articles by Babu Cheku MD MPH
J Acquir Immune Defic Syndr, 2004
Background: Perinatal HIV transmission has declined significantly in New York State (NYS) since i... more Background: Perinatal HIV transmission has declined significantly in New York State (NYS) since implementation of a 3-part regimen of zidovudine prophylaxis in the antenatal, intrapartum, and newborn periods. This study describes the factors associated with perinatal transmission in NYS from 1997 to 2000, the first 4 years of NYS's comprehensive program in which all HIV-exposed newborns were identified through universal HIV testing of newborns. Methods: This population-based observational study included all HIV-exposed newborns whose infection status was known and their mothers identified in NYS through the universal Newborn HIV Screening Program (NSP) from February 1997 to December 2000. Antepartum, intrapartum, newborn, and pediatric medical records of HIV-positive mothers/infants were reviewed for history of prenatal care, antiretroviral therapy (ART), and infant infection status. Risks associated with perinatal HIV transmission were examined. Results: Perinatal HIV transmission declined significantly from 11.0% in 1997 to 3.7% in 2000 (P < 0.05). Prenatal ART was associated with a decline in perinatal HIV transmission both for monotherapy (5.8%, relative risk [RR] = 0.3, 95% confidence interval: 0.2%-0.5%) and combination therapy [2.4%, RR = 0.1, 95% confidence interval: 0.1%-0.2%) compared with no prenatal antiretroviral prophylaxis (P < 0.05). Conclusions: Public health policies to improve access to care for pregnant women and advances in clinical care, including receipt of appropriate preventive therapies, have contributed to declines in perinatal HIV transmission in NYS.
Papers by Babu Cheku MD MPH
Reviews, 1996
Preterm birth occurs in up to 6% to 10% of all births and is the major complication of pregnancy ... more Preterm birth occurs in up to 6% to 10% of all births and is the major complication of pregnancy associated with perinatal mortality and morbidity. Previous preterm delivery is a strong predictor for preterm labour, and the earlier the birth, the more likely it is to be repeated at the same gestation. In the acute setting, betamimetics can decrease contraction frequency or delay preterm birth by 24 to 48 hours. To assess the effectiveness of prophylactic oral betamimetics for the prevention of preterm labour and birth for women with singleton pregnancies at high risk of preterm delivery. We searched the Cochrane Pregnancy and Childbirth Group&#39;s Trials Register (October 2007), CENTRAL (The Cochrane Library 2006, Issue 3), MEDLINE (January 1966 to December 2006), EMBASE (January 1985 to December 2006), and reference lists. Randomised controlled trials in singleton pregnancies at high risk of preterm labour comparing prophylactic oral betamimetics with placebo or any intervention with the specific aim of preventing preterm birth. Two authors independently assessed trial quality and extracted data. One trial (64 singleton pregnancies) was included. The trial compared the oral betamimetic agent isoxuprine with placebo. No difference was seen for perinatal mortality rate (relative risk (RR) 4.74, 95% confidence interval (CI) 0.50 to 45.00). There was no evidence of an effect of oral betamimetic agents in reduction of spontaneous onset of preterm labour (RR 1.07, 95% CI 0.14 to 8.09) or preterm birth, less than 37 weeks&#39; gestation. There was no significant association between the use of oral betamimetics and side effects sufficient to stop therapy (RR 2.51, 95% CI 0.59 to 10.76). No differences were found for infant outcomes; birthweight less than 2500 grams (RR 1.74, 95% CI 0.44 to 6.87) or neonatal death (RR 4.74, 95% CI 0.50 to 45.00). This trial had adequate methodological quality; however the sample size was inappropriate to determine any significance in neonatal outcome differences between the treatment groups. There is insufficient evidence to support or refute the use of prophylactic oral betamimetics for preventing preterm birth in women at high risk of preterm labour with a singleton pregnancy.
