Eyal Sivan - Academia.edu (original) (raw)

Papers by Eyal Sivan

American journal of obstetrics and gynecology, Jan 2, 2018

Persistently high rates of cesarean deliveries are cause for concern for physicians, patients, an... more Persistently high rates of cesarean deliveries are cause for concern for physicians, patients, and health systems. Prelabor assessment might be refined by identifying factors that help predict an individual patient's risk of cesarean delivery. Such factors may contribute to patient safety and satisfaction as well as health system planning and resource allocation. In an earlier study, neonatal head circumference was shown to be more strongly associated with delivery mode and other outcome measures, than neonatal birth weight. In the present study we aimed to evaluate the association of sonographically measured fetal head circumference measured within one week of delivery, with delivery mode. Multi-center electronic medical record-based study of birth outcomes of primiparous women with term (37-42 weeks) singleton fetuses presenting for ultrasound with fetal biometry within one week of delivery. Fetal head circumference and estimated fetal weight were correlated with maternal back...

American Journal of Obstetrics and Gynecology, 2016

Current Diabetes Reports, 2003

The Israel Medical Association journal : IMAJ, 2014

Homozygous carriers of factor V Leiden (FVL) have an up to 80-fold increased risk of venous throm... more Homozygous carriers of factor V Leiden (FVL) have an up to 80-fold increased risk of venous thrombosis, but the risk of obstetric complications in FVL homozygosity is unclear. To compare obstetric and thromboembolic complications among factor V Leiden (FVL) homozygous and heterozygous carriers treated with prophylactic dose anticoagulation during pregnancy. In this retrospective case-control study we performed a chart review for the years 2004-2010 of homozygous and heterozygous FVL carriers who were treated with low molecular weight heparin (LMWH) at a dose of 0.6 mg/kg/day during pregnancy. Adverse outcomes included thromboembolic and obstetric complications. A composite adverse obstetric outcome was defined as the presence of at least one of the following: late intrauterine fetal demise, severe intrauterine growth restriction (< 5th percentile), preeclampsia, and placental abruption. Pregnancy outcomes of homozygous and heterozygous FVL carriers were compared. We compared the ...

Current Diabetes Reports, 2005

Ultrasound in Obstetrics and Gynecology, 2000

El presente estudio tiene como objetivo conocer la problemática psicosocial y la calidad de vida ... more El presente estudio tiene como objetivo conocer la problemática psicosocial y la calidad de vida del indigente. La muestra estuvo conformada por 89 indigentes que circundan por la ciudad de Mérida a quienes se les aplicó la entrevista psicológica, como instrumento de recolección de datos. Fundamentalmente, los resultados demostraron que los grupos indigentes en nuestra ciudad, tienen una edad promedio de 40 años, son en su mayoría solteros, pertenecen al sexo masculino, están desempleados y poseen un nivel educativo equivalente a la primaria. Proceden de hogares violentos y desintegrados, tienen un bajo nivel de salud, predominando las conductas adictivas de alcoholismo y consumo de otras drogas. El grupo reflejó un nivel medio de satisfacción y felicidad, aunque la mayoría catalogó su condición negativamente, enfatizando sentimientos de tristeza y ansiedad. La depresión y disfunción social fueron reportados en menor escala. El desempleo resultó ser una variable asociada a la condición de indigencia. Finalmente, se ofrece una reflexión sobre la necesidad que existe de generar una respuesta social que MedULA,

