Objective Obesity is associated with alterations in thyroid hormone (TH) levels in obese, pregnant individuals. The maintenance of TH levels throughout gestation is important for proper fetal development. The aim of this study was to measure levels of fT3, fT4 and TSH in maternal and matched cord blood serum from normal weight, overweight and obese gravidae to determine alterations in maternal and neonatal TH levels by virtue of maternal obesity. Design, Setting, Subjects, Outcome Measures ELISA was utilized to measure fT3, fT4 and TSH levels from banked, matched maternal and neonatal (cord blood) serum (N=205 matched pairs). Data was stratified according to pre-pregnancy or first trimester BMI. Results Both maternal and neonatal fT3 levels consistently increased with increasing maternal obesity, and maternal and neonatal fT3 were significantly correlated (r =0.422, p<0.001). Maternal and neonatal fT3 were also significantly associated with birthweight (β=0.155, p=0.027 and β=0.171, p=0.018 respectively). Both the maternal and neonatal fT3 to fT4 ratio significantly increased with increasing maternal obesity. We further found that excess gestational weight gain was associated with a decrease in maternal fT4 compared with gravidae who had insufficient gestational weight gain (0.86±0.17 vs. 0.95±0.22, p<0.01). Conclusion Maternal obesity is not only associated with maternal alterations in TH, but with accompanying neonatal changes. Because both maternal obesity and alterations in TH levels are associated with childhood obesity, based on these findings and our prior analyses in a non-human primate model we propose that changes in fT3 levels in the offspring of obese mothers may be a potential molecular mediator of fetal overgrowth and childhood obesity.

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In 2012, a public tertiary care hospital in Houston, TX promoted its TOLAC services on social media, resulting in a surge of self-referrals. In 2018, an electronic survey was distributed by email to 200 women who had previously contacted the hospital regarding TOLAC and posted on 2 local social media TOLAC sites. Women were asked to participate if they ever sought TOLAC in the Houston area. Data were analyzed for trends in patient experience seeking TOLAC and comparisons were made based on number of prior cesarean deliveries (CD) and race/ethnicity. RESULTS: The survey was open for responses for 1 month, with 128 completed surveys by the end of the study time period. Of the respondents, most (64%) had 1 prior CD and identified as White (63%). 60% of all women reported contacting >3 providers before finding one that offered TOLAC, with no difference reported for women with 1 vs 2 prior CD (p¼.2). Most women (52%) reported their experience seeking TOLAC to be difficult (5 on Likert scale 1-5), with more difficulty noted by those with 2 vs 1 prior CD, but not statistically significant (p ¼ .06). White women were more likely to report an easier experience seeking TOLAC (Likert 1-4) compared to Black/African women (p¼.04). Of all respondents, 37% attempted TOLAC at the reference hospital. Of those, 70% sought care specifically for TOLAC and only 4% had received care at the hospital previously; 26% were referred by a friend, family, or obstetric provider; 70% were referred through social media information. Black/African women (p¼.02) and Hispanics (p¼.0001) were more likely to have delivered at the reference hospital than White women. CONCLUSION: Our results suggest that women seeking TOLAC have trouble finding providers who offer the service. This may be especially true for Black/African and Hispanic women and women with >1 prior CD. Women may utilize social media forums for resources and recommendations and such platforms may represent an underutilized opportunity to identify regional TOLAC services.

INTRODUCTION: The purpose of this study was to evaluate whether positive questionnaire-based screening for obstructive sleep apnea (OSA) was associated with higher rates of miscarriage (SAB). METHODS: Secondary analysis of a prospective observational study of participants enrolled in an OSA screening study between 2010–2012. This analysis received an IRB exemption. A screening questionnaire with standard Epworth (ESS), Berlin (BQ), and novel items was administered at a prenatal care visit. The results of women who completed the survey in the first trimester (1T) were assessed for association with SAB. RESULTS: In a cohort of 213 women screened in the 1T, 30% (n=64) had elevated BQ or ESS scores, 18.8% (n=40) had high ESS scores and 14.6% (n=31) had elevated BQ scores suggestive of risk of OSA. 3.29% (n=7) had high ESS and BQ scores. Women who had both elevated ESS and BQ scores were more likely to experience SAB than those who had elevated scores on one or neither (P=.018). Women who reported snoring (P=.042) or hypertension (P=.013) in the 1T were more likely to experience SAB than women who did not. In contrast, women who reported napping in the 1T were less likely to experience SAB than women who did not (P=.045). CONCLUSION: Elevated BQ and ESS scores are statistically significantly associated with SAB. Snoring, naps and hypertension were the only individual questions from the BQ and ESS with statistically significant associations with SAB. Further investigation into this topic is warranted.