Does Prepregnancy Weight or Maternal BMI at Betamethasone Administration Impact Late Preterm Respiratory Morbidity?

2019 ◽  
Vol 37 (04) ◽  
pp. 365-369
Author(s):  
Matthew J. Bicocca ◽  
Sean C. Blackwell ◽  
Baha M. Sibai
Keyword(s):  
Maternal Obesity ◽  
Controlled Trial ◽  
Secondary Analysis ◽  
Late Preterm ◽  
Respiratory Morbidity ◽  
Maternal Weight ◽  
Double Blind ◽  
Prepregnancy Bmi ◽  
Prepregnancy Weight ◽  
Maternal Bmi

Abstract Objective We sought to determine if maternal prepregnancy body mass index (BMI) is a risk factor for neonatal respiratory morbidity and to determine if increasing BMI decreased the efficacy of betamethasone (BMZ). Study Design This was a secondary analysis of the Antenatal Late Preterm Steroids trial, double-blind, randomized controlled trial involving 2,831 women between 340/7 and 365/7 weeks who received BMZ or a matching placebo. We compared the rate of neonatal respiratory morbidity among prepregnancy BMI classes in both the placebo and treatment groups. We also stratified the treatment effect by maternal BMI at the time of delivery. Results A total of 2,822 women were identified with maternal weight recorded at delivery; 2,740 women also had self-reported prepregnancy weight available. When stratified by prepregnancy BMI class, there was no difference in neonatal respiratory morbidity in the BMZ or in placebo groups. When analyzed by BMI at delivery, there was no difference in the rate of neonatal respiratory morbidity, and BMI was not a predictor of treatment response (odds ratio = 1.00, 95% confidence interval = 0.99–1.02). Conclusion Maternal prepregnancy BMI is not associated with late preterm neonatal respiratory morbidity. Maternal obesity does not decrease the efficacy of BMZ for preventing late preterm neonatal respiratory morbidity.

scholarly journals 457: Does prepregnancy weight or maternal BMI at betamethasone administration impact late preterm respiratory morbidity?

2019 ◽  
Vol 220 (1) ◽  
pp. S306-S307
Author(s):  
Matthew J. Bicocca ◽  
Han-Yang Chen ◽  
Sean Blackwell ◽  
Baha Sibai ◽  
NICHD MFMU
Keyword(s):  
Late Preterm ◽  
Respiratory Morbidity ◽  
Prepregnancy Weight ◽  
Maternal Bmi

scholarly journals Breast Milk Leptin, Breastfeeding Behavior and Infant Body Composition and Growth (P11-027-19)

2019 ◽  
Vol 3 (Supplement_1) ◽  
Author(s):  
Chloe Andrews ◽  
Daria Turner ◽  
Carmen Monthe-Dreze ◽  
Carol Wagner ◽  
Sarbattama Sen
Keyword(s):  
Body Composition ◽  
Breast Milk ◽  
Lean Mass ◽  
Controlled Trial ◽  
Secondary Analysis ◽  
Vitamin D Supplementation ◽  
Maternal Body Mass Index ◽  
Anthropometric Measures ◽  
Double Blind ◽  
Maternal Bmi

Abstract Objectives Determine the associations of i) maternal body mass index (BMI) with breast milk (BM) leptin concentration and ii) BM leptin concentration with infant breastfeeding behaviors, body composition, and growth. Methods We conducted a secondary analysis of 40 mother-infant dyads from a double-blind, randomized controlled trial of vitamin D supplementation during lactation (NCT 00412074). Study staff collected mother's BM and anthropometric data (weight, height, adiposity via DEXA scan) of mother and infant at 1 month (V1), 4 months (V4), and 7 months (V7) postpartum, and maternal report of breastfeeding behaviors at V1 and V4. BM leptin was measured using mesoscale discovery. Pearson's correlation was used to determine the association between maternal BMI and BM leptin at V1 and V4. The association of BM leptin with infant breastfeeding (BF) behaviors (number of BF events per day, duration of each BF, interval between BF, and total time BF per day) and infant anthropometric measures (BMI-Z score, total fat mass, total lean mass, and change (Δ) in these measures between V1 and V4, V1 and V7, and V4 and V7) was examined using linear regression with adjustment for covariates. Results Maternal BMI (mean 29.0 kg/m2, SD 5.1 kg/m2) positively correlated with BM leptin concentration at V1 (mean 1.1 ng/mL, SD; r = 0.5, P = 0.005) and V4 (mean 1.4 ng/mL, SD 1.5 ng/mL; r = 0.6, P = 0.001). Breast milk leptin was not associated with any measures of infant BF behaviors (Table 1). Greater BM leptin at V1 was associated with greater increase in lean mass from V1 to V4 (β = 137.5 g higher change in lean mass per ng/mL increase of leptin, P = 0.021) and greater BM leptin at V4 was associated with greater lean mass at V7 (β = 269.6g per ng/mL increase of leptin P = 0.04) (Table 2). Conclusions Higher maternal BMI was associated with higher BM leptin concentrations. Higher BM leptin was associated with higher lean mass accrual in the first year of life. We did not find evidence that BM leptin was associated with BF behaviors in this exclusively BF cohort. Further research should seek to understand the mechanisms by which BM leptin affects growth in early infancy. Funding Sources Nutrition Obesity Research Consortium at Harvard; (NIH) 5R01HD043921, NIH RR01070; and UL1 TR000062. Supporting Tables, Images and/or Graphs

