- Email: [email protected]
247: Longitudinal assessment of cardiovascular function using high resolution micro-ultrasound in a mouse model of developmental metabolic syndrome
Poster Session II
Hypertension, Diabetes, Prematurity, Physiology
245 Increased risk of maternal and infant adverse outcomes in the coexistence of pre-eclampsia and intrahepatic cholestasis of pregnancy Xiaohua Liu1, Courtney Lynch2, Wei Wei Cheng1, Mark Landon2 1 International Peace Maternity & Child Health Hospital, Shanghai Jiaotong University, Obstetrics Department, Shanghai, China, 2The Ohio State University College of Medicine, Department of Obstetrics & Gynecology, Columbus, OH
OBJECTIVE: To describe the maternal and perinatal outcomes of pregnancies complicated by combined preeclampsia and intrahepatic cholestasis of pregnancy (ICP) STUDY DESIGN: Data suggest that women with ICP have an increased odds of pre-eclampsia. What remains unknown is whether outcomes are worse if pregnancy is complicated by both disorders. To address this, we used data from a retrospective cohort study of cesarean delivery at a maternity hospital in China. Eligibility criteria included: received prenatal care between 2006 and 2012, age 18-44 years, primiparous, singleton gestation, and natural conception. A total of 56,786 pregnancies were available for analysis. RESULTS: Overall, 1,772 (3.1%) pregnancies were complicated by pre-eclampsia, 726 (1.3%) by ICP, and 81 (0.1%) by both. We found an increased risk of pre-eclampsia among women with ICP after adjustment for age, diabetes, placenta previa/accreta, obesity, and antenatal care model [RR¼3.19; 95% CI¼(2.59, 3.92)]. Outcomes were worse in pregnancies complicated by both disorders compared to those without either or only one of them. After adjustment, women with pre-eclampsia and ICP compared to those with neither disorder had an increased risk of preterm delivery [RR¼9.67; 95% CI¼(7.51, 12.46)], increased length of stay [b¼4.70 days; 95% CI¼(4.16, 5.24)], and an increased risk of maternal hemorrhage [RR¼4.21; 95% CI¼(1.38, 12.84)]. The infants had lower birth weights [b¼-651 grams; 95% CI¼(-748, -554)] and were at increased risk of having a NICU stay [RR¼4.63; 95% CI¼(3.35, 6.41)] due to the fact that 42.0% of them were delivered preterm as compared to only 4.4% of infants whose mothers had neither disorder. CONCLUSION: We have confirmed that women with ICP are at increased risk of pre-eclampsia. Further, we are the first to our knowledge to report that women whose pregnancy is complicated by both conditions and their infants represent a group at particularly high risk of poor outcomes.
246 Interaction between maternal obesity and 1-hour glucose challenge test results on maternal and perinatal outcomes Akila Subramaniam1, Victoria Jauk2, Alan Tita1, Lorie Harper1 1
University of Alabama at Birmingham, Division of Maternal-Fetal Medicine, Birmingham, AL, 2University of Alabama at Birmingham, Center for Women’s Reproductive Health, Birmingham, AL
OBJECTIVE: Given the potential interaction between carbohydrate intolerance, maternal obesity, and adverse perinatal outcomes, it is possible that obese women require a different threshold for gestational diabetes (GDM) screening. Our objective was to analyze the relationship between positive glucose challenge test (GCT) values and perinatal outcomes stratified by maternal weight. STUDY DESIGN: In this retrospective cohort study, we identified all women with singleton gestations who delivered at our institution with a GCT performed between 24-28 weeks (GCT 135 screen positive) and documented BMI at entry to care. Subjects were classified by GCT level (<120, 120-129, 130-134, 135-139, 140-144, and 145-199 mg/dL) and stratified by BMI. Primary outcomes
www.AJOG.org
included large for gestational age (LGA, >90th percentile), macrosomia (> 4000 g), shoulder dystocia, and pregnancy-induced hypertension (PIH). Logistic regression and Cochran-Armitrage tests for trend, were used to compare the subgroups with GCT <120mg/ dL serving as the reference group. RESULTS: 14525 women met enrollment criteria -8521 with a GCT < 120 mg/dL and 6004 with a GCT 120. When all women were considered, the risk of LGA, macrosomia, dystocia, and PIH increased for any GCT>140 mg/dL. However, when only BMI < 25 was considered, the risks were not increased at any level of GCT for any of the outcomes (Table). For subjects with BMI>25 the risk of LGA for a GCT 130-134 mg/dL was increased, but not at GCT of 135-139 mg/dL (some were treated for GDM). Similar, but nonsignificant, trends were observed for macrosomia and shoulder dystocia. CONCLUSION: GCT >140 mg/dL is associated with adverse outcomes in women with a BMI >25. However, women with a GCT 135-140 appear to have less risk of LGA than women with GCT 130-134, suggesting a possible effect of treating and diagnosing GDM in this group. Further studies are needed to clarify if the optimal GCT cutoff for overweight women should be lower in overweight women.
