S. Carr - Academia.edu (original) (raw)

Papers by S. Carr

Research paper thumbnail of 121: Extremes of fetal growth are associated with spontaneous preterm birth

American Journal of Obstetrics and Gynecology, 2007

Research paper thumbnail of The effect of low body mass index on the development of gestational hypertension and preeclampsia

Journal of Maternal-Fetal and Neonatal Medicine, 2007

To evaluate the relationship between low maternal body mass index (BMI) as calculated in the firs... more To evaluate the relationship between low maternal body mass index (BMI) as calculated in the first trimester and the risk of preeclampsia and gestational hypertension. Patients enrolled in the First And Second Trimester Evaluation of Risk for aneuploidy (FASTER) trial were grouped into three weight categories: low BMI (BMI <19.8 kg/m2), normal BMI (BMI 19.8 - 26 kg/m2), and overweight BMI (26.1 - 29 kg/m2). The incidences of gestational hypertension and preeclampsia were ascertained for each group. Tests for differences in crude incidence proportions were performed using Chi-square tests. Multiple logistic regression was used to adjust for maternal age, race, parity, obesity, use of assisted reproductive technology (ART), in vitro fertilization (IVF), gestational diabetes, pre-gestational diabetes, cocaine use, and smoking. The proportion of patients having gestational hypertension in the low BMI group was 2.0% compared to 3.2% for normal BMI and 6.0% for overweight BMI (p < 0.0001). Women with low BMI were also less likely to develop preeclampsia, 1.1% vs. 1.9% for normal BMI and 2.8% for overweight BMI (p < 0.0001). We found that women with low BMI in the first trimester were significantly less likely to develop gestational hypertension or preeclampsia than women with a normal BMI.

Research paper thumbnail of Preconceptional Folate Supplementation and the Risk of Spontaneous Preterm Birth: A Cohort Study

PLoS Medicine, 2009

Background: Low plasma folate concentrations in pregnancy are associated with preterm birth. Here... more Background: Low plasma folate concentrations in pregnancy are associated with preterm birth. Here we show an association between preconceptional folate supplementation and the risk of spontaneous preterm birth.

Research paper thumbnail of Fetal growth in early pregnancy and risk of delivering low birth weight infant: prospective cohort study

BMJ, 2007

Objective To determine if first trimester fetal growth is associated with birth weight, duration ... more Objective To determine if first trimester fetal growth is associated with birth weight, duration of pregnancy, and the risk of delivering a small for gestational age infant. Design Prospective cohort study of 38 033 pregnancies between 1999 and 2003. Setting 15 centres representing major regions of the United States. Participants 976 women from the original cohort who conceived as the result of assisted reproductive technology, had a first trimester ultrasound measurement of fetal crown-rump length, and delivered live singleton infants without evidence of chromosomal or congenital abnormalities. First trimester growth was expressed as the difference between the observed and expected size of the fetus, expressed as equivalence to days of gestational age. Main outcome measures Birth weight, duration of pregnancy, and risk of delivering a small for gestational age infant. Results For each one day increase in the observed size of the fetus, birth weight increased by 28.2 (95% confidence interval 14.6 to 41.2) g. The association was substantially attenuated by adjustment for duration of pregnancy (adjusted coefficient 17.1 (6.6 to 27.5) g). Further adjustments for maternal characteristics and complications of pregnancy did not have a significant effect. The risk of delivering a small for gestational age infant decreased with increasing size in the first trimester (odds ratio for a one day increase 0.87, 0.81 to 0.94). The association was not materially affected by adjustment for maternal characteristics or complications of pregnancy. Conclusion Variation in birth weight may be determined, at least in part, by fetal growth in the first 12 weeks after conception through effects on timing of delivery and fetal growth velocity.

Research paper thumbnail of Preconception multivitamin or folic acid consumption and pregnancy outcome: A population-based screening study

American Journal of Obstetrics and Gynecology, 2006

OBJECTIVE: The STAN fetal monitoring system (Neoventa Medical, Molndal, Sweden) combines fetal EC... more OBJECTIVE: The STAN fetal monitoring system (Neoventa Medical, Molndal, Sweden) combines fetal ECG analysis with standard fetal heart rate (FHR) pattern interpretation. We present the effects of increasing usage of the STAN fetal monitoring system on clinical practice and outcomes in a Swedish obstetric population over a 5-year period.

