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637: Pregnancy outcomes in women with type 2 diabetes treated with oral hypoglycemic agents
Poster Session IV
ajog.org to >1 antibiotics (p¼0.84). Of the antibiotic resistant organisms, 28.8% (171) vs 32.5% (166) were single-drug resistant and 26.4% (157) vs 22.1% (113) were multi-drug resistant (p¼0.07). Resistance to nitrofurantoin was 9.3% (55) vs 9.2% (47) (p¼0.97), while resistance to first-generation cephalosporins was 4.9% (29) vs 4.3% (22) (p¼0.65). CONCLUSION: Common uropathogens in our pregnant patient cohorts have remained similar over a 10-year period. Additionally, uropathogen antibiotic resistance is stable. Despite changes in our medical center antibiogram, sensitivity of uropathogens to common antibiotics used for empiric treatment of UTI in pregnancy is unchanged, and thus our current recommendations for obstetric practice remain appropriate.
severe disease, and use of OHA may be associated with decreased weight gain and risk for cesarean delivery in select women. Further studies are needed to examine the safety and efficacy of OHA for the treatment of type 2 diabetes in pregnancy.
638 Current status of the OBGYN hospitalist workforce in the United States Dotun Ogunyemi1, Alma Aurioles1, Rob Olson2, Nathaniel Sugiyama3, Ray Bahado-Singh1 1 Beaumont Hospital, Royal oak, MI, 2Society of OB/GYN Hospitalists, Long Beach, CA, 3Univeristy of Vermont, Burlington, VT
OBJECTIVE: To describe the satisfaction, practice and employment
characteristics of OBGYN hospitalists. STUDY DESIGN: Data is obtained by the Society of OB/GYN Hospi-
637 Pregnancy outcomes in women with type 2 diabetes treated with oral hypoglycemic agents Maisa Feghali1, John Mission1, Steve Caritis1, Janet Catov1, Christina Scifres2 1 Department of OBGYN and Reproductive Sciences, Magee-Womens Research Institute, University of Pittsburgh, Pittsburgh, PA, 2Department of Obstetrics & Gynecology, University of Oklahoma Health Sciences Center, Oklahoma City, OK
OBJECTIVE: There is a paucity of data regarding use of oral hypo-
glycemic agents (OHA) for treatment of type 2 diabetes in pregnancy. We therefore compared maternal characteristics and pregnancy outcomes in women with type 2 diabetes treated with OHA or insulin. STUDY DESIGN: This was a retrospective cohort study of 198 women with type 2 diabetes who were treated with either OHA or insulin from the first trimester onward. Demographic information and outcome data were abstracted from the medical record. Bivariate (chi square, t-test) and multivariate logistic regression analyses were used to assess whether pregnancy outcomes differed in women treated with OHA when compared to insulin. RESULTS: We found that 67/198 (33.8%) of women were treated with OHA (70% glyburide, 30% metformin). Women treated with OHA had a shorter disease duration (4.4 4.1 vs 6.8 5.0 years, p¼0.001), were more likely to have a normal pre-pregnancy BMI, and had less gestational weight gain (22.4 18.8 vs. 30.4 17.7 lbs, p¼0.005) when compared to those receiving insulin therapy. In particular, obese women who used OHA had less weight gain than those receiving insulin (19.9 18.6 vs 28.3 17.7 lbs, p¼0.008). Use of OHA was associated with lower 1st trimester HbA1c values (6.8 1.6 vs. 8.1 1.9%, p¼0.02), but 2nd (6.1 1.2 vs 6.4 1.0%, p¼0.20) and 3rd (6.3 1.1 vs 6.3 0.9%, p¼0.95) trimester HbA1c values were similar between groups. Among women who started pregnancy using OHA, 37/67 (55.2%) remained on OHA at delivery. Women who received OHA had lower rates of cesarean delivery after controlling for pre-pregnancy BMI, mean HbA1c, weight gain, and chronic hypertension (see table). CONCLUSION: Providers are more likely to use oral hypoglycemic agents in women with type 2 diabetes who begin pregnancy with less
