No abstract

healthy lifestyle and low glycaemic index dietary advice and selfmonitoring of blood glucose using glucometers. Fasting blood samples were collected following GDM diagnosis and repeated after 4-6 weeks for analysis of glucose, insulin and C-peptide. Homeostasis model assessment index (HOMA-IR) was calculated to assess insulin resistance. Changes in each parameter were calculated by paired samples t-test. Where significant changes were detected, associations with neonatal outcomes were assessed by correlation and regression analysis. RESULTS: A significant reduction in maternal fasting glucose (p<0.001) and HOMA-IR (p¼0.045) was observed, but there were no changes in serum insulin or c-peptide. Reduction in fasting glucose did not correlate with any neonatal outcomes. Reduction in HOMA-IR was inversely correlated with neonatal birthweight (r¼-0.27, p¼0.013) and macrosomia (r¼-0.28, p¼0.012). These associations remained in regression analysis, adjusting for infant sex and gestation at delivery. No associations were detected with birthweight centile, LGA, SGA, admission to NICU or cord glucose and Cpeptide. CONCLUSION: Women with GDM managed on diet experienced reductions in fasting glucose and HOMA-IR. This improvement in insulin sensitivity may help moderate birthweight and reduce the risk of macrosomia. Association between reduction in HOMA-IR among women treated for GDM with neonatal birthweight and risk of macrosomia (N¼93) HOMA-IR, homeostasis model assessment of insulin resistance. P-values calculated by multiple linear regression (a) and binary logistic regression (b), adjusting for infant sex and gestational age at delivery.

No abstract

Objectives-To evaluate the accuracy of ultrasound (US) estimated fetal weight (EFW) measurement compared with neonatal birth weight when performed by residents versus certified sonographers. The hypothesis tested was that residents and certified sonographers would not differ significantly in EFW or in EFW compared with neonatal birth weight.Methods-A retrospective chart review of 142 inpatients from July 2010 to May 2011 was conducted. Ultrasound examinations were performed by a resident physician and a certified sonographer within 7 days after the resident. Standard US measurements obtained were head circumference, biparietal diameter, abdominal circumference, femur length, estimated gestational age, and EFW. Gestational age ranged from 20 to 39 weeks. The time from US to delivery, residency year, and birth weight were collected. Measurements were compared by paired t tests, the Wilcoxon signed rank test, and repeated-measures analysis of variance.Results-The US EFW by residents and sonographers showed excellent concordance with each other regardless of the neonatal birth weight. The resident and sonographer EFW each showed excellent concordance with the neonatal birth weight, and this concordance did not differ significantly between residents and sonographers for neonates weighing less than 1000 g (P = .61) and neonates weighing greater than or equal to 1000 to less than 2000 g (P = .93). The resident EFW (P < .05) and sonographer EFW (P < .01), however, were less than the neonatal birth weight for larger neonates (≥2000 g), but the degree of underestimation was not significantly different between residents and sonographers (P = .51).Conclusions-Accurate EFW is critical for prenatal management. These data support the value of a dedicated month of US training in residency programs.

Purpose: Professional bodies such as the American College of Obstetrics and Gynecology recognize the impact of conscience-based decisions. The first time such decisions affect patients and providers is in residency. Our study sought to determine the attitudes of program directors towards various conscience-based refusals in potential applicants to obstetrics and gynecology programs. Method: An eight-question survey was sent to 279 directors of U.S. obstetrics and gynecology residencies in 2019. The survey proposed hypothetical conscientious refusals of common aspects of obstetric and gynecology practice. The survey asked respondents to categorize their reaction to these choices and choose from a list of factors which could modify their reaction. Univariate analysis and multivariate logistic regression were performed. Results: 97 program directors (35%) responded. A majority of PDs reported that the inability to prescribe or counsel on birth control, to provide methotrexate, to counsel on abortion, or to clearly enumerate refusals was impossible to work around, likely to lower an applicant’s rank, not compatible with training, or not good for patients; collectively, these responses were grouped as “negative reactions” (73–99%). Female program directors had more negative reactions to applicants who refused to prescribe birth control (aOR 15.8, 95% CI 1.7–99.5) and counsel on abortion (aOR 3.6, 95% CI 1.2–10.8). Directors from different locations and program types did not have significantly different responses. A few program directors identified that academic strength could mitigate otherwise negatively-viewed choices. Illustrative comments of directors’ attitudes are provided. Conclusions: Program directors agree that conscientious refusal to participate in certain activities is problematic for obstetrics and gynecology residency. There are very few subjective or regional differences on this stance, and few aspects of an application modify directors’ reactions.