Data presented as adjusted odds ratio (95% CI). Data adjusted for gestational diabetes mellitus, maternal age > 35 years, race, nulliparty.
247 Longitudinal assessment of cardiovascular function using high resolution micro-ultrasound in a mouse model of developmental metabolic syndrome Kathleen Vincent2, Jinping Yang3, George Saade1, Massoud Motamedi3, Egle Bytautiene1 1
University of Texas Medical Branch, Obstetrics and GynecologyeMaternal Fetal Medicine, Galveston, TX, 2University of Texas Medical Branch, Obstetrics and GynecologyeGynecology, Galveston, TX, 3University of Texas Medical Branch, Center for Biomedical Engineering, Galveston, TX
OBJECTIVE: Offspring of obese mothers develop features of metabolic syndrome later in life, including hypertension and vascular dysfunction. The objective of this study was to investigate cardiovascular function in vivo from early postnatal period until 6 months of age in an established mouse model of developmental metabolic syndrome. STUDY DESIGN: CD-1 female mice were placed on standard (SF) or high fat diet (HF) for 3 months before mating. After weaning, the offspring (7-12 pups/per group) were placed on SF diet and then imaged using Visualsonics Vevo 770 high resolution micro-ultrasound system at 1 and 6 months of age. M-mode, B-mode, and pulsed Doppler settings were used to evaluate cardiac ejection
S132 American Journal of Obstetrics & Gynecology Supplement to JANUARY 2014
www.AJOG.org
Hypertension, Diabetes, Prematurity, Physiology
fraction (EF, calculated as ventricular systolic/diastolic diameters), cardiac output (CO, calculated using left ventricular outflow tract diameter and aortic velocity), and renal artery resistive index (RRI, calculated as the average of the right and left renal arteries RI). Results were analyzed using Student t test and repeated-measures ANOVA as appropriate (significance: P<0.05). RESULTS: From 1 to 6 months of age, EF decreased significantly in HF offspring (66.1 1.7 vs 55.4 2.9 %, P<0.05, Figure) with no difference in SF offspring (65.4 1.5 vs 63.9 2.2 %). At 6 months, EF in HF group was significantly lower when compared to agematched SF group (Figure). RRI significantly decreased in SF offspring with age (0.87 0.02 vs 0.70 0.03), but remained unchanged in HF (0.89 0.01 vs 0.85 0.06). At 6 months, RRI was significantly higher in HF compared SF group. There were no significant differences in other parameters studied. CONCLUSION: The longitudinal data obtained using high resolution micro-ultrasound provides novel strong evidence for the progressive impairment in cardiovascular function later in life in offspring of obese mothers.
