Papers by Menachem Miodovnik
Revista del Hospital Materno Infantil Ramón Sardá, 2009
Proyecto académico sin fines de lucro, desarrollado bajo la iniciativa de acceso abierto
Carolina Digital Repository (University of North Carolina at Chapel Hill), 2009
Objective-To compare the rates of gestational diabetes (GDM) among women who received serial dose... more Objective-To compare the rates of gestational diabetes (GDM) among women who received serial doses of 17 alpha hydroxyprogesterone caproate (17-OHPC) versus placebo. Study Design-Secondary analysis of two double-blind randomized placebo-controlled trials of 17-OHPC given to women at risk for preterm delivery. The incidence of GDM was compared between women who received 17-OHPC or placebo. Results-We included 1094 women; 441 had singleton and 653 had twin gestations. Combining the two studies, 616 received 17-OHPC and 478 received placebo. Among singleton and twin pregnancies, rates of GDM were similar in women receiving 17-OHPC versus placebo (5.8% vs. 4.7%, p= 0.64 and 7.4% vs 7.6%, p =0.94, respectively). In the multivariable model, progesterone was not associated with GDM (adjusted odds ratio (adj OR) 1.04, 95% confidence interval (CI) 0.62 to 1.73). Conclusion-Weekly administration of 17-OHPC is not associated with higher rates of gestational diabetes in either singleton or twin pregnancies.
Carolina Digital Repository (University of North Carolina at Chapel Hill), 2021
OBJECTIVE: To describe coronavirus disease 2019 (COVID-19) severity in pregnant patients and eval... more OBJECTIVE: To describe coronavirus disease 2019 (COVID-19) severity in pregnant patients and evaluate the association between disease severity and perinatal outcomes. METHODS: We conducted an observational cohort study of all pregnant patients with a singleton gestation and a positive test result for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) who delivered at 1 of 33 U.S. hospitals in 14 states from March 1 to July 31, 2020. Disease severity was classified by National Institutes of Health criteria. Maternal, fetal, and neonatal outcomes were abstracted by centrally trained and certified perinatal research staff. We evaluated trends in maternal characteristics and outcomes across COVID-19 severity classes and associations between severity and outcomes by multivariable modeling. RESULTS: A total of 1,219 patients were included: 47% asymptomatic, 27% mild, 14% moderate, 8% severe, 4% critical. Overall, 53% were Hispanic; there was no trend in race-ethnicity distribution by disease severity. Those with more severe illness had older mean age, higher median body mass index, and pre-existing medical comorbidities. Four maternal deaths (0.3%) were attributed to COVID-19. Frequency of perinatal death or a positive
American Journal of Perinatology, Aug 3, 2016
Objective This study aims to evaluate the association between prepregnancy body mass index (BMI) ... more Objective This study aims to evaluate the association between prepregnancy body mass index (BMI) and adverse pregnancy outcomes in women with type 1 diabetes mellitus (DM). Methods This is a secondary analysis of a cohort of 426 pregnancies in women with type 1 DM recruited before 20 weeks gestation. Women were categorized according to prepregnancy BMI: low BMI (< 20 kg/m2), normal BMI (20 to < 25 kg/m2), and high BMI (≥ 25 kg/m2). The outcomes of interest were: spontaneous abortion (delivery < 20 weeks gestation); preeclampsia; emergent delivery for maternal indications (hypertension or placental abruption); and preterm delivery (< 37 weeks gestation). Analyses included proportional hazards and multiple logistic regression models with covariates: age, age at diagnosis of type 1 DM, previous spontaneous abortion, microvascular disease (nephropathy or retinopathy), and glycohemoglobin A1 concentrations. Results Low BMI was associated with preterm delivery. High BMI was associated with emergent delivery for maternal indications. Glycemic control as measured by glycohemoglobin A1 was associated with increased risk of spontaneous abortion, attenuating the association with low prepregnancy weight. Conclusion Prepregnancy BMI is a risk factor to be considered when caring for women with type 1 DM, in particular for preterm delivery (low BMI) and emergent delivery for maternal indications (high BMI).