Prenatal Diagnosis, 2003

Treatment of maternal hyperthyroidism during pregnancy is complicated by the lack of readily avai... more Treatment of maternal hyperthyroidism during pregnancy is complicated by the lack of readily available measures of the thyroid status of the fetus. The aim of this study is to describe the use of serial in utero ultrasound measurements of fetal thyroid in patients being treated for Graves&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; disease in pregnancy. Over a 24-month period, all pregnant women with Graves&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; disease attending our special Fetal Thyroid Unit were followed. Maternal thyroid status was assessed by thyroid function tests. Fetal thyroid size was measured serially by transvaginal ultrasonography between 14 and 17 weeks of gestation and by abdominal ultrasonography between 18 and 37 weeks of gestation in 20 women with Grave&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 disease. In 15 fetuses, thyroid width and circumference were within the 95% confidence interval of the normal population. In five fetuses, thyroid size was above the 95th percentile for gestational age. In three of them, thyroid size decreased concurrently with a decrease in maternal thionamide dosage, reaching normal range. These three fetuses were born euthyroid. In two fetuses, thyroid size was unaffected by a decrement in maternal drug dosage. Both had neonatal thyrotoxicosis at birth. Serial in utero ultrasonography measuring fetal thyroid size in mothers with Graves&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; disease can serve as an effective noninvasive tool for the early detection of enlarged fetal thyroid. These findings can be used to monitor the maternal antithyroid drug dosage, thereby preventing intrauterine hypothyroidism in some cases. When a dosage reduction does not cause a decrease in fetal thyroid size, transplacental passage of thyroid-stimulating antibodies causing fetal thyrotoxicosis should be suspected.

Journal of Perinatology, 2004

To compare the rate of adverse perinatal outcomes among women with gestational diabetes mellitus ... more To compare the rate of adverse perinatal outcomes among women with gestational diabetes mellitus (GDM), monitored by 1 versus 2 hourpostprandial glucose (PPG) measurements. METHODS: A total of 112 women diagnosed with GDM, by the criteria of Carpenter-Coustan, were included in the study population. Women were recruited from two different treatment settings, but were managed by the same team of health-care professionals using a standardized protocol. Allocation to treatment group was based on treatment setting. Glucose levels were measured fasting, and either 1 hour (1-hour monitoring group-target values <140 mg/dl) or 2 hours (2-hour monitoring grouptarget values <120 mg/dl) postprandially. Demographic data and perinatal outcomes were collected from their medical records. RESULTS: In all, 66 women were assigned to 1-hour monitoring group (1 h-PPG) and 46 women to 2-hour monitoring group (2 h-PPG). There were no differences in parity, family history of diabetes, rate of GDM in previous pregnancies, weight gain, pregestational BMI and 50-g-glucose challenge test (GCT) and 100-g oral glucose challenge test (OGTT) results. As expected, there was a significant difference in mean blood glucose levels between the two groups (108.1±19.2 and 94.9±21.2 mg/dl, 1-and 2 hours, respectively, p<0.0001); however, HbA1C levels were similar in the two groups. Perinatal outcomes were defined as gestational week at delivery; fetal weight (3325±471 vs 3309±608 g, respectively) and percentile (47.2±27 vs 49.6±30, respectively), and were similar for both groups. Insulin therapy was initiated more frequently in 2-hour monitoring group (28 and 40% of women in groups 1 and 2, respectively; p<0.05). Rates of macrosomia (7.5 versus 10.6%), large for gestational age (7.4 versus 15.2%), and delivery by cesarean section (24 versus 30%) were increased in group 2 (2 h-PPG) but these differences did not reach statistical significance. CONCLUSION: These data suggest that diet control in women with GDM managed by 1-hour PPG measurements is associated with a decreased rate of insulin therapy. However, neonatal and obstetrical outcomes are not determined by the timing of their glucose determinations.

Journal of Perinatology, 2007

Objective: Pregnancy is a unique situation characterized by insulin resistance. The role of adipo... more Objective: Pregnancy is a unique situation characterized by insulin resistance. The role of adiponectin, an insulin-sensitizing hormone, has not been completely clarified during pregnancy. The aim of this cross-sectional study was to evaluate adiponectin levels during pregnancy and postpartum. Study design: Adiponectin and leptin levels were tested in 80 pregnant women, 20 in each trimester (mean gestational age 10.5±1.9; 19.3±4.9; 39.3±0.8 weeks,) as well as 4 days postpartum. Results: Adiponectin levels during first (13.3±3.6 mg/ml), second (12.6±4.4 mg/ml) and third trimester (11.2±3.7 mg/ml) did not differ and were significantly higher than postpartum levels (8.8±2.1 mg/ml; P<0.0001, P<0.004 and P<0.02, respectively). Conclusion: Despite increased insulin resistance during pregnancy, no significant alterations in adiponectin levels were observed. This may imply that the regulation of adiponectin during gestation is altered. The elevated gestational adiponectin levels are consistent with increased 'adiponectin resistance' during pregnancy.