Research paper thumbnail of Early pregnancy growth determines low birth weight

American Journal of Obstetrics and Gynecology, 2006

OBJECTIVE: To evaluate the acceptability of sequential first and second trimester screening for D... more OBJECTIVE: To evaluate the acceptability of sequential first and second trimester screening for Down syndrome (DS) and trisomy 18 (T18).

Research paper thumbnail of Is there a nuchal translucency measurement above which there is no added benefit from serum screening?

American Journal of Obstetrics and Gynecology, 2005

OBJECTIVE: Reactive oxygen species (ROS) are produced in excess during inflammation as well as du... more OBJECTIVE: Reactive oxygen species (ROS) are produced in excess during inflammation as well as during ischemia/reperfusion and can damage neurons and myelin therefore is implicated as major mediators of perinatal brain injury. A pressing clinical question is whether blunting the effects of ROS in patients with documented infection or birth asphyxia can prevent or reduce brain injury. Two agents (melatonin and N-acetylcysteine (NAC)) with potent scavenging properties have been considered safe during pregnancy and, therefore, may have therapeutic value in humans. The purpose of this study was to determine whether these agents can provide neuroprotection against perinatal brain injury caused by the administration of lipopolysaccharide (LPS) sensitized hypoxia-ischemia (HI) animals.

Research paper thumbnail of Faster growth of male fetuses in first trimester of pregnancy

American Journal of Obstetrics and Gynecology, 2006

OBJECTIVE: Excess secretion of soluble fms-like tyrosine kinase-1 (sFlt-1) and interaction with p... more OBJECTIVE: Excess secretion of soluble fms-like tyrosine kinase-1 (sFlt-1) and interaction with placental growth factor (PlGF) may mediate the genesis of preeclampsia. Cigarette smoking reduces the risk of preeclampsia, leading us to hypothesize that smoking may reduce sFlt-1 secretion. We have previously shown that smoke extract reduces sFlt-1 secretion by placental explants cultured in ambient oxygen. However, hypoxia stimulates sFlt-1 secretion. Hence, the objective of this study was to measure sFlt-1 and PlGF from placental explants exposed to cigarette smoke extract under hypoxic conditions. STUDY DESIGN: Smoke extract (SM) was prepared by drawing air through lit cigarettes into culture media and nicotine level verified by HPLC. Placentae were obtained at term with IRB approval. Villous explants were cultured in DMEM/F12 with 10% FCS at 2, 10 and 20% oxygen and treated with SM for 72 hours. Media was collected at 24 hr intervals and stored at À20 C until analyzed for sFlt-1 and PlGF using an ELISA. Results are reported as sFlt-1 or PlGF pg/ml/mg explant wet weight. Mean values represent N=4/group G SE. ANOVA was performed and significance was at p!0.05*.

Research paper thumbnail of 5: Preconceptional folate prevents preterm delivery

American Journal of Obstetrics and Gynecology, 2007

Research paper thumbnail of The contribution of birth defects to prematurity and low birthweight in a population-based screening study (The FASTER Trial)

American Journal of Obstetrics and Gynecology, 2004

OBJECTIVE: Previous reports document an increase in adverse perinatal outcomes, including FD, in ... more OBJECTIVE: Previous reports document an increase in adverse perinatal outcomes, including FD, in obese women. However, there are few data regarding FD and maternal obesity in mid-pregnancy. The purpose of this study was to identify FD rates from 20 weeks onward in overweight and obese women in the state of Utah.

Research paper thumbnail of Dating of pregnancy using last menstrual period, crown-rump length, or second-trimester ultrasound biometry: results from the faster trial

American Journal of Obstetrics and Gynecology, 2003

Research paper thumbnail of Assisted reproductive technology and pregnancy outcome–a population based screening study (the faster trial)

American Journal of Obstetrics and Gynecology, 2003

OBJECTIVE: To evaluate perinatal morbidity and mortality near the limit of viability over time, a... more OBJECTIVE: To evaluate perinatal morbidity and mortality near the limit of viability over time, and the impact of aggressive obstetric and neonatal intervention on neonatal outcomes.

Research paper thumbnail of The effect of maternal prednisone use on second-trimester maternal serum unconjugated estriol levels—Results from the FASTER trial

American Journal of Obstetrics and Gynecology, 2004

OBJECTIVE: Fetal inflammatory response has been demonstrated to be involved in the pathogenesis o... more OBJECTIVE: Fetal inflammatory response has been demonstrated to be involved in the pathogenesis of preterm birth (PTB). We have previously reported on the role of Fas/Fas ligand (FasL) signal pathway of apoptosis in PTB. Subsequently we investigated the association between polymorphisms at position -670 in the Fas gene and position -124 in the FasL gene demonstrated in neonatal oral mucosa cells and PTB.

