- Email: [email protected]
[204-POS]
102
Abstracts / Pregnancy Hypertension: An International Journal of Women’s Cardiovascular Health 5 (2015) 53–156
Sociology, University of Lagos, Lagos, Nigeria, b Department of Obstetrics and Gynaecology, and the Child and Family Research Unit, University of British Columbia, Vancouver, BC, Canada, c Department of Fetal and Maternal Health, Olabisi Onabanjo University, Sagamu, Nigeria, d Division of Women and Child Health, Aga Khan University, Karachi, Pakistan, e Centre for Research in Reproductive Health, Sagamu, Nigeria) Objectives: The objective of this study was to describe community perceptions of pre-eclampsia and eclampsia in Ogun State. Background: Pre-eclampsia is a common complication of pregnancy and is responsible for high rates of morbidity and mortality, especially in less developed countries. While most studies related to pre-eclampsia and eclampsia have adopted a bio-medical model, this paper adopts a perspective which recognizes the role of the socio-cultural environment. Methods: The study was conducted in four Local Government Areas in Ogun State, Nigeria in 2012. Data were obtained through 24 focus group discussions with pregnant women (N = 94), mothers with children less than 5 years old (N = 95), male decision makers (N = 47), community leaders (N = 56), and traditional birth attendants (N = 36). In addition, nine in-depth interviews were conducted with the head of the local traditional birth attendants (N = 4), a local traditional birth attendant (N = 1), and community leaders (N = 4). Results: We determined that there are no names for preeclampsia in the local language, Yoruba, although ’’hypertension’’ and ’’convulsion’’ as disease entities have local names that are independent of pregnancy status. The cause of pre-eclampsia was perceived to be due to depressive thoughts, and the cause of eclampsia was perceived to result from exposure to cold with a few implicating spiritual forces. While, there seemed to be no local treatment for pre-eclampsia apart from preventive practices, local treatments for eclampsia included the use of herbs, concoctions, incisions, and black soap. Conclusions: This study shows that knowledge of preeclampsia and its progression to eclampsia is limited. It also reveals a gap in knowledge of the etiology and treatment of the condition. A holistic approach is recommended for sensitization at the community level, acquisition of educational skills by health workers, and the adoption of a community perspective as a sustainable approach to reduce the complications of pregnancy. Disclosures: D.O. Akeju: None. M. Vidler: None. O.T. Oladapo: None. D. Sawchuck: None. R. Qureshi: None. P. von Dadelszen: None. O.O. Adetoro: None. K. Dada: None.
Sarah Hart a, Louise Kenny b, Jenny Myers c, Philip Baker a (a Keele University, Stoke on Trent, United Kingdom, b INFANT Centre, Cork, Ireland, c University of Manchester, Manchester, United Kingdom) Objectives: Urine as a biofluid is commonly used in clinical diagnostics, including during pregnancy. Urine is a rich source of polypeptides and protein degradation products. Electron transfer dissociation (ETD) techniques have recently been applied to peptides, and improved fragmentation of long polypeptides has been demonstrated; ETD further facilitates analysis of labile post-translational modifications. We therefore applied this advanced technique for peptide dissociation to analyse and identify urinary polypeptides for the first time. Methods: We examined the urinary peptidome from normal pregnant women during pregnancy, to demonstrate that peptides are readily observed. We utilised conventional MS/ MS techniques and then used ETD (LC–MS/MS performed on an orbitrap equipped with ETD source, coupled to a nanoAcquity HPLC) to increase the identification rate of the peptides within these samples, as the polypeptide species observed are large and highly charged. Results: An increase in the number of peptides whose identities could be ascribed using routine database searching methods was enabled via use of ETD. These peptides, as anticipated, were large and highly charged (typically giving charge states of 4–8+ over a mass-to-charge range of 400–2000 m/z). Conclusions: Urinary proteomic profiling has not been able to discriminate between normal and pre-eclampsia pregnancies at gestations early enough to enable preventative strategies. Enhanced polypeptide identification achieved through ETD may facilitate clinically useful predictive tests.
