ABSTRACT An efficient and efficacious method to screen for sleep disturbance in the clinical sett... more ABSTRACT An efficient and efficacious method to screen for sleep disturbance in the clinical setting has not been systemically designed for use among pregnant women. The current study used a large prospective database to derive a short-form sleep scale and examined its predictive value on pregnancy risks. Data were collected from 1,157 gravidae attending three outpatient clinics (2010-2012). Sleep patterns were assessed by the Berlin questionnaire, Epworth Sleepiness Scale, and questions on napping behavior. Confirmatory factor analysis was used to construct a short-form sleep scale, which would be predicted to perform with a higher degree of sensitivity and specificity among gravidae. Adjusted relative risks of pregnancy risks were estimated for the short-form scale, body mass index greater than 30 kg/m, hypertension, and screening positive on the Berlin questionnaire, and Epworth Sleepiness Scale using generalized linear models. Our derived short-form sleep scale consisted of four items on snoring frequently, bothersome snoring, stopped breathing while sleeping, and falling asleep while driving. Factor loadings ranged from 0.4 to 0.9 (P<.001) and demonstrated adequate model fit (root mean square error of approximation 0.04, confirmatory fit index 0.99, Tucker-Lewis Index 0.98). A higher score on the short-form sleep scale was associated with preeclampsia (adjusted relative risk 1.30, 95% confidence interval 1.10-1.59). A body mass index greater than 30 kg/m, hypertension, and screening positive on the Berlin questionnaire were associated with gestational diabetes, preeclampsia, small-for-gestational age neonate, large-for-gestational age neonate, or both. The Epworth Sleepiness Scale was not associated with outcomes. This four-item scale on sleep disturbance during pregnancy was associated with preeclampsia adjusting for confounders. This scale may be used by clinicians to quickly assess the effect of sleep disturbance on pregnancy outcomes.
Background Shift work has been associated with adverse pregnancy outcomes. The objective of this ... more Background Shift work has been associated with adverse pregnancy outcomes. The objective of this study was to evaluate the association between sleep disturbances and adverse pregnancy outcomes. Methods and findings This was a secondary analysis of a prospective study of participants enrolled in a prospective observational study wherein gravidae were screened for sleep apnea (2010–2012). A screening questionnaire with standard sleep apnea questionnaires as well as novel items about shift work and nocturnal sleep duration was administered at a prenatal care visit. Short sleep duration was defined as less than 7 hours. Prolonged sleep duration was defined as greater than 9 hours. In a cohort of 1125 pregnant people, 9.4% reported shift work at the time of screening. Gravidae who reported shift work were more likely than gravidae who reported no shift work to develop preeclampsia (28.3% versus 13.0%, P<0.001), preeclamspsia with severe features (16.0% versus 8.5%, P = 0.010), gestati...
Our objective is to define a standard protocol for post-partum salpingectomy and provide a prospe... more Our objective is to define a standard protocol for post-partum salpingectomy and provide a prospective assessment of safety and feasibility of such a procedure. Thus, a protocol for performing post-partum salpingectomy in limited-resource environments was created based on contemporary practices for tubal ligation. Gravidae presenting for post-partum tubal ligation following vaginal delivery or at time of cesarean were prospectively approached and, if consent was obtained, enrolled. Outcomes were compared to a historical cohort of gravidae who underwent standard post-partum tubal ligation following vaginal birth or at the time of cesarean as per institutional standard of care. The primary outcome was operative time. One hundred and fifty-seven subjects underwent post-partum salpingectomy following cesarean or vaginal delivery (on post-partum days 0–2). Post-partum salpingectomy performed after vaginal delivery (n = 97) resulted in slightly longer operative times (39.1 ± 11.8 vs. 34.3...
