Publications by authors named "Shilpa Babbar"

20 Publications

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Complementary and Alternative Medicine in Obstetrics.

Authors:
Shilpa Babbar

Clin Obstet Gynecol 2021 Jun 25. Epub 2021 Jun 25.

Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Children's Mercy Kansas City, University of Missouri-Kansas City, Kansas City, Missouri.

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http://dx.doi.org/10.1097/GRF.0000000000000642DOI Listing
June 2021

Mind-Body Techniques in Pregnancy and Postpartum.

Clin Obstet Gynecol 2021 Jun 23. Epub 2021 Jun 23.

Department of Neurology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, University of Missouri-Kansas City, Children's Mercy Kansas City, Kansas City Department of Psychiatry, Kansas University Medical Center, Kansas City, Kansas RPYS-Yoga Alliance, Saint Louis, Missouri.

Maternal stress can perturb physiology and psychiatric health leading to adverse outcomes. This review investigates the effectiveness of several mind-body therapies-namely biofeedback, progressive muscle relaxation, guided imagery, tai chi, and yoga-as interventions in reducing maternal stress and other pregnancy-related conditions. Through randomized trials, these techniques have shown promising benefits for reducing pain, high blood pressure, stress, anxiety, depressive symptoms, labor pain and outcomes, and postpartum mood disturbances. As these interventions are easy to implement, low cost, and safe to perform in pregnancy, they should be considered as alternative, nonpharmaceutical interventions to use during pregnancy and postpartum care.
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http://dx.doi.org/10.1097/GRF.0000000000000641DOI Listing
June 2021

Meditation and Mindfulness in Pregnancy and Postpartum: A Review of the Evidence.

Clin Obstet Gynecol 2021 Jun 23. Epub 2021 Jun 23.

Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, University of Missouri-Kansas City, Children's Mercy Kansas City, Kansas City, Missouri Department of Neurology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.

Given their growing popularity, mindfulness practices including meditation are actively being studied in clinical trials to assess their efficacy at improving health outcomes during pregnancy and the postpartum period. We conducted a literature review to compile these studies and assessed their findings. There is sufficient evidence to support the practice of mindfulness practices in pregnancy to reduce anxiety, depression, and stress during pregnancy, which may continue to have beneficial effects through the postpartum period. There is limited evidence on the benefits of mindfulness and meditation for other aspects of pregnancy. However, due to the low-risk nature of these techniques, all women should be encouraged to engage in mindfulness practices during pregnancy.
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http://dx.doi.org/10.1097/GRF.0000000000000640DOI Listing
June 2021

Sleep among Obstetrics and Gynecology Trainees: Results from a Yoga-Based Wellness Initiative.

Am J Perinatol 2021 May 3. Epub 2021 May 3.

Department of Biomedical and Health Informatics, University of Missouri-Kansas City, Kansas City, Missouri.

Objective:  This study aimed to determine the feasibility of using a wrist-based fitness tracking device to assess sleep among Obstetrics and Gynecology (OBGYN) trainees who engaged in a yoga-based wellness program. We also sought to evaluate the effects of yoga on sleep.

Study Design:  A quality improvement initiative consisting of an 8-week wellness program of weekly yoga classes, nutrition, and physical challenges was implemented for OBGYN residents and Maternal-Fetal Medicine fellows. The Polar A370 fitness tracker device was provided and synced to the Polar Flow for Coach program for inclusion. Data obtained included total and restful sleep from each night the device were worn. Pre- and post-assessment of the Pittsburg Sleep Quality Index (PSQI) were compared. Linear mixed models were used to estimate and test the effect of yoga on sleep while controlling for on-call shifts.

Results:  Of the 15 participants who synced their device, 13 (87%) were included for analysis. Sleep data from 572 nights were analyzed. The mean (SD) total sleep was 434.28 (110.03) minutes over the 8 weeks. A minimum of 7 hours (420 minutes) of total sleep occurred 59.3% of the time. After controlling for Friday or Saturday night on-call, those who attended yoga class had a significantly greater total sleep (yoga: 425.14 minutes [41.89], no yoga: 357.33 [43.04] minutes;  = 0.04). There was no significant change in the mean global PSQI score after the program (pre: 5.0 [1.6], post: 5.1 [2.5],  = 0.35).