The Journal of Clinical Endocrinology & Metabolism, 1998

The purpose of this study was to determine whether elevation of plasma free fatty acids (FFA) in ... more The purpose of this study was to determine whether elevation of plasma free fatty acids (FFA) in early pregnancy would cause alterations in insulin-stimulated glucose disposal similar to those occurring in late gestation. Seven glucose-tolerant women underwent 4-h euglycemic hyperinsulinemic (1 mU/kg⅐min) clamping during the early second trimester of pregnancy (14-17 weeks) on 2 consecutive days, receiving either lipid (Liposyn II; 1.5 mL/min) and heparin (0.4 U/kg⅐min; L/H) or saline/glycerol (2.25 g/h; S/G) infusions. Rates of total body glucose disposal (6,6-2 H 2 glucose) and of carbohydrate and fat oxidation (indirect calorimetry) were determined at hourly intervals. Blood glucose was clamped at about 85 mg/dL. Plasma FFA increased from 290 Ϯ 50 to 1000 Ϯ 139 mol/L during L/H infusion

The Journal of Clinical Endocrinology & Metabolism, 2009

Discordant twin gestation, in which one fetus is growth restricted, is a unique model that can el... more Discordant twin gestation, in which one fetus is growth restricted, is a unique model that can elucidate the mechanism(s) by which the intrauterine environment affects fetal growth. Objective: The objective of the study was to determine the cord blood adiponectin and leptin concentrations and evaluate their association with birth weight in dichorionic twins, with and without growth discordance. Design, Setting, Participants, and Main Outcome Measure: In this cross-sectional study, arterial cord blood adiponectin and leptin concentrations were determined in two groups of newborns: 1) discordant twins, in which one of the twins is growth restricted (small for gestation age and abnormal umbilical arteries Doppler) and the other is appropriate for gestation age (AGA) (n ϭ 14 pairs); and 2) concordant twins, in which both twins are AGA (n ϭ 15 pairs). Results: Results were: 1) within the discordant twins group, the median adiponectin concentration was significantly lower in the growth-restricted newborns than in their cotwins (P ϭ 0.004); 2) within the concordant twin group, there was no significant difference in the median cord blood adiponectin concentration between the two AGA twins; 3) the median leptin concentration did not differ between the twins pairs in both study groups; 4) a positive correlation between cord blood adiponectin concentrations and both birth weight (r ϭ 0.7, P Ͻ 0.001) and gestational age (r ϭ 0.6, P Ͻ 0.02) was found only in the small-for-gestational-age newborns; 5) linear regression model revealed that birth weight is independently associated with circulating adiponectin concentration. Conclusions: Low circulating adiponectin concentrations, previously reported in adults, children, and infants who were born small for gestational age, characterize fetuses with growth restriction and are independently associated with birth weight. (J Clin Endocrinol Metab 94: 892-898, 2009) N umerous independent studies have revealed an association between newborns born small for gestational age (SGA) and subsequent metabolic complications such as insulin resistance, obesity, and other components of the metabolic syndrome (1-3). It is hypothesized that fetal adaptation to an adverse intrauterine environment determines an altered programming of endocrine pathways that predisposes these individuals to develop metabolic complications (4). However, the specific mech-anism(s) by which hostile uterine environment affects metabolic pathways has eluded elucidation. Adiponectin, the most abundant gene product (AMP1) of adipose tissue, is an antiinflammatory, antiatherogenic, adipocyte-derived plasma protein with a profound insulin-sensitizing effect (5-8). Circulating concentrations of adiponectin are paradoxically lower in obese than nonobese individuals (5, 9). In addition, weight reduction is associated with an increase in cir