scholarly journals Thiamine as a Renal Protective Agent in Septic Shock. A Secondary Analysis of a Randomized, Double-Blind, Placebo-controlled Trial

2017 ◽  
Vol 14 (5) ◽  
pp. 737-741 ◽  
Author(s):  
Ari Moskowitz ◽  
Lars W. Andersen ◽  
Michael N. Cocchi ◽  
Mathias Karlsson ◽  
Parth V. Patel ◽  
...  
Keyword(s):  
Septic Shock ◽  
Controlled Trial ◽  
Secondary Analysis ◽  
Protective Agent ◽  
Double Blind ◽  
Double Blind Placebo

A randomized controlled trial of restricted versus standard fluid management in late preterm and term infants with transient tachypnea of the newborn

2020 ◽  
Vol 13 (4) ◽  
pp. 477-487
Author(s):  
S. Sardar ◽  
S. Pal ◽  
R. Mishra
Keyword(s):  
Randomized Controlled Trial ◽  
Controlled Trial ◽  
Initial Period ◽  
Fluid Management ◽  
Late Preterm ◽  
Respiratory Morbidity ◽  
Term Infants ◽  
Randomized Controlled ◽  
Antenatal Steroid ◽  
Preterm Babies

BACKGROUND: Transient tachypnea of the newborn(TTNB) is the most common respiratory morbidity in late preterm and term babies and is pathophysiologically related to delayed lung fluid clearance after birth. Mimicking low physiological fluid intake in the initial period of life may accelerate the recovery from TTNB. In a randomized controlled trial, we compared the roles of restricted versus standard fluid management in babies with TTNB requiring respiratory support. METHODS: This parallel group,non-blinded, stratified randomized controlled trial was conducted in a level III neonatal unit of eastern India. Late preterm and term babies with TTNB requiring continuous positive airway pressure (CPAP) were randomly allocated to standard and restricted fluid arms for the first 72 hours (hrs). Primary outcome was CPAP duration. RESULTS: In total, 100 babies were enrolled in this study with 50 babies in each arm. CPAP duration was significantly less in the restricted arm (48[42, 54] hrs vs 54[48,72] hrs, p = 0.002). However, no difference was observed in the incidence of CPAP failure between the two arms. In the subgroup analysis, the benefit of reduced CPAP duration persisted in late preterm but not in term infants. However, the effect was not significant in the late preterm babies exposed to antenatal steroid. CONCLUSION: This trial demonstrated the safety and effectiveness of restrictive fluid strategy in reducing CPAP duration in late preterm and term babies with TTNB. Late preterm babies, especially those not exposed to antenatal steroid were the most benefitted by this strategy.

scholarly journals Biomarkers of Docosahexaenoic Acid but Not Arachidonic Acid Reflect Dietary Intakes in Toddlers at Ages 1 and 2 Years Who Are Not Meeting Dietary Recommendations

2019 ◽  
Vol 150 (3) ◽  
pp. 518-525
Author(s):  
Alejandra M Wiedeman ◽  
Roger A Dyer ◽  
Deanna McCarthy ◽  
Karin Yurko-Mauro ◽  
Sheila M Innis ◽  
...  
Keyword(s):  
Fatty Acids ◽  
Arachidonic Acid ◽  
Controlled Trial ◽  
Secondary Analysis ◽  
Dietary Intakes ◽  
Dietary Recommendations ◽  
Double Blind ◽  
Dietary Pufa ◽  
Food Records ◽  
Epa And Dha