Research paper thumbnail of The effect of maternal smoking on maternal serum analyte levels and down syndrome screen positivity—Results from the FASTER trial

American Journal of Obstetrics and Gynecology, 2004

OBJECTIVE: The most common aneuploidies involve chromosomes 21, 18, 13, X and Y. Currently, prena... more OBJECTIVE: The most common aneuploidies involve chromosomes 21, 18, 13, X and Y. Currently, prenatal diagnosis of aneuploidy is based on complete chromosomal analysis of cultured amniocytes requiring at least two weeks. FISH may offer rapid results but is time-consuming and cumbersome. Quantitative fluorescence polymerase chain reaction (QF-PCR) is a rapid method for the detection of chromosome copy number by amplification of repeat sequences at chromosome-specific polymorphic loci. Our objective was to assess the performance of QF-PCR in prenatal diagnosis of aneuploidy.

Research paper thumbnail of The association between first-trimester maternal serum PAPP-A and free beta-hCG concentrations and obstetric complications—a population-based screening study (the faster trial)

American Journal of Obstetrics and Gynecology, 2003

Research paper thumbnail of Intrauterine therapy for homozygous a-thalassemia

Obstet Gynecol, 1995

Background: Alpha-thalassemia is one of the most common genetic disorders in the world and is bec... more Background: Alpha-thalassemia is one of the most common genetic disorders in the world and is becoming more common in the United States with the increase in immigration of susceptible populations. This disease has been stated previously to be incompatible with extrauterine life.Case: A Filipino woman with a prior loss due to hemoglobin Bart's underwent prenatal diagnosis that confirmed recurrence in the index pregnancy. Intravascular intrauterine exchange transfusions maintained appropriate fetal growth.A cesarean delivery yielded a 2190-g male infant with minor malformations. The postnatal course was characterized by mild respiratory insufficiency. Postnatal chronic transfusion therapy is underway pending consideration for bone marrow transplantation.Conclusion: Antenatal diagnosis and therapy of homozygous a-thalassemia can prevent the prenatal consequences of hydrops and fetal death. New technologies such as stem cell transplantation may help to avert both prenatal and postnatal consequences.

Research paper thumbnail of 121: Extremes of fetal growth are associated with spontaneous preterm birth

American Journal of Obstetrics and Gynecology, 2007

Research paper thumbnail of The effect of low body mass index on the development of gestational hypertension and preeclampsia

Journal of Maternal-Fetal and Neonatal Medicine, 2007

To evaluate the relationship between low maternal body mass index (BMI) as calculated in the firs... more To evaluate the relationship between low maternal body mass index (BMI) as calculated in the first trimester and the risk of preeclampsia and gestational hypertension. Patients enrolled in the First And Second Trimester Evaluation of Risk for aneuploidy (FASTER) trial were grouped into three weight categories: low BMI (BMI <19.8 kg/m2), normal BMI (BMI 19.8 - 26 kg/m2), and overweight BMI (26.1 - 29 kg/m2). The incidences of gestational hypertension and preeclampsia were ascertained for each group. Tests for differences in crude incidence proportions were performed using Chi-square tests. Multiple logistic regression was used to adjust for maternal age, race, parity, obesity, use of assisted reproductive technology (ART), in vitro fertilization (IVF), gestational diabetes, pre-gestational diabetes, cocaine use, and smoking. The proportion of patients having gestational hypertension in the low BMI group was 2.0% compared to 3.2% for normal BMI and 6.0% for overweight BMI (p < 0.0001). Women with low BMI were also less likely to develop preeclampsia, 1.1% vs. 1.9% for normal BMI and 2.8% for overweight BMI (p < 0.0001). We found that women with low BMI in the first trimester were significantly less likely to develop gestational hypertension or preeclampsia than women with a normal BMI.

Research paper thumbnail of Preconceptional Folate Supplementation and the Risk of Spontaneous Preterm Birth: A Cohort Study

PLoS Medicine, 2009

Background: Low plasma folate concentrations in pregnancy are associated with preterm birth. Here... more Background: Low plasma folate concentrations in pregnancy are associated with preterm birth. Here we show an association between preconceptional folate supplementation and the risk of spontaneous preterm birth.

