Papers by Vani Bettegowda
Clinics in Perinatology, Jun 1, 2008
The increasing trend of delivering at earlier gestational ages has raised concerns of the impact ... more The increasing trend of delivering at earlier gestational ages has raised concerns of the impact on maternal and infant health. The delicate balance of the risks and benefits associated with continuing a pregnancy versus delivering early remains challenging. Among singleton live births in the United States, the proportion of preterm births increased from 9.7% to 10.7% between 1996 and 2004. The increase in singleton preterm births occurred primarily among those delivered by cesarean section, with the largest percentage increase in late preterm births. For all maternal racial/ethnic groups, singleton cesarean section rates increased for each gestational age group. Singleton cesarean section rates for non-Hispanic black women increased at a faster pace among all preterm gestational age groups compared with non-Hispanic white and Hispanic women. Further research is needed to understand the underlying reasons for the increase in cesarean section deliveries resulting in preterm birth.
Maternal and Child Health Journal, 2014
Immigrants have lower rates of low birth weight (LBW) and to some extent preterm birth (PTB), tha... more Immigrants have lower rates of low birth weight (LBW) and to some extent preterm birth (PTB), than their US-born counterparts. This pattern has been termed the 'immigrant health paradox'. Social ties and support are one proposed explanation for this phenomenon. We examined the contribution of social ties and social support to LBW and PTB by race/ethnicity and nativity among women in New York City (NYC). The NYC Pregnancy Risk Assessment Monitoring System survey (2004-2007) data, linked with the selected items from birth certificates, were used to examine LBW and PTB by race/ethnicity and nativity status and the role of social ties and social support to adverse birth outcomes using bivariate and multivariable analyses. SUDAAN software was used to adjust for complex survey design and sampling weights. US- and foreign-born Blacks had significantly increased odds of PTB [adjusted odds ratio (AOR)Â =Â 2.43, 95Â % CIÂ 1.56, 3.77 and AORÂ =Â 2.6, 95Â % CIÂ 1.66, 4.24, respectively] compared to US-born Whites. Odds of PTB among foreign-born Other Latinas, Island-born Puerto Ricans' and foreign-born Asians' were not significantly different from US-born Whites, while odds of PTB for foreign-born Whites were significantly lower (AORÂ =Â 0.47, 95Â % CIÂ 0.26, 0.84). US and foreign-born Blacks' odds of LBW were 2.5 fold that of US-born Whites. Fewer social ties were associated with 32-39Â % lower odds of PTB. Lower social support was associated with decreased odds of LBW (AOR 0.69, 95Â % CI 0.50, 0.96). We found stronger evidence of the immigrant health paradox across racial/ethnic groups for PTB than for LBW. Results also point to the importance of accurately assessing social ties and social support during pregnancy and to considering the potential downside of social ties.
Maternal and Child Health Journal, 2014
Non-medically indicated (NMI) deliveries prior to 39 weeks increase the risk of neonatal mortalit... more Non-medically indicated (NMI) deliveries prior to 39 weeks increase the risk of neonatal mortality, excess morbidity, and health care costs. The study's purpose was to identify maternal and hospital characteristics associated with NMI deliveries prior to 39 weeks. The study included 207,775 births to women without a previous cesarean and 38,316 births to women with a previous cesarean, using data from Florida's 2006-2007 linked birth certificate and inpatient record file. Adjusted risk ratios (ARR) and 95 % confidence intervals (CI) for characteristics were calculated using generalized estimating equation for multinomial logistic regression. Among women without a previous cesarean, NMI deliveries occurred in 18,368 births (8.8 %). Non-medically indicated inductions were more likely in women who were non-Hispanic white (ARR: 1.41, 95 % CI 1.31-1.52), privately-insured (ARR: 1.42, 95 % CI 1.26-1.59), and delivered in hospitals with <500 births per year. Non-medically indicated primary cesareans were more likely in women who were older than 35 years (ARR: 2.96, 95 % CI 2.51-3.50), non-Hispanic white (ARR: 1.44, 95 % CI 1.30-1.59), and privately-insured (ARR: 1.43, 95 % CI 1.17-1.73). Non-medically indicated primary cesareans were also more likely to occur in hospitals with <30 % nurse-midwife births, <500 births per year, and in large metro areas. Among women with previous cesarean, NMI repeat cesareans occurred in 16,746 births (43.7 %). Only weak risk factors were identified for NMI repeat cesareans. The risk factors identified varied by NMI outcome. This information can be used to inform educational campaigns and identify hospitals that may benefit from quality improvement efforts.
Clinics in Perinatology, 2008
The increasing trend of delivering at earlier gestational ages has raised concerns of the impact ... more The increasing trend of delivering at earlier gestational ages has raised concerns of the impact on maternal and infant health. The delicate balance of the risks and benefits associated with continuing a pregnancy versus delivering early remains challenging. Among singleton live births in the United States, the proportion of preterm births increased from 9.7% to 10.7% between 1996 and 2004. The increase in singleton preterm births occurred primarily among those delivered by cesarean section, with the largest percentage increase in late preterm births. For all maternal racial/ethnic groups, singleton cesarean section rates increased for each gestational age group. Singleton cesarean section rates for non-Hispanic black women increased at a faster pace among all preterm gestational age groups compared with non-Hispanic white and Hispanic women. Further research is needed to understand the underlying reasons for the increase in cesarean section deliveries resulting in preterm birth.