Journal of Asthma, Feb 19, 2010
Objective-To determine if maternal asthma or asthma severity affects newborn morphometry. Study D... more Objective-To determine if maternal asthma or asthma severity affects newborn morphometry. Study Design-A secondary analysis was performed on data collected in a multicenter prospective observational cohort study of asthma in pregnancy. Patients enrolled included women with asthma stratified by severity of disease and controls. Asthma severity was defined according to the classification proposed by the National Asthma Education Program (NAEP) Report of the Working Group on Asthma and Pregnancy, modified to include medication requirements. Newborn morphometry measurements included birth weight (BW) and multiples of the median birth weight (BW-MOM), head circumference (HC), length (L), HC:BW ratio, and ponderal index (PI). Results-Of 2480 patients there were 828 nonasthmatic controls, 828 with mild, 775 with moderate, and 49 with severe disease. Comparing all groups, there were statistically significant differences in maternal age (p < .001), race (p = .005), parity (p = .006), prepregnancy weight (p = .028), and medical care source (p = .001), with the severe asthma group having the highest mean maternal age (25.7 years), and proportion of African Americans (71.4%), proportion of multiparous patients (63.3%), and proportion of patients receiving government assistance (85.7%). When the control group was excluded from the comparisons, differences in prepregnancy weight and medical care source were no longer significant. BW-MOM and L did not differ between groups. The HC:BW ratio increased with asthma severity (p = .029) and was increased compared to controls (p = .010). This remained significant after controlling for confounding variables (both p <.001). HC was statistically significantly different between all groups (p = .032), as well as among women with varying degrees of asthma severity (p = .013), which was not clinically significant After covariates adjustment, HC was not significantly different among all groups (p =. 228), nor the asthma groups (p = .144). Conclusion-Asthma severity is associated with an increased HC:BW ratio. Severity was not found to impact HC, BW-MOM, L, or PI independently. However, the magnitudes of the effects were too small to suggest a clinically significant effect of asthma on neonatal morphometry in this large prospectively studied sample.
Obstetrics & Gynecology, 2004
OBJECTIVE: To determine neonatal and maternal outcomes stratified by asthma severity during pregn... more OBJECTIVE: To determine neonatal and maternal outcomes stratified by asthma severity during pregnancy by using the 1993 National Asthma Education Program Working Group on Asthma and Pregnancy definitions of asthma severity. The primary hypothesis was that moderate or severe asthmatics would have an increased incidence of delivery at <32 weeks of gestation compared with nonasthmatic controls. METHODS: This was a multicenter, prospective, observational cohort study conducted over 4 years at 16 university hospital centers. Asthma severity was defined according to the National Asthma Education Program Working Group on Asthma and Pregnancy classification and modified to include medication requirements. This study had 80% power to detect a 2-to 3-fold increase in delivery less than 32 weeks of gestation among the cohort with the moderate or severe asthma compared with controls. Secondary outcome measures included obstetrical and neonatal outcomes. RESULTS: The final analysis included 881 nonasthmatic controls, 873 with mild asthma, 814 with moderate, and 52 with severe asthma. There were no significant differences in the rates of preterm delivery less than 32 weeks (moderate or severe 3.0%, mild 3.4%, controls 3.3%; P ؍ .873) or less than 37 weeks of gestation. There were no significant differences for neonatal outcomes except discharge diagnosis of neonatal sepsis among the mild group compared with controls, adjusted odds ratio 2.9, 95% confidence interval 1.2, 6.8. There were no significant differences for maternal complications except for an increase in overall cesarean delivery rate among the moderate-or-severe group compared with controls (adjusted odds ratio 1.4, 95% confidence interval 1.1, 1.8). CONCLUSION: Asthma was not associated with a significant increase in preterm delivery or other adverse perinatal outcomes other than a discharge diagnosis of neonatal sepsis. Cesarean delivery rate was increased among the cohort with moderate or severe asthma. (Obstet Gynecol 2004;103:5-12.