Research paper thumbnail of Fetal growth in early pregnancy and risk of delivering low birth weight infant: prospective cohort study

BMJ, 2007

Objective To determine if first trimester fetal growth is associated with birth weight, duration ... more Objective To determine if first trimester fetal growth is associated with birth weight, duration of pregnancy, and the risk of delivering a small for gestational age infant. Design Prospective cohort study of 38 033 pregnancies between 1999 and 2003. Setting 15 centres representing major regions of the United States. Participants 976 women from the original cohort who conceived as the result of assisted reproductive technology, had a first trimester ultrasound measurement of fetal crown-rump length, and delivered live singleton infants without evidence of chromosomal or congenital abnormalities. First trimester growth was expressed as the difference between the observed and expected size of the fetus, expressed as equivalence to days of gestational age. Main outcome measures Birth weight, duration of pregnancy, and risk of delivering a small for gestational age infant. Results For each one day increase in the observed size of the fetus, birth weight increased by 28.2 (95% confidence interval 14.6 to 41.2) g. The association was substantially attenuated by adjustment for duration of pregnancy (adjusted coefficient 17.1 (6.6 to 27.5) g). Further adjustments for maternal characteristics and complications of pregnancy did not have a significant effect. The risk of delivering a small for gestational age infant decreased with increasing size in the first trimester (odds ratio for a one day increase 0.87, 0.81 to 0.94). The association was not materially affected by adjustment for maternal characteristics or complications of pregnancy. Conclusion Variation in birth weight may be determined, at least in part, by fetal growth in the first 12 weeks after conception through effects on timing of delivery and fetal growth velocity.

Research paper thumbnail of Preconception multivitamin or folic acid consumption and pregnancy outcome: A population-based screening study

American Journal of Obstetrics and Gynecology, 2006

OBJECTIVE: The STAN fetal monitoring system (Neoventa Medical, Molndal, Sweden) combines fetal EC... more OBJECTIVE: The STAN fetal monitoring system (Neoventa Medical, Molndal, Sweden) combines fetal ECG analysis with standard fetal heart rate (FHR) pattern interpretation. We present the effects of increasing usage of the STAN fetal monitoring system on clinical practice and outcomes in a Swedish obstetric population over a 5-year period.

Research paper thumbnail of Early pregnancy growth determines low birth weight

American Journal of Obstetrics and Gynecology, 2006

OBJECTIVE: To evaluate the acceptability of sequential first and second trimester screening for D... more OBJECTIVE: To evaluate the acceptability of sequential first and second trimester screening for Down syndrome (DS) and trisomy 18 (T18).

Research paper thumbnail of Is there a nuchal translucency measurement above which there is no added benefit from serum screening?

American Journal of Obstetrics and Gynecology, 2005

OBJECTIVE: Reactive oxygen species (ROS) are produced in excess during inflammation as well as du... more OBJECTIVE: Reactive oxygen species (ROS) are produced in excess during inflammation as well as during ischemia/reperfusion and can damage neurons and myelin therefore is implicated as major mediators of perinatal brain injury. A pressing clinical question is whether blunting the effects of ROS in patients with documented infection or birth asphyxia can prevent or reduce brain injury. Two agents (melatonin and N-acetylcysteine (NAC)) with potent scavenging properties have been considered safe during pregnancy and, therefore, may have therapeutic value in humans. The purpose of this study was to determine whether these agents can provide neuroprotection against perinatal brain injury caused by the administration of lipopolysaccharide (LPS) sensitized hypoxia-ischemia (HI) animals.

Research paper thumbnail of Faster growth of male fetuses in first trimester of pregnancy

American Journal of Obstetrics and Gynecology, 2006

OBJECTIVE: Excess secretion of soluble fms-like tyrosine kinase-1 (sFlt-1) and interaction with p... more OBJECTIVE: Excess secretion of soluble fms-like tyrosine kinase-1 (sFlt-1) and interaction with placental growth factor (PlGF) may mediate the genesis of preeclampsia. Cigarette smoking reduces the risk of preeclampsia, leading us to hypothesize that smoking may reduce sFlt-1 secretion. We have previously shown that smoke extract reduces sFlt-1 secretion by placental explants cultured in ambient oxygen. However, hypoxia stimulates sFlt-1 secretion. Hence, the objective of this study was to measure sFlt-1 and PlGF from placental explants exposed to cigarette smoke extract under hypoxic conditions. STUDY DESIGN: Smoke extract (SM) was prepared by drawing air through lit cigarettes into culture media and nicotine level verified by HPLC. Placentae were obtained at term with IRB approval. Villous explants were cultured in DMEM/F12 with 10% FCS at 2, 10 and 20% oxygen and treated with SM for 72 hours. Media was collected at 24 hr intervals and stored at À20 C until analyzed for sFlt-1 and PlGF using an ELISA. Results are reported as sFlt-1 or PlGF pg/ml/mg explant wet weight. Mean values represent N=4/group G SE. ANOVA was performed and significance was at p!0.05*.