Poster Session II
1-step method was used as recommended by the American Diabetes Association. Patients were excluded if: <18 years of age, BMI <25 kg/m2, or had initial GDM screening or testing <24 weeks or >34 weeks gestation. Patients were divided into 4 groups: overweight (BMI 25-29.9), class 1 obesity (BMI 30-34.9), class 2 obesity (BMI 35-39.9), and class 3 obesity (BMI 40). Data extracted included demographics, method and timing of diagnosis, treatment specifics, glucose control, and birthweight. Statistical analysis was performed using Wilcoxon signed-rank test and Student’s t-test. RESULTS: The study included 280 patients: 107 were diagnosed by the 1-step method and 173 by the 2-step method. Overall, patients in the 1-step group had earlier diagnosis, entered DIPP at earlier GA (gestational age), had lower insulin end dose, delivered infants with lower birthweight %, and had fewer infants with birthweight % >75 when compared with those in the 2-step group (p<0.05). Data were further analyzed by obesity class as presented in Table 1. CONCLUSION: The 1-step method leads to earlier diagnosis of GDM, earlier intervention, earlier achievement of glycemic control with lower doses of insulin, and lower birthweight % when compared to the traditional 2-step method in a subset of obese patients.
Data presented as meanSD or %.
249 Glyburide versus insulin for treatment of gestational diabetes (GDM): neonatal outcomes with practical experience in a large cohort SF - offspring born to mothers fed standard chow, HF - pups born to mothers fed high fat diet, #P<0.05 HF at 6 mo vs 1 mo, *P<0.05 SF vs HF at 6 months.
248 Is there a benefit from using the one-step method for the diagnosis of gestational diabetes in obese women? Janelle Foroutan1, Barak Rosenn1, Kimberly Herrera1, Brianne Bimson1, Sophia Scarpelli1, Lois Brustman1 1 St. Luke’s-Roosevelt Hospital Center, Obstetrics and Gynecology, New York, NY
OBJECTIVE: There is a lack of consensus regarding the optimal
method for the screening and diagnosis of gestational diabetes (GDM). The 1-step method leads to earlier diagnosis and earlier intervention when compared to the traditional 2-step method. We sought to determine whether using the 1-step method in patients with a pre-pregnancy BMI >24.9 kg/m2 is associated with improved outcomes when compared to the 2-step method. STUDY DESIGN: A retrospective cohort study was performed by reviewing the charts of all patients with GDM enrolled in our Diabetes in Pregnancy Program (DIPP) from January 2009-June 2012. Before 10/2010, the 2-step method was used, with a 50-gm GCT followed by a 100-gm OGTT. From 10/2010, the 75-gm OGTT
Wendy Camelo Castillo2, Kim Boggess1, Til Sturmer2, Alan Brookhart2, Daniel Benjamin3, Michelle Jonsson-Funk2 1 University of North Carolina, Ob/Gyn, Chapel Hill, NC, 2University of North Carolina, Epidemiology, Chapel Hill, NC, 3Duke University, Pedriatics, Durham, NC
OBJECTIVE: Approximately 200,000 women develop GDM annually in the US. Clinical studies suggest that oral hypoglycemic agents are comparable to insulin for GDM treatment. The objective of this study was to measure the association between practical use of glyburide or insulin for GDM treatment and neonatal outcomes. STUDY DESIGN: We conducted a retrospective cohort study using the Truven Health Analytics’ Marketscan administrative claims data from 2000-2011. We used inverse probability of treatment weights to adjust for confounding and binomial regression to estimate risk ratios and 95% confidence intervals for neonatal outcomes. RESULTS: We identified 110,940 women with GDM, of whom 9,180 (8%) were pharmacologically treated, 4957 (54%) with glyburide and 4223 (46%) with insulin. Glyburide use increased with advancing calendar year. There were no significant differences between women treated with glyburide versus insulin in age; women treated with glyburide were more likely to be obese, have hypothyroidism, or history of infertility treatment, and develop preeclampsia. There were significant differences in neonatal outcomes (Table).