Conclusion:  Wearable fitness monitors provide insight into sleep patterns displayed during training and can serve as a tool to identify those who are sleep deprived and assist in the evaluation of trainee wellness. Training programs are encouraged to provide access to yoga and mindfulness interventions to improve sleep and possibly clinical performance.

Key Points: · Yoga improves trainee sleep by approximately 60 minutes.. · Total and restful sleep are reduced during night float rotation.. · Trainees obtained 7 hours of sleep approximately 60% of the time..
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http://dx.doi.org/10.1055/s-0041-1728838DOI Listing
May 2021

Adherence rates and outcomes for 17-hydroxyprogesterone caproate use in women with a previous history of preterm birth.

Am J Obstet Gynecol MFM 2020 08 25;2(3):100166. Epub 2020 Jun 25.

Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Children's Mercy Hospital, University of Missouri-Kansas City, Kansas City, MO.

Background: Progesterone has been used for preventing preterm birth with mixed results. The American College of Obstetricians and Gynecologists and Society for Maternal-Fetal Medicine recommended the use of 17-hydroxyprogesterone caproate for risk reduction of recurrent spontaneous preterm birth based on the results of a multicenter, randomized trial in the United States. However, recent literature lacks consensus for efficacy in the American population. In addition, partial adherence and outcomes thereof are underreported. Hence, the relationship between practical adherence to 17-hydroxyprogesterone caproate and outcomes were evaluated.

Objective: The objective of this study was to evaluate the adherence to 17-hydroxyprogesterone caproate, defined as receipt of greater than 80% of intended injections, at an outpatient maternal-fetal medicine center and its effect on maternal and neonatal outcomes.

Study Design: This retrospective cohort study included women older than 18 years with a singleton gestation, history of spontaneous preterm birth who initiated 17-hydroxyprogesterone caproate weekly injections between 16 and 20 weeks' gestational age and delivered between the years 2014 and 2017. Women receiving 17-hydroxyprogesterone caproate injections outside of the clinic were excluded. The primary outcome of adherence and secondary outcomes of gestational age at delivery, birthweight, and neonatal outcomes were analyzed using descriptive data, independent t-test, Mann-Whitney U test, chi-square test, and Fisher exact test, where appropriate, with a P value <.05 being considered significant.

Results: Adherence to 17-hydroxyprogesterone caproate occurred in 38 of 92 (41.3%) women included in the study. At baseline, there was a difference in age between groups of adherent and nonadherent women (adherent: 30.8 years; nonadherent: 27.4 years; P=.002). The rate of spontaneous preterm birth less than 37, 35, and 32 weeks were not significantly different in those who were adherent vs nonadherent to 17-hydroxyprogesterone caproate. There were no differences in gestational age at delivery (adherent: 36.8±2.6 weeks; nonadherent: 36.5±3.8 weeks; P=.66), birthweight (adherent: 2776 g; nonadherent: 2709 g; P=.68), or composite neonatal morbidity (adherent: 18.4%; nonadherent: 20.4%; P=.86) between the adherent and nonadherent groups. Neonatal intensive care unit length of stay was 15.5 days in the adherent group compared with 15 days in the nonadherent group (P=.72).

Conclusion: Real-world adherence to 17-hydroxyprogesterone caproate is suboptimal with less than half of women adherent to in-clinic administration. Adherence to 17-hydroxyprogesterone caproate was not associated with a difference in gestational age at delivery or birthweight compared with nonadherence. Further studies are needed to assess the outpatient administration and benefit of 17-hydroxyprogesterone caproate therapy.
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http://dx.doi.org/10.1016/j.ajogmf.2020.100166DOI Listing
August 2020

Prospective, Blinded Evaluation of Template-Based Cesarean Documentation Error in an Obstetric Training Program.

J Patient Saf 2020 Mar 23. Epub 2020 Mar 23.

From the Division of Maternal Fetal Medicine, Department of Obstetrics, Gynecology, and Women's Health, Saint Louis University College of Medicine, St. Louis, Missouri.

Objective: Cesarean operative report accuracy impacts postoperative care and future obstetric decision-making. The impact of electronic health record template use on cesarean documentation error remains unknown. The aim of the study was to describe the incidence of resident physician documentation error in cesarean operative reports using electronic health record templates.