Disclosures: S. Hart: None. L. Kenny: Commercial Interest: Metabolomic Diagnostics. J. Myers: None. P. Baker: Commercial Interest: Metabolomic Diagnostics. doi:10.1016/j.preghy.2014.10.209
doi:10.1016/j.preghy.2014.10.208
[204-POS] [203-POS] Electron transfer dissociation for native peptide fragmentation facilitates enhanced identification of urinary peptides and proteins in pregnancy
Is early onset pre-eclampsia worse for mother or baby? Franziska M. Pettit, George J. Mangos, Gregory Davis, Amanda Henry, Mark A. Brown (St. George Hospital, Kogarah, Australia)
Abstracts / Pregnancy Hypertension: An International Journal of Women’s Cardiovascular Health 5 (2015) 53–156
Objectives: Early onset pre-eclampsia (PE) is considered a worse disorder than later onset PE for the baby but differences in maternal outcomes are less certain. Aims: To compare maternal and fetal outcomes amongst women with early onset PE (EOP) 37 weeks. Methods: We retrospectively analysed outcomes of women with hypertension in pregnancy from our data that is collected during admission and validated by a physician at discharge. Between 1991 and 2011, 4657 pregnancies were complicated by hypertension; 2148 (45%) had preeclampsia. 1536 (72%) of these cases had complete data. Results: 291 (19%) had EOP; 505 (33%) pre-term PE and 740 (48%) term PE. Maternal age was similar. Women with pre-term and term onset PE had similar maternal and fetal outcomes. Compared with term PE, women with EOP had similar rates of renal impairment (7% vs. 9%), proteinuria (76% vs. 81%), liver dysfunction (17% vs. 13%), thrombocytopenia (4.5% vs. 5%) and eclampsia (3 vs. 9/1000), but more episodes of severe hypertension (45% vs. 31%, p < 0.001) and neurological symptoms (6% vs. 11%, p < 0.05). Their babies were delivered earlier (33+5 vs. 38+4 weeks, p < 0.001), more likely were SGA (16% vs. 9%, p < 0.001) and required NICU (12% vs. 0.3%, p < 0.001). Perinatal mortality was higher in EOP (62 vs. 5/1000, p < 0.05). Conclusions: Women presenting with PE after 34 weeks have generally good maternal and fetal outcomes. Women with EOP are more likely to have severe hypertension and neurological symptoms but otherwise similar rates of other maternal complications as women with term PE. Outcomes for babies of women with EOP are significantly worse. These data highlight the fact that pre-eclampsia at any gestation poses fairly similar risks for the mother but EOP poses much greater risks for the baby. Disclosures: F.M. Pettit: None. G.J. Mangos: None. G. Davis: None. A. Henry: None. M.A. Brown: None.
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assessments and community health workers’ assessments, self-administered questionnaires, and community surveillance. Qualitative thematic analysis was conducted using QSR NVivo v10. Quantitative descriptive analyses was performed on SPSS v19/Epi Info 7. Results: Qualitative themes underscored knowledge deficits about pre-eclampsia and poor understanding of progression of illness from pre-eclampsia to eclampsia. Myths and misperceptions widely prevailed surrounding the causes of pre-eclampsia, whereas community practices related to prevention, as well as, case management were deeply rooted in their cultural beliefs, past experiences and perceptions of severity of pre-eclampsia/eclampsia. The quantitative findings from survey highlighted areas for health system capacity building needed to ensure availability of magnesium sulfate at health facilities, equipping community care providers with blood pressure monitoring devices, and training of care providers for diagnosis and management of hypertensive disorders during pregnancy. Conclusions: Feasibility assessment for the CLIP Trial was a resource-intensive, but essential, exercise to understand communities prior to the trial. The methodology used in our research work, can be used to inform future trials of this magnitude in high burden countries and elsewhere.
