Sangeeta Jain - Academia.edu (original) (raw)
Papers by Sangeeta Jain
American Journal of Perinatology, 2021
Objective This study aimed to describe baseline characteristics of a cohort of pregnant women inf... more Objective This study aimed to describe baseline characteristics of a cohort of pregnant women infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and determine if these correlate with disease severity and perinatal outcomes. Study Design This was a retrospective cohort trial conducted at the University of Texas Medical Branch Galveston, Texas. All pregnant women presented to our medical center, who were screened and tested positive for SARS-CoV-2 virus, were included. We stratified our study population in three groups: asymptomatic, symptomatic not requiring oxygen therapy, and patients requiring oxygen support to maintain oxygen saturation >94%. Relevant population characteristics, laboratory data, and maternal and neonatal outcomes were abstracted. A p-value <0.05 was considered statistically significant. Results Between March and July 2020, 91 women tested positive for SARS-CoV-2 upon admission to our labor and delivery unit. Among these, 61.5% were a...
American Journal of Obstetrics and Gynecology, 2017
In normal pregnancies, a hypoxic intrauterine environment seems necessary for the early trophobla... more In normal pregnancies, a hypoxic intrauterine environment seems necessary for the early trophoblast development. In this context, mother's serum levels of ischemia modified albumin (IMA) are elevated reflecting the oxidative stress associated with placental development. The aim of this study is to evaluate serum levels of IMA and Pregnancy Associated Plasma Protein A (PAPP-A) in mothers bearing small-for-gestational-age (SGA) fetuses compared to normal pregnancies. STUDY DESIGN: A prospective study was performed between June 2014 and May 2015. Serum total albumin, IMA and PAPP-A concentrations were determined in 101 pregnant women in 3 different periods: 1st trimester, 2nd trimester and in the post-partum. Two groups of subjects were identified: group 1) mothers bearing appropriate-for-gestational-age fetuses (AGA) and group 2) mothers bearing SGA fetuses. Serum total albumin and IMA concentrations were determined in 198 non-pregnant women as controls. RESULTS: Serum IMA concentrations increase during the gestation. IMA/Albumin serum levels in the 1st trimester were significantly higher in subjects of group 2 (p<0.05), whereas values of serum PAPP-A MoM were significantly lower (p<0.05). CONCLUSION: Elevated IMA serum levels together with low levels of PAPP-A were detected in the 1st trimester in mothers bearing SGA fetuses and that may reflect early placental changes occurring before clinical manifestation of SGA.
American Journal of Obstetrics and Gynecology, 2016
OBJECTIVE: DNA methylation, a regulatory mechanism that affects gene activity, is important in fe... more OBJECTIVE: DNA methylation, a regulatory mechanism that affects gene activity, is important in fetal development and is likely responsible for fetal programming of adult diseases. Obesity is well known to alter fetal programming and lead to long term adverse outcomes in the offspring. The objective of this study was to test the hypothesis that pre-pregnancy obesity affects DNA methylation as early as the blastocyst stage and prior to implantation. STUDY DESIGN: CD-1 female mice were fed high fat diet for 3 months prior to pregnancy (HF group, n¼3). Control mice were fed chow containing standard amount of fat (SF group, n¼3). Mice were bred and pregnancy was established by the presence of a plug (day 1). On day 4, mice were sacrificed and uterus and ovaries extracted. Blastocysts were flushed from uterus, evaluated for development, and frozen until analysis. cDNA and real time quantitative PCR were used to determine expression levels of genes regulating methylation (Dnmt1, Dnmt3a, Dnmt3b) and active demethylation (Tet1, Tet2, Tet3, Tdg, Ape1). Mann-Whitney test was used for statistical analysis (significance P <.05). RESULTS: On days 1 and 4 HF mice had significantly higher total body weight (P¼0.01 and P¼0.02, respectively). mRNA levels of Dnmt3b, Tdg and Tet3 tended to be lower in HF blastocysts as compared to SF group. No differences in Dnmt1, Dnmt3a, Tet1, Tet2, and Ape1 gene expressions were noted. CONCLUSION: This pilot study demonstrates that pre-pregnancy obesity alters genes that control DNA methylation in the blastocyst. This is the earliest evidence of fetal programming and indicates that preventive measures should be aimed at the pre-pregnancy period.