talists annually, through a voluntary survey. The survey results of the year 2014 formed the basis of this study. RESULTS: A total of 306 hospitalists and 96 non-hospitalists members completed the survey. Of the hospitalists; 53% were females and 47% males, 60% were 40-69 years of age; and the regions of practice were West (43%), South (26.8%), Northeast (18.5%) with the least in the Midwest (11.6%). About 53% practiced in an urban setting, 42% in suburban and only 5.6% practiced in a rural area. About 60% commuted less than 30 minutes to work. About 69% of hospitalists worked fulltime and 31% were part- time. About 68% had no change in employment status, while 13% new hospitalists were added to the workforce. Majority were employed by hospitals, or medical groups. About 70% practiced gynecology in addition to obstetrics. About 52% felt their workload was adequate; 40% would like more hospitalist work and 25% felt pressure to do more work. Only 42% responded that they had adequate emergency back-up. About 30% were involved in academics and only about 20% worked in multiple sites. About 60% had 24 hour shifts with 40% having mainly 12 hour shifts. However only 14% of the hospitalists surveyed would prefer to work 24 hours if given the choice. About 1/3 each worked as MFM extenders or used MFM as consultants, supervised family practice physicians, midwives and signed out to other OBGYN. Over 70% of the hospitalists were very/satisfied with all aspects of their profession. Hospitalists responded that about 58% were paid hourly rates and 42% got a set salary. Most common hourly wage was $101-110, and the commonest yearly salary reported was $200,000 - $224,999. Malpractice insurance was paid by employers in 60% and by the hospitalist in 40%. About 58% stated that employers will pay benefit for part-time FTE. CONCLUSION: The hospitalist model is considered the new paradigm of care that is a sustainable model for improved patient care and safety. This largest study to date on OB hospitalists demonstrate that most are satisfied with the career. The findings reveal a variety of employment, work and compensation models suggesting that institutions should be flexible in determining the hospitalist model that best suits their needs.
Supplement to JANUARY 2016 American Journal of Obstetrics & Gynecology
S339
ajog.org to >1 antibiotics (p¼0.84). Of the antibiotic resistant organisms, 28.8% (171) vs 32.5% (166) were single-drug resistant and 26.4% (157) vs 22.1% (113) were multi-drug resistant (p¼0.07). Resistance to nitrofurantoin was 9.3% (55) vs 9.2% (47) (p¼0.97), while resistance to first-generation cephalosporins was 4.9% (29) vs 4.3% (22) (p¼0.65). CONCLUSION: Common uropathogens in our pregnant patient cohorts have remained similar over a 10-year period. Additionally, uropathogen antibiotic resistance is stable. Despite changes in our medical center antibiogram, sensitivity of uropathogens to common antibiotics used for empiric treatment of UTI in pregnancy is unchanged, and thus our current recommendations for obstetric practice remain appropriate.
severe disease, and use of OHA may be associated with decreased weight gain and risk for cesarean delivery in select women. Further studies are needed to examine the safety and efficacy of OHA for the treatment of type 2 diabetes in pregnancy.