Obstetrics & Gynecology, Oct 1, 2006
The First-and Second-Trimester Evaluation of Risk Study allows the patient to make a better decis... more The First-and Second-Trimester Evaluation of Risk Study allows the patient to make a better decision about noninvasive screening for trisomy 21. 1 Women who are screen positive after sequential or integrated testing have a decision whether to proceed to amniocentesis.
Obstetrics & Gynecology, Aug 1, 2009
Objective-To estimate the frequency, indications, and complications of cesarean hysterectomy. Met... more Objective-To estimate the frequency, indications, and complications of cesarean hysterectomy. Methods-This was a prospective, 2-year observational study at 13 academic medical centers conducted between January 1, 1999 and December 31, 2000 on all women who underwent a hysterectomy at the time of cesarean delivery. Data was abstracted from the medical record by study nurses. The outcomes included procedure frequency, indications, and complications. Results-A total of 186 cesarean hysterectomies (0.5%) were performed from a cohort of 39,244 women who underwent cesarean delivery. The leading indications for hysterectomy were placenta accreta (38%) and uterine atony (34%). Of the hysterectomy cases with a diagnosis recorded as accreta, 18% accompanied a primary cesarean delivery while 82% had a prior procedure (p<0.001). Of the hysterectomy cases with atony recorded as a diagnosis, 59% complicated primary cesarean delivery whereas 41% had a prior cesarean (p< 0.001). Major maternal complications of cesarean hysterectomy included transfusion of red blood cells (84%) and other blood products (34%), fever (11%), subsequent laparotomy (4%), ureteral injury (3%), and death (1.6%). Accreta hysterectomy cases were more likely than atony hysterectomy cases to require ureteral stents (14% versus 3%, p=0.03) and to instill sterile milk into the bladder (23% versus 8%, p=0.02). Conclusion-The rate of cesarean hysterectomy has declined modestly in the last decade. In spite of the use of effective therapies and procedures to control hemorrhage at cesarean delivery, a small proportion of women continue to require hysterectomy to control hemorrhage from both uterine atony and placenta accreta.
American Journal of Obstetrics and Gynecology, Nov 1, 1982
Previous studies from our laboratory have shown that beta hydroxybutyrate crosses the ovine place... more Previous studies from our laboratory have shown that beta hydroxybutyrate crosses the ovine placenta in small amounts during maternal hyperketonemia and produces significant reductions in fetal PaO2 and increased fetal lactate levels. The present study evaluates the effects of fetal hyperketonemia on fetal and maternal cardiovascular and biochemical parameters. Pregnant ewes (110 to 120 days&#39; gestation) were instrumented with catheters in the femoral artery, femoral vein, and uterine veins, and electromagnetic flow probes were placed on the middle uterine arteries. The fetal carotid artery and jugular vein were catheterized, and a catheter and balloon were placed in the amniotic fluid. Beta hydroxybutyrate (0.44 mmole/min) and antipyrine (0.03 mmole/min) were simultaneously infused directly into the fetal jugular vein for 90 minutes. The fetal beta hydroxybutyrate level increased from a baseline of 0.12 +/- 0.08 to 6.80 +/- 0.46 mmoles/L and was associated with a significant decrease in fetal PaO2 (23.7 +/- 2.4 to 16.0 +/- 0.4 mm Hg) and a large increase in the fetal lactate (1.85 +/- 0.27 to 5.43 +/- 0.92 mmoles/L) at 90 minutes. The present results suggest that during fetal hyperketonemia fetal oxygenation is significantly reduced and may contribute to the increased perinatal mortality in the pregnant diabetic patient.
