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701: Does low-dose aspirin prevent preterm birth?
Poster Session IV 699 Neonatal cerebral lesions predict two-year neurodevelopmental impairment in children treated with laser surgery for twin-twin transfusion syndrome (TTTS)
Ramen Chmait1, Sheree Schrager2, Arlyn Llanes1, Anita Hamilton4, Douglas Vanderbilt3
1 Keck School of Medicine, University of Southern California, Maternal Fetal Medicine/OBGYN, Los Angeles, CA, 2Children’s Hospital Los Angeles, Division of Hospital Medicine, Los Angeles, CA, 3Keck School of Medicine of USC, Department of Pediatrics, Los Angeles, CA, 4Keck School of Medicine of USC, Department of Surgery, Los Angeles, CA
ajog.org CONCLUSION: Pre-pregnancy overweight increases the risk of GDM and cesarean delivery in women carrying twins. However, in our population, overweight was not associated with adverse neonatal outcome.
Maternal and perinatal outcome in overweight women carrying twins compare to normal BMI
OBJECTIVE: To assess whether cerebral abnormalities detected in the
newborn period is predictive of neurodevelopmental impairment (NDI) at age 2-years in survivors of TTTS that underwent laser surgery. STUDY DESIGN: 100 children treated for TTTS with laser in 2008-2010 had neurodevelopmental assessment at age 2-years (6 weeks). “High-risk survivors” had cerebral imaging (intracranial ultrasound, CT scan, and/or MRI) in the neonatal period. “High-risk survivors” were defined as: 1) delivered at <32 weeks; or 2) cerebral imaging clinically indicated. Cerebral lesions were defined as: intraventricular hemorrhage (IVH), cystic periventricular leukomalacia (PVL), ventriculomegaly, hydrocephalus, microcephaly, infarctions, congenital anomalies, porencephalic or Dandy-Walker cysts, nonspecific echogenicity, and bilateral/multiple subependymal, pseudo-, or choroid plexus cysts. NDI was a composite outcome of: Battelle Developmental Inventory 2nd Edition (BDI-2) 2 SD below norm (<70), cerebral palsy, blindness, and/or deafness. Multilevel linear regression with robust standard errors was used to evaluate associations between cerebral lesions and NDI. RESULTS: 56 children were “high-risk survivors” and had neonatal cerebral imaging. 10 twins (18%) had at least one cerebral lesion, including grade 1-2 IVH (8), cystic PVL (2), ventriculomegaly/hydrocephalus (1), bilateral subependymal cyst (1), and bilateral choroid plexus cyst (1). The risk of NDI in the “high-risk survivors” was 7% (4/56) compared to 0% (0/43) in the remaining group. Among “high-risk survivors,” cerebral lesions were a significant risk factor for NDI (OR¼19.28, p<0.001). There were no differences in prevalence of lesions or NDI between donor and recipient twins. CONCLUSION: Among “high-risk survivors” of TTTS treated with laser surgery, cerebral lesions identified on neonatal imaging were associated with neurodevelopmental impairment at 2-years.
700 Pre-pregnancy overweight in twins: the effect on maternal and neonatal outcome
Rania Okby1, Yura Druyan1, Renana Ben Yona1, Ilana Shoham Vardi2, Ruslan Sergienko2, Eyal Sheiner1 1
Soroka university medical center, Beer Sheva, Israel, 2Ben Gurion university, Beer Sheva, Israel
OBJECTIVE: To investigate the effect of pre-pregnancy maternal
overweight on perinatal outcomes in twin pregnancies. STUDY DESIGN: A retrospective population-based study was con-
ducted comparing maternal and neonatal outcome in women carrying twins with and without pre-pregnancy overweight. Overweight was defined as pre-pregnancy body mass index (BMI) of 25 kg/m2 or more. Deliveries occurred in a tertiary medical center between the years 2011 and 2012. RESULTS: 214 women carrying twins were included in the current study; of these, 100 (46.7%) had pre-pregnancy BMI 25 kg/m2. Mothers with pre-pregnancy overweight were older and gained less weight throughout the pregnancy (Table). Overweight parturients had higher rate of gestational diabetes mellitus (GDM) and cesarean deliveries. Neonatal outcome, however, was comparable between the groups (Table). Using a multivariable model, controlling for diabetes mellitus and maternal age, pre-pregnancy overweight was noted as an independent risk factor for cesarean delivery (adjusted OR¼2.2, 95% CI 1.2-3.9; P¼0.008).