We assessed the prevalence of neonatal abstinence syndrome (NAS) and fetal growth outcomes in neo... more We assessed the prevalence of neonatal abstinence syndrome (NAS) and fetal growth outcomes in neonates exposed to methadone compared to buprenorphine in utero. Three authors assessed the titles and abstracts of all potentially eligible studies. The selection criteria were randomized controlled trials and observational cohort studies from January 2000 to January 2020 which indexed and reported original data for occurrence of NAS and fetal growth outcomes in pregnant people who received methadone vs. buprenorphine treatment. The quality and possible bias of each study was assessed using the Cochrane-risk-of-bias tool. Data were pooled to compare the occurrence of NAS and fetal growth restriction among women who received methadone vs. buprenorphine treatment. Of the 106 articles screened, 1 randomized controlled trial and 5 observational cohort studies including 2041 pregnancies fulfilled the inclusion criteria. Buprenorphine is associated with less NAS and improved growth outcomes com...
Infectious Diseases in Obstetrics and Gynecology, 2022
Objective. To examine the relationship between documented β-lactam allergy and cesarean delivery ... more Objective. To examine the relationship between documented β-lactam allergy and cesarean delivery (CD) surgical site infection (SSI). Study Design. We conducted a retrospective cohort analysis of women who underwent CD at Ben Taub Hospital and Texas Children’s Pavilion for Women (Houston, TX) from August 1, 2011, to December 31, 2019. The primary exposure was a documented β-lactam allergy, and the second exposure of interest was the type of perioperative antibiotic received. The primary outcome was the prevalence of SSI. Maternal characteristics were stratified by the presence or absence of a documented β-lactam allergy, and significance was evaluated using Pearson’s chi-squared test for categorical variables and t -test for continuous variables. A logistic regression model estimated odds of SSI after adjusting for possible confounders. Results. Of the 12,954 women included, 929 (7.2%) had a documented β-lactam allergy while 12,025 (92.8%) did not. Among the 929 women with a β-lactam...
Women with obstructive sleep apnea (OSA) are at increased risk of poor pregnancy outcomes such as... more Women with obstructive sleep apnea (OSA) are at increased risk of poor pregnancy outcomes such as fetal growth restriction, hypertensive disorders of pregnancy, and gestational diabetes mellitus. Given this increased risk, we aimed to study the screening prevalence of OSA in women seeking fertility treatment. We performed a cross sectional study of patients presenting to a university-affiliated fertility clinic between March-April 2021. Patients were asked to complete OSA screening (STOP-BANG), anxiety screening (GAD-7), and depression screening (PHQ-2) questionnaires. 107 women completed the surveys. Mean age was 35.1 years and mean body mass index (BMI) was 25.7 kg/m2. Nine (8.4%) women screened positive for OSA using the STOP-BANG screening tool. Women who screened positive for OSA were more likely to be older (37.8 years vs. 34.7 years, p = 0.02) and have a higher BMI (42.6 kg/m2 vs. 27.4 kg/m2, p < 0.001). Women who screened positive for OSA were also more likely to screen p...
Objective The aim of this study was to measure the effect of obesity and systemic opioids on resp... more Objective The aim of this study was to measure the effect of obesity and systemic opioids on respiratory events within the first 24 hours following cesarean. Methods Opioid-naive women undergoing cesarean between January 2016 and December 2017 were included in this retrospective cohort study. The primary outcome was the proportion of women experiencing at least one composite respiratory outcome (oxygen saturation less than 95% lasting 30+ seconds or need for respiratory support) within 24 hours of cesarean. The impact of obesity and total systemic opioid dose in 24 hours (measured in morphine milligram equivalents [MMEs]) on the composite respiratory compromise outcome were evaluated. Results Of 2,230 cesarean births, 790 women had at least one composite respiratory event. Predictors of the composite respiratory outcome included body mass index (BMI) as a continuous variable (odds ratio = 1.063 for every one unit increase in BMI [95% confidence interval (CI): 1.021–1.108], p = 0.003...