Supplement to JANUARY 2014 American Journal of Obstetrics & Gynecology
S133
Hypertension, Diabetes, Prematurity, Physiology
245 Increased risk of maternal and infant adverse outcomes in the coexistence of pre-eclampsia and intrahepatic cholestasis of pregnancy Xiaohua Liu1, Courtney Lynch2, Wei Wei Cheng1, Mark Landon2 1 International Peace Maternity & Child Health Hospital, Shanghai Jiaotong University, Obstetrics Department, Shanghai, China, 2The Ohio State University College of Medicine, Department of Obstetrics & Gynecology, Columbus, OH
OBJECTIVE: To describe the maternal and perinatal outcomes of pregnancies complicated by combined preeclampsia and intrahepatic cholestasis of pregnancy (ICP) STUDY DESIGN: Data suggest that women with ICP have an increased odds of pre-eclampsia. What remains unknown is whether outcomes are worse if pregnancy is complicated by both disorders. To address this, we used data from a retrospective cohort study of cesarean delivery at a maternity hospital in China. Eligibility criteria included: received prenatal care between 2006 and 2012, age 18-44 years, primiparous, singleton gestation, and natural conception. A total of 56,786 pregnancies were available for analysis. RESULTS: Overall, 1,772 (3.1%) pregnancies were complicated by pre-eclampsia, 726 (1.3%) by ICP, and 81 (0.1%) by both. We found an increased risk of pre-eclampsia among women with ICP after adjustment for age, diabetes, placenta previa/accreta, obesity, and antenatal care model [RR¼3.19; 95% CI¼(2.59, 3.92)]. Outcomes were worse in pregnancies complicated by both disorders compared to those without either or only one of them. After adjustment, women with pre-eclampsia and ICP compared to those with neither disorder had an increased risk of preterm delivery [RR¼9.67; 95% CI¼(7.51, 12.46)], increased length of stay [b¼4.70 days; 95% CI¼(4.16, 5.24)], and an increased risk of maternal hemorrhage [RR¼4.21; 95% CI¼(1.38, 12.84)]. The infants had lower birth weights [b¼-651 grams; 95% CI¼(-748, -554)] and were at increased risk of having a NICU stay [RR¼4.63; 95% CI¼(3.35, 6.41)] due to the fact that 42.0% of them were delivered preterm as compared to only 4.4% of infants whose mothers had neither disorder. CONCLUSION: We have confirmed that women with ICP are at increased risk of pre-eclampsia. Further, we are the first to our knowledge to report that women whose pregnancy is complicated by both conditions and their infants represent a group at particularly high risk of poor outcomes.
246 Interaction between maternal obesity and 1-hour glucose challenge test results on maternal and perinatal outcomes Akila Subramaniam1, Victoria Jauk2, Alan Tita1, Lorie Harper1 1
University of Alabama at Birmingham, Division of Maternal-Fetal Medicine, Birmingham, AL, 2University of Alabama at Birmingham, Center for Women’s Reproductive Health, Birmingham, AL
OBJECTIVE: Given the potential interaction between carbohydrate intolerance, maternal obesity, and adverse perinatal outcomes, it is possible that obese women require a different threshold for gestational diabetes (GDM) screening. Our objective was to analyze the relationship between positive glucose challenge test (GCT) values and perinatal outcomes stratified by maternal weight. STUDY DESIGN: In this retrospective cohort study, we identified all women with singleton gestations who delivered at our institution with a GCT performed between 24-28 weeks (GCT 135 screen positive) and documented BMI at entry to care. Subjects were classified by GCT level (<120, 120-129, 130-134, 135-139, 140-144, and 145-199 mg/dL) and stratified by BMI. Primary outcomes
www.AJOG.org
included large for gestational age (LGA, >90th percentile), macrosomia (> 4000 g), shoulder dystocia, and pregnancy-induced hypertension (PIH). Logistic regression and Cochran-Armitrage tests for trend, were used to compare the subgroups with GCT <120mg/ dL serving as the reference group. RESULTS: 14525 women met enrollment criteria -8521 with a GCT < 120 mg/dL and 6004 with a GCT 120. When all women were considered, the risk of LGA, macrosomia, dystocia, and PIH increased for any GCT>140 mg/dL. However, when only BMI < 25 was considered, the risks were not increased at any level of GCT for any of the outcomes (Table). For subjects with BMI>25 the risk of LGA for a GCT 130-134 mg/dL was increased, but not at GCT of 135-139 mg/dL (some were treated for GDM). Similar, but nonsignificant, trends were observed for macrosomia and shoulder dystocia. CONCLUSION: GCT >140 mg/dL is associated with adverse outcomes in women with a BMI >25. However, women with a GCT 135-140 appear to have less risk of LGA than women with GCT 130-134, suggesting a possible effect of treating and diagnosing GDM in this group. Further studies are needed to clarify if the optimal GCT cutoff for overweight women should be lower in overweight women.