Gynecological Endocrinology, 2011

Early postpartum period is characterised by a dramatic decrease in insulin resistance and signifi... more Early postpartum period is characterised by a dramatic decrease in insulin resistance and significant metabolic alterations. The aims of this study were to determine the changes in circulating maternal concentrations of total adiponectin, adiponectin multimers, leptin and resistin before and after the delivery and to explore their relationship with insulin sensitivity. Twenty-seven normal pregnant women at term were included in this longitudinal study. Blood samples were taken before and 4 days after elective caesarean section. Total adiponectin, adiponectin multimers, leptin, resistin, glucose, insulin and prolactin were measured in maternal serum. Adiponectin multimers were measured before and after the delivery in eight women. (1) The mean maternal serum total adiponectin concentration was significantly higher before than after delivery while the relative distribution of circulating maternal adiponectin multimers did not change after delivery; (2) the median maternal serum concentration of leptin was significantly higher in the antepartum than in the postpartum period; (3) the median maternal serum resistin concentration was comparable before and after delivery; (4) multiple linear regression analysis revealed that antepartum insulin sensitivity was associated with maternal low body mass index, and low glucose concentrations in glucose challenge test, as well as with maternal age and increased leptin concentrations. Postpartum insulin sensitivity was associated with decreased circulating resistin concentrations. Despite increase in insulin sensitivity, early postpartum period is characterised by a decrease in maternal circulating total adiponectin and by steady concentrations of resistin and adiponectin multimers compared to the late third trimester.

Fertility and Sterility, 2004

There was no difference in the rate of pregnancies containing monozygotic twins after zona pelluc... more There was no difference in the rate of pregnancies containing monozygotic twins after zona pellucida micromanipulation procedures (0.9%) compared to conventional insemination (1.0%) (6/677 vs. 4/389). (Fertil Steril 2004;82:500-1. ©2004 by American Society for Reproductive Medicine.) Monozygotic multiple gestation is of great concern because of an associated increase in neonatal morbidity and mortality. Perinatal mortality risk among monozygotic twins (MZT) has been reported to be two to three times higher than the risk among dizygotic twins. The MZT results from the division of a single fertilized ovum into two genetically identical embryos, and is thought to occur in 0.42% of all deliveries (1). Calculating the rate of embryos that divided into MZT, 0.25% (6/2,363) of the embryos in the ZP micromanipulation group ended in MZT compared to 0.28% (4/1,437) of the embryos in the control group (not

Diabetes Care, 1995

OBJECTIVE To determine the possibility of an ethnic influence on the development of macrosomia (b... more OBJECTIVE To determine the possibility of an ethnic influence on the development of macrosomia (birth weight > 90th percentile for gestational age) in gestational diabetes mellitus (GDM). RESEARCH DESIGN AND METHODS We prospectively followed all African-American and Latino women enrolled in the Temple diabetes-in-pregnancy program. GDM was diagnosed in 103 African-American and 36 Latino women during the study period (1991–1994) according to the criteria of Carpenter and Coustan. All women were treated according to our previously published protocols. Data were collected on gestational weight gain, previous history of macrosomia, body mass index (BMI), and level of maternal glycemic control. RESULTS Insulin therapy was required in 53 women (37.5%) to maintain fasting blood glucose levels at < 95 mg/dl and 2-h postprandial levels at < 120 mg/dl. Macrosomia developed in 50% of the neonates of Latino women versus 19% of neonates of African-American women (relative risk 2.68; 95%...

Diabetes, 1997

It has recently been reported that the ob gene receptor was expressed on human and murine hematop... more It has recently been reported that the ob gene receptor was expressed on human and murine hematopoietic stem cells and that the ob gene product leptin stimulated hemato-and lymphopoiesis at the stem cell level. These findings suggest a role for leptin in hemato-and lymphopoiesis during fetal development. There is at present no evidence, however, that leptin is synthesized and released by the fetus. To investigate this possibility, we have measured plasma leptin concentrations in the cord blood of 78 newborn infants. We found that leptin was present in all 78 infants in concentrations comparable with those found in adults (0.6-55.7 ng/ml). Overall, plasma leptin concentrations in the cord blood of infants correlated with birth weight (r = 0.74, P < 0.001). These observations show that leptin is synthesized and released by fetal fat cells. In addition, they are compatible with the concept that leptin may play a role in human fetal hematopoiesis. Diabetes 46:917-919, 1997