WMJ : official publication of the State Medical Society of Wisconsin, 2021
PROBLEM CONSIDERED Obstructive sleep apnea (OSA) is underdiagnosed during pregnancy, but there is... more PROBLEM CONSIDERED Obstructive sleep apnea (OSA) is underdiagnosed during pregnancy, but there is strong theoretical and some empiric evidence that treatment may improve obstetric outcomes. Barriers to screening, testing, and treatment are common during pregnancy. The goal of this described intervention was to reduce these barriers and improve detection of OSA in pregnancy. METHODS Representatives from sleep medicine and perinatology established a cross-disciplinary, collaborative Sleep Pregnancy Clinic offering a streamlined referral process for multimodal screening, testing, and treatment of OSA during pregnancy. This is a retrospective analysis of data from the clinic's first 19 months. RESULTS Between June 2017 and December 2018, 134 pregnant women were referred for OSA testing. Sixty-three (47.0%) completed objective sleep testing, and 38 (60.3%) of the women who completed testing met diagnostic criteria for OSA. This intervention resulted in a statistically significant inc...
Sleep apnea is emerging as an important and underdiagnosed comorbidity in pregnancy. Screening, d... more Sleep apnea is emerging as an important and underdiagnosed comorbidity in pregnancy. Screening, diagnosis, and initiation of therapy are all time-sensitive processes during the dynamic progression of gestation. Completion of referral and testing for sleep apnea during pregnancy requires a significant commitment of time and effort on the part of the pregnant patient. We evaluated for predictors of non-completion of sleep apnea testing within our obstetric-sleep referral pipeline, in an effort to inform and optimize future referrals. We performed a retrospective chart-review of 405 pregnant patient referrals for sleep apnea evaluation at the University of Wisconsin-Madison/UnityPoint sleep apnea pregnancy clinic. We used logistic regression analysis to determine predictors of lack of completion of sleep apnea testing. The vast majority of referrals (>95%) were triaged directly to home sleep apnea testing with the Alice PDX portable device, rather than a sleep clinic visit. The over...
WMJ : official publication of the State Medical Society of Wisconsin, 2019
PROBLEM CONSIDERED While travel during pregnancy is increasingly common, both the act of travelin... more PROBLEM CONSIDERED While travel during pregnancy is increasingly common, both the act of traveling and the destination itself may pose risks to pregnant women. Thus, it is relevant to ask pregnant women about travel for individual care and to assess how often pregnant women travel. Based upon our prior study, we hypothesized that domestic travel would be common, with approximately 30% of pregnant women traveling, and that international travel also would be common, with approximately 5% of the population traveling. We also hypothesized that maternal characteristics, such as socioeconomic status, country of birth, and parity, would affect domestic and international travel during pregnancy. METHODS In order to study trends in travel by pregnant women, a survey was conducted among postpartum women at Meriter Hospital in Madison, Wisconsin, between October 17, 2016 and March 21, 2017. RESULTS Of the 61 postpartum women surveyed, 75.4% had traveled domestically and 11.4% had traveled inte...
Infants exposed to Zika virus (ZIKV) prenatally may develop birth defects, developmental deficits... more Infants exposed to Zika virus (ZIKV) prenatally may develop birth defects, developmental deficits, or remain asymptomatic. It is unclear why some infants are more affected than others, although enhancement of maternal ZIKV infection via immunity to an antigenically similar virus, dengue virus (DENV), may play a role. We hypothesized that DENV immunity may worsen prenatal ZIKV infection and developmental deficits in offspring. We utilized a translational macaque model to examine how maternal DENV immunity influences ZIKV-exposed infant macaque neurodevelopment in the first month of life. We inoculated eight macaques with prior DENV infection with ZIKV, five macaques with ZIKV, and four macaques with saline. DENV/ZIKV-exposed infants had significantly worse visual orientation skills than ZIKV-exposed infants whose mothers were DENV-naive, with no differences in motor, sensory or state control development. ZIKV infection characteristics and pregnancy outcomes did not individually diffe...
