The impact of abnormal glucose tolerance and obesity on fetal growth

Factors linked with insulin resistance were examined for their association with large-for-gestational-age (LGA) infant birth weight and gestational diabetes. Study Design. Data came from a longitudinal cohort study of 2,305 subjects without overt diabetes, analyzed using multinomial logistic and linear regression. Results. High maternal BMI (OR = 1.53 (1.11, 2.12)), height (1.98 (1.62, 2.42)), antidepressant use (1.71 (1.20, 2.44)), pregnancy weight-gain exceeding 40 pounds (1.79 (1.25, 2.57)), and high blood sugar (2.68, (1.53, 5.27)) were all positively associated with LGA birth. Strikingly, the difference in risk from diagnosed and treated gestational diabetes compared to women with a single abnormal glucose tolerance test (but no diagnosis of gestational diabetes) was significant (OR = 0.65, p = 0.12 versus OR = 2.84, p \u3c 0.01). When weight/length ratio was used instead, different factors were found to be significant. BMI and pregnancy weight-gain were found to influence the development of gestational diabetes, through an additive interaction. Conclusions. High prepregnancy BM, height, antidepressant use, pregnancy weight-gain exceeding 40 pounds, and high blood sugar were associated with LGA birth, but not necessarily infant weight/length ratio. An additive interaction between BMI and pregnancy weight-gain influenced gestational diabetes development

A qualitative exploration: questioning multisource feedback in residency education

Abstract Background Multisource feedback (MSF), involves the collection of feedback from multiple groups of assessors, including those without a traditional hierarchal responsibility to evaluate doctors. Allied healthcare professionals (AHCPs), administrative staff, peers, patients and their families may all contribute to the formative assessment of physicians. Theoretically, this feedback provides a thorough view of physician performance; however, the ability of MSF programs to consistently impact physician behavior remains in question. Therefore, the objective of this study was to explore perceptions and prerequisites to an effective MSF program in postgraduate medical education from the perspectives of both pediatric residents and AHCPs. Methods This exploratory study was conducted in a pediatric inpatient unit prior to implementation of a MSF program. Focus groups were conducted with purposefully recruited participants from three distinct groups: junior pediatric residents, senior pediatric residents, and AHCPs. Discussions were audio recorded, transcribed verbatim and analyzed using thematic analysis. Results Both residents and AHCPs expressed a strong interest in the concept of MSF. However, more in depth discussions identified barriers to residents’ acceptance of, and AHCPs’ provision of feedback. Roles and responsibilities, perceptions of expertise, hospital culture/interprofessionalism and power dynamics were identified as barriers to the acceptance and provision of feedback. All groups expressed interest in opportunities to engage in bi-directional feedback. Conclusions The identified barriers and prerequisites to providing and accepting MSF suggest limits to the efficacy of the MSF process. Our findings suggest that these factors should be considered in the design and implementation of MSF programs

The Impact of Abnormal Glucose Tolerance and Obesity on Fetal Growth

Objective. Factors linked with insulin resistance were examined for their association with large-for-gestational-age (LGA) infant birth weight and gestational diabetes. Study Design. Data came from a longitudinal cohort study of 2,305 subjects without overt diabetes, analyzed using multinomial logistic and linear regression. Results. High maternal BMI (OR=1.53 (1.11, 2.12)), height (1.98 (1.62, 2.42)), antidepressant use (1.71 (1.20, 2.44)), pregnancy weight-gain exceeding 40 pounds (1.79 (1.25, 2.57)), and high blood sugar (2.68, (1.53, 5.27)) were all positively associated with LGA birth. Strikingly, the difference in risk from diagnosed and treated gestational diabetes compared to women with a single abnormal glucose tolerance test (but no diagnosis of gestational diabetes) was significant (OR=0.65, p=0.12 versus OR=2.84, p<0.01). When weight/length ratio was used instead, different factors were found to be significant. BMI and pregnancy weight-gain were found to influence the development of gestational diabetes, through an additive interaction. Conclusions. High prepregnancy BM, height, antidepressant use, pregnancy weight-gain exceeding 40 pounds, and high blood sugar were associated with LGA birth, but not necessarily infant weight/length ratio. An additive interaction between BMI and pregnancy weight-gain influenced gestational diabetes development