Methods: Attending physicians completed a standardized audit form after cesarean deliveries, which was compared with the resident operative report. Resident physicians were blinded to the auditing process. Errors were classified as none, major, or minor using predefined definitions. Author and operative characteristics were collected for comparative and predictive analyses. Data were analyzed by presence or absence of error.

Results: We reviewed 100 cesarean operative reports. Major and minor errors were encountered in 33% and 53% of operative notes, respectively. Advancing training level was associated with lower incidence of major error (50%, for postgraduate year [PGY] 1, 33% for PGY 2, and 0% for PGY 3/4, P = 0.02), but minor errors were similar among training level, P = 0.48. Operative duration, documentation interval, and shift characteristics were similar in cases with and without documentation errors. In multiple logistic regression, PGY was predictive of major documentation error (adjusted odds ratio = 0.39, 95% confidence interval = 0.17-0.92).

Conclusions: A high incidence of clinically significant documentation error was observed in a residency training program using standardized templates for cesarean operative reports. Incidence of major error decreased with increasing training, but minor error was similar across levels of training. These data suggest that measures should be taken to improve documentation accuracy in medical training to provide optimal obstetric care.
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http://dx.doi.org/10.1097/PTS.0000000000000660DOI Listing
March 2020

Addressing Obstetrics and Gynecology Trainee Burnout Using a Yoga-Based Wellness Initiative During Dedicated Education Time.

Obstet Gynecol 2019 05;133(5):994-1001

Department of Obstetrics, Gynecology and Women's Health, Saint Louis University, St. Louis, and the Department of Bioinformatics, University of Missouri Kansas City, Kansas City, Missouri.

Objective: To estimate the feasibility of implementing a yoga-based wellness program during training and its influence on burnout, depression, anxiety, stress, and mindfulness among obstetrics and gynecology trainees.

Methods: We conducted a departmental quality improvement initiative consisting of weekly 1-hour yoga classes conducted during protected education time and nutrition and physical challenges for 24 obstetrics and gynecology residents and five maternal-fetal medicine fellows. Participants received a free wrist-worn fitness tracker device to record their activity. Preprogram and postprogram data collection included results from validated scales on burnout, mindfulness, depression and anxiety, blood pressure, heart rate, and weight. Wilcoxon signed rank tests were used for analysis. A P-value <.05 was considered significant.

Results: Over an 8-week period, 90% (n=26) of participants attended at least one yoga class and 68% attended at least 50% of the classes. No participant completed all sessions. Eighty percent (n=20) engaged in at least one nutrition challenge and 60% (n=15) in at least one physical challenge. After the program, a significant reduction in the depersonalization component of burnout (P=.04), anxiety (P=.02), and systolic (preprogram: 122, postprogram: 116 mm Hg; P=.01) and diastolic blood pressure (preprogram: 82, postprogram: 76 mm Hg; P=.01) occurred. Those participants who attended more than 50% of yoga classes demonstrated a significant reduction in systolic and diastolic blood pressure compared with less-frequent attendees (P=.02 and .04, respectively). A postprogram survey revealed feelings of increased camaraderie, appreciation, motivation, and overall training experience.

Discussion: Implementing a wellness program consisting of weekly yoga classes is feasible and may be beneficial. A wellness initiative that emphasizes active participation during education time with the autonomy to implement daily wellness activities may reduce burnout and improve well-being.
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http://dx.doi.org/10.1097/AOG.0000000000003229DOI Listing
May 2019

Time from neuraxial anesthesia placement to delivery is inversely proportional to umbilical arterial cord pH at scheduled cesarean delivery.

Am J Obstet Gynecol 2019 04 8;220(4):389.e1-389.e9. Epub 2019 Jan 8.

Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Women's Health, St Louis University School of Medicine, St Louis, MO.

Background: Neuraxial block-related hypotension and maternal obesity contribute to uterine hypoperfusion and decreased umbilical arterial pH at cesarean delivery. Between the time of anesthesia placement and delivery, the fetus may be exposed to a hypoperfused uterine environment without surgeon awareness of fetal compromise.

Objective: We sought to evaluate neonatal umbilical arterial pH according to predelivery time intervals at scheduled term cesarean.