ABSTRACT An efficient and efficacious method to screen for sleep disturbance in the clinical sett... more ABSTRACT An efficient and efficacious method to screen for sleep disturbance in the clinical setting has not been systemically designed for use among pregnant women. The current study used a large prospective database to derive a short-form sleep scale and examined its predictive value on pregnancy risks. Data were collected from 1,157 gravidae attending three outpatient clinics (2010-2012). Sleep patterns were assessed by the Berlin questionnaire, Epworth Sleepiness Scale, and questions on napping behavior. Confirmatory factor analysis was used to construct a short-form sleep scale, which would be predicted to perform with a higher degree of sensitivity and specificity among gravidae. Adjusted relative risks of pregnancy risks were estimated for the short-form scale, body mass index greater than 30 kg/m, hypertension, and screening positive on the Berlin questionnaire, and Epworth Sleepiness Scale using generalized linear models. Our derived short-form sleep scale consisted of four items on snoring frequently, bothersome snoring, stopped breathing while sleeping, and falling asleep while driving. Factor loadings ranged from 0.4 to 0.9 (P&lt;.001) and demonstrated adequate model fit (root mean square error of approximation 0.04, confirmatory fit index 0.99, Tucker-Lewis Index 0.98). A higher score on the short-form sleep scale was associated with preeclampsia (adjusted relative risk 1.30, 95% confidence interval 1.10-1.59). A body mass index greater than 30 kg/m, hypertension, and screening positive on the Berlin questionnaire were associated with gestational diabetes, preeclampsia, small-for-gestational age neonate, large-for-gestational age neonate, or both. The Epworth Sleepiness Scale was not associated with outcomes. This four-item scale on sleep disturbance during pregnancy was associated with preeclampsia adjusting for confounders. This scale may be used by clinicians to quickly assess the effect of sleep disturbance on pregnancy outcomes.
Background Shift work has been associated with adverse pregnancy outcomes. The objective of this ... more Background Shift work has been associated with adverse pregnancy outcomes. The objective of this study was to evaluate the association between sleep disturbances and adverse pregnancy outcomes. Methods and findings This was a secondary analysis of a prospective study of participants enrolled in a prospective observational study wherein gravidae were screened for sleep apnea (2010–2012). A screening questionnaire with standard sleep apnea questionnaires as well as novel items about shift work and nocturnal sleep duration was administered at a prenatal care visit. Short sleep duration was defined as less than 7 hours. Prolonged sleep duration was defined as greater than 9 hours. In a cohort of 1125 pregnant people, 9.4% reported shift work at the time of screening. Gravidae who reported shift work were more likely than gravidae who reported no shift work to develop preeclampsia (28.3% versus 13.0%, P<0.001), preeclamspsia with severe features (16.0% versus 8.5%, P = 0.010), gestati...
Our objective is to define a standard protocol for post-partum salpingectomy and provide a prospe... more Our objective is to define a standard protocol for post-partum salpingectomy and provide a prospective assessment of safety and feasibility of such a procedure. Thus, a protocol for performing post-partum salpingectomy in limited-resource environments was created based on contemporary practices for tubal ligation. Gravidae presenting for post-partum tubal ligation following vaginal delivery or at time of cesarean were prospectively approached and, if consent was obtained, enrolled. Outcomes were compared to a historical cohort of gravidae who underwent standard post-partum tubal ligation following vaginal birth or at the time of cesarean as per institutional standard of care. The primary outcome was operative time. One hundred and fifty-seven subjects underwent post-partum salpingectomy following cesarean or vaginal delivery (on post-partum days 0–2). Post-partum salpingectomy performed after vaginal delivery (n = 97) resulted in slightly longer operative times (39.1 ± 11.8 vs. 34.3...