Journal of Maternal-Fetal and Neonatal Medicine, 2003
To determine the rate of bioavailability of oral misoprostol in the tablet and a new capsule form... more To determine the rate of bioavailability of oral misoprostol in the tablet and a new capsule form in women with term pregnancies in the postpartum period. Twenty-seven women received 400 microg of misoprostol orally after delivery of the fetal vertex in either the standard tablet form or crushed in methylcellulose capsules prepared in our pharmacy. Serum levels of misoprostol free acid, the principal metabolite, were measured at 5-, 15- and 30-min intervals after administration of the medication. The pharmacokinetics of the tablet and capsule groups were then compared. Twenty patients were included in the analysis. At 5 min, there was a trend towards a statistically significant difference in the concentration of misoprostol acid in the tablet group (89 pg/ml) versus the capsule group (20 pg/ml) (p = 0.007). No significant difference in plasma concentration was noted in the two groups at 15 min (tablet group, 256 pg/ml; capsule group, 245 pg/ml; p = 0.85) or 30 min (tablet group, 381 pg/ml; capsule group, 455 pg/ml; p = 0.45). Oral misoprostol is rapidly absorbed and bioavailable in the postpartum period. Misoprostol may prove useful in postpartum management. The novel packaging of misoprostol in capsule form allows for double-blinded studies with similar pharmacokinetics to the standard tablet.
Obstetrics & Gynecology, 2004
To determine if elective cesarean delivery, when compared with trial of labor, is associated with... more To determine if elective cesarean delivery, when compared with trial of labor, is associated with better long-term motor function or ambulation status in infants with myelomeningocele. This is a retrospective cohort study of patients with myelomeningocele followed at the Spinal Dysfunction Program at Alfred I. duPont Hospital for Children in Wilmington, Delaware. Medical records were reviewed for gestational age at delivery, birthweight, anatomical level of lesion, and initial (0-6 months) and long-term (10 years or longer) motor function. Ambulation status (independent ambulation, ambulant with assistance, or wheelchair-bound) at 2 and 10 years was compared with those delivered by elective cesarean versus those delivered after trial of labor. Of the 106 patients with myelomeningocele that were identified, 87 (82%) had all the data required for this review. There were 44 patients in the elective cesarean group and 43 in the trial of labor group. There was no significant difference in gestational age at delivery or birthweight between the groups. There was statistical difference between the 2 groups when anatomical, initial, and current motor levels were compared. Compared with the elective cesarean group, patients in the trial of labor group were more likely to be ambulatory at 2 years (independently ambulant 7% versus 28%, ambulant with assistance 63% versus 65%, or wheelchair-bound 30% versus 7%, P =.003) and at 10 years (independently ambulant 5% versus 21%, ambulant with assistance 30% versus 54%, or wheelchair-bound 65% versus 25%, P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;.001). However, when logistic regression analysis was used to control for motor level of myelomeningocele, no significant association was observed in ambulatory status at ages 2 and 10 years between infants delivered by elective cesarean or after trial of labor. Elective cesarean delivery, when compared with delivery after trial of labor, was not associated with better motor function or ambulation status in myelomeningocele patients. II-2
Journal of Clinical Microbiology, 2003
We evaluated the Strep B optical immunoassay (OIA; ThermoBiostar, Inc.) for detecting light and h... more We evaluated the Strep B optical immunoassay (OIA; ThermoBiostar, Inc.) for detecting light and heavy group B streptococcus colonization in 1,306 pregnant women. The women were examined at 20 to 32 weeks gestation and were from six countries. Compared to culture, the sensitivity and specificity of OIA were 13.3 and 98.4%, respectively, for light colonization and 41.5 and 97.7%, respectively, for heavy colonization.
JAIDS Journal of Acquired Immune Deficiency Syndromes, 2003
A retrospective, blinded study was conducted to examine the prevalence of antiretroviral drug res... more A retrospective, blinded study was conducted to examine the prevalence of antiretroviral drug resistance among a cohort of HIV-infected infants born in 1998 and 1999 in New York State. The earliest available HIV-positive specimen was tested. Most samples were from infants younger than 60 days of age. Genotype data were generated for the protease and reverse transcriptase genes of HIV-1 proviral DNA from 91 infected infants. Eleven infants (12.1%) had provirus with mutations associated with drug resistance, with all three classes of antiretroviral drugs represented. Two infants (2.2%) had mutations associated with resistance to two classes of antiretrovirals. Perinatal antiretroviral drug exposure was examined; it was not found to be significantly associated with the presence of resistance mutations. However, for those infants who had perinatal antiretroviral exposure and genotypic evidence of drug resistance to HIV, the mutations that were detected correlated with at least one antiretroviral from the perinatal period. The prevalence of genotypic drug resistance among this infant cohort is comparable with that found among recently infected adults. These results suggest that resistance testing should be strongly considered for perinatally infected infants, at the earliest possible time point, to avoid use of antiretroviral drugs to which the infant has preexisting resistance.