Study Design: We performed a retrospective cohort study of cesarean deliveries between September 2014 and February 2017. Singleton gestations undergoing scheduled cesarean delivery under spinal anesthesia between 37 and 41 weeks with a reassuring preoperative nonstress test were included. Time intervals between operative room entry, spinal anesthesia placement, skin incision, uterine incision, and delivery were calculated. The primary outcome was umbilical arterial pH. Demographic data, maternal blood pressures, predelivery time intervals, and delivery outcomes were analyzed according to umbilical arterial pH intervals of <7.0, 7.01-7.10, 7.11-7.20, 7.21-7.30, and >7.30. Umbilical cord gas analytes and neonatal outcomes were analyzed by spinal to delivery time. Stepwise linear regression was performed to identify predictors of decreasing umbilical arterial pH. Receiver-operator characteristic curves were calculated for spinal to delivery time and umbilical arterial pH <7.0 and 7.1.

Results: Among 527 included participants, median umbilical arterial pH was 7.27 [interquartile range, 7.23-7.29] and body mass index was 35 kg/m [interquartile range, 30-41]. Both maternal body mass index and hypotensive episodes increased with decreasing umbilical arterial pH (P <.001, P ≤ .02). All predelivery time intervals (operative room to delivery, spinal to skin, spinal to delivery, and uterine incision to delivery) increased as umbilical arterial pH interval decreased (P < .05 for all). In a stepwise linear regression, maternal body mass index, noncephalic presentation, spinal start to delivery interval, uterine incision to delivery interval, and maximum reduction in blood pressure from baseline were predictive of decreasing umbilical arterial pH after controlling for confounding variables (F [5,442] = 17.7, P = .0001], adjusted R of 0.157. When evaluated by spinal to delivery time, both umbilical arterial and venous pH and partial pressure of carbon dioxide decreased (P < .001 for all), but base deficit and neonatal outcomes were similar (P ≥ .7 for all). There were 2 cases of hypoxic-ischemic encephalopathy (0.38%). A receiver-operating characteristic curve demonstrated that a spinal start to delivery time greater than 27 minutes was associated with an umbilical arterial pH <7.1 (area under the curve, 0.74, 100% sensitivity, 21% specificity), and an interval greater than 30 minutes was associated with an umbilical arterial pH <7.0 (area under the curve, 0.80, 100% sensitivity, 33% specificity).

Conclusion: Longer spinal-to-delivery and uterine incision-to-delivery time intervals were associated with decreasing umbilical arterial pH at scheduled term cesarean delivery. Efforts to minimize predelivery time following spinal placement could reduce the frequency of unanticipated neonatal acidemia.
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http://dx.doi.org/10.1016/j.ajog.2019.01.006DOI Listing
April 2019

Benzodiazepines in Pregnancy.

Clin Obstet Gynecol 2019 03;62(1):156-167

St. Louis College of Pharmacy, St. Louis, Missouri.

Benzodiazepine use and dependence are on the rise as well as the number of deaths attributable to the combination of opioids and benzodiazepines. Anxiety, the most frequent condition for which benzodiazepines are prescribed, occurs commonly, and is increasingly noted to coincide with pregnancy. Use of both benzodiazepine anxiolytics and anxiety in pregnancy is associated with preterm delivery and low birth weight. Short-term neonatal effects of hypotonia, depression, and withdrawal are described but long-term sequelae, if any, are poorly understood. Benzodiazepines are associated with physical dependence and withdrawal symptoms which can be serious. To avoid withdrawal, tapering off these medications is recommended. What is known about the pharmacology and pharmacokinetics, pregnancy implications, tapering schedules, and alternative strategies for anxiety are discussed.
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http://dx.doi.org/10.1097/GRF.0000000000000417DOI Listing
March 2019

The Impact of Prenatal Yoga on Exercise Attitudes and Behavior: Teachable moments from a Randomized Controlled Trial.

Int J Yoga Therap 2017 Nov;27(1):37-48

3. Department of Biomedical and Health Informatics, University of Missouri, Kansas City, MO, USA.

Objective: Pregnancy serves as an opportune time for "teachable moments" to elicit positive behavior change. We evaluated change in exercise perception, behavior and gestational weight gain in participants engaged in a one-hour educational experience.

