A county-wide obstetrical automated medical record system

Wirtschafter, David D.; Blackwell, William C.; Goldenberg, Robert L.; Henderson, Suzzon A.; Peake, Mary N.; Huddleston, John F.; Howell, Mildred

doi:10.1007/bf00992804

Cited by 25 publications

(9 citation statements)

References 2 publications

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“…Patients were identified from the obstetric automated record system 9 and a diagnosis of pregestational diabetes was confirmed on review of medical records. Only patients who reported a history of diabetes prior to pregnancy were considered to have pregestational diabetes; patients diagnosed by glucose tolerance testing during pregnancy were considered to have gestational diabetes and excluded from this analysis regardless of gestational age at diagnosis.…”

Section: Methodsmentioning

confidence: 99%

Assessing White's Classification of Pregestational Diabetes in a Contemporary Diabetic Population

Bennett

Tita

Owen

et al. 2015

Obstetrics &Amp; Gynecology

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Objective To assess the validity of White’s classification, including the role of chronic hypertension, in a contemporary diabetic population. Methods We performed a retrospective cohort study of all singleton pregnancies with preexisting diabetes mellitus from 2008 to 2013. Adverse outcomes were compared across classes B, C, D and vascular disease (R, F, H) and further stratified by the presence or absence of chronic hypertension. Outcomes examined were a composite perinatal outcome (stillbirth, neonatal death, shoulder dystocia, birth injury, seizures, requiring chest compressions or intubation at delivery, blood pressure support), small for gestational age (SGA), large for gestational age (LGA), macrosomia, shoulder dystocia, preterm delivery <37 weeks, preeclampsia, and cesarean delivery. Results Of the 475 patients, the 1980 White’s classification was significantly associated with SGA, LGA, macrosomia, preterm delivery, preeclampsia, and cesarean (p ≤ 0.01). Within each White’s class based on age or time since diagnosis alone, hypertension was significantly associated with a higher incidence of preeclampsia in class B (16% without hypertension versus 32% with hypertension, p < 0.01) and C (22% vs. 40%, p = 0.04), SGA in C (4.7% vs. 21%, p < 0.01), preterm delivery in B (25% vs. 46%, p < 0.01) and C (35% vs. 58%, p = 0.01), and the composite neonatal outcome in B (7.9% vs. 17%, p = 0.03). The incidence of adverse outcomes in classes B and C with hypertension resembles the incidence of adverse outcomes in those with diabetes one class higher. Conclusion The 1980 White’s classification system, taking into consideration the presence of chronic hypertension, remains a useful system for counseling pregestational diabetic women regarding adverse pregnancy outcomes.

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Section: Methodsmentioning

confidence: 99%

Assessing White's Classification of Pregestational Diabetes in a Contemporary Diabetic Population

Bennett

Tita

Owen

et al. 2015

Obstetrics &Amp; Gynecology

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“…Our perinatal database has been in operation since 1979 and contains almost 1,000 coded antepartum, intrapartum and postpartum items per patient. (18) Immediately following delivery, physicians record the intrapartum and postpartum data on standardized forms. All antepartum data from the patient’s clinical chart are entered by dedicated personnel and these data are subjected to scheduled audit.…”

Section: Methodsmentioning

confidence: 99%

Fetal Anomalies in Obese Women

Biggio

Chapman

Neely

et al. 2010

Obstetrics &Amp; Gynecology

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Objective To examine temporal changes in maternal weight and the association with major structural anomalies and other factors, such as diabetes, in our primary obstetric population. Methods We conducted a serial, cross-sectional study utilizing a perinatal database to identify all women with singletons who delivered in our system from 1991–2004. Three, 5-year time epochs were defined to compare patient cohorts. Maternal weight, body mass index (BMI), diabetes status, incidence of major anomalies, and demographic data were compared. Multiple logistic regression was performed to estimate factors contributing to anomaly rates. Results Forty-one thousand nine-hundred two pregnancies were included. In each time epoch, there was an increase in the mean maternal weight, the mean BMI, the proportion of women weighing in excess of 200 lb, the proportion with a BMI higher than 29, the prevalence of pregestational diabetes, and the prevalence of major anomalies (all p<0.0001). There was no significant independent association between maternal obesity and the presence of a major anomaly. In a multivariable logistic model, the major factor contributing to the rising rate of congenital anomalies was the prevalence of pre-gestational diabetes (OR 3.8, CI 2.1 – 6.6). The population-attributable risk of anomalies related to obesity increased from essentially 0% in 1991–94 to 6.1% in 2000–04, while that related to diabetes increased from 3.3% to 9.2% during the same time periods. Conclusion Although in the prevalence of maternal obesity and anomaly have increased, maternal weight alone was not associated with an increase in congenital anomalies. Instead, diabetes was significantly associated with the increase in the rate of anomalies seen in our population. Identification of maternal weight as a risk factor in epidemiologic studies may be a surrogate for pregestational diabetes.

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“…Standardized prenatal summaries (obstetric automated record) were available for women who received prenatal care from the county health department clinics, ϳ95% of the study population. 22 These standardized prenatal summaries contained summary information on each prenatal visit, all laboratory test results, and medical and obstetric history. Records were abstracted ϳ2 to 3 months after delivery.…”

Section: Study Populationmentioning

confidence: 99%