Prevalence of Chlamydia trachomatis and Neisseria gonorrhoeae and Repeat Infection Among Pregnant Urban Adolescents

Negative maternal and fetal consequences associated with Chlamydia trachomatis and Neisseria gonorrhoeae during pregnancy make diagnosis essential. The CDC recommends routine screening for sexually transmitted infections at the first prenatal visit, and third trimester repeat screening, specifically for C. trachomatis, is recommended for women under age 25 or at increased infection risk. The impact of repeat screening on diagnosis during pregnancy is not well documented among adolescents

Use of the Copper T380A Intrauterine Device by Adolescent Mothers: Continuation and Method Failure

This report contributes to limited empirical data regarding use of the Copper T380A intrauterine device among adolescent mothers

Chlamydia trachomatis Infection in Minority Adolescent Women: A Public Health Challenge

Chlamydia trachomatis is the most common bacterial sexually-transmitted infection in the United States. This disease disproportionately affects adolescent minority women, and untreated infection can lead to lasting reproductive tract morbidity. Recommendations for primary prevention include patient counseling to decrease risky behavior and increase barrier protection use; secondary prevention recommendations include screening and treatment of affected individuals and their sexual partners, barrier contraception use, as well as counseling to decrease behaviors that lead to re-infection. Despite these strategies, both incidence and prevalence of Chlamydia have continued to escalate in this population. Interventions to decrease chlamydial infection should encompass all facets of primary and secondary prevention as well as address the fundamental barrier to prevention – lack of perception of risk in this young age group

National Diabetes Data Group vs Carpenter-Coustan criteria to diagnose gestational diabetes

To compare perinatal outcomes among women diagnosed with gestational diabetes by National Diabetes Data Group (NDDG) with women only meeting Carpenter-Coustan criteria

Severe Preeclampsia and Maternal Self-Report of Oral Health, Hygiene, and Dental Care

Maternal periodontal disease diagnosed by a detailed oral health examination is associated with preeclampsia. Our objective was to measure the association between maternal self-report of oral symptoms/problems, oral hygiene practices, and/or dental service utilization prior to or during pregnancy and severe preeclampsia

Racial Disparities in Perinatal Outcomes Among Women with Gestational Diabetes

We sought to evaluate perinatal outcomes by race/ethnicity among women with gestational diabetes mellitus (GDM)

First-Trimester Maternal Serum C-reactive Protein as a Predictor of Third-Trimester Impaired Glucose Tolerance

We evaluated whether first-trimester high-sensitivity C-reactive protein (hsCRP), a suggested marker of pregnancy-associated hyperglycemia, predicts third-trimester impaired glucose tolerance (IGT) in a secondary analysis of a prospective cohort of nondiabetic singletons enrolled at <26 weeks gestation

Perinatal Outcomes in Hispanic and Non-Hispanic White Women With Mild Gestational Diabetes

OBJECTIVE—To compare perinatal outcomes between self-identified Hispanic and non- Hispanic white women with mild gestational diabetes mellitus (GDM) or glucose intolerance. METHODS—In a secondary analysis of a mild GDM treatment trial, we compared perinatal outcomes by race and ethnicity for 767 women with glucose intolerance (abnormal 50g 1-hour screen, normal 100g 3-hour oral glucose tolerance test [OGTT]), 371 women with mild GDM assigned to usual prenatal care, and 397 women with mild GDM assigned to treatment. Outcomes included: composite adverse perinatal outcome (neonatal death, hypoglycemia, hyperbilirubinemia, hyperinsulinemia; stillbirth; birth trauma), gestational age at delivery, birthweight, and hypertensive disorders of pregnancy. Adjusted regression models included: 100g 3-hour OGTT results; parity; gestational age, body mass index, maternal age at enrollment; and current tobacco use. RESULTS—The sample of 1535 women was 68.3% Hispanic and 31.7% non-Hispanic White. Among women with glucose intolerance, Hispanic women had more frequent composite outcome (37% vs. 27%, aOR 1.62 95%CI 1.10, 2.37), with more neonatal elevated C-cord peptide (19% vs. 13%, aOR 1.79 95%CI 1.04, 3.08) and neonatal hypoglycemia (21% vs. 13%, aOR 2.04 95%CI 1.18, 3.53). Among women with untreated mild GDM, outcomes were similar by race/ethnicity. Among Hispanic women with treated mild GDM, composite outcome was similar to non-Hispanic White women (35% vs. 25%, aOR 1.62 95% CI 0.92, 2.86), but Hispanic neonates had more frequent hyperinsulinemia (21% vs. 10%, aOR 2.96 95%CI 1.33, 6.60). CONCLUSION—Individual components of some neonatal outcomes were more frequent in Hispanic neonates, but most perinatal outcomes were similar between Hispanic and non-Hispanic ethnic groups