Methods: Women between 28 0/7 to 36 6/7 weeks with no prior yoga experience carrying a non-anomalous singleton fetus participated in a randomized controlled trial on prenatal yoga. The yoga group engaged in a one-hour yoga class; the attention control educational group, in a one-hour presentation on exercise, nutrition and obesity in pregnancy. Maternal perception of yoga, exercise effects and current health status was conducted before and after the intervention. Gestational weight gain (GWG) and body mass index (BMI) were assessed. A postpartum survey was performed to determine self-reported behavioral changes during and after pregnancy.

Results: Over 6 months, 52 women were randomized and 46 (88%) completed the study. Women reported a more positive attitude towards exercise and yoga after the yoga intervention. Total GWG was similar (yoga 32.9 versus education 32.8 pounds, p = 0.98). Stratified by pre-pregnancy BMI, 13% gained within and 61% gained above the Institute of Medicine guidelines in each group. Of 29 inactive women prior to the intervention, 60% of the yoga group and 75% of the education group began prenatal exercises after the intervention and 50% of each group continued to exercise after delivery. There were no significant differences between groups.

Conclusion: A one-time, one-hour intervention teaching a new exercise or educating women during pregnancy can positively impact pregnancy behaviors and perception with the potential to improve maternal and neonatal outcomes.

Clinical Trial Registration: Clinicaltrials.gov, www.clinicaltrials.gov , NCT02063711.
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http://dx.doi.org/10.17761/1531-2054-27.1.37DOI Listing
November 2017

The oral microbiome and adverse pregnancy outcomes.

Int J Womens Health 2017 8;9:551-559. Epub 2017 Aug 8.

Department of Obstetrics & Gynecology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA.

Significant evidence supports an association between periodontal pathogenic bacteria and preterm birth and preeclampsia. The virulence properties assigned to specific oral pathogenic bacteria, for example, , , , , and others, render them as potential collaborators in adverse outcomes of pregnancy. Several pathways have been suggested for this association: 1) hematogenous spread (bacteremia) of periodontal pathogens; 2) hematogenous spread of multiple mediators of inflammation that are generated by the host and/or fetal immune response to pathogenic bacteria; and 3) the possibility of oral microbial pathogen transmission, with subsequent colonization, in the vaginal microbiome resulting from sexual practices. As periodontal disease is, for the most part, preventable, the medical and dental public health communities can address intervention strategies to control oral inflammatory disease, lessen the systemic inflammatory burden, and ultimately reduce the potential for adverse pregnancy outcomes. This article reviews the oral, vaginal, and placental microbiomes, considers their potential impact on preterm labor, and the future research needed to confirm or refute this relationship.
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http://dx.doi.org/10.2147/IJWH.S142730DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5557618PMC
August 2017

The clinical significance of an estimated fetal weight below the 10th percentile: a comparison of outcomes of <5th vs 5th-9th percentile.

Am J Obstet Gynecol 2017 08 20;217(2):198.e1-198.e11. Epub 2017 Apr 20.

Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, VA.

Background: The association between small-for-gestational-age (birthweight <10th percentile for gestational age) and neonatal morbidity is well established. Yet, there is a paucity of data on the relationship between suspected small for gestational age (sonographic-estimated fetal weight <10th percentile) at 2 thresholds and subsequent neonatal morbidity.

Objective: The objective of this study was to determine the relationship between sonographic-estimated fetal weight <5th percentile vs 5-9th percentile and neonatal morbidity.

Study Design: This retrospective study involved 5 centers and included nonanomalous, singletons with sonographic-estimated fetal weight <10th percentile for gestational age who delivered from 2009-2012. Composite neonatal morbidity included respiratory distress syndrome, proven sepsis, intraventricular hemorrhage grade III or IV, necrotizing enterocolitis, thrombocytopenia, seizures, or death. Odd ratios were adjusted for center, maternal age, race, body mass index at first visit, smoking status, use of alcohol, use of drugs, and neonatal gender.