Data presented as adjusted odds ratio (95% CI). Data adjusted for gestational diabetes mellitus, maternal age > 35 years, race, nulliparty.
247 Longitudinal assessment of cardiovascular function using high resolution micro-ultrasound in a mouse model of developmental metabolic syndrome Kathleen Vincent2, Jinping Yang3, George Saade1, Massoud Motamedi3, Egle Bytautiene1 1
University of Texas Medical Branch, Obstetrics and GynecologyeMaternal Fetal Medicine, Galveston, TX, 2University of Texas Medical Branch, Obstetrics and GynecologyeGynecology, Galveston, TX, 3University of Texas Medical Branch, Center for Biomedical Engineering, Galveston, TX
OBJECTIVE: Offspring of obese mothers develop features of metabolic syndrome later in life, including hypertension and vascular dysfunction. The objective of this study was to investigate cardiovascular function in vivo from early postnatal period until 6 months of age in an established mouse model of developmental metabolic syndrome. STUDY DESIGN: CD-1 female mice were placed on standard (SF) or high fat diet (HF) for 3 months before mating. After weaning, the offspring (7-12 pups/per group) were placed on SF diet and then imaged using Visualsonics Vevo 770 high resolution micro-ultrasound system at 1 and 6 months of age. M-mode, B-mode, and pulsed Doppler settings were used to evaluate cardiac ejection
S132 American Journal of Obstetrics & Gynecology Supplement to JANUARY 2014
www.AJOG.org
Hypertension, Diabetes, Prematurity, Physiology
fraction (EF, calculated as ventricular systolic/diastolic diameters), cardiac output (CO, calculated using left ventricular outflow tract diameter and aortic velocity), and renal artery resistive index (RRI, calculated as the average of the right and left renal arteries RI). Results were analyzed using Student t test and repeated-measures ANOVA as appropriate (significance: P<0.05). RESULTS: From 1 to 6 months of age, EF decreased significantly in HF offspring (66.1 1.7 vs 55.4 2.9 %, P<0.05, Figure) with no difference in SF offspring (65.4 1.5 vs 63.9 2.2 %). At 6 months, EF in HF group was significantly lower when compared to agematched SF group (Figure). RRI significantly decreased in SF offspring with age (0.87 0.02 vs 0.70 0.03), but remained unchanged in HF (0.89 0.01 vs 0.85 0.06). At 6 months, RRI was significantly higher in HF compared SF group. There were no significant differences in other parameters studied. CONCLUSION: The longitudinal data obtained using high resolution micro-ultrasound provides novel strong evidence for the progressive impairment in cardiovascular function later in life in offspring of obese mothers.