Prevalence of Chlamydia trachomatis and Neisseria gonorrhoeae and Repeat Infection Among Pregnant Urban Adolescents

BACKGROUND: Negative maternal and fetal consequences associated with Chlamydia trachomatis and Neisseria gonorrhoeae during pregnancy make diagnosis essential. The CDC recommends routine screening for sexually transmitted infections at the first prenatal visit, and third trimester repeat screening, specifically for C. trachomatis, is recommended for women under age 25 or at increased infection risk. The impact of repeat screening on diagnosis during pregnancy is not well documented among adolescents. METHODS: A prospective cohort of 125 pregnant adolescents with at least one prenatal screen for C. trachomatis and N. gonorrhoeae was analyzed. All participants received prenatal care and delivered at one urban teaching hospital in Washington, DC. Screening results were documented for both sexually transmitted infections. Descriptive and univariate analyses were performed to describe disease prevalence. RESULTS: Thirty-one percent of pregnant adolescents were diagnosed with either C. trachomatis or N. gonorrhoeae infection during pregnancy. Of the 75% (95/125) of patients who had more than one screening test, 11% (10/95) had a re-infection, and 7% (7/95) had a new infection on repeat testing. Nine percent (9/95) had recurrent C. trachomatis, while 4% (4/95) had a new diagnosis. Three percent (3/95) had recurrent N. gonorrhoeae, while 4% (4/95) had a new diagnosis. Some experienced co-infection at either initial or repeat testing. CONCLUSIONS: Screening for C. trachomatis and N. gonorrhoeae is recommended during pregnancy. In this sample of pregnant adolescents, the overall high incidence and recurrence of C. trachomatis and N. gonorrhoeae support CDC screening and re-screening recommendations, regardless of initial test results

Severe Preeclampsia and Maternal Self-Report of Oral Health, Hygiene, and Dental Care

BACKGROUND: Maternal periodontal disease diagnosed by a detailed oral health examination is associated with preeclampsia. Our objective was to measure the association between maternal self-report of oral symptoms/problems, oral hygiene practices, and/or dental service utilization prior to or during pregnancy and severe preeclampsia. METHODS: A written questionnaire was administered to pregnant women at the time of prenatal ultrasound, and outcomes ascertained by chart abstraction. Chi square test compared maternal oral symptoms/problems, hygiene practices, and dental service utilization between women with severe preeclampsia versus normotensive women. Multivariable logistic regression was used to calculate adjusted odds ratios (aOR) and 95% confidence intervals (CI) for severe preeclampsia. Results: 48 (10%) of 470 women reported ≥ 2 oral symptoms/problems in the 6 months prior to pregnancy and 77 (16%) since pregnancy. 51(11%) reported prior periodontal treatment. 28 (6%) of 470 developed severe preeclampsia. Women with a history of periodontal treatment were more likely to develop severe preeclampsia (aOR, 95%CI: 3.71, 1.40-9.83) than women without a prior history of periodontal treatment. Self-reported oral health symptoms/problems, oral hygiene practices, or dental service utilization prior to or during pregnancy were not associated with severe preeclampsia when considered in the context of other maternal risk factors. Conclusion: Maternal self report of previous periodontal treatment prior to pregnancy is associated with severe preeclampsia