Publications by authors named "Barbra M Fisher"

11 Publications

  • Page 1 of 1

Optimal timing of influenza vaccine during pregnancy: A systematic review and meta-analysis.

Influenza Other Respir Viruses 2019 09 5;13(5):438-452. Epub 2019 Jun 5.

Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia.

Background: Pregnant women have an elevated risk of illness and hospitalisation from influenza. Pregnant women are recommended to be prioritised for influenza vaccination during any stage of pregnancy. The risk of seasonal influenza varies substantially throughout the year in temperate climates; however, there is limited knowledge of how vaccination timing during pregnancy impacts the benefits received by the mother and foetus.

Objectives: To compare antenatal vaccination timing with regard to influenza vaccine immunogenicity during pregnancy and transplacental transfer to their newborns.

Methods: Studies were eligible for inclusion if immunogenicity to influenza vaccine was evaluated in women stratified by trimester of pregnancy. Haemagglutination inhibition (HI) titres, stratified by trimester of vaccination, had to be measured at either pre-vaccination and within one month post-vaccination, post-vaccination and at delivery in the mother, or in cord/newborn blood. Authors searched PubMed, Scopus, Web of Science and EMBASE databases from inception until June 2016 and authors of identified studies were contacted for additional data. Extracted data were tabulated and summarised via random-effect meta-analyses and qualitative methods.

Results: Sixteen studies met the inclusion criteria. Meta-analyses found that compared with women vaccinated in an earlier trimester, those vaccinated in a later trimester had a greater fold increase in HI titres (1.33- to 1.96-fold) and higher HI titres in cord/newborn blood (1.21- to 1.64-fold).

Conclusions: This review provides comparative analysis of the effect of vaccination timing on maternal immunogenicity and protection of the infant that is informative and relevant to current vaccine scheduling for pregnant women.
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http://dx.doi.org/10.1111/irv.12649DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6692549PMC
September 2019

Maternal chromosome Xp deletion identified by prenatal cell-free DNA screening.

Prenat Diagn 2017 09 25;37(9):935-937. Epub 2017 Jul 25.

Division of Molecular Genetics, Quest Diagnostics, San Juan Capistrano, CA, USA.

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http://dx.doi.org/10.1002/pd.5103DOI Listing
September 2017

Can Fetal Limb Soft Tissue Measurements in the Third Trimester Predict Neonatal Adiposity?

J Ultrasound Med 2016 Sep 14;35(9):1915-24. Epub 2016 Jul 14.

Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, University of Colorado School of Medicine, Aurora, Colorado USA.

Objectives: Neonatal adiposity is associated with chronic metabolic sequelae such as diabetes and obesity. Identifying fetuses at risk for excess neonatal body fat may lead to research aimed at limiting nutritional excess in the prenatal period. We sought to determine whether fetal arm and leg soft tissue measurements at 28 weeks' gestation were predictive of neonatal percent body fat METHODS : In this prospective observational cohort study of singleton term pregnancies, we performed sonography at 28 and 36 weeks' gestation, including soft tissue measurements of the fetal arm and thigh (fractional limb volume and cross-sectional area). We estimated the neonatal body composition (percent body fat) using anthropometric measurements and air displacement plethysmography. We estimated Spearman correlations between sonographic findings and percent body fat and performed modeling to predict neonatal percent body fat using maternal characteristics and sonographic findings.

Results: Our analysis of 44 women yielded a mean maternal age of 30 years, body mass index of 26 kg/m(2), and birth weight of 3382 g. Mean neonatal percent body fat was 8.1% by skin folds at birth and 12.2% by air displacement plethysmography 2 weeks after birth. Fractional thigh volume measurements at 28 weeks yielded the most accurate model for predicting neonatal percent body fat (R(2) = 0.697; P = .001), outperforming models that used abdominal circumference (R(2)= 0.516) and estimated fetal weight (R(2)= 0.489).

Conclusions: Soft tissue measurements of the fetal thigh at 28 weeks correlated better with neonatal percent body fat than currently used sonographic measurements. After validation in a larger cohort, our models may be useful for prenatal intervention strategies aimed at the prevention of excess fetal fat accretion and, potentially, optimization of long-term metabolic health.
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http://dx.doi.org/10.7863/ultra.15.06028DOI Listing
September 2016

Antiretroviral Resistance and Pregnancy Characteristics of Women with Perinatal and Nonperinatal HIV Infection.

Infect Dis Obstet Gynecol 2016 19;2016:4897501. Epub 2016 Jun 19.

Department of Obstetrics and Gynecology, University of British Columbia, 1190 Hornby Street, 4th Floor, Vancouver, BC, Canada V6Z 2K5.