JAIDS Journal of Acquired Immune Deficiency Syndromes, 2004
Perinatal HIV transmission has declined significantly in New York State (NYS) since implementatio... more Perinatal HIV transmission has declined significantly in New York State (NYS) since implementation of a 3-part regimen of zidovudine prophylaxis in the antenatal, intrapartum, and newborn periods. This study describes the factors associated with perinatal transmission in NYS from 1997 to 2000, the first 4 years of NYS&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s comprehensive program in which all HIV-exposed newborns were identified through universal HIV testing of newborns. This population-based observational study included all HIV-exposed newborns whose infection status was known and their mothers identified in NYS through the universal Newborn HIV Screening Program (NSP) from February 1997 to December 2000. Antepartum, intrapartum, newborn, and pediatric medical records of HIV-positive mothers/infants were reviewed for history of prenatal care, antiretroviral therapy (ART), and infant infection status. Risks associated with perinatal HIV transmission were examined. Perinatal HIV transmission declined significantly from 11.0% in 1997 to 3.7% in 2000 (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05). Prenatal ART was associated with a decline in perinatal HIV transmission both for monotherapy (5.8%, relative risk [RR] = 0.3, 95% confidence interval: 0.2%-0.5%) and combination therapy [2.4%, RR = 0.1, 95% confidence interval: 0.1%-0.2%) compared with no prenatal antiretroviral prophylaxis (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05). Public health policies to improve access to care for pregnant women and advances in clinical care, including receipt of appropriate preventive therapies, have contributed to declines in perinatal HIV transmission in NYS.
American Journal of Obstetrics and Gynecology, 2006
American Journal of Obstetrics and Gynecology, 2003
OBJECTIVE: To assess the concordance between prenatal sonographic diagnosis and prognosis for fet... more OBJECTIVE: To assess the concordance between prenatal sonographic diagnosis and prognosis for fetal cystic kidney disease (FCKD) and definitive urologic postnatal or pathologic diagnosis. STUDY DESIGN: Cases of FCKD diagnosed in utero by ultrasound at our institution and subsequently evaluated by a urologist at Dupont Children's Hospital or by a pathologist from 1991 to 2002 were retrospectively reviewed. Ultrasound diagnosis was established based on standard classification. Prenatal and postnatal prognosis was defined as good, fair, and poor. In pregnancy terminations, only diagnostic accuracy, and not prognosis, was considered. RESULTS: 28 cases were identified: 11 (39.3%) multicystic dysplastic kidney disease (MCDKD), 4 (14.3%) autosomal recessive polycystic kidney disease (ARPKD), 3 (11.7%) unilateral MCKD with contralateral urinary malformation, 4 (14.2%) cystic kidneys with obstructive uropathy, and 6 (14.3%) cystic kidneys associated with structural abnormalities and genetic syndromes. 12 (42.9%) had similar bilateral pathology, 5 (17.9%) had unilateral cystic disease with contralateral urologic malformation, and 11 (39.3%) were unilateral. Oligohydramnios in 5 cases and bilateral cystic disease in 6 were associated 100% and 83.3% with fetal loss. The accuracy of prenatal diagnosis confirmed by autopsy report in 10 cases and postnatal urologic diagnosis in 16 was 78%. Misdiagnoses were due to hyperechogenicity of MCDKD interpreted as ARPCKD in 2 cases and complex urologic malformations in 4. The prognosis established by the perinatologist was concordant in 19 cases (90.4%) with the urologic postnatal diagnosis. Fetal survival rate was 57.1%. CONCLUSION: The in utero diagnosis and clinical prognosis of FCKD made by the perinatologist had high accuracy and concordance with the postnatal diagnosis and prognosis made by pediatric urologists. Collaboration between pediatric urologists and perinatologists should be further developed to benefit the affected family.
American Journal of Obstetrics and Gynecology, 2003
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articles by Babu Cheku MD MPH
Papers by Babu Cheku MD MPH