Fetal and Pediatric Pathology, 1997
This study developed a set of histologic features that will allow subclassification of placentas ... more This study developed a set of histologic features that will allow subclassification of placentas with preterm premature rupture of membranes. Placentas were obtained from patients participating in a multi-institutional NICHD Maternal-Fetal Medicine Unit Network study of antimicrobial therapy after preterm premature rupture of membranes. The rupture site was sampled by inking the open sac margin and rolling a membrane strip in four quadrants from the ink to the placental margin. Independently, four pathologists used a provisional feature list to score the slides from 15 placentas. A concordance analysis was performed on those results. With those results, the slides were reviewed concurrently to discover the source of disagreements and to revise the feature list. The sampling method frequently demonstrated a rupture site with histology distinct from that of the remainder of the membranes. After review of the preliminary scoring results, 29 features of membrane histology present in preterm premature rupture could be objectively described with agreement among four pathologists. The feature list allows both novel and commonly recognized histologic features of fetal membranes to be recorded with objectivity. This list, with the described sampling technique, is presented as a tool for clinical correlation in studies of membrane rupture, especially in preterm, premature rupture.
Pediatric Annals, Apr 1, 1996
Even though perinatal mortality of infants of diabetic mothers has decreased remarkably in recent... more Even though perinatal mortality of infants of diabetic mothers has decreased remarkably in recent years and now approaches that of the general population, these infants still face a multitude of potential complications and the propensity for increased morbidity, both in utero and postnatally. Many of these complications are clearly related to the metabolic status of the diabetic mother. Increasing awareness among insulin-dependent diabetic patients and health providers of the need for glycemic control and the ever-growing understanding of the peculiarities of diabetic pregnancies eventually should combine to provide the best possible outcome for these infants.
Clinical Obstetrics and Gynecology, Mar 1, 2000
Many women with diabetes develop complications of their chronic disease that may have a tremendou... more Many women with diabetes develop complications of their chronic disease that may have a tremendous impact on their quality of life and their ultimate prognosis. Because Type 1 diabetes often begins at a very early age, it is quite common for women in their child-bearing years to be affected by these complications. As described in this article, diabetic complications and pregnancy may significantly affect each other, but it is not always easy to predict the course of either and to counsel these patients accordingly. Nevertheless, it appears that only in rare occasions should women with diabetes be advised against pregnancy, and that in most situations, with careful and knowledgeable management, a favorable outcome of pregnancy can be expected both for the mother and her infant.
American Journal of Obstetrics and Gynecology, 1981
Screening for abnormal glucose metabolism was carried out in 2.0n pregnant women. HIstorical or c... more Screening for abnormal glucose metabolism was carried out in 2.0n pregnant women. HIstorical or clinical risk factors for gestational diabetes were present In 959 women (grol;!p 1). The remaining 1 ,118 patients composed group 2. A 50 gm oral glucose load and •a t•hour serum glucose determination with a threshold of 150 mg/dl were U8ed as a glucoso. chaIenge. 8CAM11ning. test (GeT). Patients with an abnOrmal GeT underwent an oral gIuco8It toIInIt'Ice1aet (GTT). . Group 1 patients underwent screening at the initial clinic visit or wt:M;n the • oIirIIcIiI1i8k faclor Was• fllst recognized, with repeat SiCteenIng at 28 to 32 weeks if the Initial testing we AOm'tal. Group 2 patients were 8CI'88IieCI at 28 to 32 weeks. In group 1. 69 patIenta (7;2%}""" an abnormal GeT and 14 (1.5%) demonstrated an abnormal GTI. In g/'OI.IP 2. 68pa1ien1s(6. 1 %) exhibited an abnormal GeT and 16 (1.4%) demonstrated an abnormal GTI. Theee Incidences. . not statistically different. The estimated costs per patient screened and per ca8e of gaetatIonal diabetes detected were $4.75 and $328.96, respectively. (AM.
American Journal of Obstetrics and Gynecology, May 1, 1988
Volume 158 Number 5 glucose measurements for the diagnosis of gestational diabetes. We apologize ... more Volume 158 Number 5 glucose measurements for the diagnosis of gestational diabetes. We apologize for misleading the readers on the position of the American College. Perhaps a separate issue is whether or not age 30 years is an appropriate recommendation. At the University oflowa, 74% of patients with gestational diabetes are under 30 years old. 1 Furthermore, there is no significant increase in the percentage of patients with a positive glucose tolerance test by age group until after age 36 years. Additional information supporting the importance of screening all patients is contained in The Proceedings of the Second International Workshop-Conference on Gestational Diabetes Mellitus? Thus the threshold of age 30 years may be in need of reconsideration.