American Journal of Obstetrics and Gynecology, 2007
Late preterm infants (LPI) are infants born between 34 to 36w6d gestational age. The prevailing p... more Late preterm infants (LPI) are infants born between 34 to 36w6d gestational age. The prevailing perception is that these infants do as well as term infants. Recent reports showed that they have greater respiratory distress (RD) and higher incidence of hyperbilirubinemia, feeding difficulties (FD), hypoglycemia, and temperature instability than term. Our aim was to evaluate the outcome of LPI stratified by gestational age. STUDY DESIGN: We reviewed records (nϭ201) of LPI born at the University of Texas Medical Branch. Infants with congenital anomaly or neuromuscular disease were excluded from study. Detailed pregnancy and maternal demographic data were collected. The incidence of RD, jaundice, hypoglycemia & FD was compared. Data was analyzed using Chi square test for RDS, FD and jaundice(significance: pϽ0.05) and ANOVA for hospital stay. RESULTS: The LPI constituted 9% of all deliveries, 35w4d as average gestational age at delivery. Overall incidence of RD requiring oxygen with nasal cannula/ NC-PAP was 22%, jaundice requiring phototherapy was 46%, FD requiring gavage feed was 22%, and hypoglycemia was 15%. The average hospital stay was 171 hours. Morbidity stratified by gestational age is shown in table (* shows significant difference). CONCLUSION: LPI need to be recognized as a separate group of infants associated with greater morbidity than the term infants. Revised protocols need to be instituted in the nurseries in managing these infants. Long term follow up is needed to study their neurodevelopmental outcome.
American Journal of Obstetrics and Gynecology, 2009
Induction of labor by Foley's catheter with extra-amniotic saline infusion results in a shorter s... more Induction of labor by Foley's catheter with extra-amniotic saline infusion results in a shorter successful induction to delivery process when compared with the Cook's Cervical Ripening Balloon.
American Journal of Obstetrics and Gynecology, 2009
To determine whether medical treatment of symptomatic maternal arrhythmias improves pregnancy out... more To determine whether medical treatment of symptomatic maternal arrhythmias improves pregnancy outcome. STUDY DESIGN: Retrospective cohort study of pregnant women diagnosed with cardiac arrhythmia at our institution from January 1st 2004 to December 31st 2008. Diagnosis was confirmed by Holter monitor. Tachyarrhythmias included atrial fibrillation (AF), supraventricular tachycardia (SVT), and idiopathic sinus tachycardia (HR 130 bpm). Premature ventricular contractions (PVCs) in bigeminal or trigeminal pattern were also included. Bradyarrhythmias included first, second & third degree atrioventricular heart block (AVHB) as well as idiopathic sinus bradycardia (SB) (HR 50/min). Clinical outcomes of the treated women were compared to the untreated. Student's t test and Fisher's exact test were used for statistical analysis (p Ͻ0.05 significant). RESULTS: Out of 80 women who qualified to be included, 28 (35.0%) received treatment for arrhythmia while 52 (65.0%) did not. Medical cardioversion was performed in 10/28 (35.7%). Of the treated women, 3 (5.7%) had automatic implantable cardioverter defibrillator (AICD), 22 (78.5%) received beta-blockers, and 3(5.7%) were on digoxin. PVCs was the most common diagnosis in both the treated (8/28; 28.5%) and untreated groups (18/52; 34.6%). Symptomatic episodes of arrhythmia were lower with the treatment group (median: 1 versus 3). Delivery prior to 37 weeks was lower in the treatment group, however the difference did not reach significance (2/28 [7.1%] versus 10/52 [19.2%]). Incidence of preeclampsia was similar between the two groups. Cardiomyopathy was seen only in untreated women (3/52; 5.7%). After adjusting for gestational age at delivery, mean birthweight was higher in the treatment group (3192ϩ848g versus 2795ϩ926g). CONCLUSION: Treatment of symptomatic maternal arrhythmias improves maternal and fetal outcome. Heart rate control through antiarrhytmic therapy may prevent serious maternal complications like cardiomyopathy.
