of Cancer

Hysterectomy is associated with an increased risk for adverse health outcomes. However, its connection to the risk of non‐Hodgkin's lymphoma (NHL) remains unclear. The aims of our study were to investigate the associations between hysterectomy, oophorectomy and risk of NHL and its major subtypes (eg, diffuse large B‐cell lymphoma [DLBCL]), and whether these associations were modified by exogenous hormone use. Postmenopausal women (n = 141,621) aged 50–79 years at enrollment (1993–1998) from the Women's Health Initiative were followed for an average of 17.2 years. Hysterectomy and oophorectomy were self‐reported at baseline. Incident NHL cases were confirmed by central review of medical records and pathology reports. During the follow‐up period, a total of 1719 women were diagnosed with NHL. Hysterectomy, regardless of oophorectomy status, was associated with an increased …

Journal of the American College of Cardiology

BackgroundBreast cancer (BC) survivors are vulnerable to both poor health-related quality of life (HRQoL) and cardiovascular disease (CVD). We sought to examine whether incident CVD after BC is an independent predictor of HRQoL.MethodsIn the Women's Health Initiative, we included women who were diagnosed with invasive BC during follow-up and were free of prevalent CVD prior to BC. CVD was defined as adjudicated coronary heart disease or stroke. Physical and mental HRQoL, measured by the SF-36 Physical and Mental Component Scores (PCS and MCS, respectively) were recorded post-BC. Poor PCS and MCS were defined as scores< 40. We used time-dependent Cox proportional hazards models, accounting for time to CVD, adjusted for confounders measured most proximal but prior to BC.ResultsIn 2,546 BC survivors (mean age at BC= 67), 955 and 266 women had a post-BC PCS and MCS …

The American Journal of Medicine

ObjectiveThe purpose of this study was to determine whether sleep characteristics are associated with incidence of treated diabetes in postmenopausal individuals.MethodsPostmenopausal participants ages 50-79 years reported sleep duration, sleep-disordered breathing, or insomnia at baseline and again in a subsample 3 years later. The primary outcome was self-reported new diagnosis of diabetes treated with oral drugs or insulin at any time after baseline. Multivariable Cox proportional hazards models were used.ResultsIn 135,964 participants followed for 18.1 (± 6.3) years, there was a nonlinear association between sleep duration and risk of treated diabetes. Participants sleeping ≤5 hours at baseline had a 21% increased risk of diabetes compared with those sleeping 7 hours (adjusted hazard ratio [aHR] 1.21; 95% confidence interval [CI], 1.00-1.47). Those who slept for ≥9 hours had a nonsignificant 6 …

Alzheimer's & dementia

INTRODUCTION Alzheimer's disease (AD) and AD‐related dementias (ADRD) are leading causes of death among older adults in the United States. Efforts to understand risk factors for prevention are needed. METHODS Participants (n = 146,166) enrolled in the Women's Health Initiative without AD at baseline were included. Diabetes status was ascertained from self‐reported questionnaires and deaths attributed to AD/ADRD from hospital, autopsy, and death records. Competing risk regression models were used to estimate the cause‐specific hazard ratios (HRs) and 95% confidence intervals (CIs) for the prospective association of type 2 diabetes mellitus (T2DM) with AD/ADRD and non‐AD/ADRD mortality. RESULTS There were 29,393 treated T2DM cases and 8628 AD/ADRD deaths during 21.6 (14.0–23.5) median (IQR) years of follow‐up. Fully adjusted HRs (95% CIs) of the association with T2DM were 2 …

BACKGROUND The American Heart Association (AHA), in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, nutrition, sleep, and obesity) and health factors (cholesterol, blood pressure, glucose control, and metabolic syndrome) that contribute to cardiovascular health. The AHA Heart Disease and Stroke Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, brain health, complications of pregnancy, kidney disease, congenital heart disease, rhythm disorders, sudden cardiac arrest, subclinical atherosclerosis, coronary heart disease, cardiomyopathy, heart failure, valvular disease, venous thromboembolism, and peripheral artery disease) and the associated outcomes …

bioRxiv

Transposable elements (TEs) are DNA sequences that expand selfishly in the genome, possibly causing severe cellular damage. While normally silenced, TEs have been shown to activate during aging. DNA methylation is one of the main mechanisms by which TEs are silenced and has been used to train highly accurate age predictors. Yet, one common criticism of such predictors is that they lack interpretability. In this study, we investigate the changes in TE methylation that occur during human aging. We find that evolutionarily young LINE1s (L1s), the only known TEs capable of autonomous transposition in humans, undergo the fastest loss of methylation, suggesting an active mechanism of de-repression. We then show that accurate age predictors can be trained on both methylation of individual TE copies and average methylation of TE families genome wide. Lastly, we show that while old L1s gradually lose methylation during the entire lifespan, demethylation of young L1s only happens late in life and is associated with cancer.