Obstetrics & Gynecology, 2013
OBJECTIVE: Nonmedically indicated (elective) deliveries before 39 weeks of gestation result in un... more OBJECTIVE: Nonmedically indicated (elective) deliveries before 39 weeks of gestation result in unnecessary neonatal morbidity. We sought to determine whether implementation of a process improvement program will decrease the rate of elective scheduled singleton early-term deliveries (37 0/7-38 6/7 weeks of gestation) in a group of diverse community and academic hospitals.
American Journal of Public Health, 2005
We analyzed gestational diabetes mellitus trends in New York City between 1990 and 2001 by using ... more We analyzed gestational diabetes mellitus trends in New York City between 1990 and 2001 by using information obtained from birth certificates. Gestational diabetes diagnoses among women who delivered babies increased 46%, from 2.6% (95% confidence interval [CI]=2.5, 2.7) to 3.8% (95% CI=3.7, 3.9) of births. Prevalence was highest among South and Central Asian women (11%). Given risks for adverse fetal outcomes and maternal chronic diabetes, prompt screening is critical. Metabolic control should be maintained during pregnancy and assessed postpartum for women with gestational diabetes.
American Journal of Public Health, 2005
We analyzed gestational diabetes mellitus trends in New York City between 1990 and 2001 by using ... more We analyzed gestational diabetes mellitus trends in New York City between 1990 and 2001 by using information obtained from birth certificates. Gestational diabetes diagnoses among women who delivered babies increased 46%, from 2.6% (95% confidence interval [CI]=2.5, 2.7) to 3.8% (95% CI=3.7, 3.9) of births. Prevalence was highest among South and Central Asian women (11%). Given risks for adverse fetal outcomes and maternal chronic diabetes, prompt screening is critical. Metabolic control should be maintained during pregnancy and assessed postpartum for women with gestational diabetes.
Obstetrics & Gynecology, 2011
Objective-Term pregnancy (37-41 weeks of gestation) is generally regarded as a uniform period for... more Objective-Term pregnancy (37-41 weeks of gestation) is generally regarded as a uniform period for pregnancy outcome. The purpose of this study was to estimate the trend of maternal racial/ethnic differences in mortality for early term (37 0/7-38 6/7 weeks of gestation) compared to full term births (39 0/7-41 6/7 weeks of gestation). Methods-We analyzed 46,329,018 singleton live births using the National Center for Health Statistics (NCHS) U.S. period-linked birth/infant death data from 1995 to 2006. Infant mortality rates (IMR), neonatal mortality rates (NMR), and postneonatal mortality rates (PNMR) were calculated according to gestational age, race/ethnicity, and cause of death. Results-Overall, IMR has decreased for early term and full term births between 1995 and 2006. At 37 weeks of gestation, Hispanics had the greatest decline in IMR, 35.4% (4.8/1000 to 3.1/1000), followed by 22.4% for whites (4.9/1000 to 3.8/1000),whereas blacks had the smallest decline, 6.8% (5.9/1000 to 5.5/1000), due to a stagnant NMR. When 37 weeks is compared to 40 weeks of gestation, NMR is increased : Hispanics: RR= 2.6 (95% CI 2.0-3.3); whites: RR= 2.6 (95% CI 2.2-3.1); and blacks: RR= 2.9 (2.2-3.8). There is still excess NMR at 38 weeks of gestation. At both early and full term gestations, NMR is 40% higher and PNMR is 80% higher for blacks whereas Hispanics have a reduced PNMR when compared to whites. Conclusion-Early term births are associated with higher NMR, PNMR, and IMR compared to full term births, with concerning racial/ethnic disparity in rates and trends.
There is mounting evidence that infants born late preterm (34-36 weeks) are at greater risk for m... more There is mounting evidence that infants born late preterm (34-36 weeks) are at greater risk for morbidity than term infants. This article examines the changing epidemiology of gestational length among singleton births in the United States, from 1992 to 2002. Analyzing gestational age by mode of delivery, the distribution of spontaneous births shifted to the left, with 39 weeks becoming the most common length of gestation in 2002, compared with 40 weeks in 1992 (P < 0.001). Deliveries at >40 weeks gestation markedly decreased, accompanied by an increase in those at 34 to 39 weeks (P < 0.001). Singleton births with PROM or medical interventions had similar trends. Changes in the distribution of all singleton births differed by race/ethnicity, with non-Hispanic white infants having the largest increase in late preterm births. These observations, in addition to emerging evidence of increased morbidity, suggest the need for investigation of optimal obstetric and neonatal managem...
Maternal and Child Health Journal
Maternal and Child Health Journal
Seminars in Perinatology, 2006
There is mounting evidence that infants born late preterm (34-36 weeks) are at greater risk for m... more There is mounting evidence that infants born late preterm (34-36 weeks) are at greater risk for morbidity than term infants. This article examines the changing epidemiology of gestational length among singleton births in the United States, from 1992 to 2002. Analyzing gestational age by mode of delivery, the distribution of spontaneous births shifted to the left, with 39 weeks becoming the most common length of gestation in 2002, compared with 40 weeks in 1992 (P < 0.001). Deliveries at >40 weeks gestation markedly decreased, accompanied by an increase in those at 34 to 39 weeks (P < 0.001). Singleton births with PROM or medical interventions had similar trends. Changes in the distribution of all singleton births differed by race/ethnicity, with non-Hispanic white infants having the largest increase in late preterm births. These observations, in addition to emerging evidence of increased morbidity, suggest the need for investigation of optimal obstetric and neonatal management of these late preterm infants. Semin Perinatol 30:8-15
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Papers by Vani Bettegowda