Journal of Woman’s Reproductive Health, 2016
The tocodynamometer (TOCO) has poor sensitivity and specificity in monitoring uterine contraction... more The tocodynamometer (TOCO) has poor sensitivity and specificity in monitoring uterine contractions, especially in obese patients. The intrauterine pressure catheter (IUPC) can be used to monitor adequacy of contractions, but only after amniotomy. Transabdominal uterine electromyography (EMG) and the TOCO were compared to the gold standard IUPC for monitoring uterine contractions. Methods Forty term pregnant women in labor with ruptured membranes were consented for this study. The root mean square (RMS) plot from EMG signals was compared to IUPC and TOCO recordings for 20 to 40 minutes. A comparison between the total contraction number, frequency, and the difference in contraction peak time was made using Student-t test or ANOVA (P<0.05 was significant). Results There was no significant difference in the contraction number and frequency when comparing the RMS, TOCO, and IUPC. The paper tracings had a greater standard deviation (8.57) than the digitally saved data (3.93). The mean peak time difference between TOCO and IUPC was 0.74 seconds (P=0.78; SD 5.2). For RMS vs. IUPC peaks, the mean peak difference between was 0.13 seconds (P=0.95; SD 3.93). Conclusions Uterine electrical activity measured with transabdominal uterine EMG may be used to monitor labor in patients as an alternative to the TOCO and the IUPC.
Journal of the American Academy of Nurse Practitioners, 1998
American Journal of Obstetrics and Gynecology, 2016
OBJECTIVE: Preeclampsia (PreE) is a hypertensive disorder of pregnancy afflicting 5-10% of US pre... more OBJECTIVE: Preeclampsia (PreE) is a hypertensive disorder of pregnancy afflicting 5-10% of US pregnancies. Recent reports suggest 20hydroxyeicosatetraenoic (20-HETE) may play a role in hypertension in response to placental ischemia. We hypothesized that administration of a 20-HETE synthesis inhibitor, HET0016, would improve the pathophysiology associated with PreE in the RUPP rat model of placental ischemia.
American Journal of …, 2007
Cervical dilation with regular contraction traditionally has been used to differentiate between t... more Cervical dilation with regular contraction traditionally has been used to differentiate between true and false labor. This diagnostic criterion has not been tested as most patients receive tocolytics. Our objective was to determine the time from admission to delivery in women ...
American Journal of Perinatology, 2021
Objective This study aimed to describe baseline characteristics of a cohort of pregnant women inf... more Objective This study aimed to describe baseline characteristics of a cohort of pregnant women infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and determine if these correlate with disease severity and perinatal outcomes. Study Design This was a retrospective cohort trial conducted at the University of Texas Medical Branch Galveston, Texas. All pregnant women presented to our medical center, who were screened and tested positive for SARS-CoV-2 virus, were included. We stratified our study population in three groups: asymptomatic, symptomatic not requiring oxygen therapy, and patients requiring oxygen support to maintain oxygen saturation >94%. Relevant population characteristics, laboratory data, and maternal and neonatal outcomes were abstracted. A p-value <0.05 was considered statistically significant. Results Between March and July 2020, 91 women tested positive for SARS-CoV-2 upon admission to our labor and delivery unit. Among these, 61.5% were a...
American Journal of Obstetrics and Gynecology, 2017
In normal pregnancies, a hypoxic intrauterine environment seems necessary for the early trophobla... more In normal pregnancies, a hypoxic intrauterine environment seems necessary for the early trophoblast development. In this context, mother's serum levels of ischemia modified albumin (IMA) are elevated reflecting the oxidative stress associated with placental development. The aim of this study is to evaluate serum levels of IMA and Pregnancy Associated Plasma Protein A (PAPP-A) in mothers bearing small-for-gestational-age (SGA) fetuses compared to normal pregnancies. STUDY DESIGN: A prospective study was performed between June 2014 and May 2015. Serum total albumin, IMA and PAPP-A concentrations were determined in 101 pregnant women in 3 different periods: 1st trimester, 2nd trimester and in the post-partum. Two groups of subjects were identified: group 1) mothers bearing appropriate-for-gestational-age fetuses (AGA) and group 2) mothers bearing SGA fetuses. Serum total albumin and IMA concentrations were determined in 198 non-pregnant women as controls. RESULTS: Serum IMA concentrations increase during the gestation. IMA/Albumin serum levels in the 1st trimester were significantly higher in subjects of group 2 (p<0.05), whereas values of serum PAPP-A MoM were significantly lower (p<0.05). CONCLUSION: Elevated IMA serum levels together with low levels of PAPP-A were detected in the 1st trimester in mothers bearing SGA fetuses and that may reflect early placental changes occurring before clinical manifestation of SGA.