Breast cancer research and treatment

PurposeAlthough infertility (ie, failure to conceive after≥ 12 months of trying) is strongly correlated with established breast cancer risk factors (eg, nulliparity, number of pregnancies, and age at first pregnancy), its association with breast cancer incidence is not fully understood. Previous studies were primarily small clinic-based or registry studies with short follow-up and predominantly focused on premenopausal breast cancer. The objective of this study was to assess the relationship between infertility and postmenopausal breast cancer risk among participants in the Women’s Health Initiative (analytic sample= 131,784;> 25 years of follow-up).MethodsAt study entry, participants were asked about their pregnancy history, infertility history, and diagnosed reasons for infertility. Incident breast cancers were self-reported with adjudication by trained physicians reviewing medical records. Cox proportional hazards models …

American Journal of Obstetrics and Gynecology

BackgroundThere are significant racial disparities in in vitro fertilization outcomes, which are poorly explained by individual-level characteristics. Environmental factors such as neighborhood-level socioeconomic factors may contribute to these disparities. However, few studies have directly addressed this research question in a large, racially diverse cohort.ObjectiveThis study aimed to investigate whether neighborhood deprivation is associated with differences in in vitro fertilization outcomes.Study DesignOur retrospective cohort study included 1110 patients who underwent 2254 autologous in vitro fertilization cycles between 2014 and 2019 at an academic fertility center in the Southeastern United States. Neighborhood deprivation was estimated using the Neighborhood Deprivation Index, a composite variable measuring community levels of material capital based on poverty, occupation, housing, and education …

American Journal of Obstetrics and Gynecology

ObjectiveAccurate individualized assessment of preeclampsia risk enables the identification of patients most likely to benefit from initiation of low-dose aspirin at 12-16 weeks’ gestation when there is evidence for its effectiveness, as well as guiding appropriate pregnancy care pathways and surveillance. The primary objective of this study was to evaluate the performance of artificial neural network models for the prediction of preterm preeclampsia (<37 weeks’ gestation) using patient characteristics available at the first antenatal visit and data from prenatal cell-free DNA (cfDNA) screening. Secondary outcomes were prediction of early onset preeclampsia (<34 weeks’ gestation) and term preeclampsia (≥37 weeks’ gestation).MethodsThis secondary analysis of a prospective, multicenter, observational prenatal cfDNA screening study (SMART) included singleton pregnancies with known pregnancy outcomes. Thirteen …

American Journal of Obstetrics and Gynecology

ObjectiveThis study aims to investigate whether CT-derived biomarkers, such as pre-sacral thickness and volume, are correlated with specific factors like body mass index (BMI), age, or certain medical conditions.MethodsWe examined CT images from 143 female patients with suspected or clinically diagnosed pelvic floor dysfunction. Presacral thickness (PT) was measured on axial CT images at the sacral promontory level by drawing a transverse line tangent to the anterior borders of the external or common iliac arteries, followed by measuring a perpendicular line drawn to the anterior sacral promontory at L5-S1. The presacral volume (PV) was manually measured using advanced volumetric visualization software (Vitrea, Canon Medical Systems, USA) from the sacral promontory to S3. From the medical record we extracted demographic information including age, race, and BMI and pertinent medical history (lipid …

American Journal of Obstetrics and Gynecology

BackgroundThe US Food and Drug Administration supports innovations to facilitate new indications for high-risk human papillomavirus testing. This report describes the retrospective testing of stored specimens and analysis of existing data to efficiently and cost-effectively support a new indication for the Onclarity human papillomavirus assay (Becton, Dickinson and Company, BD Life Sciences - Integrated Diagnostic Solutions, Sparks, MD). The performance of this index test was compared with that of a predicate test, the cobas human papillomavirus assay (Roche Diagnostics, Indianapolis, IN). Both human papillomavirus assays are based on real-time polymerase chain reaction platforms that detect the presence of 14 high-risk human papillomavirus genotypes. The predicate assay reports human papillomavirus types 16 and 18 as individual results and the other 12 human papillomavirus genotypes as 1 pooled …