Journal of Ultrasound in Medicine, Apr 1, 1992
The Antley-Bixler syndrome (ABS) is a multiple malformation syndrome composed of multisynostotic ... more The Antley-Bixler syndrome (ABS) is a multiple malformation syndrome composed of multisynostotic osteodysgenesis with long bone fractures, severe midfacial hypoplasia, femoral bowing, and joint contractures, including radiohumeral contractures (secondary to synostosis). The first case was described by Antley and Bixler in 1975 (in addition, a case with similar features was described in 1974 by Lacheretz and colleagues, 2 but ABS was not recognized and defined as a syndrome until 1975). At present, 12 cases (including this report) have been described (Table 1). Although most cases are thought to be a result of sporadic mutations, there are two reports (including one involving a consanguineous marriage) of recurrence in siblings, 5 indicating a possible autosomal recessive mode of inheritance. Although prenatal diagnosis was made in these siblings, previous history of an affected sibling was present. We report a case diagnosed antenatally with no previous family history and review the literature with regard to intrapartum management and overall prognosis.
Obstetrical & Gynecological Survey, 2011
Objective-Antenatal corticosteroids (ACS) decrease respiratory distress syndrome in singleton ges... more Objective-Antenatal corticosteroids (ACS) decrease respiratory distress syndrome in singleton gestations. Twin data is less clear. Obesity and BMI also affect medication distribution volume. We evaluated whether maternal or neonatal cord betamethasone concentrations differed in twin gestations or in obese patients. Study Design-Participants receiving betamethasone in a randomized controlled trial of weekly ACS were identified. We analyzed maternal delivery and cord serum betamethasone concentrations comparing singletons with twins and obese (BMI≥30) with non-obese women. Results-55 maternal and 45 cord blood samples were available. Unadjusted median maternal serum concentrations appeared paradoxically higher in both twin gestations and the obese. However, after controlling for confounders, there were no differences in betamethasone concentrations in maternal serum or cord blood between singletons and twins (p=0.61 v. p=0.14) or non-obese and obese women (p=0.67 v. 0.12). Conclusion-Maternal and umbilical cord blood serum betamethasone concentrations are not different in twin gestations or obese women.
American Journal of Obstetrics and Gynecology, 2004
Acta Obstetricia et Gynecologica Scandinavica, 2003
The benefits of a single course of antenatal corticosteroids on neonatal outcomes are well establ... more The benefits of a single course of antenatal corticosteroids on neonatal outcomes are well established. There is, however, much controversy about how long this treatment should continue, and whether repeated courses should be administered if the women remain at ...
Carolina Digital Repository (University of North Carolina at Chapel Hill), 2008
Objective-To predict individual-specific risk of uterine rupture during an attempted vaginal birt... more Objective-To predict individual-specific risk of uterine rupture during an attempted vaginal birth after cesarean (VBAC). Methods-Women with one prior low-transverse cesarean delivery who underwent a trial of labor with a term singleton were identified in a multi-center concurrently collected database of deliveries occurring during a four-year period. We analyzed different techniques to develop an accurate prediction model for uterine rupture. Results-Of the 11,855 women analyzed, 83 (0.7%) had a uterine rupture. The optimal model, based on a logistic regression,included: any prior vaginal delivery (OR 0.44, 95% CI 0.27-0.71) and labor induction(OR 1.73, 95% CI 1.11-2.69). This model, with a c-statistic of .627, had poor discriminating ability and does not allow the determination of a clinically useful estimate of the probability of uterine rupture for an individual patient. Conclusion-Patient-specific factors cannot be used to accurately predict the relatively small proportion of women who will incur a uterine rupture during an attempted VBAC after 36 weeks of gestatation. Condensation-Factors available before or at admission for delivery cannot be used to accurately predict uterine rupture during an attempted vaginal birth after cesarean. Keywords prediction; uterine rupture; vaginal birth after cesarean Even though uterine rupture during an attempted vaginal birth after cesarean (VBAC) occurs
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Papers by Menachem Miodovnik