American Journal of Obstetrics and Gynecology, 2016
OBJECTIVE: DNA methylation, a regulatory mechanism that affects gene activity, is important in fe... more OBJECTIVE: DNA methylation, a regulatory mechanism that affects gene activity, is important in fetal development and is likely responsible for fetal programming of adult diseases. Obesity is well known to alter fetal programming and lead to long term adverse outcomes in the offspring. The objective of this study was to test the hypothesis that pre-pregnancy obesity affects DNA methylation as early as the blastocyst stage and prior to implantation. STUDY DESIGN: CD-1 female mice were fed high fat diet for 3 months prior to pregnancy (HF group, n¼3). Control mice were fed chow containing standard amount of fat (SF group, n¼3). Mice were bred and pregnancy was established by the presence of a plug (day 1). On day 4, mice were sacrificed and uterus and ovaries extracted. Blastocysts were flushed from uterus, evaluated for development, and frozen until analysis. cDNA and real time quantitative PCR were used to determine expression levels of genes regulating methylation (Dnmt1, Dnmt3a, Dnmt3b) and active demethylation (Tet1, Tet2, Tet3, Tdg, Ape1). Mann-Whitney test was used for statistical analysis (significance P <.05). RESULTS: On days 1 and 4 HF mice had significantly higher total body weight (P¼0.01 and P¼0.02, respectively). mRNA levels of Dnmt3b, Tdg and Tet3 tended to be lower in HF blastocysts as compared to SF group. No differences in Dnmt1, Dnmt3a, Tet1, Tet2, and Ape1 gene expressions were noted. CONCLUSION: This pilot study demonstrates that pre-pregnancy obesity alters genes that control DNA methylation in the blastocyst. This is the earliest evidence of fetal programming and indicates that preventive measures should be aimed at the pre-pregnancy period.
American Journal of Obstetrics and Gynecology, 2007
Late preterm infants (LPI) are infants born between 34 to 36w6d gestational age. The prevailing p... more Late preterm infants (LPI) are infants born between 34 to 36w6d gestational age. The prevailing perception is that these infants do as well as term infants. Recent reports showed that they have greater respiratory distress (RD) and higher incidence of hyperbilirubinemia, feeding difficulties (FD), hypoglycemia, and temperature instability than term. Our aim was to evaluate the outcome of LPI stratified by gestational age. STUDY DESIGN: We reviewed records (nϭ201) of LPI born at the University of Texas Medical Branch. Infants with congenital anomaly or neuromuscular disease were excluded from study. Detailed pregnancy and maternal demographic data were collected. The incidence of RD, jaundice, hypoglycemia & FD was compared. Data was analyzed using Chi square test for RDS, FD and jaundice(significance: pϽ0.05) and ANOVA for hospital stay. RESULTS: The LPI constituted 9% of all deliveries, 35w4d as average gestational age at delivery. Overall incidence of RD requiring oxygen with nasal cannula/ NC-PAP was 22%, jaundice requiring phototherapy was 46%, FD requiring gavage feed was 22%, and hypoglycemia was 15%. The average hospital stay was 171 hours. Morbidity stratified by gestational age is shown in table (* shows significant difference). CONCLUSION: LPI need to be recognized as a separate group of infants associated with greater morbidity than the term infants. Revised protocols need to be instituted in the nurseries in managing these infants. Long term follow up is needed to study their neurodevelopmental outcome.
American Journal of Obstetrics and Gynecology, 2009
Induction of labor by Foley's catheter with extra-amniotic saline infusion results in a shorter s... more Induction of labor by Foley's catheter with extra-amniotic saline infusion results in a shorter successful induction to delivery process when compared with the Cook's Cervical Ripening Balloon.