American Journal of Obstetrics and Gynecology

BackgroundCytomegalovirus is responsible for the most common congenital infection, affecting 0.5% to 1.0% of live births in Europe. Congenital cytomegalovirus infection can be diagnosed during pregnancy by viral DNA amplification in the amniotic fluid, but the prognosis of fetuses without severe brain abnormalities remains difficult to establish on the basis of prenatal imaging alone.ObjectiveTo identify predictors of moderate to severe symptomatic cytomegalovirus infection among fetal blood parameters and to propose an algorithm on the basis of these parameters and on prenatal imaging that would provide the best positive and negative predictive values.Study DesignFetal blood sampling at 21–28 weeks gestation was performed in fetuses with congenital cytomegalovirus infection confirmed by amniocentesis after maternal infection in the first-trimester or periconceptional period. We compared the levels of …

American Journal of Obstetrics and Gynecology

BackgroundZika virus congenital infection evades double-stranded RNA detection and may persist in the placenta for the duration of pregnancy without accompanying overt histopathologic inflammation. Understanding how viruses can persist and replicate in the placenta without causing overt cellular or tissue damage is fundamental to deciphering mechanisms of maternal-fetal vertical transmission.ObjectivePlacenta-specific microRNAs are believed to be a tenet of viral resistance at the maternal-fetal interface. We aimed to test the hypothesis that the Zika virus functionally disrupts placental microRNAs, enabling viral persistence and fetal pathogenesis.Study DesignTo test this hypothesis, we used orthogonal approaches in human and murine experimental models. In primary human trophoblast cultures (n=5 donor placentae), we performed Argonaute high-throughput sequencing ultraviolet-crosslinking and …

American journal of obstetrics and gynecology

Sexual orientation disparities in adverse pregnancy outcomes Sexual orientation disparities in adverse pregnancy outcomes Am J Obstet Gynecol. 2024 Mar 6:S0002-9378(24)00429-0. doi: 10.1016/j.ajog.2024.02.315. Online ahead of print. Authors Payal Chakraborty 1 , Ellis Schroeder 2 , Colleen A Reynolds 3 , Sarah McKetta 3 , Juno Obedin-Maliver 4 , S Bryn Austin 5 , Bethany Everett 6 , Sebastien Haneuse 7 , Brittany M Charlton 8 Affiliations 1 Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, MA, 401 Park Dr, Suite 401 E, Boston, MA 02215; Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, MA. Electronic address: pchakraborty@hsph.harvard.edu. 2 Druid Hills High School, Atlanta, GA. 3 Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, MA; Department of …

American Journal of Obstetrics and Gynecology

BackgroundThere are limited data to guide the diagnosis and management of vasa previa. Currently, what is known is largely based on case reports or series and cohort studies.ObjectiveThis study aimed to systematically collect and classify expert opinions and achieve consensus on the diagnosis and clinical management of vasa previa using focus group discussions and a Delphi technique.Study DesignA 4-round focus group discussion and a 3-round Delphi survey of an international panel of experts on vasa previa were conducted. Experts were selected on the basis of their publication record on vasa previa. First, we convened a focus group discussion panel of 20 experts and agreed on which issues were unresolved in the diagnosis and management of vasa previa. A 3-round anonymous electronic survey was then sent to the full expert panel. Survey questions were presented on the diagnosis and …

American Journal of Obstetrics and Gynecology

BackgroundPlant-based diets have been associated with a lower risk of cardiovascular disease in nonpregnant adults, but specific evidence for their effects on risk of hypertensive disorders of pregnancy is scarce.ObjectiveThis study aimed to evaluate the prospective association between adherence to plant-based diets before pregnancy and the risk for hypertensive disorders of pregnancy. We hypothesized that women with higher adherence to plant-based diets would have a lower risk for hypertensive disorders of pregnancy.Study DesignWe followed 11,459 parous women (16,780 singleton pregnancies) without chronic diseases, a history of preeclampsia, and cancers who participated in the Nurses’ Health Study II (1991–2009), which was a prospective cohort study. Diet was assessed every 4 years using a validated food frequency questionnaire from which we calculated the plant-based diet index (higher …