Results: Of 834 women with suspected small-for-gestational-age fetuses, 513 (62%) had sonographic-estimated fetal weight <5th percentile, and 321 (38%) had sonographic-estimated fetal weight of 5-9th percentile for gestational age. At delivery, 81% of women with a suspected small-for-gestational-age fetus had a confirmed small-for-gestational-age fetus. In the group with a sonographic-estimated fetal weight <5th percentile, 59% of neonates had birthweight <5th percentile; in the group with a sonographic-estimated fetal weight 5-9th percentile, 41% had birthweight <5th percentile, and 36% had birthweight at 5-9th percentile. Neonatal intensive care unit admission differed significantly for those fetuses at <5th percentile (29%) compared with those fetuses at 5-9th percentile (15%; P<.001). The composite neonatal morbidity among the sonographic-estimated fetal weight <5th percentile group was higher than the sonographic-estimated fetal weight of 5-9th percentile group (31% vs 13%; adjusted odds ratio, 2.41; 95% confidence interval, 1.53-3.80). Similar findings were noted when the analysis was limited to sonographic-estimated fetal weight within 28 days of delivery (adjusted odds ratio, 2.22; 95% confidence interval, 1.34-3.67).

Conclusion: Eight of 10 suspected small-for-gestational-age fetuses had birthweight <10th percentile for gestational age; the prediction of actual birthweight was more accurate in the <5th percentile group. Neonates with sonographic-estimated fetal weight of <5th percentile were more likely to be admitted to the neonatal intensive care unit and have complications than were those neonates with sonographic-estimated fetal weight of 5-9th percentile.
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http://dx.doi.org/10.1016/j.ajog.2017.04.020DOI Listing
August 2017

Complementary and Alternative Medicine Use in Modern Obstetrics: A Survey of the Central Association of Obstetricians & Gynecologists Members.

J Evid Based Complementary Altern Med 2017 07 5;22(3):429-435. Epub 2016 Oct 5.

2 University of Missouri, Kansas City, MO, USA.

The use of complementary and alternative medicine during pregnancy is currently on the rise. A validated survey was conducted at the Central Association of Obstetrician and Gynecologists annual meeting to evaluate the knowledge, attitude, and practice of general obstetricians and gynecologists and maternal-fetal medicine specialists in America. We obtained 128 responses: 73 electronically (57%) and 55 via the paper survey (43%). Forty-five percent reported personally using complementary and alternative medicine and 9% of women respondents used complementary and alternative medicine during pregnancy. Overall, 62% had advised their patients to utilize some form of complementary and alternative medicine in pregnancy. Biofeedback, massage therapy, meditation, and yoga were considered the most effective modalities in pregnancy (median [semi-interquartile range] = 2 [0.5]). Maternal-fetal medicine specialists were significantly more likely to disagree on the use of complementary and alternative medicine for risk reduction of preterm birth compared to obstetricians and gynecologists ( P = .03). As the use of complementary and alternative medicine continues to rise in reproductive-age women, obstetricians will play an integral role in incorporating complementary and alternative medicine use with conventional medicine.
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http://dx.doi.org/10.1177/2156587216671215DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5871154PMC
July 2017

Yoga in Pregnancy.

Clin Obstet Gynecol 2016 Sep;59(3):600-12

St. Louis University, St. Louis, Missouri.

Yoga is a mind-body practice that encompasses a system of postures (asana), deep breathing (pranayama), and meditation. Over 36 million Americans practice yoga of which the majority are reproductive-aged women. Literature to support this practice is limited, albeit on the rise. A prenatal yoga practice has been shown to benefit women who suffer from anxiety, depression, stress, low back pain, and sleep disturbances. A small number of studies have been performed in high-risk pregnancies that also demonstrate an improvement in outcomes. The safety of performing yoga for the first time in pregnancy and fetal tolerance has been demonstrated.
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http://dx.doi.org/10.1097/GRF.0000000000000210DOI Listing
September 2016

The Role of Nicotinamide Phosphoribosyltransferase in Pregnancy: A Review.

Am J Perinatol 2016 12 2;33(14):1327-1336. Epub 2016 May 2.

Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Missouri-Kansas City, Kansas City, Missouri.

Nicotinamide phosphoribosyltransferase (NAMPT) was first reported in 1994 and has been explored in various human disease processes. However, until recently, very little has been done to define the role of NAMPT in pregnancy. NAMPT is a 52 kDa protein that has diverse functions in the human body, acting as a growth factor, cytokine, an enzyme, and an insulinomimetic agent. Initial studies examined NAMPT expression in fetal membranes and its effects on the amnion. Later research in nonpregnant studies showed an insulinomimetic effect, and attention focused on its role in gestational diabetes. In addition, as studies revealed NAMPT's function as an inflammatory cytokine, studies examined NAMPT in preeclampsia and fetal growth restriction. Several studies have confirmed that NAMPT is a marker of systemic infectious processes such as pyelonephritis and intrauterine infection. In this review, we present the current understanding of NAMPT's role in various pregnancy-related conditions as well as possible directions for future research.
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http://dx.doi.org/10.1055/s-0036-1582448DOI Listing
December 2016

Acute feTal behavioral Response to prenatal Yoga: a single, blinded, randomized controlled trial (TRY yoga).

