- Obstetrics and Gynecology
Clinical Assistant Professor, Obstetrics & Gynecology - Maternal Fetal Medicine
Fellowship: Stanford University Maternal Fetal Medicine Fellowship (2022) CA
Board Certification: American Board of Obstetrics and Gynecology, Obstetrics and Gynecology (2021)
Residency: University of Hawaii Obstetrics and Gynecology Residency (2019) HI
Medical Education: Georgetown University School of Medicine (2015) DC
Effect of gestational age at first delivery and interpregnancy interval on the recurrence of clinical chorioamnionitis.
AJOG global reports
2022; 2 (4): 100116
There is an increased odds of having a recurrence of clinical chorioamnionitis in patients with a diagnosis of clinical chorioamnionitis compared with those without clinical chorioamnionitis in a previous pregnancy. However, it is unclear how gestational age at delivery of the first pregnancy or interpregnancy interval may contribute to this increased risk.This study aimed to evaluate how gestational age of delivery in a first pregnancy and interpregnancy interval affect the odds of recurrent clinical chorioamnionitis.Using maternally linked birth record files, Nulliparous patients from California with at least 2 consecutive deliveries between the gestational ages of 20 and 44 weeks from 2007 to 2012 were identified. The rates of clinical chorioamnionitis in the second pregnancy for patients with clinical chorioamnionitis vs those without clinical chorioamnionitis in the first pregnancy, stratified by the gestational age at delivery of the first pregnancy were determined. As a secondary analysis, the analysis by interpregnancy interval (<18 months vs ≥18 months) was stratified. Corresponding crude and adjusted odds ratios for each stratum were calculated to assess the association of clinical chorioamnionitis in the first and second pregnancies.Among 31,571 nulliparous patients with clinical chorioamnionitis in the first pregnancy, the frequency of clinical chorioamnionitis in the next pregnancy was 4.0% (1257 cases). This was in comparison with the 1.0% (9177 of 896,154) of nulliparous patients without clinical chorioamnionitis in the first pregnancy who were diagnosed with clinical chorioamnionitis in the next pregnancy (adjusted odds ratio, 2.78; 95% confidence interval, 2.61-2.96). The absolute frequency of recurrence was the highest (54 cases [8.2%]) in those who delivered at 20 to 24 weeks of gestation in the first pregnancy with the diagnosis of clinical chorioamnionitis (adjusted odds ratio, 1.76; 95% confidence interval, 1.25-2.48). For pregnancies delivered at term in the first pregnancy, the frequency of clinical chorioamnionitis in the next pregnancy was higher in those diagnosed with clinical chorioamnionitis in the first pregnancy than in those without clinical chorioamnionitis in the first pregnancy (4.0% vs 1.0%; adjusted odds ratio, 2.85; 95% confidence interval, 2.66-3.05). An interpregnancy interval of <18 months was not associated with increased odds of recurrent clinical chorioamnionitis.The odds of recurrence of clinical chorioamnionitis were the strongest when a patient delivered in the term to postterm period in the first pregnancy, with the absolute risk being the highest when the first pregnancy was delivered in the periviable period (20-24 weeks of gestation). The interpregnancy interval did not seem to modify the risk of recurrent clinical chorioamnionitis.
View details for DOI 10.1016/j.xagr.2022.100116
View details for PubMedID 36316994
View details for PubMedCentralID PMC9617201
Fasting vs fed: A randomized trial assessing oral intake prior to the glucose tolerance test
MOSBY-ELSEVIER. 2022: S189
View details for Web of Science ID 000737459400263
Provider utilization of gestational diabetes screening methods - Have practices changed since the HAPO trial?
MOSBY-ELSEVIER. 2022: S483-S484
View details for Web of Science ID 000737459401108
To Eat or not to Eat? Provider Recommendations Surrounding Oral Intake Before the 50g OGTT
MOSBY-ELSEVIER. 2022: S350-S351
View details for Web of Science ID 000737459400522
Patient preferences, beliefs, and experiences regarding oral intake and the 1-hour oral glucose tolerance test
MOSBY-ELSEVIER. 2022: S325-S326
View details for Web of Science ID 000737459400479
Ketonuria is associated with a positive 1-hour oral glucose tolerance test
MOSBY-ELSEVIER. 2022: S574-S575
View details for Web of Science ID 000737459401259
Second trimester prediction of gestational diabetes: maternal analytes as an additional screening tool.
Journal of perinatal medicine
OBJECTIVES: Early diagnosis of gestational diabetes can lead to greater optimization of glucose control. We evaluated associations between maternal serum analytes (alpha-fetoprotein [AFP], free beta-human chorionic gonadotropin [beta-hCG], inhibin, and estriol) and the development of gestational diabetes mellitus (GDM).METHODS: This retrospective cohort study identified single-ton pregnancies with available second trimester serum analytes between 2009 and 2017. GDM was identified by ICD-9 and -10 codes. We examined the associations between analyte levels and GDM and to adjust for potential confounders routinely collected during genetic serum screening (maternal age, BMI, and race) using logistic regression. Optimal logistic regression predictive modeling for GDM was then performed using the analyte levels and the above mentioned potential confounders. The performance of the model was assessed by receiver operator curves.RESULTS: Out of 5,709 patients, 660 (11.6%) were diagnosed with GDM. Increasing AFP and estriol were associated with decreasing risk of GDM, aOR 0.76 [95% CI 0.60-0.95] and aOR 0.67 [95% CI 0.50-0.89] respectively. Increasing beta-hCG was associated with a decreasing risk for GDM(aOR 0.84 [95% CI 0.73-0.97]). There was no association with inhibin. The most predictive GDM predictive model included beta-hCG and estriol in addition to the clinical variables of age, BMI, and race (area under the curve (AUC 0.75), buy this was not statistically different than using clinical variables alone (AUC 0.74) (p=0.26).CONCLUSIONS: Increasing second trimester AFP, beta-hCG, and estriol are associated with decreasing risks of GDM, though do not improve the predictive ability for GDM when added to clinical risk factors of age, BMI, and race.
View details for DOI 10.1515/jpm-2021-0054
View details for PubMedID 34315194
Prepregnancy body mass index and gestational diabetes mellitus across asian subpopulations
MOSBY-ELSEVIER. 2021: S118–S119
View details for Web of Science ID 000621547400177
Comparing insulin, metformin, and glyburide in treating diabetes in pregnancy and analyzing obstetric outcomes
MOSBY-ELSEVIER. 2020: S481
View details for DOI 10.1016/j.ajog.2019.11.773
View details for Web of Science ID 000504997301086