Wesolowski, Lisa MG.
(2023)
Promoting Health Through Appreciation of Variability in Labor Using Group-Based Trajectories and Omics of the Oxytocin Pathway.
Doctoral Dissertation, University of Pittsburgh.
(Unpublished)
Abstract
Introduction/Background: The increasing rate of cesarean deliveries and use of labor augmentation methods (e.g., oxytocin infusion) has become widespread in the United States. Research indicates there may be more variation in natural labor progression that is not well understood. Under-appreciation of normal inter-individual variability in labor and the individual characteristics (demographic, clinical, genomic) that account for this variability results in limited prognostication and precision care of laboring women, putting them at risk for unnecessary interventions that could then impact their wellness and health of their infants. Characterizing variability in labor using group-based trajectories and studying the relationship between these trajectories and oxytocin genetic variants, clinical, and demographic factors could promote precision care of women in labor.
Methods: This is a cross-sectional retrospective association study, and the aims are to identify labor trajectories (aim 1), and examine the relationship between clinical, demographic, and genomic predictors of trajectory group membership (aims 2 & 3). The study utilized a sample (n=401) of low-risk (singleton, vertex presentation, term gestation) nulliparous women from the Magee Obstetric Maternal Infant (MOMI) Biobank & Database. We characterized labor progress by applying group-based trajectory analysis with SAS Software and the PROC TRAJ procedure (SAS Institute. 2022.). A logistic regression was performed upon labor trajectory group for the clinical, demographic, and genomic predictors.
Results/Conclusion: Three novel trajectories of labor were found from our group-based trajectory analyses: precipitously progressing group (20.1%), average group (59.1%) and slow progress group (20.7%). Gestational age at delivery was the only factor significantly associated with trajectory group membership. For every unit increase in gestational age, the odds of belonging to the slower progress group increased OR= 1.43, p = .019 (95% CI, 1.059,1.918). Identification of multiple labor trajectories further promotes appreciation of variation in labor patterns and considering gestational age when prognosticating about labor progression and potential intervention could lead to more tailored approaches to labor.
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Details
| Item Type: |
University of Pittsburgh ETD
|
| Status: |
Unpublished |
| Creators/Authors: |
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| ETD Committee: |
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| Date: |
4 May 2023 |
| Date Type: |
Publication |
| Defense Date: |
18 April 2023 |
| Approval Date: |
4 May 2023 |
| Submission Date: |
27 April 2023 |
| Access Restriction: |
2 year -- Restrict access to University of Pittsburgh for a period of 2 years. |
| Number of Pages: |
167 |
| Institution: |
University of Pittsburgh |
| Schools and Programs: |
School of Nursing > Nursing |
| Degree: |
PhD - Doctor of Philosophy |
| Thesis Type: |
Doctoral Dissertation |
| Refereed: |
Yes |
| Uncontrolled Keywords: |
Labor Trajectories, Oxytocin, Variation |
| Date Deposited: |
04 May 2023 12:20 |
| Last Modified: |
04 May 2023 12:20 |
| URI: |
http://d-scholarship.pitt.edu/id/eprint/44757 |
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