Objective. To compare HIV drug resistance in pregnant women with perinatal HIV (PHIV) and those with nonperinatal HIV (NPHIV) infection. Methods. We conducted a multisite cohort study of PHIV and NPHIV women from 2000 to 2014. Sample size was calculated to identify a fourfold increase in antiretroviral (ARV) drug resistance in PHIV women. Continuous variables were compared using Student's t-test and Wilcoxon rank-sum tests. Categorical variables were compared using χ (2) and Fisher's exact tests. Univariate analysis was used to determine factors associated with antiretroviral drug resistance. Results. Forty-one PHIV and 41 NPHIV participants were included. Women with PHIV were more likely to have drug resistance than those with NPHIV ((55% versus 17%, p = 0.03), OR 6.0 (95% CI 1.0-34.8), p = 0.05), including multiclass resistance (15% versus 0, p = 0.03), and they were more likely to receive nonstandard ARVs during pregnancy (27% versus 5%, p = 0.01). PHIV and NPHIV women had similar rates of preterm birth (11% versus 28%, p = 0.08) and cesarean delivery (47% versus 46%, p = 0.9). Two infants born to a single NPHIV woman acquired HIV infection. Conclusions. PHIV women have a high frequency of HIV drug resistance mutations, leading to nonstandard ARVs use during pregnancy. Despite nonstandard ARV use during pregnancy, PHIV women did not experience increased rates of adverse pregnancy outcomes.
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http://dx.doi.org/10.1155/2016/4897501DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4930810PMC
July 2017

Association of extremes of prepregnancy BMI with the clinical presentations of preterm birth.

Am J Obstet Gynecol 2014 May 7;210(5):428.e1-9. Epub 2013 Dec 7.

Department of Obstetrics and Gynecology, University of Colorado Denver, Aurora, CO.

Objective: The purpose of this study was to examine associations between the prepregnancy maternal body mass index (BMI) across the 3 clinical presentations of preterm birth (PTB).

Study Design: We conducted a retrospective cohort study of the records of 11,726 women. The World Health Organization International Classification was used to categorize BMI. The primary outcome of the study was PTB (<37 weeks' gestation) presenting as spontaneous preterm labor, preterm premature rupture of the membranes, or a medical indication. We used univariable and multivariable logistic regression analysis to analyze the data (P < .05).

Results: We found (1) a significant increase in the overall incidence of PTB at the extremes of BMI, (2) a higher risk for PTB from spontaneous preterm labor at the lower extremes (low plus moderate thinness) of BMI (adjusted odds ratio [aOR], 2.4; 95% confidence interval [CI], 1.4-4.2; P = .003), (3) a higher risk for preterm premature rupture of the membranes at the upper extremes (obese class II plus III) of BMI (aOR, 1.6; 95% CI, 1.1-2.3; P = .02), and (4) a higher risk for a medically indicated PTB at the lower (aOR, 2.8; 95% CI, 1.4-5.6; P = .004) and upper (aOR, 1.5; 95% CI, 1.1-2.2; P = .02) extreme of BMI.

Conclusion: Women at the extremes of prepregnancy BMI are at risk for PTB.
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http://dx.doi.org/10.1016/j.ajog.2013.12.011DOI Listing
May 2014

Siglec-6 expression is increased in placentas from pregnancies complicated by preterm preeclampsia.

Reprod Sci 2013 Jun 20;20(6):646-53. Epub 2012 Nov 20.

Department of Obstetrics and Gynecology, University of Colorado, Aurora, CO 80045, USA.

Sialic acid immunoglobulin-like lectin (Siglec)-6 is a transmembrane receptor that binds sialyl-TN glycans and leptin. Among eutherian mammals, only human placentas express Siglec-6. Previous work has implicated Siglec-6 in preeclampsia (PE). Preeclampsia, a leading cause of maternal and perinatal morbidity and mortality, is characterized by placental abnormalities. This study provides a comprehensive analysis of Siglec-6 protein expression during human pregnancy by disease state (PE), biologic compartment (basal plate, chorionic villi, or maternal plasma), gestational age (24-41 weeks), and labor status. Siglec-6 protein was increased in both the basal plate and chorionic villi of preterm PE placentas (P < .05). However, expression did not differ at term by disease state, compartment, or labor status. Siglec-6 was not detectable in maternal serum. Overexpression of Siglec-6 protein in preterm PE placentas may contribute to or represent a response to PE pathogenesis and suggests that preterm PE pathogenesis is distinct from term PE.
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http://dx.doi.org/10.1177/1933719112461185DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3676189PMC
June 2013

Utilization of instruments in the chairman's curio cabinet: a case report.

J Reprod Med 2012 Mar-Apr;57(3-4):164-6

Department of Obstetrics and Gynecology, University of Colorado Denver, Aurora, Colorado 80045, USA.

Background: The use of fetal destructive instruments found in curio cabinets may be unfathomable; however, these instruments continue to have a role in select cases.

Case: A 30-year-old multigravida at 40 weeks' gestation had 3 prior normal vaginal deliveries in Africa followed by a cesarean delivery with a complicated postoperative course in the United States. She was intent on having a vaginal delivery, despite repeated recommendations for surgery due to nonreassuring fetal status. After fetal demise and subsequent arrest of labor, vaginal cephalocentesis and fetal extraction were used to achieve delivery. CONCLUSION Fetal destructive procedures, such as the one described here, have a role in modern obstetrics in select cases. In addition, despite an unfortunate fetal outcome, respect for patient autonomy is paramount and is consistent with the recommendations of the American Congress of Obstetricians and Gynecologists. (J Reprod
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May 2012

Pandemic influenza A H1N1 2009 infection versus vaccination: a cohort study comparing immune responses in pregnancy.

