Meryl Megumi Sperling

All Publications

• Perinatal use of non-alcoholic beverages that mirror alcohol. American journal of obstetrics and gynecology Bowdring, M. A., Sperling, M. M., Plummer, X. D., Prochaska, J. J. 2025

  View details for DOI 10.1016/j.ajog.2025.04.016

  View details for PubMedID 40228708

• Diagnosis and Treatment of Gestational Diabetes Mellitus: A National Survey of Physician Practices. Journal of women's health (2002) Miller, S. E., Sperling, M. M., Mayo, J. A., Leonard, S. A., Lyell, D. J., Herrero, T., Blumenfeld, Y. J. 2025

  Abstract

  Aims: We aimed to identify changes in United States practice patterns in gestational diabetes mellitus (GDM) diagnosis and treatment following publication of the 2008 Hyperglycemia and Adverse Pregnancy Outcomes (HAPO) study that supported transition toward a 2-hour oral glucose tolerance test. Methods: A total of 1,030 U.S. obstetric providers were surveyed in 2021 about GDM screening, diagnosis, and treatment, as well as perceptions surrounding preparation for the 1-hour, 50-g glucose loading test (GLT). Data were compared with data from a similar 2003 survey. The study was reviewed by the Institutional Review Board at Stanford University and was determined to be exempt. Results: Of 1,030 providers surveyed, 304 (30%) responded. Most respondents continued using the two-step screening method (95.0% versus 95.2% in 2003, p = 0.18). Fewer providers used insulin as a first-line medication (64.1% in 2021 versus 82.3% in 2003, p < 0.001). However, providers practicing for 0-10 years often used insulin as first-line compared with providers practicing for over 10 years (79% versus 55%, p < 0.001). Of 2021 respondents, 39.3% believed that fasting before the 1-hour GLT lowers the glucose result, 34.3% believed it increases the result, and 26.4% believed it would have no effect. Conclusions: Despite data from the HAPO trial, the majority of providers surveyed still use the two-step method for GDM screening. There is wide variability in perceptions and counseling regarding preparation for the 1-hour GLT.

  View details for DOI 10.1089/jwh.2024.0918

  View details for PubMedID 40072219

• Episiotomy and severe perineal laceration among Asian American, Native Hawaiian, and Pacific Islander nulliparous individuals in California. AJOG global reports Chidyausiku, T., Bane, S., Sperling, M. M., Main, E. K., Carmichael, S. L. 2025; 5 (1): 100450

  Abstract

  Asian American, Native Hawaiian, and Pacific Islander individuals have increased risks for episiotomy and severe perineal laceration during vaginal delivery. The Asian American, Native Hawaiian, and Pacific Islander population in the US is diverse yet few studies disaggregate results within specific ethnicity populations.This study investigated the variability in risks for episiotomy and severe perineal laceration among 16 disaggregated Asian American, Native Hawaiian, and Pacific Islander groups, compared to Non-Hispanic White nulliparous individuals, and assessed what factors may explain the variability in risk.Birth and fetal death certificate files linked to hospital discharge records were used to identify nulliparous, term, singleton, vertex vaginal deliveries among California births, 2007 to 2020. Poisson regression models were used to examine risks of episiotomy and severe perineal laceration among 16 Asian American, Native Hawaiian, and Pacific Islander ethnicity subgroups compared with Non-Hispanic White individuals. Sequential adjustment was utilized to assess if maternal social, health-related, and delivery-related factors may explain the variability in risk for episiotomy and severe perineal laceration.Among the 224,964 Asian American, Native Hawaiian, and Pacific Islander individuals in this study cohort, the overall prevalence of episiotomy was 18.5% (N = 41,559) and prevalence of severe perineal laceration was 8.9% (N = 20,013); the prevalence of both outcomes declined during the study period. Within subgroups, prevalence of episiotomy ranged from 9.8% among Other-Pacific Islander individuals to 24.5% among Korean individuals. Prevalence of severe perineal laceration ranged from 3.4% in Guamanian individuals to 15.2% in Indian individuals. In fully adjusted models, risk ratios were greater than 1.0 (with confidence intervals excluding 1.0) for 6 subgroups for episiotomy and 9 subgroups for severe perineal laceration, compared to Non-Hispanic White individuals. After adjustment, Korean individuals were at highest risk of episiotomy (adjusted risk ratio 1.80 [95% CI 1.75, 1.85]), and Indian individuals were at highest risk of severe perineal laceration (adjusted risk ratio 2.14 [95% CI 2.07, 2.21]). Adjustment for social factors (nativity; education; payer) tended to attenuate risk ratios; subsequent adjustment for maternal health and delivery-related factors including maternal age, height, pre-pregnancy body mass index, hypertension, diabetes, gestational weight gain, fetal stress/incomplete fetal head rotation (occiput transverse or posterior), large infant size or shoulder dystocia, and forceps/vacuum did not impact risk ratios substantially.Prevalence and risks of episiotomy and severe perineal laceration varied widely among Asian American, Native Hawaiian, and Pacific Islander births in California from 2007 to 2020. The variability in risks was more influenced by differences in social rather than maternal health and delivery-related factors. This study adds to the growing understanding of disparities in health outcomes among Asian American, Native Hawaiian, and Pacific Islander subgroups.

