High Risk Pregnancy

Abstract

Paper 1: Predictors of antepartum admission in diabetes Objective: Diabetes is associated with increased healthcare utilization and cost in pregnant women. We sought to investigate the predictors of antepartum hospitalization in pregnant women with diabetes. Methods: We performed a retrospective review of women with pre-gestational diabetes who received care in a multidisciplinary program for diabetes in pregnancy at Brigham and women’s hospital from 2006-2011. Our primary outcome was antepartum hospitalization, with a secondary measure of length of stay. We modeled the multivariate odds of hospitalization prior to delivery using logistic regression. Results: We identified 244 women of whom 103 (42.2%) were hospitalized antepartum. The median (IQR) length of stay was 2 days (+2 days). There was no difference in age, race or pre-pregnancy body mass index (BMI) between women who were admitted and those who were not. Women who were admitted had a higher first Hemoglobin A1c in pregnancy (median of 7.85 + 2.75% vs 6.55 + 1.48%). In a multivariate model, markers of preconception health including first hemoglobin A1c in pregnancy (adjusted odds ratio[aOR] 1.5, 95% CI 1.24-1.81, p<0.001), smoking (aOR 4.02, CI 1.25- 12.90, p=0.019) and chronic hypertension (aOR 2.05, 95% CI 1.03-4.05, p= 0.03) were associated with increased odds of antepartum admission. First hemoglobin A1c in pregnancy was also associated with increased length of stay prior to delivery (beta=0.32, 95% CI 1.15- 5.87, p=0.004) Conclusion: In our study, glycemic control, smoking and chronic hypertension prior to pregnancy were associated with antepartum hospitalization, highlighting the importance of preconception health for reproductive-aged women with diabetes. Paper 2:Knowledge and attitudes toward prenatal yoga among women with high risk pregnancies Objective: To evaluate the attitudes and knowledge of prenatal yoga and investigate barriers and facilitators to yoga participation in high risk pregnant women receiving prenatal care in an academic tertiary care center. Methods: We surveyed a convenience sample of women receiving prenatal care through the Maternal-Fetal Medicine practice at Brigham and Women’s Hospital. We classified participants as yoga experienced or yoga naïve depending on self-report. We compared differences between the two groups using the appropriate nonparametric tests and compared bivariate odds ratios for survey results using logistic regression. Results: Of the 100 respondents, 53% had practiced yoga previously. Women with yoga experience were older (age 34.9 +5.6 vs 31 +6 years, p=0.004), more likely to be college graduates (94% vs 68%, p=0.002), and more likely to be white (77% vs 47%, p=0.002) than women without previous yoga experience. Previous yoga experience was associated with agreement that yoga was safe during their current pregnancy (OR 5.9, 95% CI 1.9-17.7). Of the women surveyed, 56% agreed that they would like to attend a prenatal yoga class. In a multivariate model including age, race and education, previous yoga experience was the only significant predictor associated with willingness to participate in prenatal yoga classes during current pregnancy. (OR 3.1, 95% CI 1.1-8.6) Conclusion: Prior yoga experience was the strongest predictor of willingness to attend a prenatal yoga class in our population. Our results suggest that women with high risk pregnancies who may benefit from prenatal yoga interventions but lack prior yoga experience may need additional education to facilitate participation.