We assessed the prevalence of neonatal abstinence syndrome (NAS) and fetal growth outcomes in neo... more We assessed the prevalence of neonatal abstinence syndrome (NAS) and fetal growth outcomes in neonates exposed to methadone compared to buprenorphine in utero. Three authors assessed the titles and abstracts of all potentially eligible studies. The selection criteria were randomized controlled trials and observational cohort studies from January 2000 to January 2020 which indexed and reported original data for occurrence of NAS and fetal growth outcomes in pregnant people who received methadone vs. buprenorphine treatment. The quality and possible bias of each study was assessed using the Cochrane-risk-of-bias tool. Data were pooled to compare the occurrence of NAS and fetal growth restriction among women who received methadone vs. buprenorphine treatment. Of the 106 articles screened, 1 randomized controlled trial and 5 observational cohort studies including 2041 pregnancies fulfilled the inclusion criteria. Buprenorphine is associated with less NAS and improved growth outcomes com...
Infectious Diseases in Obstetrics and Gynecology, 2022
Objective. To examine the relationship between documented β-lactam allergy and cesarean delivery ... more Objective. To examine the relationship between documented β-lactam allergy and cesarean delivery (CD) surgical site infection (SSI). Study Design. We conducted a retrospective cohort analysis of women who underwent CD at Ben Taub Hospital and Texas Children’s Pavilion for Women (Houston, TX) from August 1, 2011, to December 31, 2019. The primary exposure was a documented β-lactam allergy, and the second exposure of interest was the type of perioperative antibiotic received. The primary outcome was the prevalence of SSI. Maternal characteristics were stratified by the presence or absence of a documented β-lactam allergy, and significance was evaluated using Pearson’s chi-squared test for categorical variables and t -test for continuous variables. A logistic regression model estimated odds of SSI after adjusting for possible confounders. Results. Of the 12,954 women included, 929 (7.2%) had a documented β-lactam allergy while 12,025 (92.8%) did not. Among the 929 women with a β-lactam...
Women with obstructive sleep apnea (OSA) are at increased risk of poor pregnancy outcomes such as... more Women with obstructive sleep apnea (OSA) are at increased risk of poor pregnancy outcomes such as fetal growth restriction, hypertensive disorders of pregnancy, and gestational diabetes mellitus. Given this increased risk, we aimed to study the screening prevalence of OSA in women seeking fertility treatment. We performed a cross sectional study of patients presenting to a university-affiliated fertility clinic between March-April 2021. Patients were asked to complete OSA screening (STOP-BANG), anxiety screening (GAD-7), and depression screening (PHQ-2) questionnaires. 107 women completed the surveys. Mean age was 35.1 years and mean body mass index (BMI) was 25.7 kg/m2. Nine (8.4%) women screened positive for OSA using the STOP-BANG screening tool. Women who screened positive for OSA were more likely to be older (37.8 years vs. 34.7 years, p = 0.02) and have a higher BMI (42.6 kg/m2 vs. 27.4 kg/m2, p < 0.001). Women who screened positive for OSA were also more likely to screen p...
Objective The aim of this study was to measure the effect of obesity and systemic opioids on resp... more Objective The aim of this study was to measure the effect of obesity and systemic opioids on respiratory events within the first 24 hours following cesarean. Methods Opioid-naive women undergoing cesarean between January 2016 and December 2017 were included in this retrospective cohort study. The primary outcome was the proportion of women experiencing at least one composite respiratory outcome (oxygen saturation less than 95% lasting 30+ seconds or need for respiratory support) within 24 hours of cesarean. The impact of obesity and total systemic opioid dose in 24 hours (measured in morphine milligram equivalents [MMEs]) on the composite respiratory compromise outcome were evaluated. Results Of 2,230 cesarean births, 790 women had at least one composite respiratory event. Predictors of the composite respiratory outcome included body mass index (BMI) as a continuous variable (odds ratio = 1.063 for every one unit increase in BMI [95% confidence interval (CI): 1.021–1.108], p = 0.003...