PLoS One 2012 22;7(3):e33048. Epub 2012 Mar 22.

Department of Obstetrics and Gynecology, Section of Maternal-Fetal Medicine, University of Colorado School of Medicine, Aurora, Colorado, United States of America.

Background: With the emergence of H1N1 pandemic (pH1N1) influenza, the CDC recommended that pregnant women be one of five initial target groups to receive the 2009 monovalent H1N1 vaccine, regardless of prior infection with this influenza strain. We sought to compare the immune response of pregnant women to H1N1 infection versus vaccination and to determine the extent of passive immunity conferred to the newborn.

Methods/findings: During the 2009-2010 influenza season, we enrolled a cohort of women who either had confirmed pH1N1 infection during pregnancy, did not have pH1N1 during pregnancy but were vaccinated against pH1N1, or did not have illness or vaccination. Maternal and umbilical cord venous blood samples were collected at delivery. Hemagglutination inhibition assays (HAI) for pH1N1 were performed. Data were analyzed using linear regression analyses. HAIs were performed for matched maternal/cord blood pairs for 16 women with confirmed pH1N1 infection, 14 women vaccinated against pH1N1, and 10 women without infection or vaccination. We found that pH1N1 vaccination and wild-type infection during pregnancy did not differ with respect to (1) HAI titers at delivery, (2) HAI antibody decay slopes over time, and (3) HAI titers in the cord blood.

Conclusions: Vaccination against pH1N1 confers a similar HAI antibody response as compared to pH1N1 infection during pregnancy, both in quantity and quality. Illness or vaccination during pregnancy confers passive immunity to the newborn.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0033048PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3310855PMC
August 2012

Behaviors and perceptions regarding seasonal and H1N1 influenza vaccination during pregnancy.

Am J Obstet Gynecol 2011 Jun 22;204(6 Suppl 1):S107-11. Epub 2011 Feb 22.

Section of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Colorado Denver, Aurora, CO, USA.

We examined vaccination rates during pregnancy against both seasonal and pandemic H1N1 influenza and reasons for nonadherence to recommended guidelines during the 2009 through 2010 influenza season. Demographic and vaccination data were collected using a cross-sectional approach. Among 813 postpartum women, 520 (64%) reported receiving the seasonal influenza vaccination and 439 (54%) reported receiving the H1N1 influenza vaccination during pregnancy. Most received vaccinations at their obstetrician's office. Major reasons for not receiving vaccination were: not knowledgeable about the vaccine importance (25%), concerns for effects on fetal and maternal health (18% and 9%, respectively), and not knowledgeable about where to obtain vaccination (9%). Reported H1N1 influenza vaccination rates were significantly lower in blacks (37%) compared with non-Hispanic whites, Hispanics, and Asian/other (57%, 59%, and 58%, respectively; P < .0001). Subsequent campaigns for improving vaccination rates in pregnancy should focus on educating patients about vaccine importance and safety.
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http://dx.doi.org/10.1016/j.ajog.2011.02.041DOI Listing
June 2011

Antenatal screening tests: knowledge and practice patterns of obstetricians in Utah.

Am J Med Genet A 2006 Nov;140(22):2464-8

Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, University of Utah Health Sciences Center, Salt Lake City, USA.

We sought to assess knowledge and practices of obstetricians regarding antenatal testing and test the efficacy of continuing education via a direct mailing. In June 2004, an educational brochure entitled "New Options for Maternal Serum Screening for Birth Defects" as well as an anonymous survey pertaining to antenatal testing was sent to 241 American College of Obstetricians and Gynecologists (ACOG) Fellows and Junior Fellows residing in Utah. Data from the 85 (35%) respondents were analyzed. The majority of respondents practice obstetrics (81/85, or 95%). Of these, 67% of respondents perform sonograms routinely in their offices. Respondents were distributed evenly across all years of practice. Respondents offer HIV screening routinely (85%), but only 40% follow ACOG cystic fibrosis (CF) screening recommendations. Midtrimester serum screening is offered routinely by 89% of the respondents, but only 54% adequately understood the capabilities and limitations of the test. Questions related to the patient education brochure included in the mailing were answered correctly more often than the other questions. The brochure emphasized the usefulness of combined integrated screening for detecting Down syndrome, and 94% of respondents subsequently understood this concept. We show that in Utah, ACOG recommendations for HIV and maternal serum testing are being followed uniformly, but CF screening is still not being routinely offered. The accurate responses to questions related to an enclosed education brochure suggest that direct mailings may be useful for provider education, especially in regions where many providers practice remote from academic centers.
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http://dx.doi.org/10.1002/ajmg.a.31522DOI Listing
November 2006
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