Clinical Endocrinology, 2006

To validate the use of the homeostasis model assessment (HOMA) for measurement of insulin sensiti... more To validate the use of the homeostasis model assessment (HOMA) for measurement of insulin sensitivity in obese women during gestation and the postpartum period. Three consecutive measurements of insulin resistance (IR) were performed during and after pregnancy to compare the homeostasis model assessment insulin sensitivity index (HOMA-IR) to glucose utilization rates obtained during hyperinsulinaemic euglycaemic clamps (G(Rd)). Six obese women (mean second trimester BMI = 30.4 kg/m(2)) with normal glucose tolerance were studied during the second and third trimesters of pregnancy and once in the postpartum period. Thus, there were a total of 18 measurements for analysis. Correlations between the rate of glucose disappearance (G(Rd)) (the gold standard) and the HOMA-derived metabolic parameters of insulin sensitivity were significant, with a multiple R(2) of 43.5% (P = 0.003). However, when controlling for variations between patients using dummy variables, we observed that one patient differed from the other five in the relationship between G(Rd) and HOMA-IR. Applying this regression we obtained a R(2) of 72.6% (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;lt; 0.001). When the regression constant was omitted, we observed that the individual trends during pregnancy and postpartum in two patients differed statistically from the other patients between the two assessments, and we obtained a multiple R(2) of 97.3% (&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; 0.001). HOMA estimation of insulin resistance is appropriate for use during both the second and third trimesters of pregnancy and postpartum in obese women with normal glucose tolerance. It lacks sensitivity for the evaluation of individuals, where more precise measures of insulin sensitivity should be utilized.

American Journal of Perinatology, 2005

Phosphorylated insulin-like growth factor binding protein-1 (phIGFBP-1) is secreted by decidual c... more Phosphorylated insulin-like growth factor binding protein-1 (phIGFBP-1) is secreted by decidual cells and may leak into cervical secretions during detachment of the fetal membrane. The aim of this study was to determine whether a rapid bedside test for phIGFBP-1 predicts preterm birth in women with preterm uterine contractions. This was a prospective study of pregnant women who sought medical care for symptoms of preterm labor. Cervical swabs were assayed for the presence of phIGFBP-1 by a rapid bedside test. Sixty-four patients were enrolled. Eleven of them (17%) delivered preterm (&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; 35 weeks). phIGFBP-1 in cervical secretions predicted preterm birth with a sensitivity of 72.7%, a specificity of 83.0%, a positive predictive value of 47.0%, and negative predictive value of 93.6%. Positive phIGFBP-1 bedside test in women with preterm uterine contractions may indicate a significant risk for subsequent preterm birth. The absence of phIGBP-1 is a reassuring sign that the likelihood of preterm birth is low.

American Journal of Perinatology, 2003

The objective of this study is to identify the risk factors for neonatal thrombocytopenia among p... more The objective of this study is to identify the risk factors for neonatal thrombocytopenia among preterm infants. During a 4-year study period all consecutive, singleton preterm deliveries (between 27 and 35 weeks of gestation) were evaluated, and separate cohorts were compared-growth restricted (small-for-gestational-age; SGA) and appropriately grown (appropriate-for-gestational-age; AGA) infants. An initial comparison was done for the presence of thrombocytopenia (platelet count below 150,000/mL) and marked thrombocytopenia (below 100,000/mL). Following that, a comparison was made between the groups as determined by platelet count for various possible risk factors. Three hundred and five preterm infants were included in the study. Mean platelet count was significantly lower in the SGA group (p = 0.0009). Ninety-three neonates (31%) were thrombocytopenic and 212 infants with a normal platelet count served as controls. In the thrombocytopenic group, the rate of preeclampsia was significantly higher (p = 0.002). Thrombocytopenic infants had a significantly lower average gestational age at delivery (p = 0.002), lower birth weight (p = 0.0001), and low 5-minute Apgar score (p = 0.0002). They were more likely to suffer from intraventricular hemorrhage (IVH) ( p = 0.04) and sepsis (p = 0.002). Growth restriction, lower gestational age and low 5-minute Apgar score (&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;7) were found to be significantly independent risk factors for marked thrombocytopenia, when analyzed separately. Growth restriction, lower gestational age at delivery, and low 5-minutes Apgar score are significantly associated with neonatal thrombocytopenia in preterm infants, which may lead to significant morbidity. Screening these high-risk groups for thrombocytopenia might be beneficial in terms of early diagnosis and management.