WMJ : official publication of the State Medical Society of Wisconsin, 2021
PROBLEM CONSIDERED Obstructive sleep apnea (OSA) is underdiagnosed during pregnancy, but there is... more PROBLEM CONSIDERED Obstructive sleep apnea (OSA) is underdiagnosed during pregnancy, but there is strong theoretical and some empiric evidence that treatment may improve obstetric outcomes. Barriers to screening, testing, and treatment are common during pregnancy. The goal of this described intervention was to reduce these barriers and improve detection of OSA in pregnancy. METHODS Representatives from sleep medicine and perinatology established a cross-disciplinary, collaborative Sleep Pregnancy Clinic offering a streamlined referral process for multimodal screening, testing, and treatment of OSA during pregnancy. This is a retrospective analysis of data from the clinic's first 19 months. RESULTS Between June 2017 and December 2018, 134 pregnant women were referred for OSA testing. Sixty-three (47.0%) completed objective sleep testing, and 38 (60.3%) of the women who completed testing met diagnostic criteria for OSA. This intervention resulted in a statistically significant inc...
Sleep apnea is emerging as an important and underdiagnosed comorbidity in pregnancy. Screening, d... more Sleep apnea is emerging as an important and underdiagnosed comorbidity in pregnancy. Screening, diagnosis, and initiation of therapy are all time-sensitive processes during the dynamic progression of gestation. Completion of referral and testing for sleep apnea during pregnancy requires a significant commitment of time and effort on the part of the pregnant patient. We evaluated for predictors of non-completion of sleep apnea testing within our obstetric-sleep referral pipeline, in an effort to inform and optimize future referrals. We performed a retrospective chart-review of 405 pregnant patient referrals for sleep apnea evaluation at the University of Wisconsin-Madison/UnityPoint sleep apnea pregnancy clinic. We used logistic regression analysis to determine predictors of lack of completion of sleep apnea testing. The vast majority of referrals (>95%) were triaged directly to home sleep apnea testing with the Alice PDX portable device, rather than a sleep clinic visit. The over...
WMJ : official publication of the State Medical Society of Wisconsin, 2019
PROBLEM CONSIDERED While travel during pregnancy is increasingly common, both the act of travelin... more PROBLEM CONSIDERED While travel during pregnancy is increasingly common, both the act of traveling and the destination itself may pose risks to pregnant women. Thus, it is relevant to ask pregnant women about travel for individual care and to assess how often pregnant women travel. Based upon our prior study, we hypothesized that domestic travel would be common, with approximately 30% of pregnant women traveling, and that international travel also would be common, with approximately 5% of the population traveling. We also hypothesized that maternal characteristics, such as socioeconomic status, country of birth, and parity, would affect domestic and international travel during pregnancy. METHODS In order to study trends in travel by pregnant women, a survey was conducted among postpartum women at Meriter Hospital in Madison, Wisconsin, between October 17, 2016 and March 21, 2017. RESULTS Of the 61 postpartum women surveyed, 75.4% had traveled domestically and 11.4% had traveled inte...
Infants exposed to Zika virus (ZIKV) prenatally may develop birth defects, developmental deficits... more Infants exposed to Zika virus (ZIKV) prenatally may develop birth defects, developmental deficits, or remain asymptomatic. It is unclear why some infants are more affected than others, although enhancement of maternal ZIKV infection via immunity to an antigenically similar virus, dengue virus (DENV), may play a role. We hypothesized that DENV immunity may worsen prenatal ZIKV infection and developmental deficits in offspring. We utilized a translational macaque model to examine how maternal DENV immunity influences ZIKV-exposed infant macaque neurodevelopment in the first month of life. We inoculated eight macaques with prior DENV infection with ZIKV, five macaques with ZIKV, and four macaques with saline. DENV/ZIKV-exposed infants had significantly worse visual orientation skills than ZIKV-exposed infants whose mothers were DENV-naive, with no differences in motor, sensory or state control development. ZIKV infection characteristics and pregnancy outcomes did not individually diffe...
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