638 Current status of the OBGYN hospitalist workforce in the United States Dotun Ogunyemi1, Alma Aurioles1, Rob Olson2, Nathaniel Sugiyama3, Ray Bahado-Singh1 1 Beaumont Hospital, Royal oak, MI, 2Society of OB/GYN Hospitalists, Long Beach, CA, 3Univeristy of Vermont, Burlington, VT
OBJECTIVE: To describe the satisfaction, practice and employment
characteristics of OBGYN hospitalists. STUDY DESIGN: Data is obtained by the Society of OB/GYN Hospi-
637 Pregnancy outcomes in women with type 2 diabetes treated with oral hypoglycemic agents Maisa Feghali1, John Mission1, Steve Caritis1, Janet Catov1, Christina Scifres2 1 Department of OBGYN and Reproductive Sciences, Magee-Womens Research Institute, University of Pittsburgh, Pittsburgh, PA, 2Department of Obstetrics & Gynecology, University of Oklahoma Health Sciences Center, Oklahoma City, OK
OBJECTIVE: There is a paucity of data regarding use of oral hypo-
glycemic agents (OHA) for treatment of type 2 diabetes in pregnancy. We therefore compared maternal characteristics and pregnancy outcomes in women with type 2 diabetes treated with OHA or insulin. STUDY DESIGN: This was a retrospective cohort study of 198 women with type 2 diabetes who were treated with either OHA or insulin from the first trimester onward. Demographic information and outcome data were abstracted from the medical record. Bivariate (chi square, t-test) and multivariate logistic regression analyses were used to assess whether pregnancy outcomes differed in women treated with OHA when compared to insulin. RESULTS: We found that 67/198 (33.8%) of women were treated with OHA (70% glyburide, 30% metformin). Women treated with OHA had a shorter disease duration (4.4 4.1 vs 6.8 5.0 years, p¼0.001), were more likely to have a normal pre-pregnancy BMI, and had less gestational weight gain (22.4 18.8 vs. 30.4 17.7 lbs, p¼0.005) when compared to those receiving insulin therapy. In particular, obese women who used OHA had less weight gain than those receiving insulin (19.9 18.6 vs 28.3 17.7 lbs, p¼0.008). Use of OHA was associated with lower 1st trimester HbA1c values (6.8 1.6 vs. 8.1 1.9%, p¼0.02), but 2nd (6.1 1.2 vs 6.4 1.0%, p¼0.20) and 3rd (6.3 1.1 vs 6.3 0.9%, p¼0.95) trimester HbA1c values were similar between groups. Among women who started pregnancy using OHA, 37/67 (55.2%) remained on OHA at delivery. Women who received OHA had lower rates of cesarean delivery after controlling for pre-pregnancy BMI, mean HbA1c, weight gain, and chronic hypertension (see table). CONCLUSION: Providers are more likely to use oral hypoglycemic agents in women with type 2 diabetes who begin pregnancy with less
talists annually, through a voluntary survey. The survey results of the year 2014 formed the basis of this study. RESULTS: A total of 306 hospitalists and 96 non-hospitalists members completed the survey. Of the hospitalists; 53% were females and 47% males, 60% were 40-69 years of age; and the regions of practice were West (43%), South (26.8%), Northeast (18.5%) with the least in the Midwest (11.6%). About 53% practiced in an urban setting, 42% in suburban and only 5.6% practiced in a rural area. About 60% commuted less than 30 minutes to work. About 69% of hospitalists worked fulltime and 31% were part- time. About 68% had no change in employment status, while 13% new hospitalists were added to the workforce. Majority were employed by hospitals, or medical groups. About 70% practiced gynecology in addition to obstetrics. About 52% felt their workload was adequate; 40% would like more hospitalist work and 25% felt pressure to do more work. Only 42% responded that they had adequate emergency back-up. About 30% were involved in academics and only about 20% worked in multiple sites. About 60% had 24 hour shifts with 40% having mainly 12 hour shifts. However only 14% of the hospitalists surveyed would prefer to work 24 hours if given the choice. About 1/3 each worked as MFM extenders or used MFM as consultants, supervised family practice physicians, midwives and signed out to other OBGYN. Over 70% of the hospitalists were very/satisfied with all aspects of their profession. Hospitalists responded that about 58% were paid hourly rates and 42% got a set salary. Most common hourly wage was $101-110, and the commonest yearly salary reported was $200,000 - $224,999. Malpractice insurance was paid by employers in 60% and by the hospitalist in 40%. About 58% stated that employers will pay benefit for part-time FTE. CONCLUSION: The hospitalist model is considered the new paradigm of care that is a sustainable model for improved patient care and safety. This largest study to date on OB hospitalists demonstrate that most are satisfied with the career. The findings reveal a variety of employment, work and compensation models suggesting that institutions should be flexible in determining the hospitalist model that best suits their needs.
Supplement to JANUARY 2016 American Journal of Obstetrics & Gynecology
S339