701 Does low-dose aspirin prevent preterm birth?
Rebecca Jessel1, Amanda Allshouse3, Kent Heyborne2
1 University of Colorado, Maternal Fetal Medicine, Denver, CO, 2Denver Health Medical Center, Obstetrics and Gynecology, Denver, CO, 3University of Colorado, School of Public Health, Denver, CO
OBJECTIVE: Low-dose aspirin (LDA) has been noted to reduce the
preterm birth (PTB) rate in multiple meta-analyses of the preeclampsia (PreE) prevention trials. It is unclear if this effect of LDA is entirely due to a reduction in indicated PTB (iPTB) versus reductions in preterm premature rupture of membranes (PPROM) or spontaneous PTB (sPTB). In the MFMU high-risk Aspirin (HRA) study a near significant decrease in PTB (RR 0.9; 95% CI 0.9, 1.0) was found despite no effect on PreE. The objective of this study was to assess the impact of LDA on iPTB, sPTB, and PPROM PTB in the MFMU HRA study population. STUDY DESIGN: A secondary analysis of the MFMU Network HRA study was performed, including women at increased risk of PreE due to insulin dependent diabetes (IDDM), hypertension (HTN) or previous PreE. Women with multiple gestations were excluded. Definitions of PTB varied by gestational age (GA) at delivery (<37, <35 or < 32 weeks) and by type of PTB (iPTB, PPROM PTB, sPTB). iPTB included any patient induced for IUFD, HTN, PreE/pregnancyinduced HTN, oligohydramnios, suspected IUGR, or fetal stress/ distress. Variables known clinically to influence PTB were identified (nulliparity, maternal age, BMI) and controlled for in multivariable logistic regression. RESULTS: LDA was initiated at from 18-23w. Of 1789 women with singleton pregnancies, 545 (31%) delivered <37w (6% sPTB, 19% iPTB, 6% PPROM PTB). LDA-treated women had a significant reduction in PPROM before 35 weeks (p < 0.047). Otherwise, rates of PTB did not differ significantly by LDA randomization by GA or type of PTB, either in the study population as a whole or within each risk subgroup (IDDM, HTN, or prior PreE). CONCLUSION: We found no reduction in the rate of PTB in any subgroup treated with LDA as stratified by GA at delivery, type of PTB, or risk-group, with the exception of PPROM <35 weeks, a finding of doubtful significance given multiple comparisons. The attributable risk of iPTB was high and LDA started relatively late, possibly limiting the generalizability of these findings.
S342 American Journal of Obstetrics & Gynecology Supplement to JANUARY 2015
Ramen Chmait1, Sheree Schrager2, Arlyn Llanes1, Anita Hamilton4, Douglas Vanderbilt3
1 Keck School of Medicine, University of Southern California, Maternal Fetal Medicine/OBGYN, Los Angeles, CA, 2Children’s Hospital Los Angeles, Division of Hospital Medicine, Los Angeles, CA, 3Keck School of Medicine of USC, Department of Pediatrics, Los Angeles, CA, 4Keck School of Medicine of USC, Department of Surgery, Los Angeles, CA
ajog.org CONCLUSION: Pre-pregnancy overweight increases the risk of GDM and cesarean delivery in women carrying twins. However, in our population, overweight was not associated with adverse neonatal outcome.
Maternal and perinatal outcome in overweight women carrying twins compare to normal BMI
OBJECTIVE: To assess whether cerebral abnormalities detected in the
newborn period is predictive of neurodevelopmental impairment (NDI) at age 2-years in survivors of TTTS that underwent laser surgery. STUDY DESIGN: 100 children treated for TTTS with laser in 2008-2010 had neurodevelopmental assessment at age 2-years (6 weeks). “High-risk survivors” had cerebral imaging (intracranial ultrasound, CT scan, and/or MRI) in the neonatal period. “High-risk survivors” were defined as: 1) delivered at <32 weeks; or 2) cerebral imaging clinically indicated. Cerebral lesions were defined as: intraventricular hemorrhage (IVH), cystic periventricular leukomalacia (PVL), ventriculomegaly, hydrocephalus, microcephaly, infarctions, congenital anomalies, porencephalic or Dandy-Walker cysts, nonspecific echogenicity, and bilateral/multiple subependymal, pseudo-, or choroid plexus cysts. NDI was a composite outcome of: Battelle Developmental Inventory 2nd Edition (BDI-2) 2 SD below norm (<70), cerebral palsy, blindness, and/or deafness. Multilevel linear regression with robust standard errors was used to evaluate associations between cerebral lesions and NDI. RESULTS: 56 children were “high-risk survivors” and had neonatal cerebral imaging. 10 twins (18%) had at least one cerebral lesion, including grade 1-2 IVH (8), cystic PVL (2), ventriculomegaly/hydrocephalus (1), bilateral subependymal cyst (1), and bilateral choroid plexus cyst (1). The risk of NDI in the “high-risk survivors” was 7% (4/56) compared to 0% (0/43) in the remaining group. Among “high-risk survivors,” cerebral lesions were a significant risk factor for NDI (OR¼19.28, p<0.001). There were no differences in prevalence of lesions or NDI between donor and recipient twins. CONCLUSION: Among “high-risk survivors” of TTTS treated with laser surgery, cerebral lesions identified on neonatal imaging were associated with neurodevelopmental impairment at 2-years.