ABSTRACT Background Long-chain n–6 and n–3 PUFAs are important for growth and development. However, little is known about requirements and current dietary intakes of these fatty acids in toddlers. Objectives This study assessed dietary intakes of n–6 and n–3 PUFAs and determined the relation to circulating PUFAs in toddlers at ages 1 and 2 y. Methods This is a secondary analysis of data from toddlers enrolled in a double-blind randomized controlled trial of arachidonic acid (ARA) and DHA supplementation between ages 1 and 2 y. Dietary intakes of fatty acids were estimated by 3-d food records, and fatty acid composition in plasma total phospholipids, red blood cell phosphatidylethanolamine (PE), and phosphatidylcholine (PC) were assessed by GC at baseline in all subjects (n = 110; mean age 1.12 y; 64% male) and in the control subjects at 2 y (n = 43). Results The dietary intakes of ARA, EPA, and DHA at age 1 y (baseline) were [mean (median)] 36.8 (30.0), 16.0 (0.00), and 31.1 (10.0) mg/d, respectively. Dietary intakes increased to 52.7 (45.0), 35.8 (0.00), and 64.8 (20.0) mg/d, respectively, at age 2 y (P < 0.05). The predominant dietary source of EPA and DHA was fish/seafood; eggs were an important source of ARA and DHA. Dietary DHA intakes were positively associated with plasma PE and PC DHA (P < 0.05). No relations between dietary ARA intakes and plasma PE and PC ARA (P > 0.05) were observed. Conclusions These findings suggest that most toddlers are not meeting the recommendation for dietary PUFA intakes and that higher dietary DHA intakes are reflected in plasma PE and PC DHA composition. Further work is required to investigate a biomarker for dietary ARA intake. This trial is registered at clinicaltrials.gov as NCT01263912.

Dapagliflozin does not affect short-term blood pressure variability in patients with type-2 diabetes mellitus

2020 ◽  
Author(s):  
Eirini Papadopoulou ◽  
Marieta P Theodorakopoulou ◽  
Charalampos Loutradis ◽  
Georgios Tzanis ◽  
Glykeria Tzatzagou ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Blood Pressure ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Blood Pressure Variability ◽  
Controlled Trial ◽  
Secondary Analysis ◽  
Short Term ◽  
Double Blind

Abstract Background Increased blood-pressure-variability (BPV) is associated with increased cardiovascular and all-cause mortality in patients with type 2 diabetes mellitus (T2DM). Sodium-glucose-co-transporter-2 (SGLT-2) inhibitors decrease the incidence of cardiovascular events, renal events, and death in this population. This study aimed to evaluate the effect of dapagliflozin on short-term BPV in patients with T2DM. Methods This is a secondary analysis of a double-blind, randomized, placebo-controlled trial in 85 patients with T2DM (NCT02887677). Subjects were randomized to oral dapagliflozin 10mg once daily or placebo for 12 weeks. All participants underwent 24-h ambulatory blood pressure (BP) monitoring with the Mobil-O-Graph NG device at baseline and study-end. Standard-deviation (SD), weighted-SD (wSD), coefficient-of-variation (CV), average-real-variability (ARV) and variation-independent-of-mean (VIM) were calculated with validated formulae for the 24-h and the daytime and nighttime periods. Results Dapagliflozin reduced 24-h brachial BP compared to placebo. From baseline to study-end 24-h brachial BPV indexes did not change with dapagliflozin (SBP-ARV: 11.51±3.45 vs 11.05±3.35; p=0.326, SBP-wSD: 13.59±3.60 vs 13.48±3.33; p=0.811) or placebo (SBP-ARV: 11.47±3.63 vs 11.05±3.00; p=0.388, SBP-wSD: 13.85±4.38 vs 13.97±3.87 ; p=0.308). Similarly, no significant changes in BPV indexes for daytime and nighttime were observed in any group. At study-end, no differences between the groups were observed for any BPV index. Deltas(Δ) of all indexes during follow-up were minimal and not different between-groups (SBP-wSD: dapagliflozin: -0.11±3.05 vs placebo: 0.12±4.20; p=0.227). Conclusions This study is the first to evaluate the effects of an SGLT-2 inhibitor on short-term BPV in patients with T2DM, showing no effect on dapagliflozin on all BPV indexes studied.

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