Research paper thumbnail of 5: Preconceptional folate prevents preterm delivery

American Journal of Obstetrics and Gynecology, 2007

Research paper thumbnail of The contribution of birth defects to prematurity and low birthweight in a population-based screening study (The FASTER Trial)

American Journal of Obstetrics and Gynecology, 2004

OBJECTIVE: Previous reports document an increase in adverse perinatal outcomes, including FD, in ... more OBJECTIVE: Previous reports document an increase in adverse perinatal outcomes, including FD, in obese women. However, there are few data regarding FD and maternal obesity in mid-pregnancy. The purpose of this study was to identify FD rates from 20 weeks onward in overweight and obese women in the state of Utah.

Research paper thumbnail of Dating of pregnancy using last menstrual period, crown-rump length, or second-trimester ultrasound biometry: results from the faster trial

American Journal of Obstetrics and Gynecology, 2003

Research paper thumbnail of Assisted reproductive technology and pregnancy outcome–a population based screening study (the faster trial)

American Journal of Obstetrics and Gynecology, 2003

OBJECTIVE: To evaluate perinatal morbidity and mortality near the limit of viability over time, a... more OBJECTIVE: To evaluate perinatal morbidity and mortality near the limit of viability over time, and the impact of aggressive obstetric and neonatal intervention on neonatal outcomes.

Research paper thumbnail of The effect of maternal prednisone use on second-trimester maternal serum unconjugated estriol levels—Results from the FASTER trial

American Journal of Obstetrics and Gynecology, 2004

OBJECTIVE: Fetal inflammatory response has been demonstrated to be involved in the pathogenesis o... more OBJECTIVE: Fetal inflammatory response has been demonstrated to be involved in the pathogenesis of preterm birth (PTB). We have previously reported on the role of Fas/Fas ligand (FasL) signal pathway of apoptosis in PTB. Subsequently we investigated the association between polymorphisms at position -670 in the Fas gene and position -124 in the FasL gene demonstrated in neonatal oral mucosa cells and PTB.

Research paper thumbnail of The effect of maternal smoking on maternal serum analyte levels and down syndrome screen positivity—Results from the FASTER trial

American Journal of Obstetrics and Gynecology, 2004

OBJECTIVE: The most common aneuploidies involve chromosomes 21, 18, 13, X and Y. Currently, prena... more OBJECTIVE: The most common aneuploidies involve chromosomes 21, 18, 13, X and Y. Currently, prenatal diagnosis of aneuploidy is based on complete chromosomal analysis of cultured amniocytes requiring at least two weeks. FISH may offer rapid results but is time-consuming and cumbersome. Quantitative fluorescence polymerase chain reaction (QF-PCR) is a rapid method for the detection of chromosome copy number by amplification of repeat sequences at chromosome-specific polymorphic loci. Our objective was to assess the performance of QF-PCR in prenatal diagnosis of aneuploidy.

Research paper thumbnail of The association between first-trimester maternal serum PAPP-A and free beta-hCG concentrations and obstetric complications—a population-based screening study (the faster trial)

American Journal of Obstetrics and Gynecology, 2003

Research paper thumbnail of Intrauterine therapy for homozygous a-thalassemia

Obstet Gynecol, 1995

Background: Alpha-thalassemia is one of the most common genetic disorders in the world and is bec... more Background: Alpha-thalassemia is one of the most common genetic disorders in the world and is becoming more common in the United States with the increase in immigration of susceptible populations. This disease has been stated previously to be incompatible with extrauterine life.Case: A Filipino woman with a prior loss due to hemoglobin Bart's underwent prenatal diagnosis that confirmed recurrence in the index pregnancy. Intravascular intrauterine exchange transfusions maintained appropriate fetal growth.A cesarean delivery yielded a 2190-g male infant with minor malformations. The postnatal course was characterized by mild respiratory insufficiency. Postnatal chronic transfusion therapy is underway pending consideration for bone marrow transplantation.Conclusion: Antenatal diagnosis and therapy of homozygous a-thalassemia can prevent the prenatal consequences of hydrops and fetal death. New technologies such as stem cell transplantation may help to avert both prenatal and postnatal consequences.