American journal of obstetrics and gynecology

Prospective first-trimester transvaginal 3-dimensional power Doppler and hysterectomy association in placenta accreta spectrum Prospective first-trimester transvaginal 3-dimensional power Doppler and hysterectomy association in placenta accreta spectrum Am J Obstet Gynecol. 2024 Mar 2:S0002-9378(24)00423-X. doi: 10.1016/j.ajog.2024.02.310. Online ahead of print. Authors Christina L Herrera 1 , Quyen N Do 2 , Yin Xi 2 , Catherine Y Spong 3 , Diane M Twickler 4 Affiliations 1 Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75390-9032; Parkland Health, Dallas, TX. Electronic address: christina.herrera@utsouthwestern.edu. 2 Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX. 3 Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, …

American Journal of Obstetrics and Gynecology

BackgroundIn the LIBERTY Long-Term Extension study, once-daily relugolix combination therapy (40 mg relugolix, estradiol 1 mg, norethindrone acetate 0.5 mg) substantially improved uterine fibroid-associated heavy menstrual bleeding throughout the 52-week treatment period in the overall study population.ObjectiveBlack or African American women typically experience a greater extent of disease and symptom burden of uterine fibroids vs other racial groups and have traditionally been underrepresented in clinical trials. This secondary analysis aimed to assess the efficacy and safety of relugolix combination therapy in the subgroup population of Black or African American women with uterine fibroids in the LIBERTY Long-Term Extension study.Study DesignBlack or African American premenopausal women (aged 18–50 years) with uterine fibroids and heavy menstrual bleeding who completed the 24-week …

American Journal of Obstetrics and Gynecology

BackgroundIn July 2017, the State of Victoria’s largest maternity service implemented a new clinical guideline to reduce the rates of stillbirth at term for South Asian women.ObjectiveThis study aimed to evaluate the impact of offering fetal surveillance from 39 weeks to South Asian-born women on rates of stillbirth and neonatal and obstetrical interventions.Study DesignThis was a cohort study of all women receiving antenatal care at 3 large metropolitan university-affiliated teaching hospitals in Victoria, who gave birth in the term period between January 2016 and December 2020. Differences in rates of stillbirth, neonatal deaths, perinatal morbidities, and interventions after July 2017 were determined. Multigroup interrupted time-series analysis was used to assess changes in rates of stillbirth and induction of labor.ResultsA total of 3506 South Asian-born women gave birth before, and 8532 after the change in practice …

American journal of obstetrics and gynecology

Prospective first-trimester transvaginal 3-dimensional power Doppler and hysterectomy association in placenta accreta spectrum Prospective first-trimester transvaginal 3-dimensional power Doppler and hysterectomy association in placenta accreta spectrum Am J Obstet Gynecol. 2024 Mar 2:S0002-9378(24)00423-X. doi: 10.1016/j.ajog.2024.02.310. Online ahead of print. Authors Christina L Herrera 1 , Quyen N Do 2 , Yin Xi 2 , Catherine Y Spong 3 , Diane M Twickler 4 Affiliations 1 Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75390-9032; Parkland Health, Dallas, TX. Electronic address: christina.herrera@utsouthwestern.edu. 2 Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX. 3 Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, …

American journal of obstetrics and gynecology

Corrigendum to Research biopsies in patients with gynecologic cancers: patient-reported outcomes, perceptions, and preferences: Am J Obstet Gynecol 225 (2021) 658.e1-658.e9/Article 658 Corrigendum to Research biopsies in patients with gynecologic cancers: patient-reported outcomes, perceptions, and preferences: Am J Obstet Gynecol 225 (2021) 658.e1-658.e9/Article 658 Am J Obstet Gynecol. 2024 Apr 27:S0002-9378(24)00475-7. doi: 10.1016/j.ajog.2024.03.039. Online ahead of print. Authors Ainhoa Madariaga 1 , Gita Bhat 2 , Michelle K Wilson 2 , Xuan Li 3 , Sunu Cyriac 2 , Valerie Bowering 4 , Wendy Hunt 4 , David Gutierrez 4 , Luisa Bonilla 2 , Lawrence Kasherman 2 , Michelle McMullen 2 , Lisa Wang 5 , Sangeet Ghai 6 , Neesha C Dhani 2 , Amit M Oza 2 , Stephanie Lheureux 7 Affiliations 1 Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, …

American Journal of Obstetrics and Gynecology

BackgroundUrinary microbiome (urobiome) studies have previously reported on specific taxa and community differences in women with mixed urinary incontinence compared with controls. Therefore, a hypothesis was made that higher urinary and vaginal microbiome diversity would be associated with increased urinary incontinence severity.ObjectiveThis study aimed to test whether specific urinary or vaginal microbiome community types are associated with urinary incontinence severity in a population of women with mixed urinary incontinence.Study DesignThis planned secondary, cross-sectional analysis evaluated associations between the urinary and vaginal microbiomes and urinary incontinence severity in a subset of Effects of Surgical Treatment Enhanced With Exercise for Mixed Urinary Incontinence trial participants with urinary incontinence. Incontinence severity was measured using bladder diaries and …