  View details for DOI 10.1016/j.xagr.2025.100450

  View details for PubMedID 40093873

  View details for PubMedCentralID PMC11909455

• A Hidden Workflow Inequity of Penicillin Allergy Evaluation in Pregnancy. Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology Dunham, T. B., Zhu, L., Lee, J. H., Sperling, M., Hoyte, E., Gibbs, R., Liu, A. Y., Simard, J. F. 2024

  View details for DOI 10.1016/j.anai.2024.09.017

  View details for PubMedID 39370037

• Referral Patterns and Uptake of Penicillin Delabeling in Pregnancy Dunham, T., Zhu, L., Lee, J., Sperling, M., Hoyte, E., Gibbs, R., Simard, J., Liu, A. MOSBY-ELSEVIER. 2024: AB164

  View details for Web of Science ID 001267526000508

• Prepregnancy body mass index and gestational diabetes mellitus across Asian and Pacific Islander subgroups in California. AJOG global reports Sperling, M. M., Leonard, S. A., Blumenfeld, Y. J., Carmichael, S. L., Chueh, J. 2023; 3 (1): 100148

  Abstract

  The American College of Obstetricians and Gynecologists recommends early screening for gestational diabetes mellitus among pregnant Asian people with a prepregnancy body mass index ≥23.0 kg/m2, in contrast with the recommended screening at a body mass index ≥25 kg/m2 for other races and ethnicities. However, there is significant heterogeneity within Asian and Pacific Islander populations, and gestational diabetes mellitus and its association with body mass index among Asian and Pacific Islander subgroups may not be uniform across all groups.This study aimed to analyze the association between body mass index and gestational diabetes mellitus among Asian and Pacific Islander subgroups in California, specifically gestational diabetes mellitus rates among those with a body mass index above vs below 23 kg/m2, which is the cutoff point for the designation of being overweight among Asians populations.Using a linked delivery hospitalization discharge and vital records database, we identified patients who gave birth in California between 2007 and 2017 and who self-reported to be 1 of 13 Asian and Pacific Islander subgroups, which was collected from birth and fetal death certificates. In each subgroup, we evaluated the association between body mass index and gestational diabetes mellitus using multivariable logistic regression models adjusted for age, education, parity, payment method, the trimester in which prenatal care was initiated, and nativity. We fit body mass index nonlinearly with splines and categorized body mass index as being above or below 23 kg/m2. Predicted probabilities of gestational diabetes mellitus with 95% confidence intervals were calculated across body mass index values using the nonlinear regression models.The overall prevalence of gestational diabetes mellitus was 14.3% (83,400/584,032), ranging between 8.4% and 17.1% across subgroups. The highest prevalence was among Indian (17.1%), Filipino (16.7%), and Vietnamese (15.5%) subgroups. In these subgroups, gestational diabetes mellitus was diagnosed in 10% to 13% of those with a body mass index <23.0 kg/m2 and in 22% of those with a body mass index ≥23 kg/m2. Gestational diabetes mellitus was least common among Korean (8.4%), Japanese (9.0%), and Samoan (9.8%) subgroups with a gestational diabetes mellitus rate of 5% to 7% among those with a body mass index <23.0 kg/m2 and in 10% to 15% among those with a body mass index ≥23 kg/m2. Although Samoan patients had the highest rate of obesity, defined as body mass index ≥30 kg/m2 (57.4%), they had the third lowest prevalence of gestational diabetes mellitus. Conversely, Vietnamese patients had the second lowest rate of obesity (2.4%) but the highest rate of gestational diabetes mellitus at a body mass index of ≥23 kg/m2 (22.3%).Gestational diabetes mellitus and its association with body mass index varied among Asian subgroups but increased as body mass index increased. Subgroups with the lowest prevalence of obesity trended toward a higher prevalence of gestational diabetes mellitus and those with a higher prevalence of obesity trended toward a lower prevalence of gestational diabetes mellitus.