Am J Obstet Gynecol 2016 Mar 22;214(3):399.e1-8. Epub 2015 Dec 22.

Department of Obstetrics and Gynecology, Truman Medical Center, Kansas City, MO.

Background: In 2012, yoga was practiced by 20 million Americans, of whom 82% were women. A recent literature review on prenatal yoga noted a reduction in some pregnancy complications (ie, preterm birth, lumbar pain, and growth restriction) in those who practiced yoga; to date, there is no evidence on fetal response after yoga.

Objectives: We aimed to characterize the acute changes in maternal and fetal response to prenatal yoga exercises using common standardized tests to assess the well-being of the maternal-fetal unit.

Study Design: We conducted a single, blinded, randomized controlled trial. Uncomplicated pregnancies between 28 0/7 and 36 6/7 weeks with a nonanomalous singleton fetus of women who did not smoke, use narcotics, or have prior experience with yoga were included. A computer-generated simple randomization sequence with a 1:1 allocation ratio was used to randomize participants into the yoga or control group. Women in the yoga group participated in a 1-time, 1 hour yoga class with a certified instructor who taught a predetermined yoga sequence. In the control group, each participant attended a 1-time, 1 hour PowerPoint presentation by an obstetrician on American Congress of Obstetricians and Gynecologists recommendations for exercise, nutrition, and obesity in pregnancy. All participants underwent pre- and postintervention testing, which consisted of umbilical and uterine artery Doppler ultrasound, nonstress testing, a biophysical profile, maternal blood pressure, and maternal heart rate. A board-certified maternal-fetal medicine specialist, at a different tertiary center, interpreted all nonstress tests and biophysical profile data and was blinded to group assignment and pre- or postintervention testing. The primary outcome was a change in umbilical artery Doppler systolic to diastolic ratio. Sample size calculations indicated 19 women per group would be sufficient to detect this difference in Doppler indices (alpha, 0.05; power, 80%). Data were analyzed using a repeated-measures analysis of variance, a χ(2), and a Fisher exact test. A value of P < .05 was considered significant.

Results: Of the 52 women randomized, 46 (88%) completed the study. There was no clinically significant change in umbilical artery systolic to diastolic ratio (P = .34), pulsatility index (P = .53), or resistance index (P = .66) between the 2 groups before and after the intervention. Fetal and maternal heart rate, maternal blood pressure, and uterine artery Dopplers remained unchanged over time. When umbilical artery indices were individually compared with gestational age references, there was no difference between those who improved or worsened between the groups.

Conclusion: There was no significant change in fetal blood flow acutely after performing yoga for the first time in pregnancy. Yoga can be recommended for low-risk women to begin during pregnancy.
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http://dx.doi.org/10.1016/j.ajog.2015.12.032DOI Listing
March 2016

Hot yoga establishments in local communities serving pregnant women: a pilot study on the health implications of its practice and environmental conditions.

J Environ Health 2014 Oct;77(3):8-12

Community and Environmental Health, Old Dominion University, Norfolk, VA, USA.

Hot yoga establishments have been increasing in popularity in local communities. Studios may support participation among pregnant women though no clinical studies currently exist that examine prenatal hot yoga effects. The pilot study described in this article aimed to assess the spread of prenatal hot yoga and to provide information on the environmental conditions and practices of those who engage in hot yoga within a local community. A thermal environment meter was used to measure ambient air conditions during three 90-minute hot yoga classes. Mothers who practiced prenatal hot yoga were more likely than non-hot yoga practitioners to have someone aside from an obstetrician/gynecologist discuss prenatal exercise safety with them. Prenatal public health education campaigns need to be refined. Public health officials and obstetricians/gynecologists need to be aware that those who engage in a hot yoga practice are more likely to trust someone other than their health care provider or public health professional regarding safety of this practice.
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October 2014

Obstetric Recommendations in American Congress of Obstetricians and Gynecologists Practice Bulletins versus UpToDate: a comparison.