American journal of obstetrics and gynecology

BackgroundClerkship grades in obstetrics and gynecology play an increasingly important role in the competitive application process to residency programs. An analysis of clerkship grading practices has not been queried in the past 2 decades in our specialty.ObjectiveThis study aimed to investigate obstetrics and gynecology clerkship directors’ practices and perspectives in grading.Study DesignA 12-item electronic survey was developed and distributed to clerkship directors with active memberships in the Association of Professors of Gynecology and Obstetrics.ResultsA total of 174 of 236 clerkship directors responded to the survey (a response rate of 73.7%). Respondents reported various grading systems with the fewest (20/173 [11.6%]) using a 2-tiered or pass or fail system and the most (72/173 [41.6%]) using a 4-tiered system. Nearly one-third of clerkship directors (57/163 [35.0%]) used a National Board of …

American Journal of Obstetrics and Gynecology

Respiratory syncytial virus is a leading cause of lower respiratory tract illness globally in children aged <5 years. Each year, approximately 58,000 hospitalizations in the United States are attributed to respiratory syncytial virus. Infants aged ≤6 months experience the most severe morbidity and mortality. Until recently, prevention with the monoclonal antibody, palivizumab, was only offered to infants with high-risk conditions, and treatment primarily consisted of supportive care. Currently, 2 products are approved for the prevention of respiratory syncytial virus in infants. These include the Pfizer bivalent recombinant respiratory syncytial virus prefusion F protein subunit vaccine, administered seasonally to the pregnant person between 32 0/7 and 36 6/7 weeks of gestation, and the monoclonal antibody, nirsevimab, administered to infants aged up to 8 months entering their first respiratory syncytial virus season. With few …

American Journal of Obstetrics and Gynecology

BackgroundGestational diabetes (GDM) is associated with an increased risk of hypertensive disorders of pregnancy (HDP), but there are limited data on fetal growth and neonatal outcomes when both conditions are present.ObjectivesWe evaluated the risk of abnormal fetal growth and neonatal morbidity in pregnancies with co-occurrence of GDM and HDP.Study DesignIn a retrospective study of 47,093 singleton pregnancies, we compared the incidence of appropriate for gestational age birthweight (AGA) in pregnancies affected by GDM alone, HDP alone, or both GDM and HDP (GDM/HDP) to that in pregnancies affected by neither disorder using generalized estimating equations (covariates: maternal age, nulliparity, BMI, insurance type, race, marital status and prenatal care site). Secondary outcomes were large for gestational age birthweight (LGA), small for gestational age birthweight (SGA), and a neonatal …

American journal of obstetrics and gynecology

BackgroundIdentifying risk factors for Alzheimer disease in women is important as women compose two-thirds of individuals with Alzheimer disease. Previous work links vasomotor symptoms, the cardinal menopausal symptom, with poor memory performance and alterations in brain structure, function, and connectivity. These associations are evident when vasomotor symptoms are monitored objectively with ambulatory skin conductance monitors.ObjectiveThis study aimed to determine whether vasomotor symptoms are associated with Alzheimer disease biomarkers.Study DesignBetween 2017 and 2020, the MsBrain study enrolled 274 community-dwelling women aged 45 to 67 years who had a uterus and at least 1 ovary and were late perimenopausal or postmenopausal status. The key exclusion criteria included neurologic disorder, surgical menopause, and recent use of hormonal or nonhormonal vasomotor …

American Journal of Obstetrics and Gynecology

BackgroundContemporary guidance for preoperative feeding allows solids up to 6 hours and clear fluids up to 2 hours before anesthesia. Clinical trial evidence to support this approach for cesarean delivery is lacking. Many medical practitioners continue to follow conservative policies of no intake from midnight to the time of surgery, especially in pregnant women.ObjectiveThis study aimed to evaluate the pragmatic approach of permitting free access to water up to the call to dispatch to the operating theater vs fasting from midnight in preoperative oral intake restriction for planned cesarean delivery under spinal anesthesia on perioperative vomiting and maternal satisfaction.Study DesignA randomized controlled trial was conducted in the obstetrical unit of the University of Malaya Medical Centre from October 2020 to May 2022. A total of 504 participants scheduled for planned cesarean delivery were randomized …