728: Should unwanted pregnancy be considered a high-risk perinatal condition?

Poster Session V

Clinical Ob, Epidemiology, ID, Intrapartum Fetal, Operative Ob, Med-Surg-Diseases, Ob Quality & Safety, Public & Global Health

727 Prenatal maternal stress associated with potentially life threatening situations and preterm birth and low birthweight Tamar Wainstock2, Liat Lerner-Geva2, Saralee Glasser2, Ilana Shoham-Vardi2, Eyal Anteby1 1

Barzilai Medical Center, Obstetrics and Gynecology, Ashkelon, Israel, Faculty of Health Sciences, Ben Gurion University, Epidemiology, Beer Sheva, Israel 2

OBJECTIVE: To analyze the association between chronic stress caused by frequent exposure to life-threatening rocket attacks, and the risk of preterm birth (PTB) and delivery of low birthweight (LBW) infants. STUDY DESIGN: A retrospective cohort study. The deliveries of women residing in a town exposed to rocket attacks (Exposed Group) were compared to deliveries of women who lived in an unexposed town (Unexposed Group). Demographic and medical data were abstracted from patients’ records at the medical center serving both towns. Exposure information was obtained from official local authorities. Intensity of exposure was calculated for both the preconception and pregnancy periods. RESULTS: The rates of PTB and LBW were higher in Exposed vs. Unexposed Groups (9.1% vs. 6.8%, P⫽0.004; and 7.6% vs. 5.8%, P⫽0.02, respectively) . After controlling for possible confounders, including marital status, maternal age, background health problems and gestational hypertension, the risk for both outcomes remained significantly higher in the Exposed Group (PTB: adj. OR⫽ 1.3, 95% CI 1.1-1.7; LBW: adj. OR⫽1.3, 95%CI 1.03-1.7). Among exposed subjects, no linear association was found between these risks and the intensity of exposure either preconception or during pregnancy. CONCLUSION: Chronic exposure to life-threatening events during preconception and pregnancy is associated with increased risk of PTB and LBW.

728 Should unwanted pregnancy be considered a high-risk perinatal condition? Timothy Dye1, Martha Wojtowyz4, Ann Dozier2, Bliss Kaneshiro1, Donna Bacchi4, Christopher Glantz3, Dena Towner1 1 John A. Burns School of Medicine, University of Hawaii, Obstetrics, Gynecology, and Women’s Health, Honolulu, HI, 2University of Rochester School of Medicine and Dentistry, Community and Preventive Medicine, Rochester, NY, 3University of Rochester School of Medicine and Dentistry, Obstetrics and Gynecology, Rochester, NY, 4SUNY Upstate Medical University, Public Health and Preventive Medicine, Syracuse, NY

OBJECTIVE: Prevention of unintended pregnancy has long been a hallmark of American public health. Despite declines in some pregnancy rates (e.g. in teens), pregnancies unintended at conception often exceed 50 percent. Of note are women whose pregnancies were unwanted at conception (the most severe form of unintended pregnancy) and their outcomes. STUDY DESIGN: This project accessed a large birth cohort of all live births occurring in two NY regions. Records were abstracted for perinatal variables and women were asked a standardized “intentions of pregnancy at conception” question. Women indicating pregnancy was unwanted at conception totaled 10,436, those with “mistimed” (too early) totaled 42,822, and those intended totaled 97,019. Multinomial logistic regression generated odds ratios (OR). Given the large cohort, only risk differences of 10%⫹ were considered. All ORs noted are statistically significant. Women with an unwanted pregnancy at conception that resulted in a live birth are the study’s focus, denoted as “UWLB.” RESULTS: Women with UWLB were more likely to have socio-medical risks (Table 1), including substance use, infection, poor prior outcomes, and lack of prenatal care. Women with UWLB were more likely depressed and less active. Women with UWLB more frequently were hospitalized and experienced complications, and their infants more likely to have poor outcomes (Figure). Infants of UWLB more often required transfer to another institution, less likely were breastfed, and more likely placed in adoption/care. Interestingly, women with UWLB were no more likely to be referred for high risk.

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CONCLUSION: With 6.5 percent of women delivering a live birth report-

ing that their pregnancies were not wanted at conception, combined with poor outcomes, unwanted pregnancy is similar to other risks for which women receive focused prenatal attention. As such, considering unwanted pregnancy a high risk condition with targeted care strategies may help women reach appropriate care quicker, to help avert the poor outcomes shown in this large cohort.

Significant odds ratios (OR) comparing birth outcomes from women delivering live births unwanted at conception with women delivering births intended at conception

Significant odds ratios (OR) comparing risks in pregnancy for women delivering live births unwanted at conception with women delivering births intended at conception

Source: Central New York Perinatal Data System, Finger Lakes Perinatal Data System, 2004-2008.

American Journal of Obstetrics & Gynecology Supplement to JANUARY 2013