Am J Perinatol 2015 Apr 29;32(5):427-44. Epub 2014 Dec 29.

Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, Virginia.

Objective: To compare the obstetric recommendations in American Congress of Obstetricians and Gynecologists (ACOG) practice bulletins (PB) with similar topics in UpToDate (UTD).

Study Design: We accessed all obstetric PB and cross-searched UTD (May 1999-May 2013). We analyzed only the PB which had corresponding UTD chapter with graded recommendations (level A-C). To assess comparability of recommendations for each obstetric topic, two maternal-fetal medicine (MFM) subspecialists categorized the statement as similar, dissimilar, or incomparable. Simple and weighted kappa statistics were calculated to assess agreement between the two raters.

Results: We identified 46 ACOG obstetric PB and 86 UTD chapters. There were 50% fewer recommendations in UTD than in PB (181 vs. 365). The recommendations being categorized as level A, B, or C was significantly different (p < 0.001) for the two guidelines. While the overall concordance rate between the two MFM subspecialists was 83% regarding the recommendations for the same topic as similar, dissimilar, or incomparable, the agreement was moderate (kappa, 0.56; 95% confidence intervals, 0.48-0.65).

Conclusion: Though obstetricians have two sources for graded recommendations, incongruity among them may be a source of consternation. Congruent recommendations from ACOG and UTD could enhance compliance and potentially optimize outcomes.
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http://dx.doi.org/10.1055/s-0034-1396684DOI Listing
April 2015

Exercise and yoga during pregnancy: a survey.

J Matern Fetal Neonatal Med 2015 Mar 27;28(4):431-5. Epub 2014 May 27.

Department of Obstetrics and Gynecology, Truman Medical Center Hospital Hill , Kansas City, MO , USA and.

The primary objective of this survey was to ascertain the opinions, practices and knowledge about exercise, including yoga, during pregnancy; the secondary objective to compare the responses among women with body mass index (BMI) <30 kg/m(2) versus ≥30 kg/m(2). Survey consisted of 20 multiple choice questions assessing demographics and exercise practices, and five questions testing their knowledge about it during pregnancy (ACOG Committee Opinion # 267). Of the 500 surveys distributed, 84% (422) responses were analyzed. While 86% of women responded that exercise during pregnancy is beneficial, 83% felt it was beneficial to start prior to pregnancy, and walking was considered the most beneficial (62%). The majority (64%) of respondents were currently exercising during pregnancy and 51% exercised 2-3 times/week. Among the five questions testing knowledge about prenatal exercise, majority (range 60 to 92%) were aware of ACOG recommendations. About half had a BMI ≥30. Knowledge about benefits of exercise during pregnancy did not differ significantly between obese and non-obese. Yoga was tried significantly more among non-obese, 65% believed it is beneficial, and 40% had attempted yoga before pregnancy. In our population, the majority believes that exercise, including yoga, is beneficial and they are active.
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http://dx.doi.org/10.3109/14767058.2014.918601DOI Listing
March 2015

Yoga during pregnancy: a review.

Am J Perinatol 2012 Jun 7;29(6):459-64. Epub 2012 Mar 7.

Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, VA 23507, USA.

The purpose of this review article is to evaluate the peripartum outcomes of yoga during pregnancy, including the postpartum period and lactation. The PubMed database was analyzed from January 1970 to January 2011. We identified five prospective observational studies (n = 575) and three randomized clinical trials (RCTs; n = 298), which were analyzed separately. The nonrandomized trials indicated a significant reduction in rates of preterm labor (p < 0.0006), intrauterine growth retardation (p <0.003), low birth weight (p < 0.01), pregnancy discomforts (p = 0.01), and perceived sleep disturbances (p = 0.03) in those who practiced yoga during pregnancy. Results of the RCTs indicated that doing yoga during pregnancy can significantly lower pain and discomfort (p < 0.05) and perceived stress (p = 0.001) and improve quality of life in physical domains (p = 0.001). All three RCTs were poorly compliant with the Consolidated Standard of Reporting Trials statement. While awaiting an appropriately designed RCT to determine the benefits of yoga during pregnancy, it remains a viable exercise option.
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http://dx.doi.org/10.1055/s-0032-1304828DOI Listing
June 2012