doi:10.1016/j.preghy.2014.10.210
[205-POS] Methodology for assessing the feasibility of community level interventions for pre-eclampsia in South Asian and African contexts Asif R. Khowaja (University of British Columbia, Vancouver, Canada, Vancouver, BC, Canada) Objectives: To assess the feasibility of a multi-country Community Level Interventions for Pre-eclampsia (CLIP) Trial in the African and South Asian contexts. Methods: A mixed methodology approach guided by normalization process theory was used in Nigeria, Mozambique, Pakistan, and India. Multiple methods of data collection were employed to explore enabling and impeding factors for the CLIP package utilization. Qualitative data were collected through participatory observation, document review, focus group discussions and in-depth interviews with diverse groups of community members, key informants at community level, healthcare providers, and policy makers. Quantitative data were collected through health facility
Disclosure: A.R. Khowaja: None. doi:10.1016/j.preghy.2014.10.211
[206-POS] Morphological/immunohistochemical alterations of endometrial and placental site areas in preeclampsia Zulfiya Khodzhaeva, Eugene Kogan, Tatyana Demura, Albina Akatyeva, Olga Vavina, Anastasia Safonova, Alexey Kholin, Gennady Sukhikh (Federal Research Center for Obstetrics, Gynecology & Perinatology, Ministry of Healthcare of the Russian Federation,
Abstracts / Pregnancy Hypertension: An International Journal of Women’s Cardiovascular Health 5 (2015) 53–156
Sociology, University of Lagos, Lagos, Nigeria, b Department of Obstetrics and Gynaecology, and the Child and Family Research Unit, University of British Columbia, Vancouver, BC, Canada, c Department of Fetal and Maternal Health, Olabisi Onabanjo University, Sagamu, Nigeria, d Division of Women and Child Health, Aga Khan University, Karachi, Pakistan, e Centre for Research in Reproductive Health, Sagamu, Nigeria) Objectives: The objective of this study was to describe community perceptions of pre-eclampsia and eclampsia in Ogun State. Background: Pre-eclampsia is a common complication of pregnancy and is responsible for high rates of morbidity and mortality, especially in less developed countries. While most studies related to pre-eclampsia and eclampsia have adopted a bio-medical model, this paper adopts a perspective which recognizes the role of the socio-cultural environment. Methods: The study was conducted in four Local Government Areas in Ogun State, Nigeria in 2012. Data were obtained through 24 focus group discussions with pregnant women (N = 94), mothers with children less than 5 years old (N = 95), male decision makers (N = 47), community leaders (N = 56), and traditional birth attendants (N = 36). In addition, nine in-depth interviews were conducted with the head of the local traditional birth attendants (N = 4), a local traditional birth attendant (N = 1), and community leaders (N = 4). Results: We determined that there are no names for preeclampsia in the local language, Yoruba, although ’’hypertension’’ and ’’convulsion’’ as disease entities have local names that are independent of pregnancy status. The cause of pre-eclampsia was perceived to be due to depressive thoughts, and the cause of eclampsia was perceived to result from exposure to cold with a few implicating spiritual forces. While, there seemed to be no local treatment for pre-eclampsia apart from preventive practices, local treatments for eclampsia included the use of herbs, concoctions, incisions, and black soap. Conclusions: This study shows that knowledge of preeclampsia and its progression to eclampsia is limited. It also reveals a gap in knowledge of the etiology and treatment of the condition. A holistic approach is recommended for sensitization at the community level, acquisition of educational skills by health workers, and the adoption of a community perspective as a sustainable approach to reduce the complications of pregnancy. Disclosures: D.O. Akeju: None. M. Vidler: None. O.T. Oladapo: None. D. Sawchuck: None. R. Qureshi: None. P. von Dadelszen: None. O.O. Adetoro: None. K. Dada: None.
Sarah Hart a, Louise Kenny b, Jenny Myers c, Philip Baker a (a Keele University, Stoke on Trent, United Kingdom, b INFANT Centre, Cork, Ireland, c University of Manchester, Manchester, United Kingdom) Objectives: Urine as a biofluid is commonly used in clinical diagnostics, including during pregnancy. Urine is a rich source of polypeptides and protein degradation products. Electron transfer dissociation (ETD) techniques have recently been applied to peptides, and improved fragmentation of long polypeptides has been demonstrated; ETD further facilitates analysis of labile post-translational modifications. We therefore applied this advanced technique for peptide dissociation to analyse and identify urinary polypeptides for the first time. Methods: We examined the urinary peptidome from normal pregnant women during pregnancy, to demonstrate that peptides are readily observed. We utilised conventional MS/ MS techniques and then used ETD (LC–MS/MS performed on an orbitrap equipped with ETD source, coupled to a nanoAcquity HPLC) to increase the identification rate of the peptides within these samples, as the polypeptide species observed are large and highly charged. Results: An increase in the number of peptides whose identities could be ascribed using routine database searching methods was enabled via use of ETD. These peptides, as anticipated, were large and highly charged (typically giving charge states of 4–8+ over a mass-to-charge range of 400–2000 m/z). Conclusions: Urinary proteomic profiling has not been able to discriminate between normal and pre-eclampsia pregnancies at gestations early enough to enable preventative strategies. Enhanced polypeptide identification achieved through ETD may facilitate clinically useful predictive tests.