American Journal of Obstetrics and Gynecology, 2009
To determine whether medical treatment of symptomatic maternal arrhythmias improves pregnancy out... more To determine whether medical treatment of symptomatic maternal arrhythmias improves pregnancy outcome. STUDY DESIGN: Retrospective cohort study of pregnant women diagnosed with cardiac arrhythmia at our institution from January 1st 2004 to December 31st 2008. Diagnosis was confirmed by Holter monitor. Tachyarrhythmias included atrial fibrillation (AF), supraventricular tachycardia (SVT), and idiopathic sinus tachycardia (HR 130 bpm). Premature ventricular contractions (PVCs) in bigeminal or trigeminal pattern were also included. Bradyarrhythmias included first, second & third degree atrioventricular heart block (AVHB) as well as idiopathic sinus bradycardia (SB) (HR 50/min). Clinical outcomes of the treated women were compared to the untreated. Student's t test and Fisher's exact test were used for statistical analysis (p Ͻ0.05 significant). RESULTS: Out of 80 women who qualified to be included, 28 (35.0%) received treatment for arrhythmia while 52 (65.0%) did not. Medical cardioversion was performed in 10/28 (35.7%). Of the treated women, 3 (5.7%) had automatic implantable cardioverter defibrillator (AICD), 22 (78.5%) received beta-blockers, and 3(5.7%) were on digoxin. PVCs was the most common diagnosis in both the treated (8/28; 28.5%) and untreated groups (18/52; 34.6%). Symptomatic episodes of arrhythmia were lower with the treatment group (median: 1 versus 3). Delivery prior to 37 weeks was lower in the treatment group, however the difference did not reach significance (2/28 [7.1%] versus 10/52 [19.2%]). Incidence of preeclampsia was similar between the two groups. Cardiomyopathy was seen only in untreated women (3/52; 5.7%). After adjusting for gestational age at delivery, mean birthweight was higher in the treatment group (3192ϩ848g versus 2795ϩ926g). CONCLUSION: Treatment of symptomatic maternal arrhythmias improves maternal and fetal outcome. Heart rate control through antiarrhytmic therapy may prevent serious maternal complications like cardiomyopathy.
Journal of Woman’s Reproductive Health, 2016
The tocodynamometer (TOCO) has poor sensitivity and specificity in monitoring uterine contraction... more The tocodynamometer (TOCO) has poor sensitivity and specificity in monitoring uterine contractions, especially in obese patients. The intrauterine pressure catheter (IUPC) can be used to monitor adequacy of contractions, but only after amniotomy. Transabdominal uterine electromyography (EMG) and the TOCO were compared to the gold standard IUPC for monitoring uterine contractions. Methods Forty term pregnant women in labor with ruptured membranes were consented for this study. The root mean square (RMS) plot from EMG signals was compared to IUPC and TOCO recordings for 20 to 40 minutes. A comparison between the total contraction number, frequency, and the difference in contraction peak time was made using Student-t test or ANOVA (P<0.05 was significant). Results There was no significant difference in the contraction number and frequency when comparing the RMS, TOCO, and IUPC. The paper tracings had a greater standard deviation (8.57) than the digitally saved data (3.93). The mean peak time difference between TOCO and IUPC was 0.74 seconds (P=0.78; SD 5.2). For RMS vs. IUPC peaks, the mean peak difference between was 0.13 seconds (P=0.95; SD 3.93). Conclusions Uterine electrical activity measured with transabdominal uterine EMG may be used to monitor labor in patients as an alternative to the TOCO and the IUPC.
Journal of the American Academy of Nurse Practitioners, 1998
American Journal of Obstetrics and Gynecology, 2016
OBJECTIVE: Preeclampsia (PreE) is a hypertensive disorder of pregnancy afflicting 5-10% of US pre... more OBJECTIVE: Preeclampsia (PreE) is a hypertensive disorder of pregnancy afflicting 5-10% of US pregnancies. Recent reports suggest 20hydroxyeicosatetraenoic (20-HETE) may play a role in hypertension in response to placental ischemia. We hypothesized that administration of a 20-HETE synthesis inhibitor, HET0016, would improve the pathophysiology associated with PreE in the RUPP rat model of placental ischemia.
American Journal of …, 2007
Cervical dilation with regular contraction traditionally has been used to differentiate between t... more Cervical dilation with regular contraction traditionally has been used to differentiate between true and false labor. This diagnostic criterion has not been tested as most patients receive tocolytics. Our objective was to determine the time from admission to delivery in women ...