700 Pre-pregnancy overweight in twins: the effect on maternal and neonatal outcome
Rania Okby1, Yura Druyan1, Renana Ben Yona1, Ilana Shoham Vardi2, Ruslan Sergienko2, Eyal Sheiner1 1
Soroka university medical center, Beer Sheva, Israel, 2Ben Gurion university, Beer Sheva, Israel
OBJECTIVE: To investigate the effect of pre-pregnancy maternal
overweight on perinatal outcomes in twin pregnancies. STUDY DESIGN: A retrospective population-based study was con-
ducted comparing maternal and neonatal outcome in women carrying twins with and without pre-pregnancy overweight. Overweight was defined as pre-pregnancy body mass index (BMI) of 25 kg/m2 or more. Deliveries occurred in a tertiary medical center between the years 2011 and 2012. RESULTS: 214 women carrying twins were included in the current study; of these, 100 (46.7%) had pre-pregnancy BMI 25 kg/m2. Mothers with pre-pregnancy overweight were older and gained less weight throughout the pregnancy (Table). Overweight parturients had higher rate of gestational diabetes mellitus (GDM) and cesarean deliveries. Neonatal outcome, however, was comparable between the groups (Table). Using a multivariable model, controlling for diabetes mellitus and maternal age, pre-pregnancy overweight was noted as an independent risk factor for cesarean delivery (adjusted OR¼2.2, 95% CI 1.2-3.9; P¼0.008).
701 Does low-dose aspirin prevent preterm birth?
Rebecca Jessel1, Amanda Allshouse3, Kent Heyborne2
1 University of Colorado, Maternal Fetal Medicine, Denver, CO, 2Denver Health Medical Center, Obstetrics and Gynecology, Denver, CO, 3University of Colorado, School of Public Health, Denver, CO
OBJECTIVE: Low-dose aspirin (LDA) has been noted to reduce the
preterm birth (PTB) rate in multiple meta-analyses of the preeclampsia (PreE) prevention trials. It is unclear if this effect of LDA is entirely due to a reduction in indicated PTB (iPTB) versus reductions in preterm premature rupture of membranes (PPROM) or spontaneous PTB (sPTB). In the MFMU high-risk Aspirin (HRA) study a near significant decrease in PTB (RR 0.9; 95% CI 0.9, 1.0) was found despite no effect on PreE. The objective of this study was to assess the impact of LDA on iPTB, sPTB, and PPROM PTB in the MFMU HRA study population. STUDY DESIGN: A secondary analysis of the MFMU Network HRA study was performed, including women at increased risk of PreE due to insulin dependent diabetes (IDDM), hypertension (HTN) or previous PreE. Women with multiple gestations were excluded. Definitions of PTB varied by gestational age (GA) at delivery (<37, <35 or < 32 weeks) and by type of PTB (iPTB, PPROM PTB, sPTB). iPTB included any patient induced for IUFD, HTN, PreE/pregnancyinduced HTN, oligohydramnios, suspected IUGR, or fetal stress/ distress. Variables known clinically to influence PTB were identified (nulliparity, maternal age, BMI) and controlled for in multivariable logistic regression. RESULTS: LDA was initiated at from 18-23w. Of 1789 women with singleton pregnancies, 545 (31%) delivered <37w (6% sPTB, 19% iPTB, 6% PPROM PTB). LDA-treated women had a significant reduction in PPROM before 35 weeks (p < 0.047). Otherwise, rates of PTB did not differ significantly by LDA randomization by GA or type of PTB, either in the study population as a whole or within each risk subgroup (IDDM, HTN, or prior PreE). CONCLUSION: We found no reduction in the rate of PTB in any subgroup treated with LDA as stratified by GA at delivery, type of PTB, or risk-group, with the exception of PPROM <35 weeks, a finding of doubtful significance given multiple comparisons. The attributable risk of iPTB was high and LDA started relatively late, possibly limiting the generalizability of these findings.
S342 American Journal of Obstetrics & Gynecology Supplement to JANUARY 2015