Disclosures: S. Hart: None. L. Kenny: Commercial Interest: Metabolomic Diagnostics. J. Myers: None. P. Baker: Commercial Interest: Metabolomic Diagnostics. doi:10.1016/j.preghy.2014.10.209
doi:10.1016/j.preghy.2014.10.208
[204-POS] [203-POS] Electron transfer dissociation for native peptide fragmentation facilitates enhanced identification of urinary peptides and proteins in pregnancy
Is early onset pre-eclampsia worse for mother or baby? Franziska M. Pettit, George J. Mangos, Gregory Davis, Amanda Henry, Mark A. Brown (St. George Hospital, Kogarah, Australia)
Abstracts / Pregnancy Hypertension: An International Journal of Women’s Cardiovascular Health 5 (2015) 53–156
Objectives: Early onset pre-eclampsia (PE) is considered a worse disorder than later onset PE for the baby but differences in maternal outcomes are less certain. Aims: To compare maternal and fetal outcomes amongst women with early onset PE (EOP) 37 weeks. Methods: We retrospectively analysed outcomes of women with hypertension in pregnancy from our data that is collected during admission and validated by a physician at discharge. Between 1991 and 2011, 4657 pregnancies were complicated by hypertension; 2148 (45%) had preeclampsia. 1536 (72%) of these cases had complete data. Results: 291 (19%) had EOP; 505 (33%) pre-term PE and 740 (48%) term PE. Maternal age was similar. Women with pre-term and term onset PE had similar maternal and fetal outcomes. Compared with term PE, women with EOP had similar rates of renal impairment (7% vs. 9%), proteinuria (76% vs. 81%), liver dysfunction (17% vs. 13%), thrombocytopenia (4.5% vs. 5%) and eclampsia (3 vs. 9/1000), but more episodes of severe hypertension (45% vs. 31%, p < 0.001) and neurological symptoms (6% vs. 11%, p < 0.05). Their babies were delivered earlier (33+5 vs. 38+4 weeks, p < 0.001), more likely were SGA (16% vs. 9%, p < 0.001) and required NICU (12% vs. 0.3%, p < 0.001). Perinatal mortality was higher in EOP (62 vs. 5/1000, p < 0.05). Conclusions: Women presenting with PE after 34 weeks have generally good maternal and fetal outcomes. Women with EOP are more likely to have severe hypertension and neurological symptoms but otherwise similar rates of other maternal complications as women with term PE. Outcomes for babies of women with EOP are significantly worse. These data highlight the fact that pre-eclampsia at any gestation poses fairly similar risks for the mother but EOP poses much greater risks for the baby. Disclosures: F.M. Pettit: None. G.J. Mangos: None. G. Davis: None. A. Henry: None. M.A. Brown: None.
103
assessments and community health workers’ assessments, self-administered questionnaires, and community surveillance. Qualitative thematic analysis was conducted using QSR NVivo v10. Quantitative descriptive analyses was performed on SPSS v19/Epi Info 7. Results: Qualitative themes underscored knowledge deficits about pre-eclampsia and poor understanding of progression of illness from pre-eclampsia to eclampsia. Myths and misperceptions widely prevailed surrounding the causes of pre-eclampsia, whereas community practices related to prevention, as well as, case management were deeply rooted in their cultural beliefs, past experiences and perceptions of severity of pre-eclampsia/eclampsia. The quantitative findings from survey highlighted areas for health system capacity building needed to ensure availability of magnesium sulfate at health facilities, equipping community care providers with blood pressure monitoring devices, and training of care providers for diagnosis and management of hypertensive disorders during pregnancy. Conclusions: Feasibility assessment for the CLIP Trial was a resource-intensive, but essential, exercise to understand communities prior to the trial. The methodology used in our research work, can be used to inform future trials of this magnitude in high burden countries and elsewhere.
doi:10.1016/j.preghy.2014.10.210
[205-POS] Methodology for assessing the feasibility of community level interventions for pre-eclampsia in South Asian and African contexts Asif R. Khowaja (University of British Columbia, Vancouver, Canada, Vancouver, BC, Canada) Objectives: To assess the feasibility of a multi-country Community Level Interventions for Pre-eclampsia (CLIP) Trial in the African and South Asian contexts. Methods: A mixed methodology approach guided by normalization process theory was used in Nigeria, Mozambique, Pakistan, and India. Multiple methods of data collection were employed to explore enabling and impeding factors for the CLIP package utilization. Qualitative data were collected through participatory observation, document review, focus group discussions and in-depth interviews with diverse groups of community members, key informants at community level, healthcare providers, and policy makers. Quantitative data were collected through health facility
Disclosure: A.R. Khowaja: None. doi:10.1016/j.preghy.2014.10.211
[206-POS] Morphological/immunohistochemical alterations of endometrial and placental site areas in preeclampsia Zulfiya Khodzhaeva, Eugene Kogan, Tatyana Demura, Albina Akatyeva, Olga Vavina, Anastasia Safonova, Alexey Kholin, Gennady Sukhikh (Federal Research Center for Obstetrics, Gynecology & Perinatology, Ministry of Healthcare of the Russian Federation,