American Journal of Obstetrics and Gynecology, 2001

OBJECTIVE: This study was undertaken to compare the rate of abnormal glucose levels measured afte... more OBJECTIVE: This study was undertaken to compare the rate of abnormal glucose levels measured after 1 hour (>140 mg%) with those measured after 2 hours (>120 mg%) postprandially in women with gestational diabetes mellitus (GDM). STUDY DESIGN: Sixty-eight women were included in this study. All had GDM based on the criteria of Carpenter-Coustan. Women with fasting glucose levels of 105 mg% or more were excluded from the study. All women were initially treated by diet. All women measured daily capillary blood glucose levels when fasting as well as 1 hour and 2 hours postprandially for 1 week, immediately after diagnosis of GDM. Glucose levels were obtained by memory-based glucometers. All women were followed in a specialized gestational-diabetes clinic throughout the pregnancy. Insulin therapy was started on an individual basis according to common clinical criteria. Epidemiologic and perinatal data were collected from medical charts. RESULTS: The average age of the women was 30.8 ± 5.4 years. Thirty-five percent of participants were primipara. The mean gestational age at diagnosis was 28.8 ± 5.4 weeks. Glucose measurements included 618 readings during fasting and 2730 either 1 hour or 2 hours postprandial. Rates of abnormal glucose (>95 mg% when fasting; >140 mg% 1 hour or >120 mg% 2 hours after each meal) per person were the following: fasting, 27.1% abnormal glucose measurements; postbreakfast, 22.4% abnormal levels after 1 and 8.5% after 2 hours (P <.01); postlunch, 16.4% abnormal levels after 1 hour and 18.2% after 2 hours (not significant); postdinner, 16.3% abnormal levels after 1 hour and 30.1% after 2 hours (P <.01). CONCLUSION: The rate of abnormal values was 2.5-fold greater 1 hour postbreakfast than 2 hours postbreakfast, in contrast to an opposite ratio of a 2-fold increase in the rate of abnormal values 2 hours postdinner versus 1 hour postdinner. Therefore, differential measurement (1 hour after breakfast and 2 hours after dinner) might impose stricter criteria for controlling blood glucose levels. Further clinical research should explore whether differential measurements might reduce the rate of diabetes-associated complications.

American Journal of Obstetrics and Gynecology, 2005

The purpose of this study was to evaluate the relationship between pre-pregnancy maternal body ma... more The purpose of this study was to evaluate the relationship between pre-pregnancy maternal body mass index (mBMI) and the risk of subsequent low birth weight (LBW) at term. STUDY DESIGN: This is an analysis of data from a single institution from 1996 to 2004. Data was collected by chart review at the time of discharge and maintained in an electronic database. We included only those who delivered their 1st and 2nd pregnancies at our institution, and delivered a term singleton infant in both pregnancies. Pre-pregnancy mBMI's were calculated for the 1st and 2nd deliveries. We evaluated the impact of mBMI on birth weight (BWT) and LBW (BWT ! 2500 grams). The impact of LBW in the 1st pregnancy on the rate of subsequent LBW was also assessed. We also evaluated change in mBMI between pregnancies to determine if weight gain or oss altered the risk of subsequent LBW. A p!0.05 was considered significant. RESULTS: 1,029 women met our inclusion criteria. We found a positive correlation between BWT in the 1st and 2nd pregnancies (p! 0.0001, R 2 =0.24). Increasing mBMI was associated with increasing BWT (p!0.0001) in the first pregnancy. Women delivering a LBW infant in the 1st pregnancy were more likely to have LBW in the 2nd pregnancy (14.3 vs. 3.9%, relative risk 3.7, p = 0.02). Overall the risk of LBW in the 2nd pregnancy did not change with increasing or decreasing mBMI between pregnancies (p = 0.17). After controlling for LBW in the 1st pregnancy (p = 0.005), and pregravid mBMI (p = 0.06), risk of LBW in the 2nd pregnancy was not altered by change in mBMI (ANOVA, p = 0.36). CONCLUSION: Though LBW at term is associated with low mBMI and a prior LBW delivery, change in mBMI between pregnancies does not alter this risk.