American College of Obstetricians and Gynecologists, April 26-30
The annual meeting of the American College of Obstetricians and Gynecologists was held from April 26 to 30 in Chicago and attracted more than 3,000 participants from around the world, including clinicians, academicians, allied health professionals, and others interested in obstetrics and gynecology. The conference highlighted recent advances in the prevention, detection, and treatment of conditions impacting women, with presentations focusing on the advancement of health care services for women worldwide.
In one study, Audrey Merriam, M.D., of the Christiana Care Health System in Newark, Del., and colleagues found that maternal age and bed rest in pregnancy increase a woman's risk of developing gestational diabetes. Specifically, the investigators found that a day of bed rest increased the risk by 1.04.
"The conclusion of the study was that we found bed rest for pregnant women does increase the risk of developing gestational diabetes in addition to the other risks bed rest poses," said Merriam. "Physicians should be thinking strongly before placing a woman on bed rest as there is no evidence that it benefits any pregnancy condition and can lead to more harm for pregnant women."
In another study, Dina El-Kady, M.D., of the Good Samaritan Health System in West Islip, N.Y., and colleagues found that when looking at pregnant women who received the influenza vaccine, women who were vaccinated had a lower rate of severe preeclampsia compared to women who were not vaccinated. There was no difference seen in women for mild preeclampsia.
"In terms of clinical practice, women can be counseled that a reduction in the risk of severe preeclampsia may be an added benefit to the many benefits already known from the vaccine," said El-Kady. "Traditionally, women believe that it will protect them and their unborn from the flu. Recent data are now suggesting that there actually may be additional obstetrical benefits. In addition, this can be investigated as a risk reduction strategy in women with a prior history of severe preeclampsia."
Lisa Masinter, M.D., of the Northwestern University Feinberg School of Medicine in Chicago, and colleagues found that U.S. women who have cesarean deliveries are less likely to continue childbearing, especially as they undergo higher numbers of cesarean deliveries. However, women who live below the federal poverty level, unlike women above the poverty line, are less likely to discontinue childbearing even with high numbers of cesarean deliveries.
"Among 6,526 respondents who represent the childbearing population of the United States, cesarean delivery, regardless of birth order, was associated with a lower likelihood of future birth. This decreased in a stepwise fashion as the number of cesarean deliveries increased," said Masinter.
Specifically, the investigators found that among women with three births, those with two or three cesarean deliveries were 37 and 59 percent, respectively, less likely to have a fourth birth when compared to women with three vaginal deliveries (after adjusting for confounders, including prior pregnancy intention). When stratified by income (greater or less than federal poverty level), the investigators found that this relationship was significantly attenuated for low-income women.
"We believe that desired family size should also be taken into account when patients are counseled prior to non-emergent, specifically elective, cesarean deliveries," said Masinter. "Moreover, given the known risks faced by women who have multiple cesarean deliveries, most notably placenta accreta, these findings underscore that family planning counseling should be given particular importance in the post-cesarean population."
Katherine Gold, M.D., of the University of Michigan Health System in Ann Arbor, and colleagues found that levels of distress among bereaved mothers was quite high, even nine months after loss. Specifically, the investigators found that nine months after delivery, women with perinatal loss (stillbirth and early infant death in the first month) had more than a four-fold increased risk of depressive symptoms and more than a six-fold increase in symptoms of posttraumatic stress disorder compared to mothers with a live birth. In addition, bereaved mothers also had twice the risk of symptoms for generalized anxiety disorder and social phobia, which has not previously been reported.
"Whether a woman had a stillbirth versus infant death, her mental health outcomes were the same. Stillbirth is often more stigmatized and minimized compared to infant death, so it is important to understand that mental health outcomes for moms are similar," said Gold. "Loss is a powerful and often traumatic experience for mothers, and creates significant risk for psychiatric symptoms."
Stephanie Chu, M.D., of the University of Colorado in Denver, and colleagues compared the risk profiles for planned home births compared with hospital births. Using the U.S. Centers for Disease Control and Prevention's National Vital Statistics database, the investigators found a significant number of high-risk pregnancies delivered at home.
"Six high-risk pregnancy conditions associated with increased adverse outcomes had a higher prevalence in planned home births than in hospital births (advanced maternal age, postdates, macrosomia, premature rupture of membranes, and precipitous and prolonged labor), whereas three others (prior cesarean delivery, nullipara, preterm births) had a high prevalence," the authors write.