  View details for DOI 10.1016/j.xagr.2022.100148

  View details for PubMedID 36632428

  View details for PubMedCentralID PMC9826825

• Adverse Pregnancy Outcomes Among Asian Subgroups - Does Gestational Diabetes Mellitus Increase the Risk? Perlman, N. C., Sperling, M. M., Mayo, J., Leonard, S. A., Blumenfeld, Y. J., Carmichael, S. L., Maine, E., Chueh, J., Bianco, K. SPRINGER HEIDELBERG. 2023: 131A-132A

  View details for Web of Science ID 001043029500223

• Fasting Compared With Fed and Oral Intake Before the 1-Hour Oral Glucose Tolerance Test: A Randomized Controlled Trial. Obstetrics and gynecology Sperling, M. M., Leonard, S. A., Miller, S. E., Hurtado, J., El-Sayed, Y. Y., Herrero, T., Faig, J., Carter, S., Blumenfeld, Y. J. 2023; 141 (1): 126-133

  Abstract

  OBJECTIVE: To evaluate the effect of fasting compared with eating before the 1-hour oral glucose tolerance test (OGTT) on gestational diabetes mellitus (GDM) screening results.METHODS: In a single-center, prospective randomized trial, participants were randomized to: 1) fasting for 6 or more hours or 2) oral intake ("fed") within 2 hours of the 50-g, 1-hour OGTT. The 1-hour OGTT was administered after 24 weeks of gestation. A positive screen result was defined as a serum glucose level of 140 mg/dL or higher. Protocol adherence was assessed by a survey administered immediately after the OGTT. We planned to enroll 100 participants in each group to detect an absolute difference of 20 percentage points or more on the 1-hour OGTT screen-positive rate using Fisher exact test, assuming an estimated screen-positive rate of 45% in the fasting and 25% in the fed group and 10% attrition, with a two-sided alpha=0.05, power=0.8. The primary outcome was the 1-hour OGTT screen-positive rate. Secondary outcomes included mean 1-hour OGTT glucose values, GDM diagnosis, maternal and neonatal outcomes, and patient perceptions regarding the 1-hour OGTT.RESULTS: From November 2020 through April 2021, 200 participants were randomized. One hundred ninety-five completed the 1-hour OGTT (97 fasting, 98 fed). Participant surveys confirmed 97.9% (n=95) adherence to the fasting and 91.8% (n=90) adherence to the fed groups. The screen-positive rate was significantly higher in the fasting than the fed group (32.0% vs 13.3%, respectively, P=.002), as was the mean glucose value (127.7 mg/dL vs 113.3 mg/dL, P=.002). The incidence of GDM in the fasting group was 12.4% (n=12) and in the fed group was 5.1% (n=5) (P=.08). There were no significant differences in maternal or neonatal outcomes.CONCLUSION: Fasting for 6 or more hours doubled the incidence of a positive 1-hour OGTT result when compared with eating within 2 hours of the test.CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, NCT04547023.

  View details for DOI 10.1097/AOG.0000000000005013

  View details for PubMedID 36701613

• Effect of gestational age at first delivery and interpregnancy interval on the recurrence of clinical chorioamnionitis. AJOG global reports Sperling, M. M., Sie, L., Leonard, S. A., Girsen, A. I., Lee, H. C., Gibbs, R. S. 2022; 2 (4): 100116

  Abstract

  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 Sperling, M., Leonard, S. A., Miller, S. E., El Sayed, Y. Y., Herrero, T., Faig, J., Carter, S., Blumenfeld, Y. J. 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? Miller, S. E., Sperling, M., Cruz, G., Schulkin, J., Leonard, S. A., Lyell, D. J., Herrero, T., Blumenfeld, Y. J. 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 Miller, S. E., Sperling, M., Cruz, G., Schulkin, J., Leonard, S. A., Lyell, D. J., Herrero, T., Blumenfeld, Y. J. 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 Sperling, M., Leonard, S. A., Miller, S. E., El-Sayed, Y. Y., Herrero, T., Faig, J., Carter, S., Blumenfeld, Y. J. 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 Sperling, M., Leonard, S. A., Miller, S. E., El-Sayed, Y. Y., Herrero, T., Faig, J., Carter, S., Blumenfeld, Y. J. 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 Sperling, M. M., Towner, D., Davis, J., Yamasato, K. 2021

  Abstract

  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 Sperling, M., Leonard, S. A., Waldrop, A. R., Miller, S., Blumenfeld, Y. J., Carmichael, S., Chueh, J. 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 Sperling, M., Bentley, J., Girsen, A., Leonard, S. A., Sherwin, E. B., Panelli, D. M., Suharwardy, S., El Sayed, Y., Herrero, T. MOSBY-ELSEVIER. 2020: S481

  View details for DOI 10.1016/j.ajog.2019.11.773

  View details for Web of Science ID 000504997301086