Poster Session II
1-step method was used as recommended by the American Diabetes Association. Patients were excluded if: <18 years of age, BMI <25 kg/m2, or had initial GDM screening or testing <24 weeks or >34 weeks gestation. Patients were divided into 4 groups: overweight (BMI 25-29.9), class 1 obesity (BMI 30-34.9), class 2 obesity (BMI 35-39.9), and class 3 obesity (BMI 40). Data extracted included demographics, method and timing of diagnosis, treatment specifics, glucose control, and birthweight. Statistical analysis was performed using Wilcoxon signed-rank test and Student’s t-test. RESULTS: The study included 280 patients: 107 were diagnosed by the 1-step method and 173 by the 2-step method. Overall, patients in the 1-step group had earlier diagnosis, entered DIPP at earlier GA (gestational age), had lower insulin end dose, delivered infants with lower birthweight %, and had fewer infants with birthweight % >75 when compared with those in the 2-step group (p<0.05). Data were further analyzed by obesity class as presented in Table 1. CONCLUSION: The 1-step method leads to earlier diagnosis of GDM, earlier intervention, earlier achievement of glycemic control with lower doses of insulin, and lower birthweight % when compared to the traditional 2-step method in a subset of obese patients.
Data presented as meanSD or %.
249 Glyburide versus insulin for treatment of gestational diabetes (GDM): neonatal outcomes with practical experience in a large cohort SF - offspring born to mothers fed standard chow, HF - pups born to mothers fed high fat diet, #P<0.05 HF at 6 mo vs 1 mo, *P<0.05 SF vs HF at 6 months.
248 Is there a benefit from using the one-step method for the diagnosis of gestational diabetes in obese women? Janelle Foroutan1, Barak Rosenn1, Kimberly Herrera1, Brianne Bimson1, Sophia Scarpelli1, Lois Brustman1 1 St. Luke’s-Roosevelt Hospital Center, Obstetrics and Gynecology, New York, NY
OBJECTIVE: There is a lack of consensus regarding the optimal
method for the screening and diagnosis of gestational diabetes (GDM). The 1-step method leads to earlier diagnosis and earlier intervention when compared to the traditional 2-step method. We sought to determine whether using the 1-step method in patients with a pre-pregnancy BMI >24.9 kg/m2 is associated with improved outcomes when compared to the 2-step method. STUDY DESIGN: A retrospective cohort study was performed by reviewing the charts of all patients with GDM enrolled in our Diabetes in Pregnancy Program (DIPP) from January 2009-June 2012. Before 10/2010, the 2-step method was used, with a 50-gm GCT followed by a 100-gm OGTT. From 10/2010, the 75-gm OGTT
Wendy Camelo Castillo2, Kim Boggess1, Til Sturmer2, Alan Brookhart2, Daniel Benjamin3, Michelle Jonsson-Funk2 1 University of North Carolina, Ob/Gyn, Chapel Hill, NC, 2University of North Carolina, Epidemiology, Chapel Hill, NC, 3Duke University, Pedriatics, Durham, NC
OBJECTIVE: Approximately 200,000 women develop GDM annually in the US. Clinical studies suggest that oral hypoglycemic agents are comparable to insulin for GDM treatment. The objective of this study was to measure the association between practical use of glyburide or insulin for GDM treatment and neonatal outcomes. STUDY DESIGN: We conducted a retrospective cohort study using the Truven Health Analytics’ Marketscan administrative claims data from 2000-2011. We used inverse probability of treatment weights to adjust for confounding and binomial regression to estimate risk ratios and 95% confidence intervals for neonatal outcomes. RESULTS: We identified 110,940 women with GDM, of whom 9,180 (8%) were pharmacologically treated, 4957 (54%) with glyburide and 4223 (46%) with insulin. Glyburide use increased with advancing calendar year. There were no significant differences between women treated with glyburide versus insulin in age; women treated with glyburide were more likely to be obese, have hypothyroidism, or history of infertility treatment, and develop preeclampsia. There were significant differences in neonatal outcomes (Table).
Supplement to JANUARY 2014 American Journal of Obstetrics & Gynecology
S133